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-Project Gutenberg's Observations on the Diseases of Seamen, by Gilbert Blane
-
-This eBook is for the use of anyone anywhere in the United States and most
-other parts of the world at no cost and with almost no restrictions
-whatsoever.  You may copy it, give it away or re-use it under the terms of
-the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org.  If you are not located in the United States, you'll have
-to check the laws of the country where you are located before using this ebook.
-
-Title: Observations on the Diseases of Seamen
-
-Author: Gilbert Blane
-
-Release Date: September 8, 2016 [EBook #53007]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON DISEASES OF SEAMEN ***
-
-
-
-
-Produced by Wayne Hammond and The Online Distributed
-Proofreading Team at http://www.pgdp.net (This file was
-produced from images generously made available by The
-Internet Archive)
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-character superscript, characters will be enclosed in curly braces.
-
-Italics delimited by underscores.]
-
-
-
-
-  OBSERVATIONS
-
-  ON THE
-
-  DISEASES
-
-  OF
-
-  SEAMEN.
-
-  BY
-
-  GILBERT BLANE, M. D.
-
-  F. R. S. S. LOND. AND EDIN.
-
-  PHYSICIAN EXTRAORDINARY TO THE PRINCE OF WALES,
-  PHYSICIAN TO THE DUKE OF CLARENCE,
-  AND TO ST. THOMAS’S HOSPITAL.
-
-  THE SECOND EDITION,
-
-  WITH CORRECTIONS AND ADDITIONS.
-
-  LONDON:
-
-  Printed by JOSEPH COOPER;
-  And sold by JOHN MURRAY, No. 32 Fleet Street;
-  J. JOHNSON, St. Paul’s Church Yard;
-  And by WILLIAM CREECH, in Edinburgh.
-
-  M.DCC.LXXXIX.
-
- Nec Medici, nec Imperatores, nec Oratores, quamvis artis præcepta
- perceperint, quidquam magna laude dignum sine usu et excercitatione
- consequi possunt.
-
-  CICERO.
-
-
-
-
-CONTENTS.
-
-
-  PART I.
-
-  BOOK I.
-
-
-  Comprehending the Medical History of the Fleet, from March 1780,
-    till August 1781                                                  17
-
-
-  CHAP. I.
-
-  ACCOUNT of the Health of the Fleet from March 1780,
-    till July following                                            _ib._
-
-
-  CHAP. II.
-
-  ACCOUNT of the Health of the Fleet from August 1780,
-    till December following                                           35
-
-  CHAP. III.
-
-  ACCOUNT of the Health of the Fleet from January 1781,
-    till July 1781, both Months included                              46
-
-
-  BOOK II.
-
-  Continuation of the Medical History of the Fleet, from August
-    1781, till the Conclusion of the War in April 1783                63
-
-
-  CHAP. I.
-
-  Some ACCOUNT of the Interval between the Campaigns of
-    1781, and the Junction of the Reinforcement from England in
-    April 1782                                                     _ib._
-
-
-  CHAP. II.
-
-  ACCOUNT of the Health of the Fleet from the Junction
-    of the Squadron from England, till the general Rendezvous at
-    St. Lucia, in the beginning of April                              75
-
-
-  CHAP. III.
-
-  STATE of HEALTH of the Fleet in April 1782                          98
-
-  CHAP. IV.
-
-  ACCOUNT of the Health of the Fleet while it lay at
-    Jamaica, during May, June, and part of July, 1782                109
-
-
-  CHAP. V.
-
-  ACCOUNT of the Health of the Fleet from its leaving Jamaica
-    on the 17th of July 1782, till its Departure from New York
-    on the 25th of October following                                 139
-
-
-  CHAP. VI.
-
-  ACCOUNT of the Health of the Fleet from its Departure from
-    New York till the Conclusion of the War                          158
-
-
-  BOOK III.
-
-  Of the NUMBERS and MORTALITY of different DISEASES sent to
-    Hospitals, with a general View of the whole Mortality during
-    the War                                                          185
-
-
-
-
-  PART II.
-
-
-  Of the CAUSES of Sickness in Fleets, and the Means of PREVENTION   211
-
-  Introduction                                                     _ib._
-
-
-  CHAP. I.
-
-  Of Air      225
-
-  Sect. I. Of the noxious Effects of Land Air in particular
-    Situations                                                       227
-
-  Sect. II. Of the Effects of foul Air from the Neglect of
-    Cleanliness in Men’s Persons--INFECTION      237
-
-    1. Means of preventing the Introduction of Infection             240
-
-    2. Means of preventing the Production of Infection               254
-
-    3. Means of eradicating Infection                                264
-
-  Sect. III. Of the foul Air generated in a Ship                     281
-
-  ---- IV. Means of guarding against Infection and bad Air           293
-
-
-  CHAP. II.
-
-  Of Aliment                                                         300
-
-  Sect. I. Of solid Food                                           _ib._
-
-  ---- II. Of Drink                                                  319
-
-  Of Water                                                           324
-
-
-  CHAP. III.
-
-  Of Clothing                                                        334
-
-
-  CHAP. IV.
-
-  Of Exercise                                                        343
-
-  CONCLUSION                                                         349
-
-  APPENDIX to PART II.                                               352
-
-  Memorial to the Admiralty                                        _ib._
-
-  Supplement to the Memorial                                         364
-
-
-  PART III.
-
-  DESCRIPTION and TREATMENT of the Diseases most frequently
-    occurring in Fleets in hot Climates                              368
-
-
-  CHAP. I.
-
-  Of Fevers                                                          370
-
-    1. Of the infectious Ship Fever                                  371
-
-    2. Of the bilious Remitting Fever                                415
-
-    3. Of the Yellow Fever                                           425
-
-    4. Of the Effects of some unusual Remedies in the Cure of
-        obstinate Intermittent Fevers                                456
-
-
-  CHAP. II.
-
-  Of Fluxes                                                          466
-
-
-  CHAP. III.
-
-  Of Scurvy                                                          499
-
-
-  CHAP. IV.
-
-  Of the WOUNDS received in the Actions of April 1782                519
-
-  APPENDIX TO PART III.                                              545
-
-  Assortment of Medicines to be carried to Sea                       548
-
-  Formulæ Medicamentorum                                             550
-
-
-
-
-  DEDICATION.
-
-  TO HIS
-
-  ROYAL HIGHNESS
-
-  PRINCE WILLIAM-HENRY.
-
-
-  SIR,
-
-The following Work is the fruit of several years labour employed in the
-Public Service, chiefly under that great and successful Admiral, Lord
-Rodney, in a series of Naval Operations, which have been productive
-of events more glorious than any recorded in the Annals of Britain.
-As your Royal Highness was present during some part of the service
-which is the subject of these Observations, and as You have not only
-honoured the Sea Service by embracing it as a profession, and enrolling
-your illustrious Name among its officers, but in undergoing the dangers
-and fatigues of actual service, which is so necessary to attain that
-practical Skill which Your Royal Highness is well known to possess, I
-have, upon these grounds, presumed to lay this Work at Your feet. I
-should do this with greater satisfaction, were it more worthy of Your
-acceptance; but however inadequate my abilities may have been to the
-talk, it has been my sincere aim to produce a work of some utility to
-that only Bulwark of our Country, the British Navy, of which your Royal
-Highness is the Pride and the Hope.
-
-Your Royal Highness’s Permission to inscribe this work to You, and
-the personal Notice and Protection with which you have been pleased
-to honour me, I consider as the first Distinctions of my life, and of
-which I shall ever entertain a becoming sense, by cherishing those
-indelible sentiments of Respect, Gratitude, and Attachment, which are
-due to Your Royal Highness from
-
-    Your Royal Highness’s
-      Most faithful,
-        Most obedient, and
-          Most devoted Servant,
-        GILBERT BLANE.
-
-    LONDON,
-    May 1, 1785.
-
-
-
-
-PREFACE.
-
-
-Having been appointed by Lord Rodney Physician to the Fleet under his
-command, in the beginning of the year 1780, I determined to avail
-myself, to the utmost of my abilities, of the advantages which this
-field of observation afforded. This I was led to do, in order to
-satisfy my own mind as a matter of duty, as well as to find out, if
-possible, the means of bettering the condition of a class of men, who
-are the bulwark of the state, but whose lot is hardship and disease,
-above that of all others.
-
-A fleet, consisting seldom of less than twenty ships of the line
-of battle, and sometimes exceeding forty, which I attended in the
-different scenes of active service in that distant and unhealthy
-region, for more than three years, has afforded me opportunities of
-making observations upon a large scale.
-
-My object has been prevention as much as cure; and as the former must
-more particularly depend on a knowledge of the external causes of
-disease, I have collected and arranged all the facts upon this subject
-that came within my reach, considering these as the only grounds from
-whence the remote causes of health and sickness could be deduced.
-
-When I entered upon my employment, the Commander in Chief gave an
-order, that every surgeon in the fleet should send me a monthly
-return, stating the degree of prevalence of different diseases, the
-mortality, and whatever else related to the health of the respective
-ships. This was done with a view to enable me to regulate the reception
-of men into hospitals, so that each ship might have a due proportion of
-relief, according to the degree of sickness on board, taking care at
-the same time that the hospitals should not be overcrowded; and also
-to acquaint the Commander in Chief, from time to time, of the state
-of sickness, or the predominance of particular diseases, in order to
-recommend such articles of diet, or other means, as might tend to cure
-them, or to check their progress. These returns have served also in
-this work as a method of collecting a multitude of well-established
-facts, tending to ascertain the causes and course of disease.
-
-While the fleet was in port, I also superintended and visited daily the
-hospitals, of which there is one at almost every island on the station;
-and having kept an account of the different kinds of disease that were
-admitted, and of their mortality, I have in this way likewise been
-furnished with a number of facts that may throw light on the history of
-human maladies.
-
-Nevertheless, I do not boast of having made great discoveries; and
-every person of a correct judgement must be aware how difficult it
-is to ascertain truths, and to draw fair and solid inferences, on
-medical subjects. I have attempted little more than to amass, from my
-own observation, and by the assistance of the surgeons of the fleet,
-a number of well-established facts, and to arrange them in such a
-methodical manner, as to prove a groundwork for investigation; and I am
-persuaded that others, of more sagacity and enlarged knowledge than
-myself, may be able to deduce from them, observations that may have
-escaped me especially if these new, but imperfect, attempts should come
-to be compared with similar ones that may be made by other observers in
-other climates, and in other circumstances of service.
-
-I met with several obstacles in instituting inquiries, purely medical,
-to the extent I could have wished. There is, in the first place, from
-the nature of the subject, a great difficulty attending all practical
-inquiries in medicine; for, in order to ascertain truth, in a manner
-that is satisfactory to a mind habituated to chaste investigation,
-there must be a series of patient and attentive observations upon
-a great number of cases, and the different trials must be varied,
-weighed, and compared, in order to form a proper estimate of the real
-efficacy of different remedies and modes of treatment.
-
-But besides this difficulty belonging to the nature of the subject,
-there were others connected with the nature of the service; for the
-hospitals were at times so inadequate in point of size, and so ill
-provided with necessary articles and accommodations, particularly
-during the first part of my attendance, that my principal care was to
-remedy these defects by proper superintendence and representation.
-
-A due attention to air, diet, and cleanliness, is not only more
-essential than mere medical treatment, but the sick cannot be
-considered as fit subjects for evincing the powers of medicine till
-they are properly provided for in these respects. These inconveniences
-were owing, in a great measure, to the unusual extent of the service;
-for there was a much greater naval force in those seas, at this period,
-than was ever before known, and there was of course a proportional
-want of accommodation for the sick. Towards the end of the war these
-difficulties were much obviated, so that a fairer field of observation
-presented itself.
-
-Another obstacle to my practical inquiries was, that the fleets I
-belonged to seldom remained more than six weeks or two months at any
-one place, so that any series of observations that might have been
-instituted was interrupted, and I was in a great degree deprived of the
-fruits of them, by not seeing the event of cases under my management.
-
-The peace in the spring of the year 1783 put an end to all my
-inquiries, and particularly prevented me from following out some
-practical researches. I have ventured, however, in one part of this
-work, to give the result of my experience in some diseases, more
-especially such as are peculiar to the climate and mode of life.
-
-Upon the whole, I have, in the following work, humbly attempted to
-follow what I conceive to be the only true method of cultivating any
-practical art, that is, to collect and compare a great number of
-facts. A few individual cases are not to be relied on as a foundation
-of general reasoning, the deductions from them being inconclusive and
-fallacious, and they are liable to be turned and glossed, according as
-the mind of the observer may he biassed by a favourite prepossession or
-hypothesis. It has been my study to exhibit a rigid transcript of truth
-and nature upon a large scale, and to take the average of numberless
-particular facts, to serve as a groundwork for observation; and I
-have endeavoured to analyse and collate these facts, by throwing the
-monthly returns that were made to me into the form of Tables, as the
-most certain and compendious way for finding their general result. If
-the materials are not sufficiently ample, or if the method should be
-found faulty and imperfect, let it be remembered, that I had no example
-to go by in this field of observation. It is to be regretted, that ages
-have passed without any attempts being made to transmit regular records
-of this kind to posterity. It would not only be extremely curious, as
-a piece of natural knowledge, but would conduce greatly to medical
-improvement and public utility, were we possessed of such information
-concerning the causes and nature of the diseases prevailing at sea, in
-various circumstances of weather, climate, and diet, in remote ages and
-countries, or even in our own age and country, as might enable us to
-compare them with present facts, and to ascertain more precisely the
-means of preventing and removing such diseases.
-
-The favourable reception which the first edition of this work has met
-with, renders it necessary to offer another to the Public; and though
-no new opportunities have occurred of making additional observations in
-the naval service I have endeavoured, during the last two years, from
-a pretty extensive experience in a large hospital, and from private
-practice, to add some new information on some practical points; and I
-hope this edition will be found throughout more full and correct than
-the former.
-
-The method I propose to follow in this work, is, First, to deliver the
-history of the different voyages and expeditions, so far as relates to
-health, giving an account of the prevalence and nature of the diseases
-and mortality on board of ships and in hospitals.
-
-Secondly, To deduce, from observations founded on these facts, and also
-from the former experience of others, the causes of sickness in fleets,
-and the means of prevention.
-
-Thirdly, To deliver some practical observations on the cure of the most
-common diseases incident to fleets, particularly in hot climates.
-
-
-
-
-  OBSERVATIONS.
-
-  PART I.
-
-  BOOK I.
-
- Comprehending the MEDICAL HISTORY of the FLEET, from March, 1780, till
- August, 1781.
-
-
-
-
-CHAP. I.
-
- Containing an Account of the HEALTH of the FLEET from March,
- 1780, till July following.----Five Ships of the Line arrive at
- Barbadoes from Europe in March--Join a large Squadron then on that
- Station--Their Health compared--Engagements with the Enemy in April
- and May producing Hardship and Exposure, but little Increase of
- Sickness--Method of collecting the Returns of the Surgeons--Influence
- of Situation upon Health in Harbours--Course of the Seasons, and
- Temperature of the West Indies--The Fleet reinforced in June and July
- with Ships from England and North America--Their Health.
-
-
-During the war, which broke out with France in 1778, and with Spain in
-1779, the West Indies was the principal seat of naval operations, and
-much greater fleets were then employed in that quarter of the world
-than in any former period.
-
-Though there had been a great squadron on the Caribbee station during
-the greater part of 1779, no physician was appointed to it till the
-beginning of the next year, when I arrived there in that character with
-my friend and protector, Lord Rodney.
-
-There were then sixteen ships of the line on that station, most of
-which had been upwards of twelve months in the climate; and they were
-reinforced at this time by five more from England.
-
-The squadron which we found on the station was then extremely healthy,
-and in several of the ships there was not a man unfit for duty. We were
-told, however, that they had all been subject to sickness, particularly
-to the dysentery, soon after their arrival in that climate. Of the five
-with which the fleet was at this time reinforced, all but the Intrepid
-left England at Christmas, making part of the squadron which effected
-the first relief of Gibraltar, under the command of Lord Rodney, who
-continued his route to the West Indies, in order to take the command
-on the Windward station, where he arrived on the 16th of March. The
-Intrepid had arrived with a convoy the day before. These five ships
-were all pretty healthy on their passage, except the Sandwich and
-Terrible, in which a fever prevailed; but they had almost recovered
-from it before they arrived in the West Indies. A dysentery broke
-out in April in all the ships newly arrived, and it prevailed to the
-greatest degree in those which had been most affected with fevers in
-Europe, namely, in the Terrible and Intrepid. The Sandwich and Ajax
-were also affected, though in a less degree; but the Montagu, though
-this was her first voyage, and though she was just off the stocks, had
-been the most healthy of any of them from the time of leaving England,
-and continued so during all this campaign. I have not observed that
-new ships are more unhealthy than others, unless they are built of
-ill-seasoned timber; and they have this advantage, that there is no
-previous infection adhering to them. What may have contributed also
-to the superior health of the Montagu, was the precaution that was
-taken when this ship was first manned and fitted out, of stripping and
-washing the men that were brought from the guardship to complete the
-crew.
-
-The Intrepid, while in England, had been afflicted with fevers to a
-most uncommon degree; for, being one of the fleet in the Channel cruise
-the year before, almost the whole crew either died at sea, or were
-sent to the hospital upon arriving at Portsmouth. This ship, after
-refitting, was pretty healthy for a little time; but, probably from the
-operation of the old adhering infection, she became extremely sickly
-immediately after joining our fleet, and sent two hundred men to the
-hospital the first two months after arriving in the West Indies. Most
-of these were ill of the dysentery.
-
-The Pegasus frigate arrived with the ships from Gibraltar, and we have
-here an instance of the superior health commonly enjoyed by this class
-of ships over ships of the line; for when she was dispatched to England
-in the end of April, there had not been a man taken ill from the time
-of her arrival on the station.
-
-This season was a very active one in the operations of war; for,
-besides the general battle of the 17th of April, there were two partial
-actions in May; and, from the 15th of the former month till the 20th of
-the latter, our fleet was constantly in the face of the enemy’s, except
-for a few days that it was refitting at St. Lucia after the first
-battle. This was extremely harrassing to the men, not only from the
-incessant labour necessary in the evolutions of the fleet, but by their
-being constantly at quarters with the ships clear for action; for, in
-that situation, they had nothing to sleep upon but the bare decks, the
-hammocks and bedding being removed from between decks, where they might
-embarrass the men in fighting, and they become useful on the quarter
-deck, by serving to barricade the ship, which is done by placing them
-in ranges on the gunwale, to cover the men from the enemy’s grape and
-small shot. These hardships were productive of some sickness, though
-much less than might have been expected; for the weather is at all
-times warm, and it was at this time extremely moderate and dry. Besides
-we shall see in other instances as well as this, that, in the ardour
-inspired by the presence of an enemy, men are less exhausted by their
-exertions than on ordinary and less interesting occasions.
-
-Almost the whole of the sick and wounded, to the number of 750, were
-put on shore at Barbadoes, where all the fleet, except three ships[1],
-arrived on the 22d of May.
-
-I now began to keep regular and methodical accounts of the sickness
-and mortality in the fleet, though in a manner more imperfect and less
-accurate than was afterwards adopted. I was embarked on board of the
-Sandwich, where the Commander in Chief had his flag, so that I was
-always present with the main body of the fleet, whether at sea or in
-port.
-
-A form of monthly returns[2] was adopted, which, as well as other
-points of method, was afterwards improved.
-
-After collecting the returns for each month, I made abstracts of them
-in tables; in one column of which the complement of each ship is set
-down, in order to form calculations of the comparative prevalence
-and mortality of different diseases at different times. One of the
-abstracts is here inserted, (Table I.) by way of specimen, and the
-proportional result of them for fourteen months is set down in another
-table, (Table II.)
-
-Though this last exhibits a tolerably just view, yet it may be
-remarked, as one imperfection, that there was no distinction made
-at this time in my returns between the killed and those who died
-of disease; so that in the month of May, which stands first, the
-proportion is too high; for there were sixty-four killed, and two
-hundred wounded, in the two actions of that month.
-
-
-TABLE I.
-
-  +--------------------------------------------+
-  | ABSTRACT OF RETURNS,                       |
-  | 1ST JUNE, 1781.                            |
-  +--------------------------------------------+
-  |   Transcriber’s keys:                      |
-  |                                            |
-  |   A Complement.                            |
-  |   B Sick and Wounded on Board.             |
-  |   C Sent to the Hospital in the            |
-  |       course of last Month.                |
-  |   D Dead on Board in the course            |
-  |       of last Month.                       |
-  +----------------+--------+------+------+----+
-  | SHIPS’         |   A    |  B   |  C   | D  |
-  | NAMES.         |        |      |      |    |
-  +----------------+--------+------+------+----+
-  | Sandwich       |   732  |  28  |  36  |  2 |
-  +----------------+--------+------+------+----+
-  | Barfleur       |   767  | 133  |  22  |  1 |
-  +----------------+--------+------+------+----+
-  | Gibraltar      |   650  |  67  |  88  | 10 |
-  +----------------+--------+------+------+----+
-  | Triumph        |   650  |   7  |   9  |  2 |
-  +----------------+--------+------+------+----+
-  | Centaur        |   650  |  45  |  26     5 |
-  +----------------+--------+------+------+----+
-  | Torbay         |   600     31  |  57  |  5 |
-  +----------------+--------+------+------+----+
-  | Monarch        |   600  |  62  |  14  |  2 |
-  +----------------+--------+------+------+----+
-  | Terrible       |   600  |  85  |  24  |  1 |
-  +----------------+--------+------+------+----+
-  | Alfred         |   600  |  57  |  38  |  1 |
-  +----------------+--------+------+------+----+
-  | Russel         |   600  |  44  | 134  |  7 |
-  +----------------+--------+------+------+----+
-  | Alcide         |   600  |  42  |  35  |  1 |
-  +----------------+--------+------+------+----+
-  | Shrewsbury     |   600  |  30  |  23  |  5 |
-  +----------------+--------+------+------+----+
-  | Invincible     |   600  |  50  |  63  |  9 |
-  +----------------+--------+------+------+----+
-  | Resolution     |   600  | 107  |  54  |  3 |
-  +----------------+--------+------+------+----+
-  | Ajax           |   550  |  20  |  10  |  2 |
-  +----------------+--------+------+------+----+
-  | Princessa      |   560  |  88  |  40  |  5 |
-  +----------------+--------+------+------+----+
-  | Belliqueux     |   500  |  19  |   0  |  1 |
-  +----------------+--------+------+------+----+
-  | Prince William |   500  |  25  |  14  |  2 |
-  +----------------+--------+------+------+----+
-  | Panther        |   420  |  16  |   6  |  0 |
-  +----------------+--------+------+------+----+
-  | Triton         |   200  |   5  |   1  |  0 |
-  +----------------+--------+------+------+----+
-  | Hyena          |   200  |  11  |   0  |  0 |
-  +----------------+--------+------+------+----+
-  | Cyclops        |   200  |   5  |   2  |  0 |
-  +----------------+--------+------+------+----+
-  |     Total      | 11979  | 977  | 696  | 64 |
-  +----------------+--------+------+------+----+
-
-The main body of the fleet lay at Barbadoes till the 6th of June, and
-the men had recruited extremely by their stay there; for vegetables,
-fruit, and other refreshments, can be procured at an easier rate, and
-in much greater plenty, at this island, than any other on the station.
-
-The fleet arrived at St. Lucia the next day after it sailed from
-Barbadoes, and remained there till the 18th of June. The whole of this
-month was showery at this island, though it is not accounted the common
-rainy season; for more rain falls here than at any of the other islands
-at that time in our possession, being the most mountainous, as well as
-the most woody and uncultivated, of them all. These rains produced some
-increase of sickness, but very little, when compared to what took place
-at the same time in the army on shore, and in the ships refitting at
-the Carenage. There died about this time from fifty to fifty-five men
-every week in an army of not quite two thousand men.
-
-The difference in point of health between the Carenage (which, as the
-word implies, is the place where ships go to be hove down, or otherwise
-repaired) and Gros-Islet Bay, where the main body of the fleet lay,
-affords a striking proof of the effects of situation. The Carenage is
-a land-locked creek, with a marsh adjacent to it, whereas the other is
-a road open to the fine air of the sea, the only land sheltering it to
-windward being a small, dry island, consisting of one hill, of half a
-league in circumference, and some of the cliffs of the main island of
-St. Lucia.
-
-The increase of sickness here was farther prevented by the men
-having little labour to perform on shore, nor any haunts to
-encourage intemperance, a vice which the Admiral endeavoured still
-more effectually to prevent, by ordering all the rum stills in the
-neighbourhood to be destroyed.
-
-It may be proper here to introduce a general account of the seasons
-and temperature of the West Indies, as there will be frequent occasion
-hereafter to make allusions to them. With regard to the heat, though
-the range of the temperature is very small, in comparison of what it
-is in Europe, the variations follow the same seasons; for July and
-August are the hottest months, and December and January the coolest.
-This we would naturally expect, as our plantations lie all in the
-northern hemisphere, between the 10th and 20th degree of N. latitude,
-and therefore bear the same relation as Europe does to the sun’s
-annual course. The hurricanes happen in the same season in which the
-periodical rains chiefly fall, that is, in the months of August,
-September, and October, which are called the hurricane months, and
-this is also the most unhealthy season. The time of the year which is
-most apt to be rainy, next to this, is from the middle of May to the
-middle or end of June, but this is not invariable. The lowest I ever
-observed the thermometer was at 69°; it stands very commonly at 72° at
-sunrise, in the cool season, rising to 78° or 79° in the middle of the
-day. In the hot season, the common range is from 76° to 83°. It seldom
-exceeds this in the shade at sea; and the greatest height at which I
-ever observed it in the shade at land was 87°. This is far short of
-the extremes of heat which they experience at certain seasons on the
-continent of North America, even very far north. In Pennsylvania and
-New York, the thermometer, I have been assured, rises frequently above
-90°. It does so commonly enough in the East Indies; but I believe it
-never was known to rise so high in the West Indies, so that the heat,
-comparatively speaking, may be called moderate and steady.
-
-The comparative mortality in June is small, owing to the fleet’s having
-been cleared of all the bad cases at Barbadoes before it sailed from
-thence. Though the proportion of sick in July is less, that of the
-mortality is greater, (see Table II.) which seems to be owing to this
-circumstance, that the cases taken ill during the rainy weather of June
-did not terminate fatally till the succeeding month.
-
-In the course of this summer the fleet was reinforced by several ships
-of the line from England. The Triumph arrived in May, without any sick
-on board; but a flux prevailed a few weeks afterwards, without any
-evident cause, except the influence of the climate, and the exposure
-and fatigues during the operations of May. The disease, however, soon
-subsided, and the ship being kept in excellent order and discipline,
-continued healthy during all the remaining time in which she served
-with us.
-
-In June, the Russel, of 74 guns, arrived from North America, and the
-Shrewsbury, a ship of the same rate, from England. The former left
-England in 1778, but was obliged to put back by stress of weather
-and sickness, and upon arriving afterwards on the coast of America,
-was extremely afflicted both with fevers and the scurvy. These were
-removed to the hospital, and this ship had become free of all sickness
-before sailing for the West Indies, except that a few of the men were
-seized with fevers, and she remained healthy after arriving there, not
-suffering from any regular attack of sickness, such as affected the
-ships in general from Europe. The Shrewsbury left England healthy, but
-was soon attacked with a fever and flux, which continued to prevail
-till the end of the year.
-
-The fever in these two ships resembled rather the low ship fever of
-Europe than the bilious one peculiar to the climate. This last, indeed,
-seldom or never prevails to a great degree on board of a ship, unless
-it has been caught on the watering duty, or from some other exposure to
-the air of the land. I have, however, known a few instances of bilious
-fevers in men who never had been on shore from the time they left
-England; I have even known men of the same description attacked with
-intermittent fevers, which are supposed to depend still more on land
-air. This is perhaps owing either to the quantity of water in a great
-ship, part of which is always more or less putrid, or to the fresh-cut
-wood of the country taken on board for fuel, the steam of all which
-must resemble a good deal the effluvia of woods and marshes, which are
-supposed to give rise to intermittents.
-
-In the beginning of July our fleet was reinforced with the Culloden,
-Egmont, and Centaur, all of 74 guns. In the end of the same month
-we were joined by the Alcide and Torbay, of the same rate, and also
-directly from England. The fleet was at this time at St. Christopher’s,
-having arrived there on the 22d of the month, with a large convoy from
-England, which had joined it at St. Lucia, under protection of the
-Thunderer and Berwick, two ships of the line, which being bound to
-Jamaica, I do not reckon as belonging to our fleet.
-
-
-TABLE II.
-
- Shewing the proportional Sickness and Mortality, in relation to the
- whole Numbers on board, for fourteen Months.
-
-  +------------------------------------------------------+
-  | Transcriber’s keys:                                  |
-  | A Proportion of Sick and                             |
-  |     Wounded on board on                              |
-  |     the First of the Month.                          |
-  |                                                      |
-  | B Proportion of Sick and                             |
-  |     Wounded sent to the                              |
-  |     Hospital in the Course                           |
-  |     of the Month.                                    |
-  |                                                      |
-  | C Proportion of Deaths                               |
-  |     on board in the Course                           |
-  |     of the Month.                                    |
-  +-----------------+-----------+----------+-------------+
-  | Months.         |   A       |   B      |   C         |
-  +-----------------+-----------+----------+-------------+
-  |                 | ONE IN    | ONE IN   | ONE IN      |
-  +-----------------+-----------+----------+-------------+
-  | May, 1780       |  18½      |  20½     |  87         |
-  | June            |  13       |  68½     | 418         |
-  | July            |  17½      |  80      | 163         |
-  | August          |  18       | 227      |  80         |
-  | September       |   9       |   6      | 188         |
-  | October         |  14       |  25      |   0         |
-  | November        |  33½      | 192      | 265         |
-  | December        |  16       |  67      | 185         |
-  | January, 1781   |  14       |  60½     | 316         |
-  | February        |  18       | 413      | 214         |
-  | March           |  15½      |  30      | 201         |
-  | April           |  11       |  59      | 169         |
-  | May             |   9½      |  17      | 188         |
-  | June            |  12       |  40      | 701         |
-  +-----------------+-----------+----------+-------------+
-  | Mean Proportion |  15½      |  93      | 227         |
-  +-----------------+-----------+----------+-------------+
-
-
-
-
-CHAP. II.
-
- Account of the HEALTH of the FLEET from August, 1780, till December
- following.----The Fleet divided--The principal Squadron goes to North
- America--Fluctuation between Fevers and Fluxes--The Alcide and Torbay
- the most sickly Ships--Health mended by the Climate and Diet in North
- America--Hurricane in the West Indies--Sufferings in consequence of
- it--Fevers the chief Disease.
-
-
-The hurricane months approaching, the season for active operations in
-the West Indies was now over. The whole force of the enemy, consisting
-of thirty-fix French and Spanish ships of the line, having gone to St.
-Domingo in the end of July, ten sail of the line were detached after
-them from our station, for the protection of Jamaica. The Admiral
-sailed for North America in August, with eleven ships of the line,
-leaving six for the protection of the islands.
-
-There was little alteration in the general state of the sick during the
-voyage to America, and indeed we found no diminution of the West-India
-heat, which at this season is at the greatest height, until we came to
-the 33° of N. latitude.
-
-The only material alteration in point of health was in the Alcide and
-Torbay, which had arrived from England with a few men ill of fevers;
-but in the course of this voyage these two ships became as unhealthy as
-any that ever came under my observation. There was a greater number of
-sick on board of them than all the fleet besides, and it increased to
-such a degree, that upon their arrival at New York, which was in the
-middle of September, after a passage of three weeks, near one half of
-their men were unfit for duty. In the Alcide it was a fever that raged;
-in the Torbay it was a dysentery; and the unusual degree of sickness
-and mortality which appears in the Table for the month of September,
-was owing to the very sickly state of these two ships.
-
-
-TABLE III.
-
-Shewing the Number of Fevers and Fluxes on board on
-the First of each Month, and the Number sent to the Hospital in the
-Course of the Month.
-
-  [Key:
-  B On board.
-  H Sent to the Hospital.
-
-  +---------------+-------------------+-------------------+-------------------+
-  |               |     MAY, 1780.    |       JUNE.       |       JULY.       |
-  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
-  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
-  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
-  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 16th March    |  6 |  0 | 16 | 19 |  3 |  0 | 12 |  0 | 10 |  5 | 16 |  3 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Terrible,     |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 16th March    |  0 |  0 | 40 | 20 |  0 |  3 | 86 | 75 |  3 | 25 | 60 | 24 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 7th May       |    |  0 |    |  0 |  0 |  0 |  0 |  0 |  0 |  0 | 32 | 17 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 18th June     |    |    |    |    |    |    |    |    | 22 |  0 |  0 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Shrewsbury,   |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 26th June     |    |    |    |    |    |    |    |    |  5 |  0 |  0 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d Nov.      |    |    |    |    |  3 |  0 |  2 |  0 |  5 | 12 | 15 |  4 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d November  |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-
-  +---------------+-------------------+-------------------+-------------------+
-  |               |      AUGUST.      |     SEPTEMBER.    |      OCTOBER.     |
-  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
-  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
-  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
-  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 16th March    | 20 |  0 |  5 |  0 | 16 |  4 |  5 |  2 |  5 |  9 |  4 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Terrible,     |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 16th March    | 25 |  0 | 30 | 13 | 19 | 12 | 41 |  9 |  2 |  0 |  3 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 7th May       |  5 |  0 |  7 |  0 |  0 |  0 |  3 |  0 | continued healthy.|
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 18th June     |  5 |  0 |  7 |  0 |  0 |  0 |  3 |  0 | continued healthy.|
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Shrewsbury,   |    |    |    |    |    |    |    |    | No Return, the    |
-  | 26th June     | 14 |  0 | 12 |  0 | 20 |  0 | 20 |  0 | Ship being absent.|
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     | 17 |  0 |  0 |  0 | 54 |  0 |  3 | 22 | 20 |  2 | 59 | 37 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     |  6 |  0 |  3 | 0  |  3 | 0  |169 |143 |  3 |  0 | 12 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d Nov.      |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d November  |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-
-  +---------------+-------------------+-------------------+-------------------+
-  |               |     NOVEMBER.     |     DECEMBER.     |   JANUARY, 1781.  |
-  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
-  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
-  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
-  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 16th March    |  3 |  0 |  5 |  0 |  8 |  0 | 10 |  0 |  9 |  0 | 13 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Terrible,     |  continued quite  |    |    |    |    |    |    |    |    |
-  | 16th March    |      healthy.     |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 7th May       |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 18th June     |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Shrewsbury,   | No Return, the    |    |    |    |    |    |    |    |    |
-  | 26th June     | Ship being absent.|  0 |  0 | 13 |  0 |  1 |  0 |  7 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     |  0 |  0 | 23 | 10 |  0 |  0 | 14 |  0 |  6 |  5 | 17 |  0 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 30th July     |  6 |  0 | 5  |  0 |  0 |  1 | 22 | 30 |  5 |  0 | 10 |  1 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d Nov.      |    |    |    |    |    |    |    |    |    |    |    |    |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
-  | 22d November  |    |    |    |    |  6 |  0 |  5 |  0 | 15 | 16 | 11 |  8 |
-  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
-
-We shall hereafter see reason for supposing that fever and dysentery
-proceed from the same cause; and as both these ships arrived
-from England in a similar state with regard to health, fevers would
-probably have been the prevailing disease in both; but a part of the
-87th regiment, then serving as marines in the fleet, was put on board
-of the Torbay at St. Christopher’s, and some of them being ill of the
-dysentery, gave this turn to the disease which afterwards prevailed on
-board. I have formed a Table to shew the fluctuating state of these
-two diseases, and this was one of my first and most imperfect attempts
-towards a medical history of the fleet in a methodical way. (Table III.)
-
-There was but little sickness in the rest of this squadron, except in
-the Terrible, where the dysentery prevailed a good deal. None of the
-ships of the line which we found in the West Indies, upon our arrival
-there, were now in company, except the Yarmouth, and this was the most
-healthy of all the ships that went to North America.
-
-The health of the fleet was very much recruited by its short stay in
-America; for the men were supplied with fresh meat and spruce beer,
-and they enjoyed the two finest months of the year in that temperate
-climate. The squadron left New York in the middle of November, and
-though dispersed by a violent storm, all the ships arrived safe in the
-West Indies before the middle of December.
-
-In October the fleet had attained such a degree of health, that though
-the calculation in the Table is made from five of the most sickly
-ships, no death happened in this month on board of any of them. In
-November the mortality was also inconsiderable, though the ships left
-in the West Indies are included in the calculation; which, had it been
-made upon those only that went to North America, the deaths would have
-been no more than one in seven hundred and eleven in this month, which
-is rather less than that of any other month in the Table.
-
-The amendment in health, in consequence of the change of climate, was
-most remarkable in the Terrible, which, by the time she left America,
-had entirely got rid of the violent dysentery that had prevailed for
-some time on board. This sudden change in the health of this ship was
-evidently owing to the great attention of the Captain to cleanliness
-and discipline, and no less to the assiduity and abilities of the
-Surgeon. The Alcide still continued sickly, though not so much so as
-the Torbay. The former had sailed on a cruise in October, and having
-met with very rough weather, the sick list was thereby increased. The
-dysentery now prevailed in that ship, as well as fevers, and those
-men chiefly were attacked with fevers who were ill of the scurvy, or
-recovering from it. This was not very common; and there were several
-other remarkable particulars with regard to the fevers in this ship;
-for her men were not only uncommonly subject to this disease, both in
-America and the West Indies, but to all the various forms of it; the
-low, infectious, ship fever of Europe, the bilious remitting, and the
-malignant yellow fever of hot climates. It would appear from this,
-as well as other instances, that a ship may assume, as it were, a
-particular constitution, or a tendency to some particular disease,
-for a length of time, and this depending on some lurking and adhering
-infection, or the manner in which she may have been victualled,
-watered, disciplined, or manned.
-
-The great benefit derived to the health of the fleet, from the change
-of climate, as well as other reasons, justified the Admiral in going
-to North America; and there was the more merit in this measure, as it
-was undertaken without precedent, and without instruction. Upon our
-return we found there was great good fortune in it, as well as wisdom;
-for there had happened on the 10th of October a more violent hurricane
-than any in the memory of man, and the ravage it made both by sea and
-land is, perhaps, unparallelled in history. Several of the ships of the
-line were exposed to it; but though they suffered extremely, and were
-in the utmost danger, none were lost. Two of them happened to be at
-Antigua, which was out of the track of this hurricane, as it extended
-only from the 12th to the 15th degree of N. latitude; so that the only
-islands that suffered by it were Barbadoes, St. Lucia, St. Vincent, and
-Martinico.--Four frigates, and as many sloops of war, either foundered
-or were wrecked, and about one thousand seamen perished in them. One
-of the buildings of the hospital at Barbadoes was entirely demolished
-by the impetuosity of the sea, which, having risen to a great height,
-dashed a ship against it, and twenty-three seamen were buried in the
-ruins[3].
-
-The Montague suffered most on this occasion, and was also most
-subject to sickness and mortality, brought on in consequence of the
-great fatigue and hardships of the men in bringing her into port
-and refitting her; for the ship was almost torn to pieces both in
-the rigging and hull, and the bedding and other necessaries and
-conveniencies were entirely destroyed. The fever that prevailed on
-board at this time was of the most malignant kind known in this
-climate; and the worst cases arose in watering, and the other
-necessary duties on shore, from which the men would sometimes return
-frantic, and die in a few hours. There was a party of soldiers on
-board; and as they were not called upon to perform any duties on
-shore, they had but little sickness in companion of the sailors.
-
-The other ships having suffered less from the storm, were also less
-sickly, as it was not necessary for them to remain so long in the
-unhealthy Carenage to repair.
-
-The only disease that prevailed at this time, in these two ships, was
-fevers, there being few or no fluxes, though they had been so frequent
-in the former part of the year. Though fevers and fluxes depend on the
-same general causes, yet when these causes exist in a higher degree,
-it would appear that they are more apt to produce fevers. Thus the
-exhalations of the earth from marshes are more apt to produce fevers;
-and mere excesses of heat and cold, or moisture, are more apt to
-produce fluxes; just as in Europe a catarrh, which may be considered as
-a local febrile affection, as well as a dysentery, will be excited by
-exposure to cold or damp, without any specific bad quality in the air.
-
-The Ajax and Montague are the only two ships of those left in the West
-Indies, which are included in the estimate of sickness and mortality
-in November and December, and they bear a very great proportion to the
-whole; for out of forty-four that died in fourteen ships of the line in
-November, twenty died in the Montague, and five in the Ajax; and out of
-forty-three, the whole number of deaths in December in twenty-one ships
-of the line, ten were of the Montague, and eleven of the Ajax.
-
-
-
-
-CHAP. III.
-
- Account of the HEALTH of the FLEET from January, 1781, till July,
- 1781, both Months included.----Arrival of seven Ships of the Line
- from England--Increase of Sickness in consequence of a Descent on St.
- Vincent’s--Long Cruise to windward of Martinico--Great Prevalence
- of Scurvy--Difference of Health in different Ships--New Ships not
- more unhealthy than others--Why Frigates are more healthy than Ships
- of the Line--Remarkable Cure of Scurvy in two Ships--Essence of
- Malt--Vegetables most antiscorbutic in their natural State--Advantage
- of supplying Refreshments on board of Ships in preference to Hospitals.
-
-
-We are now come to that period in which our fleet was reinforced with
-seven ships of the line, which arrived at Barbadoes from England on the
-5th of January, 1781, under the command of Lord Hood. This addition,
-with two which had arrived in November, made the force upon this
-station again amount to twenty-one ships of the line.
-
-
-TABLE IV.
-
-Shewing the Number of each Disease on board on the First of each Month,
-the Numbers sent to the Hospital, and Dead, in the Course of the Month.
-
-  KEY:
-  B  On board.
-  H  Sent to the Hospital.
-  D  Dead.
-
-  +--------------+------------------------------------------------+
-  |   SHIPS’     |                                                |
-  |   NAMES.     |               FEBRUARY, 1781.                  |
-  | N. B. Those  +---------------+---------------+----------------+
-  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
-  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
-  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  | D  |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Sandwich     |   8 |  0 |  0 |   4 |  0 |  0 |   2 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Barfleur   |   8 |  0 |  1 |   4 |  0 |  1 |   3 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Gibraltar  |  25 |  0 |  2 |   4 |  0 |  0 |   4 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triumph      |   0 |  0 |  1 |   1 |  0 |  1 |  21 |   8 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Centaur      |   2 |  0 |  0 |   2 |  0 |  0 |  20 |   0 |  8 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Torbay       |   6 |  0 |  0 |  11 |  0 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Monarch      |  13 |  0 |  3 |  13 |  0 |  0 |   2 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Terrible     |   2 |  0 |  0 |  10 |  0 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Montagu      |  40 |  0 |  8 |  14 |  0 |  5 |   4 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alfred       |   4 |  0 |  0 |   4 |  0 |  0 |   4 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Russel       |   0 |  0 |  0 |   7 |  0 |  1 |   2 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alcide       |   1 |  0 |  2 |   9 |  0 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Invincible |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Resolution   |   1 |  0 |  0 |   7 |  0 |  1 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Shrewsbury   |   8 |  0 |  0 |   0 |  1 |  1 |   6 |   7 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Ajax         |   8 |  0 |  1 |   6 |  0 |  5 |   3 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Princessa  |   8 |  0 |  1 |   3 |  0 |  1 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Intrepid     |  18 |  1 |  1 |  10 |  4 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Belliqueux |  11 |  0 |  0 |  10 |  0 |  5 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Prince     |     |    |    |     |    |    |     |     |    |
-  | William      |  21 |  0 |  0 |  17 |  0 |  0 |   4 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Panther    |   2 |  0 |  0 |   4 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triton       |   7 |  0 |  0 |  15 |  2 |  0 |  14 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   2 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Cyclops      |   4 |  1 |  0 |   3 |  0 |  0 |   0 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |     Total    | 197 |  2 | 19 | 158 |  7 | 21 |  93 |  19 | 10 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-
-  +--------------+------------------------------------------------+
-  |   SHIPS’     |                                                |
-  |   NAMES.     |                    MARCH.                      |
-  | N. B. Those  +---------------+---------------+----------------+
-  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
-  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
-  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Sandwich     |   8 |  3 |  1 |   4 |  0 |  0 |   2 |   2 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Barfleur   |  28 |  4 |  0 |  35 |  0 |  0 |   5 |  27 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Gibraltar  |   8 |  1 |  0 |   0 |  0 |  0 |   6 |  22 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triumph      |   3 |  0 |  0 |   2 |  0 |  1 |  24 |  18 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Centaur      |   7 |  0 |  0 |   4 |  0 |  0 |  50 |   0 |  8 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Torbay       |   7 |  0 |  0 |   8 |  0 |  0 |   8 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Monarch      |   5 |  0 |  0 |   4 |  0 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Terrible     |   2 |  0 |  0 |   9 |  0 |  2 |   3 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Montagu      |   § |  § |  5 |   § |  § |  3 |   § |   § |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alfred       |  25 |  0 |  0 |   8 |  0 |  1 |  56 |  16 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Russel       |   7 |  0 |  0 |   8 |  2 |  0 |   0 |  61 |  5 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alcide       |   1 |  0 |  0 |   1 |  0 |  0 |  15 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Invincible |   6 |  1 |  0 |   1 |  0 |  0 |   5 |   6 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Resolution   |   6 |  0 |  0 |   5 |  0 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Shrewsbury   |   5 |  0 |  1 |   6 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Ajax         |   2 |  0 |  2 |  10 |  0 |  5 |   6 |   0 |  6 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Princessa  |   6 |  0 |  5 |   2 |  0 |  0 |   4 | 102 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Intrepid     |  10 |  0 |  0 |   9 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Belliqueux |   3 |  1 |  2 |  52 |  0 |  1 |   0 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Prince     |     |    |    |     |    |    |     |     |    |
-  | William      |  23 | 12 |  0 |  47 | 62 |  5 |   6 |  10 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Panther    |   5 |  0 |  0 |   8 |  0 |  0 |   4 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triton       |   3 |  2 |  0 |  12 |  2 |  0 |   6 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Hyena        |   0 |  0 |  0 |   0 |  1 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Cyclops      |   4 |  0 |  0 |   3 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |     Total    | 174 | 24 | 16 | 238 | 67 | 18 | 202 | 265 | 27 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |   SHIPS’     |                                                |
-  |   NAMES.     |                     APRIL.                     |
-  | N. B. Those  +---------------+---------------+----------------+
-  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
-  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
-  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Sandwich     |   6 |  0 |  2 |   9 |  1 |  1 |   2 |   4 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Barfleur   |  24 |  0 |  0 |  25 |  0 |  0 |  33 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Gibraltar  |   0 |  0 |  1 |   0 |  0 |  0 |  18 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triumph      |   0 |  0 |  1 |   3 |  0 |  2 |  12 |   0 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Centaur      |   1 |  0 |  0 |   3 |  1 |  0 |  55 |   1 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Torbay       |   6 |  0 |  0 |   8 |  0 |  0 |  23 |  27 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Monarch      |   8 |  0 |  4 |  17 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Terrible     |   0 |  0 |  0 |  10 |  0 |  0 |   4 |   3 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Montagu      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alfred       |  11 |  0 |  0 |  26 |  0 |  1 | 116 |  44 |  4 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Russel       |   0 |  0 |  0 |   4 |  0 |  1 |  44 |   0 |  3 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alcide       |   1 |  0 |  0 |   3 |  0 |  0 |   8 |  16 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Invincible |   4 |  0 |  0 |   4 |  0 |  0 |   2 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Resolution   |   5 |  0 |  0 |   8 |  0 |  2 |   7 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Shrewsbury   |   4 |  3 |  0 |   0 |  0 |  0 |   4 |   6 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Ajax         |   4 |  0 |  1 |  15 |  4 |  2 |  30 |   5 | 10 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Princessa  |   6 |  0 |  0 |   1 |  0 |  0 |  40 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Intrepid     |   9 |  § |  § |  13 |  § |  § |   1 |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Belliqueux |   0 |  0 |  0 |   3 |  0 |  0 |   2 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Prince     |     |    |    |     |    |    |     |     |    |
-  | William      |  19 |  2 |  0 | 147 | 40 |  0 |  16 |   7 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Panther    |   2 |  0 |  0 |   4 |  3 |  0 |   9 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triton       |   2 |  0 |  0 |   2 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   2 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Cyclops      |   2 |  0 |  0 |   2 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |     Total    | 115 |  5 |  9 | 317 | 49 |  9 | 428 | 115 | 26 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-
-  ----------------------------------------------------------------+
-  |   SHIPS’     |                                                |
-  |   NAMES.     |                      MAY.                      |
-  | N. B. Those  +---------------+---------------+----------------+
-  | marked *,    |     Fever.    |     Flux.     |    Scurvy.     |
-  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
-  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Sandwich     |   2 |  2 |  1 |  10 |  5 |  0 |   5 |  18 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Barfleur   |  12 |  3 |  1 |  16 |  1 |  0 |  54 |  10 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Gibraltar  |   4 |  0 |  0 |   0 |  0 |  0 |  30 |  22 |  4 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triumph      |   0 |  1 |  1 |   0 |  0 |  0 |  13 |   8 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Centaur      |   0 |  0 |  0 |   2 |  0 |  2 |  15 |   4 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Torbay       |   6 |  0 |  0 |  13 |  7 |  0 |  44 |  31 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Monarch      |   5 |  2 |  2 |   3 |  0 |  0 |  57 |  11 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Terrible     |   0 |  0 |  1 |  10 |  4 |  0 |   5 |  20 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Montagu      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alfred       |  15 | 10 |  1 |  11 |  3 |  0 | 130 |  25 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Russel       |   0 |  1 |  0 |   8 |  0 |  0 | 132 | 102 |  4 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alcide       |   0 |  0 |  1 |   1 |  0 |  0 |  40 |  35 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Invincible |   7 |  0 |  1 |   6 |  8 |  4 |  31 |  54 |  4 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Resolution   |   5 |  2 |  0 |   9 |  0 |  0 |  15 |  45 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Shrewsbury   |   3 |  1 |  0 |   5 |  2 |  0 |  22 |   6 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Ajax         |   4 |  1 |  1 |   3 |  0 |  0 |   8 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Princessa  |   2 |  0 |  0 |   2 |  0 |  1 |  30 |  40 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Intrepid     |   § |  § |  § |   § |  § |  § |   § |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Belliqueux |   0 |  0 |  0 |   2 |  0 |  0 |   2 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Prince     |     |    |    |     |    |    |     |     |    |
-  | William      |   5 |  5 |  2 |  53 |  5 |  0 |   7 |   4 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Panther    |   3 |  2 |  0 |   8 |  4 |  0 |   1 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triton       |   2 |  0 |  0 |   4 |  0 |  0 |   0 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Cyclops      |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |     Total    |  76 | 30 | 12 | 166 | 39 |  7 | 641 | 436 | 22 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-
-  +--------------+------------------------------------------------+
-  |   SHIPS’     |                                                |
-  |   NAMES.     |                     JUNE.                      |
-  | N. B. Those  +---------------+---------------+----------------+
-  | marked *,    |     Fever.    |     Flux.     |    Scurvy.     |
-  | arrived with +----+----+-----+-----+----+----+-----+--- -+----+
-  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  | D  |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Sandwich     |   2 |  0 |  0 |   3 |  0 |  0 |  10 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Barfleur   |  20 |  0 |  0 |  13 |  0 |  0 |  58 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Gibraltar  |   3 |  1 |  0 |   4 |  0 |  0 |  48 |  17 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triumph      |   1 |  0 |  0 |   0 |  0 |  0 |   6 |   5 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Centaur      |   4 |  0 |  0 |   9 |  0 |  1 |  15 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Torbay       |  16 |  0 |  0 |   6 |  0 |  0 |   9 |   0 |  1 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Monarch      |   4 |  3 |  1 |   4 |  0 |  0 |  36 |   5 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Terrible     |   3 |  1 |  0 |  12 |  0 |  0 |  20 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Montagu      |   § |  0 |  0 |   § |  0 |  2 |   § |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alfred       |  14 |  § |  § |  10 |  0 |  0 |  26 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Russel       |   0 |  1 |  0 |  19 |  1 |  0 |  14 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Alcide       |   4 |  2 |  0 |   5 |  0 |  0 |  26 |   5 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Invincible |   8 |  0 |  0 |  22 |  0 |  0 |  10 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Resolution   |   1 |  0 |  0 |   3 | 12 |  0 |  84 |   0 |  2 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Shrewsbury   |   3 |  § |  § |   4 |  § |  § |  20 |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Ajax         |   2 |  0 |  0 |   2 |  0 |  1 |   6 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Princessa  |   2 |  0 |  0 |   6 | 40 |  0 |  70 | 154 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Intrepid     |   § |  § |  § |   § |  § |  § |   § |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Belliqueux |   2 |  0 |  1 |   3 |  0 |  0 |   8 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Prince     |     |    |    |     |    |    |     |     |    |
-  | William      |   4 |  4 |  2 |  13 |  3 |  1 |   8 |   7 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | * Panther    |   3 |  0 |  0 |   8 |  1 |  0 |   1 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Triton       |   2 |  0 |  1 |   1 |  0 |  0 |   0 |   1 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Hyena        |   3 |  0 |  1 |   2 |  0 |  0 |   5 |   0 |  0 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  | Cyclops      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-  |     Total    | 101 | 12 |  6 | 149 | 57 |  5 | 480 | 198 |  4 |
-  +--------------+-----+----+----+-----+----+----+-----+-----+----+
-
-  N. B. Where the Spaces are marked thus, §, no Return was made.
-
-The whole fleet was tolerably healthy during this month, the season
-being dry and cool; there was, however, a small increase of sickness
-at this time, and it was owing to a descent made on St. Vincent’s in
-December. The soldiers, (of whom there was still a regiment on board of
-the fleet) the marines, and some of the seamen, had been on shore for
-one night only; but many of them having lain on the ground, some having
-been intoxicated, or having eaten to excess of sugar-cane and fruit,
-caught fevers and fluxes, which increased the proportion of diseases
-and deaths the following months, as appears by the Table.
-
-I have exhibited, in another Table, a view of the sickness and
-mortality of this fleet for the five succeeding months. (Table IV.)
-This account, as well as most of those that are to follow, is confined
-to three diseases, that may be called the sea epidemics. These are,
-fever, flux, and scurvy.
-
-The whole fleet met at Barbadoes on the 13th of January, and no service
-was undertaken till the accounts of the Dutch war arrived on the 30th
-of that month. In consequence of this intelligence, the greater part of
-the ships of war went against St. Eustatius, which was taken on the 3d
-of February.
-
-Ten days after this a squadron of seventeen ships of the line was sent
-to cruise to windward of Martinico, with a view to intercept a French
-squadron which was then said to be on its passage from Europe. The
-cruise was there continued for six weeks; after which small divisions
-of the ships were sent to water and refit, by turns, at St. Lucia, and
-were relieved by the ships left for the protection of that island.
-
-Soon after this, the whole squadron came to leeward of Martinico; and
-though the former intelligence had proved false, the greater part
-of our fleet still kept the sea, in order to block up the enemy in
-Fort-Royal Bay. This they continued to do till the 29th of April, when
-a French fleet of twenty-two ships of the line, from Europe, joined by
-four from Martinico, forced their way into their own port, pushing to
-leeward our fleet, consisting only of eighteen ships of the line; so
-that the greater part of them did not get into port till they came to
-an anchor at Barbadoes on the 23d of May.
-
-It was in this season of cruising, and keeping the sea, that the fleet
-contracted such a degree of scurvy as had never before been known in
-the West Indies. This disease is not so apt to arise in a hot climate
-as in a cold one; and the prevalence of it on this occasion was owing
-to the men having been for a great length of time upon sea victualling;
-for one part of the fleet had not had a fresh meal from the time of
-leaving America, that is, for six months; and that part of it which
-came last from England had been in the same circumstances for seven
-months; nor had any of them been in a place capable of supplying
-vegetable refreshments from the time they left Barbadoes in the end of
-January. But though no fresh meat or vegetables could be procured at
-St. Lucia or St. Eustatius, yet the scurvy did not make such progress
-in the ships that lay at anchor there, as in those that were at sea;
-and it appears that the time in which it prevailed most was, while the
-greatest number of ships was at sea, that is, in the month of March.
-It appears, indeed, by the Table, that there was a greater number ill
-of this complaint on the 1st of May than on the 1st of April; but it
-appears also, that more were sent to the hospital in March than in
-April, and very near half of the May list must have been taken ill in
-March[4]. The difference of being in port and at sea consists chiefly,
-1st, In there being plenty of water while in port, so that it can be
-used freely, not only to drink, but to wash the clothes; and we know
-that cleanliness tends greatly to ward off the scurvy. 2dly, Though
-no fresh meat nor vegetables could be procured at those ports, sugar,
-which may be considered as a very antiscorbutic article of diet, could
-always be procured at a very cheap rate, and the seamen, when in port,
-used to exchange their salt provisions for it. 3dly, There is at sea
-a dismal uniformity of life, favourable to indolence and sadness, and
-therefore tending to hasten the progress and aggravate the symptoms of
-the scurvy; whereas the change of scene and variety of objects, when in
-port, tend to cheer and recreate the mind, and thereby to avert this
-disease.
-
-The squadron that came from England under Lord Hood, suffered, upon the
-whole, much less from acute diseases, during the first months of their
-service in this climate, than the ships that arrived with Lord Rodney,
-which was probably owing, in part at least, to the former having
-arrived at the driest and coolest season of the year. The Barfleur,
-however, had a large proportion of all the three prevailing diseases;
-and large ships are in general more subject to them than those of a
-smaller rate. But of all the ships in the fleet, the Alfred had the
-greatest proportion of the three sea epidemics. The Prince William
-suffered more than any other ship in the fleet from the flux, and the
-Princessa from the scurvy. In some instances, reasons can be assigned
-for the prevalence of particular diseases in particular ships, such as
-accidental infection, or the manner in which they have been victualled,
-manned, or disciplined; but in many cases the cause is so subtile or
-obscure as to elude our inquiry.
-
-The most healthy of the new squadron, during this campaign, were the
-Belliqueux and Panther; the former was a new ship, and came from
-England with a very irregular and ill-disciplined crew. Soon after
-arriving in the climate, she was threatened with a dysentery, which,
-though it spread a good deal, did not prove severe nor mortal; but
-being left at St. Eustatius on this account, while the rest of the
-fleet was cruising, she soon became very healthy, and remained so. This
-is the second instance we have had occasion to remark of a new ship
-being healthy.
-
-The Panther preserved her health by being on small separate cruises,
-and frequently in port, not being attached to the main squadron. The
-Sandwich was the only other ship not engaged in the long cruise.
-
-Of the ships lately from England, that were employed in this cruise,
-the Gibraltar seems to have been the least sickly. This ship left
-England healthy; but having received a draft of dirty men when upon
-the eve of sailing, a fever of the infectious kind broke out on the
-passage, so that she arrived in the West Indies in a sickly state.
-This fever disappeared very soon after; and it is proved by this,
-as well as other facts, that a warm climate, so far from tending to
-generate, or even to foster the infection of fever, tends rather to
-extinguish it. The Gibraltar had been put under excellent discipline
-by her former commander, while in the Channel service; and this being
-afterwards kept up, the men were always clean and regular. This was the
-Spanish Admiral’s ship, taken by the fleet under the command of Lord
-Rodney off Cape St. Vincent’s, in January 1780. She was then called
-the Phœnix, and was of a singular excellence both with respect to
-materials and construction. Whether the cedar, of which a great part of
-her timbers consisted, contributed to the healthiness, by its balsamic
-effluvia, I will not pretend to determine.
-
-The Invincible was also uncommonly healthy during this cruise, which
-may likewise be ascribed to good discipline, and to her having been
-more than three years in commission before sailing from England,
-whereby the men were brought into order, and accustomed to each other
-and to a sea life. This ship was almost singular in having no acute
-diseases for several months after arriving from Europe; but at length
-paid the tribute to the climate in May and June, as may be seen in the
-Table.
-
-From the account of the three frigates at the bottom of the list in
-the Table, it appears how much more healthy they are than ships of the
-line. The total complements of the three is exactly equal to that of
-one seventy-four-gun ship; but their whole sickness and mortality is
-less than that of any one ship of the line of that class, although the
-Triton was uncommonly sickly for a frigate.
-
-There seem to be several causes for the superior degree of health
-usually enjoyed by this smaller class of ships. There is less chance of
-mixtures of men in frigates, as their complement is smaller, and it is
-more easy for the captain and officers to keep an eye over a few men
-than a great number; for, in a great ship, there are generally men,
-who, concealing themselves in the most retired parts, no one takes
-cognizance of them, and they destroy themselves, and infect others,
-by their laziness and filth. In the next place, there is a greater
-proportion of volunteers and real seamen in frigates, and more landmen
-and pressed men in ships of the line, the former being more in request,
-on account of the greater chance of prize money. Lastly, a small ship
-is more easily ventilated, and the mass of foul air issuing from
-the hold, from the victuals, water, and other stores, as well as the
-effluvia exhaling from the men’s bodies, is less than in a large ship.
-
-Many other and more minute remarks might be made on different ships
-in this season of hard service; but to do this would be tedious, and
-the inspection of the Tables may suggest observations to the reader.
-There is a striking and instructive fact, however, with regard to two
-ships, which I cannot help relating. The Alcide and Invincible, both
-of seventy-four guns, in working to windward, after the action with
-the French fleet, on the 29th of April, anchored at Montserrat on the
-11th of May, in order to water. They remained there only part of two
-days, and they procured no refreshment, except a few bushels of limes.
-The scurvy then prevailed to a great degree in both ships; but between
-this time and the 23d of May, when they came to an anchor at Barbadoes,
-sixty men, who had been confined with this disease, were discharged,
-as fit for duty, from the sick list of the Invincible, and a hundred
-and fourteen from that of the Alcide. These were the only two ships
-that had the advantage of the limes; and during these twelve remaining
-days of the voyage the scurvy continued to increase in all the other
-ships. Dr. Lind is the first author who gives a decided preference to
-lemons, limes, and oranges, over every other antiscorbutic; and the
-above-mentioned fact proves as demonstrably as possible the infinite
-advantage of this species of acid in scurvy.
-
-The fleet was supplied with essence of malt during all this campaign;
-and though it was, no doubt, of service, it was far from having that
-powerful and manifest effect that the acid fruits had, and certainly
-did by no means prevent the scurvy in all cases. I have strong
-testimonies, however, of its beneficial effects from the surgeons of
-several of the ships, particularly of the Gibraltar, Centaur, Torbay,
-and Alcide, in all of which it was found either to cure the scurvy in
-its first beginning, to retard its progress, or to mend the appearance
-of scorbutic ulcers, and dispose them to heal.
-
-I had conceived that melasses, being a vegetable sweet, must have
-been a very powerful antiscorbutic; but the greatest part of the last
-reinforcement of seven ships came from England furnished with this as
-an article of victualling, as a substitute for a certain proportion of
-oatmeal, which was withheld agreeably to a late very judicious order
-of the Admiralty. But though I am persuaded that this article of diet
-mitigated the disease, it was very far from preventing it; and the
-Princessa in particular, which suffered most from the scurvy, was well
-supplied with it.
-
-There is reason to think that it is not in the vegetable sweet alone
-that the antiscorbutic principle resides, but in this in conjunction
-with the natural mucilage, such as exists in the malt. I suspect
-likewise that the change which the essence undergoes in its preparation
-tends also to rob it of some of its original virtue. But the melasses
-are still farther altered by being deprived of the natural mucilage
-by means of quick lime, with which all sugar is clarified in the
-boilers. Dr. Hendy, of Barbadoes, to whom I have been obliged for
-several remarks, informed me, that the liquor, before it undergoes this
-operation, has been found by him to produce the most salutary effects
-in the scurvy; but as this cannot be had at sea, we had no opportunity
-of comparing it with other antiscorbutics. It is certain also that the
-medical effects of the native sweet juices are, in other respects, very
-different from what they are in their refined state; for manna, wort,
-and the native juice of the sugar cane, are purgative; whereas sugar
-itself is not at all so[5]. This affords a presumption, that they may
-be also different in their antiscorbutic quality; and there is reason
-to think, from experience, that the more natural the state in which
-any vegetable is, the greater is its antiscorbutic quality. Vegetables,
-in the form of sallads, are more powerful than when prepared by fire;
-and I know, for certain, that the rob of lemons and oranges is not
-to be compared to the fresh fruit. Raw potatoes have been used with
-advantage in the fleet, particularly by Mr. Smith, of the Triton,
-who made the scorbutic men eat them, sliced with vinegar, with great
-benefit. This accords also with what Dr. Mertans, of Vienna, has lately
-communicated to the Royal Society of London.
-
-When the fleet arrived at Barbadoes on the 23d of May, it was found
-that the number of sick on board amounted to sixteen hundred, and that
-there was not accommodation for more than two hundred at the hospital.
-As there was hardly any complaint but scurvy, the Admiral, at my
-representation, issued an order for serving the sick on board of their
-own ships with fruit and other vegetables and refreshments, such as
-milk and soft bread. This course of diet commenced in the beginning
-of June; and as the greater part of the fleet was near four weeks
-thereafter in port, they enjoyed the advantages of it during that time;
-and the very great diminution of sickness and mortality, which appears
-by the Tables in that month, sufficiently evinces the benefit derived
-from it. In less than four weeks the fleet, from being very sickly,
-became extremely healthy.
-
-It was remarked, that the men recovered faster on board than on shore;
-and it would appear that land air, merely as such, has no share in the
-cure of the scurvy, and that the benefit arises from the concomitant
-diet, cleanliness, and recreation. The expedient of curing men on board
-of their ships was here suggested by necessity; but it succeeded so
-well, that it was adopted afterwards in preference to an hospital,
-which is indeed a useful relief to a fleet where there are contagious,
-acute disorders; but with regard to scurvy, I am convinced, that on
-foreign stations, at least, where the accommodations of the sick are
-more indifferent than in England, many advantages would arise from
-supplying men with refreshments on board of their ships. It appears
-that only four men died of this disease in the whole fleet in the month
-of June, though there were so many ill of it; whereas it appears by
-the books of hospitals, that scorbutic men die there in a much greater
-proportion, and chiefly in consequence of other diseases, particularly
-the flux, which they catch by infection, or bring on by intemperance.
-It is farther in favour of this scheme, that great numbers of those
-sent on shore are lost by desertion. It is also a great saving to
-Government, the expence not being a fourth part of what it would cost
-at an hospital.
-
-The fleet left Barbadoes on the 10th and 12th of July, and continued
-healthy till the greater part of it sailed for North America in the
-beginning of August.
-
-
-
-
-PART I.
-
-BOOK II.
-
- Continuation of the MEDICAL HISTORY of the FLEET, from August, 1781,
- till the Conclusion of the War in April, 1783.
-
-
-
-
-CHAP. I.
-
- Some Account of the Interval between the Campaign of 1781 and the
- Junction of the Reinforcement from England in April, 1782.----The
- main Body of the Fleet goes to North America--Lord Rodney goes to
- England, and returns to the West Indies with twelve Ships of the
- Line--Health of the Fleet in England--Sickness most prevalent in
- the Beginning of a War--A natural Tendency to Recovery in Ships and
- Individuals--Advantages of this Squadron in point of Victualling.
-
-
-When the main body of the fleet went to America in August, Lord Rodney
-went to England for the recovery of his health.--Wishing to lay before
-the public boards several reforms that suggested themselves to me in
-the course of the late service, I accompanied the Admiral, purposing to
-return when the season for hostile operations should have brought back
-the fleet from the coast of America.
-
-Soon after arriving in England, I presented a memorial[6] to the Board
-of Admiralty, proposing such means for the preservation of the health
-of the fleet as had occurred to me during my past service.
-
-The Board of Admiralty considered this memorial with all the attention
-that could be expected in the general hurry of service, inseparable
-from a great and extensive war; and I am happy in being able to say,
-that, in consequence of my application, most of the particulars
-recommended have since been so far carried into effect as to produce a
-practical conviction of their utility.
-
-Lord Rodney having recovered his health, hurried out to his station
-with all the force that could then be equipped, as the enemy were
-expected at the Caribbee Islands, with a superior force, after their
-successes against us in the autumn campaign in America.
-
-I had again the honour to accompany the Admiral. He first sailed from
-Portsmouth, with four ships of the line, on the 14th of December, and
-was to have been joined by two more that lay ready at Plymouth; but by
-the time we arrived off this harbour the wind became contrary, whereby
-we were detained there till the 14th of January, 1782. During this time
-more ships were got ready, and six were added to the squadron; for the
-public anxiety at that time called forth every exertion to strengthen
-this reinforcement, upon which the fate of the whole West Indies was
-supposed to depend.
-
-This fleet cleared the Channel in the midst of a storm, and with the
-wind at the same time so scanty, that we barely weathered Ushant; but
-Lord Rodney’s perseverance and resolution, stimulated by the exigency
-of the occasion, banished all hesitation and timidity. The rough
-weather, and contrary winds, continued through the variable latitudes;
-but having met with fresh blowing trade winds, common at that season,
-we had the good fortune to get safe to Barbadoes with the whole
-squadron on the 19th of February.
-
-All the twelve ships[7] of this reinforcement had been on service for
-a considerable length of time since they had been last commissioned,
-except the Anson, a new ship, which had never before been at sea, and
-the Fame and Yarmouth, which had lately undergone a thorough repair,
-since which time they had been only for a few weeks at sea in the
-Channel before they were ordered on this expedition.
-
-The only ship that was sickly when we left England was the Fame, on
-board of which some pressed men, with the infection about them, had
-been received from the Conquestadore guardship; and the fever which
-broke out in Plymouth Sound, where I was first sent for to visit that
-ship, was probably owing to the infection which these men brought with
-them. The other ships were, upon the whole, healthy; for it appeared
-by the weekly accounts delivered to the Admiral, that the mortality,
-including even that of the Fame, for the four weeks before we sailed,
-had been only one in thirteen hundred, and that there had been about
-one in twenty-nine on the sick list.
-
-An opportunity offered on this occasion of comparing the health of
-ships of war in England with that in the West Indies. The health of the
-fleet in general at home was at this time about the proportion above
-mentioned; but it is to be remarked, that it was healthier then than in
-the former part of the war.
-
-Plymouth hospital, which is calculated for twelve hundred men, was not
-half full; and there were not at this time more than six hundred men
-at that of Haslar, which is calculated to contain two thousand; but
-the latter was generally full during the first two or three years of
-the war, from the great fleets that put into Portsmouth. At one time
-part of the sick were even obliged to be accommodated with tents in the
-neighbourhood of the hospital, for want of room. But towards the end
-of the year 1781 the infectious fever, which constitutes a great part
-of the sickness in the European seas, was almost extirpated, and in
-a cruise of five weeks in the north part of the Bay of Biscay, under
-Admiral Darby, in September and October of this year, only six men were
-buried in that time from twenty-eight ships of the line.
-
-This was chiefly owing, as I apprehend, to the length of time which the
-war had continued, in consequence of which the men of the respective
-ship’s companies had been accustomed to each other, and habituated
-to the mode of life peculiar to a man of war, regulating themselves
-according to certain rules of good order and cleanliness. The causes
-of the fever above mentioned, as shall be more fully illustrated
-hereafter, are chiefly connected with the circumstances occurring in
-the beginning of a war, when men of all descriptions are mixed, without
-proper precautions being taken to guard against the infection imported
-from jails or guardships. The sickness in the French fleet was still
-greater in the beginning of the war than in the British; and this has
-been the case in all the wars of this century. In the fleet commanded
-by the Comte d’Orvilliers, in 1779, the sickness was so great as to
-disable many of the ships from service, and great numbers of men were
-landed at Brest, with a fever so malignant as to infect the inhabitants
-of the town and country adjacent. I believe, besides, that the general
-health prevailing at this time in the fleet in England, was, in part,
-owing to the sour crout and melasses, which were now supplied more
-amply than had ever been done before. The entire exemption from scurvy
-in particular is to be ascribed to these improvements in diet.
-
-There is a tendency in acute diseases to wear themselves out, both
-in individuals that labour under them, and when the infection is
-introduced into a community. Unless there was such a _vis medicatrix_,
-there could be no end to the fatality of these distempers; for the
-infectious matter would go on multiplying itself without end, and would
-necessarily destroy every person who might be actually attacked, and
-would infect every person who might be exposed to it. But animal nature
-is so constituted, that this poison, after exciting a certain set of
-motions in the body, loses its effect, and recovery takes place; and
-those who happen not to be infected at first, become in some measure
-callous to its impression, by being habitually exposed to it. There is,
-therefore, a natural proneness to recovery, as well with regard to that
-indisposition which takes place among a set of men living together,
-as with regard to a single individual who actually labours under the
-disease. Thus the most prevailing period of sickness is when men are
-new to their situation and to each other, so that time of itself may
-prove the means of prevention as well as of cure.
-
-This consideration, however, ought not to supersede any part of
-our attention with regard to the scurvy, which does not become
-spontaneously extinct like acute diseases.
-
-During the three first weeks of this passage from England to the West
-Indies, there was wet and boisterous weather, but it had very little
-effect in augmenting sickness; and though it not only subjected the men
-to fatigue, cold, and damp, but prevented the ships from opening their
-lower-deck ports till the 2d of February, between the 31st and 32d
-degree of latitude, thereby producing close air and moisture where the
-men sleep, yet, in the whole squadron, from its leaving England till
-this time, there were only seven deaths, four of which were in the Fame.
-
-The only sea epidemic that made its appearance was the infectious ship
-fever, which, in many cases, was attended with pleuritic, rheumatic,
-and other inflammatory symptoms, owing to the cold and wet, to which
-the men were exposed in the variable latitudes. The warm, dry, fresh
-breezes which we had during the remainder of the passage, were probably
-what prevented any bad consequences from the former hardships, for
-there died only four men from the above-mentioned date till we arrived
-at Barbadoes; and it appeared by the Admiral’s weekly account, that the
-proportion of the sick neither increased nor diminished from the time
-we got into a warm climate and fine weather till our arrival on the
-19th of February.
-
-This squadron left England with several advantages in point of
-victualling, which no ships had before enjoyed. They were amply
-supplied with sour crout and melasses; they had all more or less wine,
-of an excellent quality; and the Formidable had an entire supply of
-it, in place of spirits, of which none was put on board. This slip had
-hitherto, and did for some months afterwards, enjoy an extraordinary,
-perhaps an unparallelled, degree of health. What farther contributed
-to the health of this ship was, that she had been long in commission,
-and most of the recruits with which the crew had been completed were
-men turned over from other ships. There was also extraordinary medical
-attention paid, particularly in watching the first beginnings of
-complaints.
-
-Upon the arrival of the squadron at Barbadoes, it was found, that,
-the two hostile fleets having returned from North America in the
-beginning of December, the campaign had opened with the siege of St.
-Christopher’s, which had been invested by twenty-eight ships of the
-line, and a considerable army. Our fleet, under Lord Hood, having
-attempted, with great enterprise and skill, but without success, to
-relieve it, Lord Rodney made haste to join them with the reinforcement
-he had brought from England. He remained at anchor at Barbadoes only
-one night, and in a few days came off Antigua, where he was informed of
-the surrender of St. Christopher’s; and here, on the 25th of February,
-he was joined by the rest of the fleet in their return to windward.
-
-
-
-
-CHAP. II.
-
- Account of the HEALTH of the FLEET from the Junction of the
- Squadron from England, till the general Rendezvous at St. Lucia
- in the Beginning of April.----The Fleet found on the Station very
- healthy--Health of the Ships from the American Station--Health of
- the Ships from England compared with that of the Ships found on the
- Station--Small-pox prevalent--Instance of the remarkable Efficacy
- of Lemon Juice in curing the Scurvy--Additional Reinforcement from
- England--Watering Duty dangerous and unhealthy--The most healthy Ships
- those that had been longest in the Climate--List of the Numbers taken
- ill of each Complaint in March--Inflammation of the Liver not common
- in the West Indies.
-
-
-The fleet which was found in the West Indies consisted of all the
-sixteen that went from thence to America in August, 1781, (except the
-Terrible, which had been lost) together with six ships of the line[8]
-from the American station, the St. Albans, which arrived from England
-in November, and the Russel, which had remained in the West Indies
-during the hurricane months. They were all extremely healthy, having
-only one man in twenty-eight on the sick list, and very few had been
-sent to hospitals.
-
-This fleet, after arriving from America, had lain at anchor for three
-weeks at Barbadoes, where it had the advantage of the vegetable
-refreshments which that island affords; but during three weeks that
-it lay at anchor, in the face of the enemy, at St. Christopher’s,
-the men were excluded from all communication with the shore, and had
-no vegetable food, except some yams, with which they were supplied
-from Antigua, in place of biscuit, of which there was at this time a
-scarcity. These ships had therefore been in no port for six weeks,
-except for a few days that they lay in the road of Antigua refitting,
-and putting the sick and wounded on shore.
-
-The men had also been deprived of their natural rest, and exposed to
-the air during all the time that the fleet was at anchor before St.
-Christopher’s; for they had been twice attacked by the enemy in that
-situation, and were therefore under the necessity of keeping the ships
-constantly clear for action; yet no increase of sickness followed.
-This might partly be owing to the eagerness and alacrity of spirits
-naturally excited in such a situation, and also to the fleet not lying
-under the lee of any land, and having springs upon their cables, so
-that they had all the perflation and all the purity of air which ships
-enjoy when at sea. The fumigation which ships undergo in battle, has
-also been thought to contribute to their health.
-
-To whatever cause it was owing, the fleet we found in the West Indies
-was at this time healthier than that which had just come from England;
-and there was but little difference in the degree of health of the
-different ships that composed it. Of those which left the West Indies
-in August, and returned in December, the only one that could be said
-to have any epidemic disease was the Prince William, which had never
-got entirely free from the dysentery that was formerly mentioned as
-prevailing so much on board of this ship last year. The disease was
-kept up, by the ship never having been cleared of the men affected
-with it, and by the crew in general being ill provided with slops[9],
-a circumstance that would render them more susceptible of whatever
-infection they might be exposed to.
-
-There were also some remains of the same disease in the Intrepid, the
-seeds of it having been more or less continued from the summer of 1780,
-at which time it prevailed to a most violent degree. The Alfred had
-a few of all the sea epidemics, and had been for a long time before
-more or less in the same situation, from a neglect of cleanliness,
-particularly of the men’s persons.
-
-The only ship in which there was any thing like an epidemic was the
-Canada, This ship, when at home, had for many months before she sailed
-been in unremitting service, and very little in port. On the passage
-from England to America, in August, 1781, there broke out a severe
-dysentery, to which the scorbutic habit of the men, from being so
-long at sea, probably predisposed them. Though it had abated much in
-February, 1782, it was then by no means extinct, and continued till
-April. The Prince George had been in commission all the war, and was a
-model of discipline and cleanliness, and consequently of health. This
-continued till the passage from America, when, upon the first cold
-weather after leaving New York, there broke out a violent dysentery, of
-which sixteen men died. This is agreeable to what Dr. Lind observes,
-that the flux may be brought on by a sudden transition, either from
-cold to heat, or from heat to cold. All the men that were ill of this
-disease having been sent to the hospital at Barbadoes, and the usual
-attention to cleanliness having been kept up, the disease entirely
-vanished.
-
-All the other ships of the American station had been more or less
-visited with sickness after they left England, except the Bedford. This
-was probably owing to this ship having been longer in commission than
-any of the others, that is, for four years, and all that time under
-the same commander. This last circumstance falls to the lot of few
-ships; but a great advantage attends it; for the mutual knowledge and
-attachment of the captain and ship’s company is naturally productive of
-regularity and good discipline, and thereby of health.
-
-The Royal Oak, Prudent, and America, which left England with the
-Bedford, though they had been afflicted with the scurvy and other
-complaints soon after arriving in America, had been quite healthy for
-some time before coming to the West Indies, and were so much so at
-this period, that, though there were a few sores and slight complaints
-on their sick lists, there was not a man confined with illness, so
-as properly to be called sick. The Royal Oak, having been the flag
-ship of Admiral Arbuthnot, was manned with choice seamen, which is a
-circumstance generally conducive to health; for these being accustomed
-to a sea life, are more provident, more handy and methodical in all
-that relates to diet, cloathing, and cleanliness. The scurvy, which
-infected her upon first arriving in America, was successfully treated
-on board by serving to those who were ill of it a mess, composed of
-soft bread, baked on purpose, and mixed with wine and essence of malt.
-
-The Prudent, though now quite healthy, had been sickly soon after being
-put into commission in Europe, and upon first arriving in America. She
-had been uncommonly sickly, when a new ship, upon her first voyage,
-which was to the East Indies, during the peace. This remarkable degree
-of sickness was probably owing to a particular experiment that was made
-in preparing the wood of which she was built. This experiment consisted
-in soaking the timber for a length of time in a strong pickle, in order
-to make it less corruptible. The only other ship on which the trial of
-this was made was the Intrepid; and it has been already mentioned that
-this was an extremely sickly ship. The effect of it upon the wood was
-to cause a constant moisture and mouldiness in the orlops and holds.
-In the Intrepid, the sickness was never conquered till a practice was
-followed of pumping and bailing her with great care, and putting a fire
-into the well for six hours every day, by which means the dampness, and
-the mildew produced by it, were removed and prevented, and the ship
-thereby rendered healthy.
-
-The two squadrons being united, and consisting of thirty-four ships
-of the line, proceeded to St. Lucia, where they arrived on the 1st of
-March.
-
-I received monthly returns as formerly, and the form of them was
-improved by adding a column for the numbers taken ill of the several
-diseases in the course of the month. The returns of February are not
-complete, there being none for the 1st of that month, as we had not
-then arrived; but as the returns of the 1st of March have relation to
-the preceding month, a judgement may be formed of the sickness and
-mortality of February from the following table:
-
-
-EXTRACT from the RETURNS of the 1st of March, 1782.
-
-  +------------------+-----------+-----------+-----------+
-  |                  |Put on the | Died last |Sent to the|
-  |    DISEASES.     | Sick List |last Month.|  Hospital |
-  |                  |last Month.|           |last Month.|
-  +------------------+-----------+-----------+-----------+
-  | Fevers           |      53   |     15    |      9    |
-  |                  |           |           |           |
-  | Fluxes           |     263   |     67    |      0    |
-  |                  |           |           |           |
-  | Scurvy           |     121   |      2    |      5    |
-  |                  |           |           |           |
-  | Other Complaints |     618   |     25    |     59    |
-  +------------------+-----------+-----------+-----------+
-  |    Total         |    1555   |    109    |     73    |
-  +------------------+-----------------------+-----------+
-
-  This account is abstracted from the returns of twenty-nine ships of
-  the line, and two frigates.
-
-The diseases and deaths under the head of “Other Complaints,” is much
-more numerous in this month than usual, which is chiefly owing to the
-preceding actions with the enemy, and to the prevalence of the small
-pox. Of the deaths under this head, seventeen were in consequence
-of wounds, six from small pox, one from a mortification[10] in the
-shoulder, and one from consumption.
-
-None of the epidemics affected one part of the squadron more than
-another, except that the ships last from England had a less proportion
-of the flux than the rest; and the few cases of this disease that were
-in these ships arose after their arrival in the climate. The Conqueror
-and Fame, which were the two most sickly ships, had no complaints but
-fevers.
-
-The fevers had now begun to take on some of the characteristic symptoms
-of the climate; the chief of which is a greater abundance of bile. In
-the Repulse, two men had the yellow colour of the skin, which is so
-peculiar to the fevers of this climate.
-
-The crew of the Anson caught an infectious fever from a guardship in
-England; and when the Prothée sailed, there was a fever of the same
-kind on board; but from the change of climate, the symptoms became
-milder, and the disease disappeared in both these ships in the course
-of this month.
-
-The small pox prevailed more at this time in the fleet than I have ever
-known it to do either before or since, and that both in the squadron
-from England and in that from North America. There were six cases
-in the Formidable, all of which did well, though two were of the
-confluent kind.
-
-Though there needs hardly any additional proof of the extraordinary
-efficacy of lemon juice in curing the scurvy, yet it may be of service
-to impress so useful a truth on the mind by mentioning such striking
-proofs of it as occurred from time to time. The Arrogant spoke with
-a Portuguese vessel near Madeira, from which some of this fruit was
-procured, and the only scorbutic man on board happening to have some
-of the most desperate symptoms, such as putrid gums, contracted hams,
-the calves of the leg hard and livid, and frequent faintings, a fair
-opportunity offered for trying its virtues. The man was allowed two of
-them daily, and was perfectly well in sixteen days, during all which
-time the ship was at sea, so that it was impossible to ascribe the cure
-to any other cause.
-
-The fleet remained at St. Lucia from the 1st till the 18th of March,
-completing the water, provisions and stores, landing the sick at the
-hospital, and also watching the motions of the enemy, who arrived about
-the same time at Martinico from the siege of St. Christopher’s. During
-this time we were reinforced with the Duke, of 90 guns, and the Warrior
-and Valiant, of 74 guns, from England. On the 18th the whole fleet,
-except the Invincible, which was detached with a convoy to Jamaica,
-sailed on a cruise to windward of Martinico, in quest of a French
-convoy expected from Europe; which having eluded us, and got into their
-own harbour, the whole fleet returned to St. Lucia on the 30th of
-March, excepting the Prudent, which was sent to Barbadoes.
-
-We found at St. Lucia the Magnificent, of 74, and the Agamemnon, of 64
-guns, which were the last reinforcement of this campaign, making the
-British fleet on this station amount to forty ships of the line, a much
-greater force than was ever before employed on foreign service. They
-were all copper bottomed.
-
-The weather continued fine all this month, yet there was some increase
-of sickness, owing chiefly to the hardship the men underwent in
-wooding and watering. In Choc Bay, where the fleet watered, there was
-at this time a higher surf than was ever remembered, which made the
-operation of watering (at all times noxious in this climate) uncommonly
-toilsome and dangerous. It was, indeed, next to impracticable; for many
-longboats were staved on the beach, by which several men had their
-limbs broken, and some lost their lives, by being crushed or drowned;
-but the necessity of the service admitted of no relaxation or delay.
-There was no increase of wind to account for this surf, so that it was
-owing either to something in the currents, or to some subterraneous
-cause; and there had been felt at Barbadoes and St. Lucia, about this
-time, a slight shock of an earthquake[11], to which many imputed
-this extraordinary surf. In other respects, there were fewer causes
-of sickness than usually occur to a fleet in port in this part of the
-world; for the air of the road is remarkably pure, and there were fewer
-temptations and opportunities of intemperance than at the other islands.
-
-The monthly returns of the surgeons were very full and complete; but as
-it would be tedious to insert at length those of every particular ship,
-and as the number of ships fluctuated in different months, I shall do
-no more hereafter than set down the general results from calculation,
-so as to shew the proportional prevalence of disease and mortality in
-each month.
-
-
-TABLE, shewing the proportional Sickness and Mortality in March.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys:                     |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |     Course of this Month.               |
-  |                                         |
-  | B Proportion of those who died, in      |
-  |     relation to the Numbers of the Sick.|
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     20 |     64 |
-  |                       |        |        |
-  | Fluxes                |     35 |     71 |
-  |                       |        |        |
-  | Scurvy                |    126 |      0 |
-  |                       |        |        |
-  | Other Complaints      |     33 |    108 |
-  +-----------------------|--------+--------+
-  | General Proportion    |      9 |     76 |
-  +-----------------------+--------+--------+
-
-The first column is formed by dividing the whole number on board by
-the number taken ill. The second column is formed by first adding the
-number ill on board on the first of the month to the number taken ill
-during the month, subtracting from this sum the number sent to the
-hospital, and dividing the remainder by the number of deaths.
-
-The number on the sick list of twenty-eight ships of the line, and two
-frigates, on the first of this month, was eight hundred and forty-five;
-the number put on the lists in the course of the month was one thousand
-eight hundred and eighty-four; and the number sent to the hospital in
-the same time was three hundred and seventy-three; and there died on
-board thirty-one.
-
-The total mortality this month, in relation to the whole number of men
-on board, was one in six hundred and seven.
-
-It almost always happens, that ships of war are more or less short of
-complement, and allowance is made for this in all the calculations; for
-having had an opportunity of inspecting the weekly accounts delivered
-to the Admiral, it was always in my power to be informed how many there
-were short of the legal complement of men in each ship.
-
-It appears, from comparing the Tables of this month with those of the
-preceding, that there had been a great increase of fevers and fluxes,
-particularly of the latter. The fevers prevailed chiefly in the ships
-lately from England, especially the Fame and Conqueror. In the Duke
-there were a great number ill of fevers; but this ship not having
-arrived from England till after the first of the month, is not included
-in the calculation. The fluxes were most prevalent in the ships we
-found on the station, particularly the Canada, Resolution, and Nymph
-frigate. The scurvy had increased very little, but prevailed most in
-the ships we found here. The only ships of the new squadron that had
-this disease to a considerable degree, were the Conqueror and Nonsuch.
-The former had indeed a good many ill of it; but the return having
-been made in an imperfect manner, this ship is not included in the
-calculation.
-
-But the ships that were by far the most healthy were those that had
-been the longest from England, the Ajax, Russel, Montague, Royal Oak,
-and Prudent. There had been formerly a great mortality in all these
-ships; and it would appear that this uncommon degree of health was
-owing, in some measure at least, to this circumstance, that the most
-weakly had been swept off by the different distempers to which they
-were exposed; so that only the more hardy and robust had survived.
-
-Under the head of “Other Complaints,” a much smaller number were put on
-the list, and still fewer died, in this than the preceding month. This
-difference is owing to the number that died of wounds last month.
-
-There died on board, in the course of this month, thirteen of fevers,
-seven of fluxes, and seven of other complaints, of whom five died
-of small pox, one of asthma, and one of wounds he received at St.
-Christopher’s.
-
-In order to show more fully and minutely what are the complaints
-incident to fleets in this climate, I shall set down a list of the
-numbers taken ill of the different diseases and accidents during this
-month, extracted from the returns of twenty-eight ships of the line,
-and two frigates.
-
-  Fevers                 806
-  Fluxes                 463
-  Scurvy                 130
-  Ulcers                 129
-  Small pox               49
-  Pectoral complaints     40
-  Venereal complaints     32
-  Colds                   30
-  Rheumatism              18
-  Angina                  10
-  Gravel                   3
-  Dropsy                   1
-  Ophthalmia               1
-  Leprosy                  1
-  Fistula in ano           3
-  Hernia humoralis         1
-  Abscess                  1
-  Fractures                3
-  Various slight
-    accidents, as
-    bruises, cuts,
-    scalds, &c.          163
-                        ----
-                Total   1884
-
-The number of ulcers bears here a smaller proportion to the whole than
-it does in general to the sum total of the sick list; for being the
-most tedious of all complaints, they consequently accumulate more than
-any other. Thus many of the cases now set down as slight accidents,
-will, in the ensuing month, be in the state of obstinate ulcers.
-
-Most of the diseases of one hot climate resemble those of another,
-so far as I know; but there is one disease which we hear of as being
-extremely prevalent all over the East Indies, which is hardly ever met
-with in the tropical regions of the West. This is the inflammation
-of the liver, of which I remember to have seen only one well-marked
-case, and it was that of a gentleman who had been in the East Indies,
-and had been subject to it there: nor do I recollect more than one,
-or at most two, cases of this sort out of several thousand cases of
-various diseases that were reported to me. This is either owing to the
-greater heat and dryness of the air in the East Indies, or some other
-peculiarity with which we are not acquainted[12].
-
-Every other inflammatory complaint exists more or less, though they are
-much rarer than in cold and temperate climates. The phthisis pulmonalis
-is not so common as in cold climates, but proves sooner fatal to most
-constitutions. There are certain pulmonic complaints, particularly
-those of the asthmatic kind, to which the climate of the West Indies
-is remarkably favourable; but those in which there are tubercles and
-ulceration seem to be hurried faster to a fatal termination. The
-climates, from the thirtieth to the fortieth degree of latitude, seem
-to be best suited to consumptive complaints. The rheumatisms that occur
-in hot climates are mostly of the chronic kind.
-
-
-
-
-CHAP. III.
-
- State of Health of the Fleet in April 1782----Battles on the 9th and
- 12th--The Fleet very healthy--from the Quality of Provisions--from the
- Effects of Victory--Advantages of close Action--What Diseases most
- prevalent--Extraordinary Degree of Health in the Formidable.
-
-
-This month being interesting, on account of the memorable engagements
-that happened in it, the remarks shall, for this reason, be somewhat
-more full and particular.
-
-Three ships of the line having been sent to protect convoys to Jamaica,
-and one having been sent to protect a convoy to Barbadoes, there
-remained thirty-six at St. Lucia in the beginning of this month. By
-the end of the first week their damages were repaired, their water and
-provisions complete, and the sick in a great measure recovered.
-
-An equal force of the enemy lay over against us at Martinico, the
-two powers of Britain and France being to make this distant quarter
-of the world the theatre for trying their strength, and deciding the
-sovereignty of the seas. In the view of this great event, our commander
-forwarded the necessary duties of the fleet with such zeal and
-diligence, and watched the motions of the enemy with such vigilance,
-that he overtook their grand squadron a few hours after they left their
-own port, and engaged them two several days, with a success, glorious
-and complete.
-
-Nothing had been wanting to equip this fleet for the great and decisive
-exertion it was to make. Every ship, except two, might be said to
-be healthy, most of them were complete in men, well appointed with
-officers, and well found in stores and provisions.--Conformable to this
-was the eagerness, the confidence, and resolution, which led them to
-success and victory.
-
-After this battle, the whole fleet, with the prizes, bore away for
-Jamaica, where part of it arrived on the last days of April, but the
-greater part of it kept the sea, till after the middle of May.
-
-As this month is more than usually interesting, the tables are given at
-full length, and a column is added for the wounded.
-
-The sum total, of the numbers of the men on board of the thirty-six
-ships that composed the line of battle on the 12th of April, was
-21,608, and the mortality during the month, exclusive of those who were
-killed or died of wounds, was one in 862.
-
-There was less sickness, and less death, from disease in this month,
-than any of the former twenty-three months, in which I kept records of
-the fleet, and less than in any subsequent month, till the fleet got to
-the coast of America.
-
-To account for this, it is to be observed, that the men had not
-been exposed to the noxious air of the shore in watering, as in the
-preceding month: they had received from England a fresh supply of
-provisions, among which was sour krout, melasses, and essence of malt,
-all in addition to the ordinary articles of victualling: many of the
-ships were supplied with wine, in place of rum, and as the weather was
-all along dry and fine, the men suffered the less from the exposure and
-want of sleep, which are the necessary consequences of keeping ships
-clear for battle for several days and nights together.
-
-
-TABLE V.
-
-ABSTRACT of the RETURNS for APRIL, 1782.
-
-  Key:
-  F Sick on board on the 1st of the Month.
-  M Put on the List during the Month.
-  D Dead.
-  H Sent to the Hospital.
-
-  +----------------+-----------------------+-----------------------+
-  |    SHIPS’      |        FEVER.         |         FLUX.         |
-  |    NAMES       +-----+-----+-----+-----+-----+-----+-----+-----+
-  |                |  F  |  M  |  D  |  H  |  F  |  M  |  D  |  H  |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Formidable   |   0 |   6 |   0 |   1 |   2 |   7 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Barfleur       |   6 |  20 |   0 |   1 |   5 |  13 |   0 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Prince George  |   0 |  12 |   2 |   1 |   4 |  18 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Duke         |  57 |  78 |   2 |  32 |   0 |   3 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Namur        |   5 |  14 |   0 |   2 |  11 |   9 |   0 |   3 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Royal Oak      |   1 |   4 |   0 |   0 |  11 |  23 |   0 |   3 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Alfred         |   8 |  46 |   1 |   0 |   6 |  14 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Montagu        |   6 |  11 |   0 |   0 |   8 |   2 |   1 |   5 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Valiant      |   § |  10 |   1 |   0 |   § |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Monarch        |   5 |  21 |   1 |   0 |   3 |  10 |   0 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Warrior      |   0 |   2 |   0 |   0 |   6 |  12 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Centaur        |  12 |  20 |   0 |   1 |  10 |  15 |   0 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Magnificent  |   0 |  21 |   0 |   0 |   0 |   8 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Bedford        |  11 |  20 |   0 |   0 |   3 |  27 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Ajax           |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Canada         |   0 |   6 |   1 |   4 |  24 |  70 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Resolution     |  19 |  25 |   1 |   0 |  21 |  27 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Hercules     |   2 |  38 |   0 |   4 |   5 |  18 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Russel         |   3 |   3 |   0 |   0 |   5 |   4 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Fame         |  36 |  50 |   0 |   0 |   3 |   8 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Torbay         |  10 |  10 |   0 |   0 |   9 |   2 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Princessa      |   1 |   2 |   0 |   0 |   2 |   8 |   0 |   3 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Conqueror    |  30 |   § |   1 |  11 |   0 |   § |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Arrogant     |   2 |  16 |   0 |   0 |   6 |  33 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Marlborough  |   7 |  19 |   2 |   0 |  12 |  21 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Yarmouth     |   0 |   3 |   0 |   0 |   4 |   3 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Belliqueux     |  43 | 118 |   0 |   0 |   6 |   4 |   0 |   2 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Prince William |   4 |  27 |   0 |   0 |   2 |  24 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Repulse      |  20 |  40 |   0 |   0 |   2 |   2 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | St. Albans     |   1 |  22 |   0 |   0 |   0 |   6 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Agamemnon    |   2 |   5 |   0 |   0 |   0 |   1 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Prothée      |   6 |  13 |   1 |   0 |   5 |  49 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | America        |   2 |   5 |   0 |   0 |   3 |  14 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Anson        |   3 |   6 |   0 |   0 |   0 |  26 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Nonsuch      |   6 |  11 |   1 |   0 |   0 |   4 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Alcide         |   2 |   6 |   0 |   2 |   7 |  16 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Ramillies      |   § |  26 |   1 |   4 |   § |   6 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Nymph          |   2 |   7 |   0 |   0 |   8 |   9 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Flora          |   0 |   0 |   0 |   0 |   2 |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  |     Total      | 312 | 743 |  15 |  65 | 195 | 516 |   7 |  19 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-
-  +----------------+-----------------------+-----------------------+
-  |    SHIPS’      |        SCURVY.        |        WOUNDS.        |
-  |    NAMES       +-----+-----+-----+-----+-----+-----+-----+-----+
-  |                |  F  |  M  |  D  |  H  |  F  |  M  |  D  |  H  |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Formidable   |   0 |   5 |   0 |   0 |   0 |  37 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Barfleur       |   6 |  30 |   0 |   1 |   0 |  37 |   8 |   6 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Prince George  |   0 |   7 |   0 |   0 |   0 |  14 |   3 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Duke         |   0 |   1 |   0 |   0 |   0 |  60 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Namur        |   8 |   5 |   0 |   2 |   0 |  25 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Royal Oak      |   1 |   1 |   0 |   1 |   0 |  54 |   5 |  15 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Alfred         |  15 |  14 |   0 |   2 |   0 |  30 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Montagu        |   2 |   2 |   0 |   0 |   0 |  25 |   5 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Valiant      |   § |   0 |   0 |   0 |   0 |  37 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Monarch        |   0 |   1 |   0 |   1 |   0 |  33 |   2 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Warrior      |   0 |   0 |   0 |   0 |   0 |  20 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Centaur        |   5 |  15 |   0 |   0 |   0 |  14 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Magnificent  |   7 |  16 |   0 |   0 |   0 |  20 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Bedford        |   1 |  10 |   0 |   0 |   0 |  17 |   4 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Ajax           |   0 |   0 |   0 |   0 |   0 |  30 |   1 |   5 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Canada         |   1 |   8 |   0 |   0 |   1 |  12 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Resolution     |   0 |   0 |   0 |   0 |   0 |  19 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Hercules     |   0 |  12 |   0 |   2 |   0 |  18 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Russel         |   0 |   1 |   0 |   0 |   4 |  29 |   3 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Fame         |   0 |   7 |   2 |   0 |   1 |  12 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Torbay         |   3 |   2 |   0 |   0 |   0 |  25 |   3 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Princessa      |   0 |   0 |   0 |   0 |   0 |  19 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Conqueror    |  10 |   § |   0 |   0 |   0 |  23 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Arrogant     |   4 |  10 |   0 |   0 |   0 |  11 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Marlborough  |   0 |   6 |   0 |   0 |   0 |  16 |   1 |   1 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Yarmouth     |   3 |   3 |   0 |   0 |   0 |  33 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Belliqueux     |   0 |   3 |   0 |   0 |   0 |  10 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Prince William |   5 |  18 |   0 |   0 |   1 |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Repulse      |   3 |   2 |   0 |   0 |   0 |   9 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | St. Albans     |   0 |   0 |   0 |   0 |   0 |   7 |   1 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Agamemnon    |   0 |   0 |   0 |   0 |   0 |  23 |   7 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Prothée      |   0 |   0 |   0 |   0 |   0 |  24 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | America        |   2 |   0 |   0 |   0 |   1 |  27 |   2 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Anson        |   1 |   1 |   0 |   0 |   0 |  13 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | * Nonsuch      |  18 |  25 |   0 |   6 |   0 |   2 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Alcide         |   7 |   0 |   0 |   0 |   0 |  15 |   0 |   3 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Ramillies      |   § |   3 |   0 |   3 |     |     |     |     |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Nymph          |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  | Flora          |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-  |     Total      | 103 | 208 |   2 |  18 |   8 | 810 |  60 |  32 |
-  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
-
-  N. B. The Ships marked thus, *, came from England in February and
-  March, 1782.
-
-All the Ships named in the Table were in the Engagements in April,
-except the Ramillies and the two Frigates.
-
-In the Spaces marked thus, §, no Return was made.
-
-Might not this extraordinary degree of health have also been owing,
-in part, to the effects of success upon the spirits of the men? It
-is related[13], that, when the fleet under Admiral Matthews was off
-Toulon, in daily expectation for some time of engaging the combined
-fleet of France and Spain, there was a general stop put to the progress
-of disease, particularly of the scurvy, from the influence of that
-generous flow of spirits, with which the prospect of battle inspires
-British seamen. But if the mere expectation and ardour of a battle,
-without any happy event, could have such a sensible effect, what must
-have been the effect of the exultation of VICTORY, a victory in which
-the naval glory of our country was revived and retrieved, after a
-series of misfortunes and disgraces, which had well nigh extinguished
-the national pride in every department of service! The plain and
-honest, though unthinking seaman, is not less affected by this than
-the more enlightened lover of his country. Even the invalids at the
-hospital demonstrated their joy, upon hearing of this victory, by
-hoisting shreds of coloured cloth on their crutches.
-
-It would appear, that there is something in situations of exertion and
-danger, which infuses a sort of preternatural vigour. When the mind is
-interested and agitated by active and generous affections, the body
-forgets its wants and feelings, and is capable of a degree of labour
-and exertion, which it could not undergo in cold blood. The quantity of
-muscular action employed in fighting at a great gun for a few hours, is
-perhaps more that what is commonly employed in a week in the ordinary
-course of life, and though performed in the midst of heat and smoke,
-and generally with the want of food and drink, yet the powers of nature
-are not exhausted nor overstrained; even the smart of wounds is not
-felt; and the future health of those who survive unhurt by external
-violence is so far from being injured, that it is sometimes mended by
-this violent, but salutary agitation.
-
-The loss in action, and the number of mortal wounds, were not so great
-as might have been expected in a battle continued for a whole day.
-This advantage was owing to the superiority of our fire, as well as to
-the closeness of the fight, of which the Commander in Chief set the
-illustrious example, by penetrating the enemy’s line with his own ship;
-a bold and singular effort which first decided the event of the day.
-When ships in action are opposed to each other at a small distance,
-the velocity of cannon balls is so great, that in penetrating a ship’s
-side, few or no splinters are torn off; and by these more men are
-commonly killed and wounded, than by the ball itself. For the same
-reason, a close shot does less damage also to the ship itself, than
-a distant one; for a quick-flying ball makes an aperture less than
-its own diameter, whereas a spent one produces innumerable deadly
-splinters, at the same time shivering the object it strikes, and making
-wide and extensive rents in it. The proportion of the wounded to the
-killed, is also greater in distant, than in close fight, on account of
-the great number of small splinters; and we have an experimental proof
-of this, in comparing the action in Fort Royal Bay in April 1781, with
-this near Dominica in April 1782. In the former, the enemy having kept
-far to windward, and engaged at a great distance, the proportion of
-the wounded to the killed was considerably more than four to one[14];
-whereas in the latter, where the greater part of the battle was close,
-the proportion of the wounded to the killed, was little more than three
-to one[15].
-
-Though it is a remark not belonging to a medical work, yet it may be
-observed, that the greatest advantage that arose to us from close
-action was, that the fire of the enemy was thereby silenced; for the
-advantages would be mutual and equal, on the supposition, that the
-French, in such a situation, were to keep the deck, and stand to their
-guns equally well with the British seamen.
-
-It appears, by examining the table, that the ships in which the fevers
-chiefly prevailed this month, were those that came last from England,
-and that those in which the fluxes prevailed most were chiefly of the
-squadron we found on the station, namely, the Canada, Resolution, and
-Prince William. The latter however recovered greatly in the course of
-this month. Some of the Ships that arrived last from England, namely,
-the Arrogant, Prothée, and Anson, were also considerably afflicted with
-fluxes, but they were of an extremely mild kind; and the small number
-of deaths from this disease in comparison with those from fevers, is a
-proof of a former observation, that this is the safest form in which
-an acute disease can shew itself. This small degree of mortality was
-also owing to the judicious method of treating it which was in general
-practised throughout the fleet; and it is but justice to the medical
-gentlemen to say, that they shewed on this, as well as every other
-occasion, great skill and attention in the treatment of the sick and
-wounded.
-
-The sum total of fevers and fluxes that have been put on the list
-this month, is much the same as that of the preceding month; but the
-proportion of fluxes in April is much greater.
-
-The proportion of scurvy is somewhat increased; which is not to be
-wondered at, when it is considered, that though the fleet had not
-been so long at sea as is necessary to produce it, especially in this
-climate, yet the men having had no refreshments when last in port, may
-be considered as having been all that time at sea.
-
-The superior degree of health in this month will appear in a still
-stronger light, if we cast our eye on the column expressing the number
-sent to the hospital, the proportion of which is, comparatively, very
-small.
-
-The ships that had been the longest from England, were still among the
-most healthy. But of all the fleet, none was so free from sickness
-and mortality as the Formidable. No man belonging to this ship died
-of disease for the first four months after sailing from Plymouth,
-though there were at times 900 men on board, and never less than the
-established complement, which is 750; and so few were taken sick
-in that time, that only thirteen were sent to hospitals, and their
-complaints were small-pox and ulcers.
-
-This ship left England provided with every thing that could be supposed
-to conduce to the health of men, and may be considered as an experiment
-to prove what degree of health may be attained by proper management and
-attention. She was furnished not only with abundance of sour krout,
-melasses, and essence of malt, in common with the other ships; but what
-was peculiar to her, was an entire supply of excellent wine, in place
-of spirits, of which none was used during the period mentioned.
-
-
-
-
-CHAP. IV.
-
- Account of the HEALTH of the FLEET while it lay at Jamaica during
- May, June, and Part of July, 1782.----French Prizes Causes of
- Sickness--Their Difference from the English in point of Cleanliness
- and Discipline--Bad Effects of Land Wind and Watering Duty--Situation
- of Port Royal--Season uncommonly dry and windy--Fluxes more prevalent
- at Sea than in Harbour--Comparison of the Sickness at this Time with
- that of the Army and with that of the Squadron under Admiral Vernon
- forty-one Years before--Effects of Contagion and foul Air--Officers
- more affected than the common Men.
-
-
-All the squadron that was left to windward of Jamaica, consisting of
-twenty-four ships of the line, kept the sea during great part of May,
-the last division of it not having come to Port Royal till the 25th of
-that month.
-
-The whole fleet remained in harbour during the remainder of the month,
-and the whole of the next, except the Warrior, Prothée, and Russell;
-the two former were sent on a cruise, in which the Warrior continued
-quite healthy, as she had been ever since her arrival from England; and
-in the Prothée a great check was given to the fevers and fluxes which
-had begun to prevail at Port Royal. The Russell was sent to England
-with a convoy.
-
-
-TABLE, shewing the proportional Prevalence of Sickness and Mortality in
-May.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill or      |
-  |   wounded in the Course of the Month.   |
-  |                                         |
-  | B Proportion of those that died in      |
-  |   relation to the Numbers of Sick or    |
-  |   wounded.                              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     26 |     29 |
-  |                       |        |        |
-  | Fluxes                |     18 |     63 |
-  |                       |        |        |
-  | Scurvy                |     57 |     34 |
-  |                       |        |        |
-  | Wounds                |    627 |     60 |
-  |                       |        |        |
-  | Other Complaints      |     44 |    127 |
-  +-----------------------+--------+--------+
-  | General Proportion,   |        |        |
-  |   including wounded   |      7½|     46 |
-  |                       |        |        |
-  | General Proportion,   |        |        |
-  |   exclusive of Wounds |      8 |     48 |
-  +-----------------------+--------+--------+
-
-The whole number of sick on board on the first of this month, in
-thirty-six ships of the line and two frigates, upon which the preceding
-calculation is formed, was one thousand four hundred and eighteen. The
-whole number taken ill in the course of the month was two thousand
-eight hundred and twenty-eight; the number sent to the hospital was one
-hundred and seventy-three; and there died on board ninety-four.
-
-The proportion of those who died this month, in relation to the whole
-number on board, was one in two hundred and eighty-seven.
-
-There was a considerable increase of sickness and mortality this month
-in all the common diseases, and chiefly in that part of the squadron
-which was in port. There was less increase in the number of fevers
-than either of the other two epidemics; but such was their increased
-malignancy, that more died of them than of both the others. The number
-of fluxes was more than double of what it was the preceding month, and
-the mortality from them was also in a much greater proportion, as may
-be seen from the Tables.
-
-The fevers prevailed chiefly in port, and the fluxes at sea. A good
-many of the latter, indeed, arose in the Alcide, though constantly in
-port; but this seemed to be owing to contagion conveyed by some British
-soldiers, who were sent on board of this ship after being retaken in
-one of the French men of war, several of whom were ill of this disease.
-But there were few fluxes in those ships at Jamaica in which the most
-malignant fevers appeared. There were a few in those in which the
-fevers arose from the air of the marshes on the watering duty; but
-there were none on board of the French prizes, nor in those ships in
-which that sort of fever was which proceeded from a similar cause, that
-is, filth and animal effluvia. Upon the whole, in those ships in which
-the fever was most malignant, there the fewest fluxes were found.
-
-Several circumstances contributed to the increase of sickness and
-mortality this month.
-
-1st. The infection, or rather the foul air, of the French prizes, in
-most of which a very bad fever broke out among the officers and men
-that were sent from the ships of our fleet to take charge of them.
-
-The discipline and internal œconomy of the French ships of war are
-greatly inferior to those of the British. Their decks are never washed,
-and there is a great defect in every point of cleanliness and order.
-The free course of the air is obstructed by lumber of every kind, and
-by bulkheads, which are not taken down even in the time of battle;
-and the gratings are covered night and day with tarpaulins, even in a
-hot climate. There are not even scuppers opened on the lower deck as
-outlets to the water and filth, which necessarily accumulate there, and
-for which the only vent is a pipe contrived on purpose, passing from
-that deck along the ship’s side into the hold, which becomes thereby a
-common sink, inconceivably putrid and offensive. And in addition to the
-ordinary causes of corruption, there was one peculiar to the occasion;
-for the blood, the mangled limbs, and even whole bodies of men, were
-cast into the orlop, or hold, and lay there putrifying for some time.
-The common sailors among the French have a superstitious aversion to
-the throwing of bodies overboard immediately after they are killed, the
-friends of the deceased wishing to reserve their remains, in order to
-perform a religious ceremony over them when the hurry and danger of the
-day shall be over. When, therefore, the ballast, or other contents of
-the holds of these ships, came to be stirred, and the putrid effluvia
-thereby let loose, there was then a visible increase of sickness. For
-the first three weeks after the capture, the stench proceeding from the
-numbers of wounded men contributed also to taint the air.
-
-The Ville de Paris was much more sickly than the other prizes, not
-only from her being larger, and thereby containing a greater mass of
-foul air, but by receiving the surviving part of the crew of the Santa
-Monica, one of our frigates, which had been cast away on the Virgin
-Islands, and whose men were so reduced by hardship and intemperance,
-that most of them were taken ill as soon as they came to breathe the
-unwholesome air of the French prize. To whatever cause it was owing,
-the fever was much more violent here than in the other prizes, and
-it generally carried men off on the third or fourth day; and what is
-remarkable, the officers were affected by it in a greater proportion
-than the common men. One lieutenant, and every warrant officer, except
-the boatswain, died of it. This was a proof that the sickliness was
-owing to the bad air, and not to the intemperance and irregularity so
-usual on board of prizes, which only the common men give into; and the
-probable cause of the officers being most affected is, that they were
-accustomed in common to a purer air, by living in the most clean and
-airy parts of the ship.
-
-It is also remarkable, that the Ville de Paris was healthy when taken,
-and had been so ever since leaving France in March, 1781; nor had any
-other of the captured ships of the line been sickly for some time
-before, except the Ardent, when she arrived at Martinico four months
-before, at which time the greater part of the crew were sent to the
-hospital with fevers. This, as well as other facts of the same kind,
-tends to prove, that when men come to be much habituated to bad air,
-their health is not affected by it.
-
-The French ships were purified by washing and scraping, by fumigating
-daily with gunpowder and vinegar, and by the use of wind sails; but
-nothing seemed to contribute so much to sweeten the air in them as
-burning fires in the hold; for this tended both to make the putrid
-matter exhale, and to carry it off, by producing a perpetual change of
-air. Captain Curgenven, who at this time commanded the Ville de Paris,
-had great merit from his very assiduous and successful endeavours in so
-difficult a duty as the management and equipment of this great ship. In
-consequence of the judicious measures taken, and the men becoming more
-used to the bad air, the sickness ceased in the course of a few weeks.
-
-In the accounts given in the tables, the French prizes are not
-included, for the disorderly state in which they were at this time
-prevented my receiving regular returns: but having made inquiry
-concerning the mortality in the Ville de Paris, I found, that of a
-crew of three hundred and twelve men, there died ten in the month of
-May, and there were thirty sent to the hospital, whose cases were so
-unfavourable, that about one half died. The only diseases were fevers.
-The surgeon of the Ardent told me about the same time, that one third
-of the crew of that ship was ill of fevers.
-
-The second cause of the prevalence of sickness, while the fleet was at
-Jamaica, was, the watering duty, which was carried on at Rock-fort,
-about three leagues from Port Royal. It was the practice of many of the
-ships to leave the water casks on shore all night, with men to watch
-them; and as there is a land wind in the night, which blows over some
-ponds and marshes, there were hardly any of the men employed on that
-duty who were not seized with a fever of a very bad sort, of which a
-great many died. The ships that followed a different practice were
-somewhat longer in watering; but this was much more than compensated by
-their preserving the health and saving the lives of their men.
-
-The land wind which blows on the shore in the night time, is a
-circumstance in which Jamaica differs from the small islands to
-windward, over which the trade wind blows without any interruption: but
-though this land wind blows upon Port Royal from some marshes at a few
-miles distance, it does not seem to produce sickness, for it is a very
-healthy place, and several of the ships enjoyed as good health as in
-the best situations on the windward station. The bay which forms this
-harbour is bounded towards the sea by a peninsula of a singular form,
-being more than ten miles in length, and not a quarter of a mile broad
-at any part. Great part of it is swampy and overgrown with mangroves,
-and though of such small extent, we fancied that some of the ships that
-lay immediately to leeward of this part were more sickly than those
-that were close to the town of Port Royal, which stands at the very
-extremity of this long peninsula upon a dry, gravelly soil.
-
-The weather this month was uniformly dry in port; but at sea the
-air was moist and hazy. Between Jamaica and Hispaniola, where part
-of the squadron was left to cruise, dead calms prevailed; and this,
-joined to the moisture of the air, was probably what caused the flux
-to prevail chiefly in this part of the fleet. At Port Royal, on the
-contrary, there was a strong dry breeze, which set in every day about
-nine o’clock in the morning, and blew all day so fresh, that there was
-frequently danger in passing from one ship to another in boats. This
-is called, in the language of the country, the _fiery sea breeze_, an
-epithet which it seems to have got not from its absolute heat, but from
-the feverish feeling which it occasions by drying up the perspiration.
-It was remarked, that this breeze was stronger this season than had
-ever been remembered; and it sometimes even blew all night, preventing
-the land breeze from taking its usual course. This year was farther
-remarkable for the want of the rains that were wont to fall in the
-months of May and June. We shall have occasion to remark hereafter,
-that this was a very uncommon season also in Europe and America. The
-heat, by the thermometer, this month, on board of a ship at Port Royal,
-was, in general, when lowest in the night, at 77°, and when highest in
-the day, in the shade, at 83°.
-
-There was a considerable increase of scurvy in this month, compared
-with the former months of this campaign; but very inconsiderable,
-compared with what had occurred in cruises of the same length in former
-years. The last division of the fleet had been at sea seven weeks, all
-but one day, when it arrived at Port Royal; and though the scurvy had
-appeared in several of the ships, it did not prevail in any of them to
-a great degree, except in the Nonsuch. Out of fourteen deaths which
-happened in the whole fleet from this disease, in May, seven of them
-were in this ship, and several were sent from her to the hospital in
-the last and most desperate stage of it. But, upon the whole, the cases
-of the true sea scurvy in the fleet, in general, were few and slight,
-and a great many of those given in the reports under the head of
-scurvy, were cutaneous eruptions or ulcers, not properly to be classed
-with it.
-
-The cruise in the preceding year to windward of Martinico, may be
-compared with that in May of this year; for the fleet in both cases had
-been at sea about the same length of time. But the comparison is very
-greatly in favour of the latter, which is most probably to be imputed
-to the plentiful supply of melasses, wine, sour krout, and essence of
-malt. But no adequate reason that I could discover can be assigned for
-the prevalence of it in the Nonsuch to a degree so much more violent
-than in the other ships; and it was here farther remarkable, that it
-attacked every description of men indiscriminately; for I was assured
-by the officers and by the surgeon, that not only the helpless and
-dispirited landsman was affected, but old seamen, who had never before
-suffered from it on the longest cruises. I have been led by this, and
-some other facts, to suspect that there may be something contagious in
-this disease.
-
-
-JUNE.
-
-The greater part of the fleet remained at Jamaica during this month,
-refitting and watering. Twelve ships of the line were sent to sea on
-the 17th, under the command of Rear-admiral Drake, but not being able
-to get to windward on account of the fresh breezes that prevailed,
-they returned to Port Royal on the 28th. Such of these ships as were
-sickly, became more healthy while at sea; but some bad fevers arose,
-particularly in the Princessa; and it is a curious circumstance, that
-these fevers attacked only those men who had been on shore on the
-watering duty; from which it would appear, that something caught or
-imbibed, which is the cause of the fever, lies inactive for some time
-in the constitution, some of the men not having been affected for more
-than a week after they had been at sea.
-
-The weather continued dry and windy, as in the former month; but the
-heat was in general about two degrees higher, the thermometer varying
-from 79° to 84½°.
-
-
-TABLE, shewing the proportional Sickness and Mortality in June.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of this Month.                 |
-  |                                         |
-  | B Proportion of those who died, in      |
-  |   relation to the Numbers of the Sick.  |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     11 |     19 |
-  |                       |        |        |
-  | Fluxes                |     20 |     83 |
-  |                       |        |        |
-  | Scurvy                |     47 |    231 |
-  |                       |        |        |
-  | Other Complaints      |     37 |     97 |
-  +-----------------------+--------+--------+
-  | General Proportion    |      6 |     39 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths in relation to the whole numbers on board, was
-one in one hundred and thirty-eight.
-
-There was only one in thirty of the sick sent to the hospital in the
-course of this month.
-
-There was an increase both in the numbers and fatality of fevers.
-This increase was chiefly in that sort of fever which depends on the
-air and climate, the greater part of which was caught on the watering
-duty. There was a diminution of those fevers depending on infection,
-and the foul air of ships, which arose in the French prizes. The care
-that was taken in purifying these ships was very effectual; for only
-four died this month in the Ville de Paris, and fewer also were sent
-to the hospital than in May. The increase of the other kind of fever
-was chiefly owing to there being a greater number of ships in port, the
-crews of which were employed in watering, and partly, no doubt, to the
-increase of heat in the weather. The ships in which the fevers were
-most fatal were the Monarch, the Duke, the Torbay, and the Resolution.
-The sickness in the Duke was still in a great measure owing to the same
-infection that had hitherto prevailed; for this ship had never been
-cleared of the infectious fever, for want of room at the hospital. That
-which broke out in the Torbay was also of the low infectious kind, few
-of them having the symptoms of that which is peculiar to the climate,
-which prevailed in the other ships. This ship, though formerly very
-subject to infectious complaints, had been remarkably healthy for some
-time past; but it would appear that there was a large stock of latent
-infection, which shewed itself from time to time.
-
-Some ships, particularly the Montague and Royal Oak, had no increase
-of fevers or other complaints, though the one lay in port for seven,
-and the other for eleven weeks, and were more or less exposed to the
-causes of sickness which affected the rest of the fleet. This is a
-proof, among many others, that a particular combination of causes
-is necessary to produce a disease: no single one, however powerful,
-being sufficient, without the concurrence of others. What seemed to
-be wanting here was the predisposition requisite for the admission of
-disease into the constitution; for the ships that enjoyed this happy
-exemption were such as had long-established and well-regulated crews,
-accustomed to the service and climate.
-
-There had been this month a diminution both of the numbers and
-mortality of fluxes, which is agreeable to what was before remarked,
-that fevers were more apt than fluxes to prevail in the bad air of a
-harbour[16]. It was also before remarked, that there were few or no
-fluxes in those ships in which the fever was most malignant; and now
-that the fever began to grow more mild in the French prizes, the flux
-began to appear. In the Barfleur, Duke, and Namur, both diseases seemed
-to prevail equally; but the fevers, though numerous, were more of the
-low nervous kind than bilious or malignant; and the fluxes chiefly
-attacked those who were recovering from fevers. We may farther remark,
-that these three men of war were three-decked ships, of 90 guns, the
-crews of which being more numerous, and composed of a more mixed set
-of men, were consequently subject to a greater chance of infection,
-and a greater variety of complaints. The Formidable still remained
-healthy to an extraordinary degree. Some fevers were indeed imported
-from the Ville de Paris by men that had been lent to that ship, and who
-were taken ill after their return. Of these, a few of the worst cases
-were sent to the hospital, and two died on board, who, with one that
-died the preceding month, make the whole mortality of this ship, since
-leaving England, amount only to the loss of three men.
-
-There has been little or no increase of scurvy this month; for though
-the numbers put on the list appear to be greater, the mortality is much
-less. It may indeed appear a matter of surprise that there should have
-been any scurvy at all, considering that the greater part of the fleet
-was at anchor all this month. But as this was the greatest fleet that
-had ever visited Jamaica, it was impossible to find fresh provisions
-for the whole; and the small supply they had did not amount to one
-fresh meal in a week. Port Royal is also remote from the cultivated
-part of the island, so that fruit and vegetables were both scarce and
-high priced, particularly this year, on account of the usual rains in
-May and June having failed. There was, however, an allowance of fresh
-provisions and vegetables made to the sick by public bounty; for as
-the hospital could contain but a small proportion of the sick and
-wounded, an order was given for the supply of fresh meat, fruit, and
-vegetables, to the sick, and five hundred pounds of Peruvian bark were
-also distributed as a public gratuity, besides sugar, coffee, and wine.
-
-With these aids, and the various good articles of victualling from
-England, the fleet was preserved uncommonly healthy for a West-India
-campaign: for though the mortality had increased considerably during
-our stay at Jamaica, yet the loss of men, upon the whole, was small,
-compared with that of other great fleets in this climate on former
-occasions. The greatest squadron, next to this, that had ever been
-on this station was that under Admiral Vernon in the year 1741, at
-the same season. From this fleet upwards of eleven thousand men were
-sent to the hospital in the course of that and the preceding year, of
-whom there died one in seven, besides what died on board of their own
-ships and in two hospital ships[17]. The disproportion of sickness
-in the two fleets will appear still greater, when it is considered
-that Admiral Vernon’s contained only fifteen thousand seamen and
-marines[18]; whereas that under Lord Rodney contained twenty-two
-thousand. What added to the sickness of the former was the unfortunate
-expedition to Carthagena in April, 1741; to which probably it was owing
-that a much greater proportion of yellow fevers were landed from the
-fleet at that time than from ours, as appears by the papers left by Mr.
-Hume, who was then surgeon of the hospital. The hospital was then at a
-place called Greenwich, on the side of the bay opposite to Port Royal,
-and was very large; but it was found to be in a situation so extremely
-unhealthy, that it was soon after abandoned and demolished, and the
-hospital has since been at Port Royal.
-
-It appears by the tables, that a greater number was put on the list
-under the head of _other complaints_ in this month than the last.
-This was owing to the great number of ulcers which I have remarked to
-keep pace with feverish as well as scorbutic complaints; for when the
-constitution of the air is favourable to disease, or the habit of body
-prone to it, wounds and sores are found then to be more difficult of
-cure. There were twelve deaths besides those occasioned by what have
-been called the three epidemics. Of these, five perished by drowning
-and other accidents, three died of ulcers, one of wounds received in
-action, one of _cholera morbus_, and one of an abscess.
-
-It has appeared that very few ships of this numerous fleet preserved
-their health while lying at anchor; and it would seem that short and
-frequent cruises are very conducive to health. It was eleven weeks from
-the time that the first of our fleet came to anchor at Jamaica till the
-main body of it sailed for America on the 17th of July. Great fleets
-are in time of war under the necessity of being at one time longer at
-sea, and at another time longer in port, than is consistent with the
-health of the men, the ships being obliged to act in concert and to
-co-operate with each other. This is one reason, among others, for ships
-of the line being more sickly than frigates. As ships of war must be
-guided by the unavoidable exigencies of service, it would be absurd
-to consider health only; but if this were to be the sole object of
-attention, a certain salutary medium could be pointed out in dividing
-the time between cruising and being in harbour; and it is proper that
-this should be known, that regard may be had to it, as far as may be
-consistent with the service. I would say, then, that in a cold climate
-men ought not to be more than six weeks at sea at one time, and need
-not be less than five weeks, and that a fourth part of their time spent
-in port would be sufficient to replenish their bodies with wholesome
-juices. In a warm climate men may be at sea a considerable time longer,
-without contracting scurvy, provided they have been under a course of
-fresh and vegetable diet when in port.
-
-Though contagion is not so apt either to arise or to spread in this
-climate as in colder ones, there were several circumstances about this
-time tending to prove that it may exist in a hot climate. Those ships
-which had their men returned to them from the French prizes, in all of
-which fevers prevailed, had an increase of sickness not only in the
-men that were returned, but in the rest of the crew. There was another
-presumption of contagion, from the proportion of mortality among the
-surgeons and their mates, who were by their duty more exposed to the
-breath, effluvia, and contact of the sick. There died, during our stay
-at Jamaica, three of the former, and four of the latter, which is a
-greater proportion than what died of any other class of officers or men.
-
-It has been the opinion of some, that fevers do not arise from any
-putrid _effluvia_, except those of the living human body, or some
-specific infection generated by it while under the influence of
-disease. It has been alledged in proof of this, that the putrid air in
-some great cities is breathed without any bad effects; and a celebrated
-professor of anatomy[19] used to observe, that those employed in
-dissecting dead bodies did not catch acute diseases more readily than
-other people. I believe this may be true, in a climate like Europe,
-where cold invigorates the body, and enables it to resist the effects
-of foul air; but I am persuaded it is otherwise in tropical climates.
-The external heat of the air induces great languor and relaxation, and
-we cannot breathe the same portion of air for the same length of time
-in a hot as in a cold climate, without great uneasiness. The want of
-coolness must, therefore, be compensated by a more frequent change of
-air, and by its greater purity: any foulness of the air is accordingly
-more felt in a hot climate; and, according to the modern theory, air,
-already loaded with putrid phlogistic vapour, will be less qualified
-to absorb the same sort of vapour from the blood in the lungs, in
-which, according to this theory, the use of respiration consists. Be
-this as it will, there is something in purity of air which invigorates
-the circulation, and refreshes the body; and the contrary state of it
-depresses and debilitates, particularly in a hot climate; and in this
-way foul air may induce disease, like any other debilitating cause,
-independent of infection, or any specific quality. There was no reason
-to suspect any such infection in the Ville de Paris; for there was no
-sickness on board of this ship when in possession of the enemy, and
-the sickness that prevailed after her being captured seemed to proceed
-from what may be called simple putrefaction. There was an instance
-of the same kind in one of our own ships of the line, in which a bad
-fever broke out in the beginning of July, which seemed to be owing
-to the foul air of a neglected hold; for there was a putrid stench
-proceeding from the pumps, which pervaded the whole ship. I perceived
-this very sensibly one day, when visiting some officers who were ill of
-fevers; and before I left the ship an alarm was given of two men being
-suffocated in what is called the _well_, which is the lowest accessible
-part of the hold. This fever was of a very malignant kind, and fell
-upon the officers more than the men; for six of them were seized with
-it, of whom three died on the third day after being taken ill.
-
-The fevers, which were of the greatest malignity at this time, affected
-the officers more than the common men. Only one captain died at Jamaica
-while the fleet was there, and it was of this fever. We lost five
-lieutenants, of whom four died of it; and this was the disease which
-carried off the three surgeons. But foul air was not the only cause
-that produced this fever among the officers, several of whom brought
-it on by hard drinking, or fatiguing themselves by riding or walking
-in the heat of the sun. It cannot be too much inculcated to those who
-visit tropical countries, that exercise in the sun, and intemperance,
-are most pernicious and fatal practices, and that it is in general by
-the one or the other that the better sort of people, particularly those
-newly arrived from Europe, shorten their lives.
-
-Before leaving Jamaica, I sent to England a Supplement to the Memorial
-given in, last year[20].
-
-
-
-
-CHAP. V.
-
- Account of the HEALTH of the FLEET, from its leaving Jamaica on
- the 17th of July, till its Departure from New York on the 25th
- of October.----What Diseases most prevalent on the Passage to
- America--Rapid Increase of the Scurvy during the last Week of
- the Passage--Method of supplying the Sick at New York--The Fleet
- uncommonly healthy in October--State of the Weather and of Health in
- America in Summer and Autumn, 1782.
-
-
-The season of the hurricanes approaching, and all the convoys destined
-for England this year being dispatched, the main body of the fleet,
-consisting of twenty-four ships of the line, left Port Royal on the
-17th of July, under the command of Admiral Pigot, in order to proceed
-to the coast of America. A great convoy for England had been sent off a
-few days before, protected by the Ville de Paris and six other ships of
-the line, which we overtook and passed at the west end of the island.
-When we arrived off the Havannah, a large squadron of the enemy was
-seen there in readiness to sail, which induced the Admiral to wait in
-sight of it for the convoy, which did not come up till ten days after.
-Owing to this delay, and our meeting with baffling winds on the rest of
-the passage, we did not arrive at New York till the 7th of September.
-We found there the Invincible and Warrior, which sailed after us, but
-arrived before us, by having taken the windward passage.
-
-
-TABLE, shewing the proportional Prevalence of different Diseases, and
-their Mortality, in July, 1782.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     13½|     16 |
-  |                       |        |        |
-  | Fluxes                |     24 |     49 |
-  |                       |        |        |
-  | Scurvy                |     91 |      0 |
-  |                       |        |        |
-  | Other Complaints      |     20 |    134 |
-  +-----------------------+--------+--------+
-  | General Proportion    |      5½|     33 |
-  +-----------------------+--------+--------+
-
-The mortality this month, in relation to the whole numbers on board,
-was one in a hundred and thirty.
-
-There were only one in thirty-eight of the sick sent to the hospitals.
-
-The fevers arose chiefly during the first two weeks after leaving
-Jamaica, which renders it probable that the seeds of them were brought
-from thence. Had they been owing to the heat simply, they would have
-been as apt to arise in some subsequent part of the passage; for the
-tropical heats at this season of the year extend to the 30th degree
-of latitude, which we did not cross till the 22d of August, that is,
-near five weeks after leaving Jamaica. The only ships in which the
-fever could be imputed to infection or foul air were the Barfleur,
-Alcide, and the Aimable frigate. The first had received, as recruits,
-at Jamaica, men who had been confined for some time before in a French
-jail, and a fever of a bad kind spread on board of her soon after.
-The Aimable was a prize from the French; and the sickness was here so
-evidently owing to foul air, that, whenever the contents of the hold
-were stirred, so as to let loose the putrid effluvia, there was then an
-evident increase of sickness. The fever in the Alcide was of a peculiar
-slow kind, to be described hereafter, and seemed to be a continuation
-of the same infection which had so long existed in that ship.
-
-The Duke, which had hitherto been by far the most subject to fevers of
-any ship in the fleet, became more and more free from them even in the
-most early part of this passage, and might be said to be entirely so at
-the time she arrived in America. The fever had been so very prevalent
-in this ship since leaving England, that there was hardly a man who had
-escaped it. Could this have any effect in making them less liable to
-catch it a second time?
-
-In the course of this passage the dysenteries came to prevail over the
-fevers, as we have found to be commonly the case at sea. It appears
-by the former table, compared with the next, that the mortality in
-fevers was much the same, and that in the dysentery it was greater
-than while the fleet was at Jamaica. This does not argue, however,
-that the diseases were equally malignant, but was owing to the want
-of an hospital, and of those comforts of diet which the sick enjoyed
-on board while in harbour. This last was particularly felt in the
-dysenteries, in the cure of which more depends upon diet than in most
-other diseases. In all the calculations of mortality on board of ships,
-if any have been sent to the hospital, they are to be deducted from the
-number; and these make a greater difference in the mortality on board
-than their numbers simply would indicate; for only the worst cases, and
-those therefore who were most likely to die, used to be sent to the
-hospital. But as the fleet was at sea during the whole of this month,
-no allowance of this kind is to be made.
-
-
-TABLE, shewing the proportional Sickness and Mortality in August.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     31 |     17 |
-  |                       |        |        |
-  | Fluxes                |     46 |     35 |
-  |                       |        |        |
-  | Scurvy                |     25 |     66 |
-  |                       |        |        |
-  | Other Complaints      |     27 |     43 |
-  +-----------------------+--------+--------+
-  | General Proportion    |  7½    |     31 |
-  +-----------------------+--------+--------+
-
-The mortality this month, in relation to the whole numbers on board,
-was one in one hundred and sixty-nine.
-
-The scurvy began to appear very soon upon this passage; for by the end
-of August, at which time the fleet had only been six weeks at sea, and
-that in a warm climate, and in dry weather, it had made considerable
-progress. It first appeared and prevailed most in the Prince George
-and Royal Oak, though they had been ten weeks at Jamaica. This was the
-first sickness with which the latter had been affected since arriving
-in the West Indies; and there was no perceivable peculiarity in either
-of them to account for their being subject to it more early, or more
-violently, than the rest of the fleet. If the disease is contagious,
-as has been suspected, there might be a few men on board of them, who,
-being uncommonly prone to the disease, would be soon affected, and
-communicate it, or at least hasten the symptoms in those who might be
-less predisposed to it. But this is only conjecture. Before the end of
-the voyage, the whole fleet was more or less afflicted with it, though
-it had been only seven weeks and three days at sea; but the men had
-received so few refreshments while in port, that their constitutions
-were prepared to fall into this disease. The Barfleur, Alfred, and
-Princessa, were most affected with it next to the two ships mentioned
-above.
-
-The seventeen ships which arrived from England in February and March
-were much less affected with it than the rest of the fleet, which was,
-no doubt, owing to the wine, melasses, and sour krout, with which they
-were so amply supplied. Though these articles were all expended before
-leaving Jamaica, yet the good effects of them on the constitutions of
-the men were visible in the course of this passage.
-
-The America was the most free from it of all the ships of the old
-squadron; and this was owing to the great humanity and attention of the
-captain[21], who, as soon as any of the men were taken ill, allowed
-them wine and other refreshments from his private store. There was
-another proof in the Conqueror of the great importance of attending
-to this disease in its earliest stage. Mr. Lucas, the surgeon of this
-ship, by watching the first beginnings of it, by a proper regulation of
-diet, and the administration of the essence of malt and juice of limes,
-not only prevented the progress of the disease, but proved, that,
-with great attention, it may even be cured at sea. It is of the utmost
-consequence in this disease to put the men on the sick list on the
-very first appearance of the symptoms, so that they may early have the
-advantage of proper treatment and regimen. It is only at this period of
-it that the effects of essence of malt are sensible; but we have seen
-that the juice of certain fruits will cure it in more advanced stages.
-
-There is a very important remark suggested by comparing the two
-preceding tables with that which follows. It appears that in the month
-of September a much greater number was taken ill of scurvy, and also
-that there died of this disease a greater proportion than in the two
-preceding months. All the mischief from it in that month happened in
-the first week of it, during which as many died as in the whole month
-of August; for the fleet came to an anchor on the 7th of September at
-New York, where the worst cases were immediately sent to the hospital,
-and those that remained on board were supplied with every necessary
-refreshment. Had the fleet remained longer at sea, the mortality would
-probably have increased in the same progression; and this circumstance
-ought to be well considered in undertaking cruises.
-
-
-TABLE, shewing the proportional Prevalence of Sickness and Mortality in
-September.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  |  Fevers               |     49 |     31 |
-  |  Fluxes               |     46 |     68 |
-  |  Scurvy               | 15½    |     39 |
-  |  Ulcers               |     68 |      0 |
-  |  Other Complaints     |     62 |    226 |
-  +-----------------------|--------+--------+
-  |  General Proportion,  |      7 |     58 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths, in relation to the whole numbers on board,
-was one in three hundred and ninety-eight.
-
-About one third of all the sick were sent to the hospital.
-
-As the proportion of ulcers was uncommonly great, I thought it worth
-while to make a calculation of it. The Barfleur had the greatest
-number; and this ship, for causes I cannot assign, was more afflicted
-with bad ulcers than any other in the fleet, for several months
-together.
-
-The fleet having arrived at New York in this unhealthy state, the first
-care was to make provision for the sick. There were somewhat more than
-fifteen hundred on the sick lists of all the ships, and the hospital
-could accommodate little more than six hundred. In order that it might
-not be overcrowded, and that each ship might have a just share of
-relief, I went round the fleet to ascertain the due proportion of those
-cases that were the most proper objects for being sent on shore. All
-the infectious and acute Complaints, and some of the worst scorbutics,
-were accordingly sent to the hospital. Those who were kept on board
-being chiefly such as were affected with the scurvy, were supplied with
-various refreshments in their respective ships, and seemed to recover
-as soon as if they had been sent on shore. They had indeed almost every
-advantage enjoyed by those at the hospital; for, besides fresh meat
-thrice a week, and spruce beer daily in common with the other seamen,
-each man on the sick list was supplied every week at the public expence
-with four pounds of apples and half a pound of sope. There were also
-thirty casks of limes taken in a prize, which were distributed among
-the scorbutic men, and proved of infinite use. Admiral Pigot’s great
-zeal for the good of the service, as well as his natural humanity,
-induced him to listen to whatever was proposed for the benefit of the
-men.
-
-The supply of sope was a thing entirely new in the service; but the
-good effect of all the other articles would most probably have
-been defeated, unless the men had been furnished with the means of
-cleanliness, which is the most essential requisite of health. The
-advantage of this method will appear by the returns of next month to
-have been very conspicuous; and it was on this occasion more than any
-other that I saw realised in every particular the plan proposed in
-the memorial to the Admiralty. It may be added, that the sick that
-were left on board were not even without the recreation of the shore
-enjoyed by those at the hospital; for most of the captains had the
-attention to send daily on shore, for amusement and exercise, such as
-were able to walk. Thus there were all the advantages of an hospital
-obtained at much less expence to Government, and without the risque of
-intemperance, desertion, or infection, which are the inconveniencies
-connected with an hospital. What farther contributed to health at this
-time was, a large quantity of excellent wine with which the fleet was
-supplied.
-
-
-TABLE, shewing the proportional Sickness and Mortality in October.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of those died, in relation |
-  |   to the Numbers of the Sick.           |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     45 |    250 |
-  |                       |        |        |
-  | Fluxes                |     61 |     69 |
-  |                       |        |        |
-  | Scurvy                |     34 |    197 |
-  |                       |        |        |
-  | Ulcers                |    181 |      0 |
-  |                       |        |        |
-  | Other Complaints      |    127 |      0 |
-  +-----------------------|--------+--------+
-  | General Proportion    |     12½|    196 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths in this month, in relation to the whole number
-on board, was only one in fourteen hundred and seventy-eight.
-
-About one in twenty-nine of the sick was sent to the hospital.
-
-There was, upon the whole, less sickness and mortality in this month
-than in any other during which I kept records of the fleet. This was,
-no doubt, owing in part to the climate, but was chiefly the effect of
-the extraordinary attention paid to the refreshments of the men. The
-fleet was here exactly in the same situation, and at the same season,
-two years before, but was not near so healthy.
-
-Nor were the advantages derived from the great plenty of refreshments,
-procured at this time at New York, merely temporary; for the men’s
-constitutions were so much improved by them, that the part of the
-fleet which remained under the command of Lord Hood was at sea for
-twelve weeks without being affected by the scurvy. This was chiefly
-to be ascribed to the previous refreshments; for we have seen, that,
-in a passage of seven weeks from Jamaica to New York, the fleet was
-greatly affected with the scurvy, in consequence of not having had the
-advantages of fresh meat and vegetables when last in port. The climate
-had, no doubt, also a share in keeping off the scurvy; for the greater
-part of the twelve weeks was taken up in a cruise off St. Domingo; and,
-I believe, it never was known that a fleet was so long at sea, in a
-cold climate, without being greatly affected with this disease.
-
-It appears, that though the proportion of fevers had increased somewhat
-this month over that of fluxes, yet the former were less fatal; and, I
-think, the true dysentery is more frequent in this climate, and more
-apt to prove fatal in its acute state, than in the West Indies. I have
-indeed preferred the term flux to that of dysentery, for this reason,
-that the symptoms in many cases did not rise so high as properly to
-constitute dysentery; and the disease proves fatal in the West Indies
-more frequently in the chronic than in the acute state. The fluxes were
-daily gaining ground when we left New York, and continued to prevail
-to a great degree in the Magnificent, which remained in that climate
-several weeks after us.
-
-The climate and situation of the fleet had a greater effect in
-diminishing ulcers than any other complaints; for the proportion of
-them in this month is little more than one third of what it was in the
-last.
-
-The calculation for October was made upon thirteen ships of the line,
-which sailed from New York on the 25th of that month.
-
-The weather had then begun to grow cold; but few or none of the
-diseases peculiar to a cold climate had appeared. There occurred, while
-we were at New York, several cases of inflammation of the liver among
-the officers and men who came from the West Indies. It was remarked
-formerly, that this complaint hardly ever occurred in the West Indies;
-but it would appear that the residing there disposes to an inflammation
-of this organ upon changing to a colder climate.
-
-The preceding summer had been uncommonly cold, not only in North
-America, but in the whole temperate part of the northern hemisphere,
-so far as I could learn by inquiry. In consequence of this, the crops
-failed in Europe, America, and the northern parts of Asia. The same
-circumstance had a remarkable effect on the reigning diseases of the
-season at New York; for, instead of the bilious complaints common in
-the end of summer and in autumn, a slight fever of the inflammatory
-kind had prevailed. An epidemic catarrh had spread all over Europe,
-and some part of Asia, in the earlier part of the year; and perhaps
-this was connected with the peculiar state of the atmosphere about this
-time. It was before observed, that there was something unusual in the
-state of the weather at Jamaica while the fleet lay there; and it is
-possible that this might be owing to the same general cause.
-
-
-
-
-CHAP. VI.
-
- Account of the HEALTH of the FLEET from its Departure from New
- York till the Conclusion of the War.----Passage to the West
- Indies--Account of the Ships there during our Absence--Arrival of a
- Squadron from England--Of these, two Ships only were healthy--Causes
- of this--Inflammatory Complaints in the Union--Probable Cause of
- these--Comparison of the two Squadrons--Increase of Sickness from
- Recruits brought from England--from French prisoners.
-
-
-Thirteen ships of the line sailed from America for the West Indies on
-the 25th of October, under the command of Admiral Pigot, and the other
-half of the fleet was left under Lord Hood, to watch the motions of the
-French squadron, which was then at Boston.
-
-The day on which we left the coast of America a storm came on, which
-lasted two days; but the rest of the passage being fair and moderate,
-we arrived at Barbadoes on the 20th of November, where the fleet
-continued for the remainder of the month.
-
-All the above-mentioned squadron, except two ships, is comprehended
-in the calculation of the following table, and also the Magnificent,
-Prudent, and Nonsuch. The two last had continued in the West Indies,
-during our absence.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in November.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Number of Sick.                   |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     54 |     25 |
-  | Fluxes                |     78 |    132 |
-  | Scurvy                |     86 |      0 |
-  | Ulcers                |     94 |      0 |
-  | Other Complaints      |     46 |    103 |
-  +-----------------------+--------+--------+
-  | General Proportion    |     15 |     77 |
-  +-----------------------+--------+--------+
-
-About a sixth part of the whole sick were sent to the hospital this
-month, and one half of these were sent to the hospital at Halifax from
-the Magnificent.
-
-The proportion of deaths this month, in relation to the whole number on
-board, was one in eight hundred and eighty-seven.
-
-Fewer were taken ill this month than the preceding, but more in
-proportion died; which might partly be owing to the fleet having been
-more at sea, and partly to the change of climate.
-
-Fevers were now more numerous, and also more fatal than any other
-disease; and we see them follow the contrary proportion to fluxes
-in the progress to the southward, that they did in our progress to
-the northward. These fevers prevailed chiefly in the Formidable and
-Warrior. In the former it first appeared among some men that had been
-pressed at New York from a privateer, some of whom were seized a few
-days after our arrival at Barbadoes with the yellow fever, and they
-were the only instances of it at this time in the fleet.
-
-The scurvy continued to diminish, but the ulcers increased as we came
-into the torrid zone.
-
-Diseases in general were so slight and so few at this time, that the
-whole squadron from America sent only forty-eight men to the hospital
-at Barbadoes from its arrival to the end of the month.
-
-It may be proper here to give an account of some of the ships that
-remained on this station, while the main body of the fleet was in
-America.
-
-The Prudent, when she left us, was extremely healthy, and continued
-so till a flux broke out in July, which was communicated by some men
-from a cartel, who were ill of this disease. It spread among the ship’s
-company, and prevailed for three months. The only deaths during the
-seven months that this ship was separated from the fleet were, two from
-flux, and one from scurvy, and only twenty-five were sent to hospitals.
-This is a proof how much more healthy the windward station is than that
-of Jamaica. The scurvy arose at one time, in a cruise of five weeks,
-though there was no appearance of it at another time in a cruise of six
-weeks. The cause of this seems to be the difference of the weather at
-the two periods; for it was very wet in the former, and very dry in
-the latter. The time in which this ship was most exposed to sickness
-was while she was under repair at Antigua, a situation in which hardly
-any ship escapes a severe visitation of sickness; yet this ship was
-not at all affected by it, which seemed to be owing to the uncommon
-pains taken by the captain to prevent the men from labouring in the sun
-during the hot part of the day.
-
-The Nonsuch was five months separated from the fleet, during which time
-ten men died. Nine of these died of fevers, and one of the dysentery.
-She sailed from Jamaica for Barbadoes about the same time that the
-fleet sailed for North America, and was nine weeks on the passage.
-A fever was the prevailing disease, and the men probably inhaled
-the seeds of it at Jamaica, in common with most of the other ships’
-companies that were there. The scurvy, which had formerly prevailed
-so much, appeared at this time; but it was in a very moderate degree,
-considering the length of the passage. None died of it, and few
-were so ill as to require being sent to the hospital. Had this ship
-gone into a colder climate, like the others, it would probably have
-prevailed to a greater degree. The whole number sent to the hospitals
-for various complaints, during the five months, was only thirteen.
-
-The Nymph frigate was the only other ship left in the West Indies
-which is included in the tables. There happened only two deaths in
-her from June to October, both months included. One of these was from
-scurvy, the other from asthma. She was in that time upon two cruises,
-each of which lasted eight weeks. During the first the weather was dry
-and fine, and during the other it was wet and sultry, with the same
-effect upon health as in the Prudent; for in the second cruise the
-scurvy prevailed to a considerable degree, but not at all during the
-first. This disease was prevented from becoming violent or fatal, on
-either occasion, by the great attention of Mr. Anderson, the surgeon.
-He found great benefit from the essence of malt, when given early in
-the complaint; and some limes having been taken in a prize, while this
-disease was at the worst, the scorbutic men were so much recovered by
-the use of them, that they were all able to return to duty before the
-ship arrived in port.
-
-
-DECEMBER.
-
-The whole squadron remained at anchor at Barbadoes, and nothing worth
-notice occurred till the arrival of a reinforcement of eight ships
-of the line, under Sir Richard Hughes, on the 8th of December. This
-squadron had been detached by Lord Howe, after the relief of Gibraltar,
-and the action with the combined fleets on the 20th of October. It
-consisted of one ship of 90 guns, one of 80, three of 74, and three of
-64. They sailed from England on the 9th of September, and from that
-time till their arrival at Barbadoes they had not been in port, except
-for ten days that they were at Madeira, where they were supplied with
-fresh meat, fruit, and vegetables, by which means the scurvy, which
-had begun to prevail to a considerable degree, was almost entirely
-eradicated, and the health of the men was surprisingly restored, for so
-short a time.
-
-When they joined us, however, there was a good deal of sickness on
-board of them all, except the Union and Ruby. The former had been more
-than three years in commission, and in that time had never been sickly,
-and had now all the advantages of a long-established and well-regulated
-ship’s company. All the rest had been newly commissioned and manned
-when they left England. The superior health of the Ruby was owing to
-her having been manned with the crews of other ships, some of which
-had just arrived from the West Indies; whereas the others had been
-manned chiefly by draughts of pressed men from guardships, or by raw
-volunteers, of whom a great many were raised in Ireland about this
-time. The Bellona and Berwick having been somewhat longer in commission
-than the rest, were less sickly.
-
-The following tables will shew the comparative state of health of the
-squadron formerly on the station with that which had newly arrived from
-England.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the old
-Squadron, in December.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of Sick.                  |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-   | Fevers               | 32     |     80 |
-   | Fluxes               | 94     |     99 |
-   | Scurvy               | 62     |      0 |
-   | Ulcers               | 64     |      0 |
-   | Other Complaints     | 57     |     71 |
-   +----------------------+--------+--------+
-   | General Proportion,  | 11½    |    124 |
-   +----------------------+--------+--------+
-
-The proportion of the deaths this month to the whole number of men
-belonging to this part of the fleet, was one in eleven hundred and two.
-There were fifty-six sent to the hospital, which was one in eighteen of
-all the sick.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the new
-Squadron, in December.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Number of Sick.                   |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     11 |     55 |
-  | Fluxes                |     86 |      0 |
-  | Scurvy                |    107 |      0 |
-  | Ulcers                |    191 |      0 |
-  | Other Complaints      |     56 |     54 |
-  +-----------------------+--------+--------+
-  | General Proportion    |      5 |     64 |
-  +-----------------------+--------+--------+
-
-The proportion of the deaths this month to the whole number of men
-belonging to this part of the fleet, was one in four hundred and forty.
-
-There were one hundred and eighty-nine sent to the hospital; but the
-proportion to the whole number of sick cannot be ascertained, as we do
-not know how many were on the list on the first of the month.
-
-The increase of fevers in the old squadron was chiefly owing to their
-having spread in the Nonsuch; and they seemed to partake more of
-that kind which originates in jails and ships, than of that which
-is peculiar to the climate. The body of one of the men who died of
-this fever was inspected at the hospital, and there was found to be
-inflammation and even perforation of the intestines, without any
-previous symptom that could lead to expect such an appearance, a
-circumstance more likely to happen in the former sort of fever than the
-latter.
-
-The increase of scurvy was owing to the numbers that were taken ill
-of it in the Magnificent on the passage from Halifax, from whence
-she sailed in the beginning of this month, and joined the fleet at
-Barbadoes in the end of it. There was a great deal of sickness in this
-ship at Halifax, and on the passage, owing to the want of such clothing
-as was suitable to that severe climate. One of the principal complaints
-was an inflammatory sore throat.
-
-There was no change in the situation of the fleet, only that four ships
-of the line were sent on the 16th to cruise near Guadaloupe, and they
-continued at sea till the beginning of February.
-
-The new squadron was much afflicted with the jail fever, brought from
-England; and it was much more prevalent, as well as malignant, on board
-of the Suffolk than any of the rest. During the passage it prevailed
-most in the Princess Amelia, not less than twenty having died of it.
-It subsided in this ship before she arrived in the West Indies; but on
-board of the Suffolk it continued to rage for some months after.
-
-As the hospital at Barbadoes was too small to contain all the sick
-of this squadron, only the cases of greatest danger and the most
-infectious were sent on shore, and those that remained were provided
-with fresh vegetables and milk on board of their own ships, in the same
-manner as had been formerly practised with such success on similar
-occasions. This was continued for four weeks, during which time they
-all got into tolerable health, except the Suffolk.
-
-There appeared, by the returns of the new squadron, to be a greater
-number under the head of “Other Complaints,” which was owing to the
-number of pulmonic complaints, the consequence of the influenza which
-prevailed in Europe, at sea, as well as on shore, in the spring and
-beginning of the summer of this year.
-
-Though inflammatory complaints are rare in this climate, yet in a few
-of the ships there was some appearance of them; and I remarked that
-they occurred in those ships which were in other respects most healthy,
-and most free from infection. A good many of the men were seized with
-inflammatory sore throats in the Bellona a few days before she arrived
-at Barbadoes, and this was in other respects the most healthy ship
-next to the Union and Ruby. In the Union there was no violent acute
-complaint whatever, which was very singular among so great a body of
-men; but several rheumatisms, coughs, and catarrhs, arose in her this
-month, and there even occurred two pleurisies in the following month.
-The bowel complaints which occurred on board of this ship were also
-of an inflammatory nature. These distempers seemed to proceed from
-accidental exposure and irregularity; and is it not highly probable
-that these causes, instead of producing local inflammatory complaints,
-might have been the means of exciting bad fevers and fluxes, as in the
-other ships, had the men been equally predisposed to them, by living in
-foul air, or under the influence of infection?
-
-The following tables will shew the comparative state of health of the
-two squadrons in the three first months of next year.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the old
-Squadron in January, 1783.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     67 |     70 |
-  | Fluxes                |    157 |      0 |
-  | Scurvy                |     44 |      0 |
-  | Ulcers                |      0 |      0 |
-  | Other Complaints      |     48 |    117 |
-  +-----------------------+--------+--------+
-  | General Proportion    |     12½|    214 |
-  +-----------------------+--------+--------+
-
-The mortality this month, in relation to the whole number on board, was
-one in twelve hundred and fifty-seven. About one fifteenth of all the
-sick were sent to the hospital.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the new
-Squadron in January, 1783.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     12 |     48 |
-  | Fluxes                |     29 |    153 |
-  | Scurvy                |    320 |      0 |
-  | Ulcers                |    137 |      0 |
-  | Other Complaints      |     19 |      0 |
-  +-----------------------+--------+--------+
-  | General Proportion    |      5½|    109 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths to the whole number on board was one in five
-hundred and forty. About one in thirty of all the sick were sent to the
-hospital.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the old
-Squadron in February.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     46 |     69 |
-  | Fluxes                |    159 |      0 |
-  | Scurvy                |     63 |      0 |
-  | Ulcers                |    100 |      0 |
-  | Other Complaints      |     51 |    136 |
-  +-----------------------+--------+--------+
-  | General Proportion    |     13½|    173 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths to the whole number on board was one in
-sixteen hundred and ninety-seven. One ninth of all the sick were sent
-to the hospital.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the new
-Squadron in February.
-
-  +-----------------------------------------+
-  | Transcriber’s Keys                      |
-  |                                         |
-  | A Proportion of those taken ill in the  |
-  |   Course of the Month.                  |
-  |                                         |
-  | B Proportion of Deaths, in relation to  |
-  |   the Numbers of the Sick.              |
-  +-----------------------+--------+--------+
-  |                       |    A   |    B   |
-  |       DISEASES.       |        |        |
-  |                       | ONE IN | ONE IN |
-  +-----------------------+--------+--------+
-  | Fevers                |     30 |     50 |
-  | Fluxes                |     34 |      0 |
-  | Scurvy                |    212 |      0 |
-  | Ulcers                |    174 |      0 |
-  | Other Complaints      |     52 |      0 |
-  +-----------------------+--------+--------+
-  | General Proportion    |     11 |    185 |
-  +-----------------------+--------+--------+
-
-The proportion of deaths to the whole number was one in twelve hundred
-and seventy-six. The proportion sent to the hospital was the same this
-month as in the other part of the squadron.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the old
-Squadron, in March.
-
-  +--------------------------------------------+
-  | Transcriber’s Keys                         |
-  |                                            |
-  | A Proportion of those taken ill in the     |
-  |   Course of the Month.                     |
-  |                                            |
-  | B Proportion of Deaths, in relation to     |
-  |   the Numbers of Sick.                     |
-  +-------------------------+--------+---------+
-  | DISEASES.               | A      | B       |
-  +-------------------------+--------+---------+
-  |                         | ONE IN | ONE IN  |
-  +-------------------------+--------+---------+
-  | Fevers                  |     28 |  12½    |
-  | Fluxes                  |     71 |   0     |
-  | Scurvy                  |     46 |   0     |
-  | Ulcers                  |    226 |   0     |
-  | Other Complaints        |     76 |  44     |
-  +-------------------------+--------+---------+
-  | General Proportion,     |     11 | 194     |
-  +-------------------------+--------+---------+
-
-The proportion of deaths to the whole number was one in thirteen
-hundred and sixty-one. About one ninth of all the sick were sent to the
-hospital.
-
-
-TABLE, shewing the Prevalence of Sickness and Mortality in the new
-Squadron, in March.
-
-  +-------------------------------------------+
-  | Transcriber’s Keys                        |
-  |                                           |
-  | A Proportion of those taken ill in the    |
-  |   Course of the Month.                    |
-  |                                           |
-  | B Proportion of Deaths, in relation to    |
-  |   the Number of Sick.                     |
-  +-------------------------+--------+--------+
-  | DISEASES.               | A      | B      |
-  +-------------------------+--------+--------+
-  |                         | ONE IN | ONE IN |
-  +-------------------------+--------+--------+
-  | Fevers                  |     44 |      0 |
-  | Fluxes                  |     49 |      0 |
-  | Scurvy                  |    123 |      0 |
-  | Ulcers                  |    183 |      0 |
-  | Other Complaints        |     38 |    138 |
-  +-------------------------+--------+--------+
-  | General Proportion      |     12 |    403 |
-  +-------------------------+--------+--------+
-
-The proportion of deaths to the whole number was one in four thousand
-and eighty-seven. About one in eleven of all the sick were sent to the
-hospital.
-
-The main body of the fleet remained at Barbadoes till the 12th of
-January, when they went to cruise to windward of Martinico, in order to
-intercept a French squadron expected from North America. This cruise
-lasted four weeks; and intelligence being received of the enemy’s
-having taken a different route, the whole fleet bore away for St.
-Lucia, where it came to an anchor on the 8th of February.
-
-In the course of the three months above mentioned, we see the two
-squadrons approaching to each other, in point of health, till they
-became pretty equal and similar; and the new squadron became even
-somewhat more healthy than the old.
-
-The increase of fevers in the old squadron was owing to two causes.
-One was the importation of new-raised recruits brought from England
-by some ships that arrived in the beginning of January. These were
-distributed to such ships as stood most in need of men; and being very
-dirty and ill cloathed, were likely to harbour infection. They were
-evidently the cause of sickness in the Warrior and Royal Oak; for these
-ships were before that time healthy, and the fever began with these
-strangers, and spread amongst the former crew. It is remarkable that
-the ships that brought them from England were not affected by them.
-
-It was caught in the Royal Oak from six men that came from England in
-the Anson, which men, though first put on board the Namur, communicated
-no fever there, having been kept separate from the rest of the men; but
-being sent to the Royal Oak, they were themselves first taken ill with
-a fever, which afterwards spread to about thirty of the other men. What
-was singular in this fever was, that the eyes and skin of all that were
-affected by it became yellow, though without any particular malignancy;
-for only two died on board, and one in the hospital. There was one
-whose skin was very yellow, yet his complaint was so slight as never to
-confine him to his bed.
-
-The other cause of the increased proportion of fevers in the old
-squadron was, the great number of these complaints that arose in the
-Magnificent. This ship having been sent on a cruise about the middle
-of February, and the weather being rainy, squally, and uncommonly
-cold, for the climate, many fevers of the inflammatory kind appeared.
-During this cruise she made prize of a large French frigate, called
-the Concord, and the greater part of the prisoners being taken on
-board, the fever from that time assumed a different type, with new and
-uncommon symptoms; for, instead of being inflammatory and requiring
-bleeding, as before, it became more of a low, putrid kind, and was
-attended in most cases, if not in all, with a continual sweating;
-so that, instead of evacuations, the remedies that were found most
-effectual were the Peruvian bark, blisters, and opium. Thus we see
-fevers variously modified according to men’s constitutions, the state
-of the air, and the noxious _effluvia_ of the strangers that intermix
-with them.
-
-We find the proportion of fluxes increasing in the new squadron in
-January and February, as they had formerly done in most of the ships
-soon after their arrival from England. They were observed also to
-prevail principally in those ships that had formerly been most subject
-to fevers, and not to arise till the fever had subsided. They were
-found, for instance, to arise later in the Suffolk, where the fever was
-obstinate and malignant, than in the Princess Amelia, where the fever
-had been at one time general and fatal, but not so violent and lasting
-as in the other.
-
-The four ships that were sent to cruise near Guadaloupe continued at
-sea for seven weeks; and it was owing to the prevalence of scurvy in
-these and in the Magnificent that the proportion of that disease was
-greater at this time in the old than in the new squadron.
-
-The fleet remained at St. Lucia till the accounts of the peace arrived
-in the beginning of April. The service was then at an end, and I
-returned to England with the first division of the fleet, which sailed
-from St. Lucia on the 12th of April, under the command of Rear-admiral
-Sir Francis Drake, who was at this time in extremely bad health, and
-requested me to accompany him.
-
-
-
-
-PART I.
-
-BOOK III.
-
-Of the Numbers and Mortality of different Diseases sent to Hospitals.
-
-
-
-
-CHAP. I.
-
- Hospital at Gibraltar, 1780--at Barbadoes, 1780--Causes
- of Mortality from various Diseases--Accidents--the
- Hurricane--Wounds--Amputations--Scorches--Fluxes very apt to arise at
- the Hospital--Proportion that were received and died at Antigua--St.
- Christopher’s--St. Lucia, and at Barbadoes, 1782--at Jamaica, 1782--at
- New York, Autumn, 1780--1782--General View of the Admissions and
- Mortality at all the Hospitals during the War.
-
-
-In order to judge of the loss sustained by disease, in the course of
-that service of which a relation has been attempted, the sick sent to
-the hospitals must be taken into account. I shall, therefore, give a
-short view of the different diseases admitted, and their mortality, at
-the several hospitals connected with the fleets in which I served. This
-will serve also to illustrate the different effects that different
-situations have upon the health and recovery of men[22].
-
-The fleet which effected the first relief of Gibraltar, under the
-command of Lord Rodney, consisting of twenty ships of the line, arrived
-there in the third week of January, 1780, after a passage of three
-weeks and a few days from England, in which they had an action with
-the Spanish fleet, and obtained a victory over them, on the 16th of
-that month. The whole fleet, except one ship, sailed from Gibraltar on
-the 13th of February, and while it lay there, the diseases sent to the
-hospital, and their respective mortality, were as follows[23]:
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |       622 |    65 |           9½|
-  | Fluxes             |        17 |     0 |           0 |
-  | Scurvy             |        13 |     1 |          13 |
-  | Ulcers             |        20 |     3 |           7 |
-  | Wounds             |        29 |     9 |           3 |
-  | Other Complaints   |        12 |     3 |           4 |
-  +--------------------+-----------+-------+-------------+
-  |   Total            |       713 |    79 |           9 |
-  +--------------------+-----------+-------+-------------+
-
-[24]This comprehends not only the deaths in the time the fleet remained
-there, but all that happened afterwards. The mortality, from wounds
-and ulcers, is greater than might be expected in so fine a climate, and
-at the coolest season of the year; but as the place was then besieged,
-the sick and wounded could not be supplied with those refreshments that
-were necessary to the recovery of the men, and wounds and ulcers are
-complaints very apt to be affected by the quality of the diet.
-
-
-The following is an Account of the Men admitted at the Hospital at
-Barbadoes in the Campaign of 1780, that is, from the 16th of March till
-the end of June:
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |       277 |    43 |           6½|
-  | Fluxes             |        70 |    22 |           4 |
-  | Scurvy             |       199 |    47 |           4 |
-  | Ulcers             |        92 |    16 |           5½|
-  | Wounds             |       167 |    61 |           2½|
-  | Other Complaints   |       129 |    23 |           5½|
-  +--------------------+-----------+-------+-------------+
-  |     Total          |       943 |   212 |           4½|
-  +--------------------+-----------+-------+-------------+
-
-The fevers were chiefly from the five line-of-battle ships that came
-immediately from Europe in March. Upon their arrival they sent on shore
-one hundred and ninety-three men ill of fevers, only one with the
-flux, fifteen with the scurvy, and five with ulcers.
-
-When these ships returned to Barbadoes in May, along with the rest
-of the fleet, the greater part of the sick were then also on board
-of them. By that time the flux and scurvy had broke out. The former
-prevailed chiefly in the Terrible; the latter in the Intrepid. That
-part of the fleet which we found on the station sent on shore a very
-small proportion of all the classes of complaints, except wounds.
-
-Of the wounds, nineteen were amputations, of which there died nine,
-mostly of the locked jaw. There were forty-six scorched by gunpowder,
-of whom there died fourteen; so that, besides those who were killed
-outright, and those who died on board in consequence of accidents of
-this kind, before they could be sent to an hospital, about one fourth
-of all the wounds, and the same proportion of all the deaths from
-wounds, at the hospital, was owing to this cause. This circumstance
-ought to induce commanders to take every precaution to prevent such
-accidents. In the subsequent part of the war they were less frequent,
-in consequence of that greater caution, and more accurate method of
-working great guns, which were acquired by practice and experience[25].
-
-In the account of the mortality, I have included only such as died
-before the 1st of January, 1781; for if any were carried off after that
-time, it was most probably by some incidental complaint. There were
-sixty-five of them at that time remaining, and they were chiefly men
-disabled by lameness waiting for a passage to England as invalids.
-
-Out of the twenty-three that were killed by the fall of the house in
-the hurricane on the 10th of October, eight were of the number above
-accounted for; but these are not included in any of the classes of
-deaths.
-
-The mortality among the men admitted at this time was greater than
-what occurred afterwards in any of the hospitals that I attended,
-except that at Jamaica. The principal cause of this was, that as the
-fleet was so much greater than had ever been known here before, there
-was not suitable accommodation for such numbers as it was necessary to
-send on shore, and we had not then fallen on the method of supplying
-refreshments to the men on board of their ships. The circumstance by
-which the men suffered most was, the great crowding which the want of
-room made necessary. There is here no public building appropriated for
-an hospital; so that this, as well as every thing else, being found
-by contract, and the number of sick being so much greater than it was
-usual to provide for, the whole was at this time conducted in a manner
-not very regular.
-
-It appears that the greatest mortality in any class of disease was that
-of the fluxes, of which the greatest number sent to hospitals are such
-as have languished for some time under this disease, in which state it
-generally proves fatal in the West Indies, in consequence of incurable
-ulcers in the great intestines, to which the heat of the climate, as
-well as the scorbutic habit and sea diet, is particularly unfavourable.
-But the whole of the mischief arising from it does not appear in the
-table; for it was the most apt of any disease to supervene upon other
-complaints which were under cure at the hospital. It more particularly
-attacked those who were recovering from the scurvy, and was the cause
-of the greater number of deaths under this head in the table. It was
-found to be more contagious than fevers, either because the men’s
-constitutions were more predisposed to it, or, perhaps, because the
-infectious matter of it being more gross and less volatile, it is not
-so readily dissipated by the heat of the climate; for, either from
-this, or some other circumstance, infectious fevers are not so easily
-generated, nor so apt to spread, as in Europe. That these fluxes were
-owing to infection may be inferred from hence, that, when men ill of
-the scurvy were cured on board of the ships they belonged to, they
-were not liable to this disease, neither did they prevail at these
-hospitals afterwards, when great care was taken to separate infectious
-diseases from the others.
-
-The only regular hospital on this station is that at Antigua. This
-island being the seat of the royal dock yard, there is an established
-hospital in time of peace as well as war. It so happened, that great
-fleets never came here to put their sick and wounded on shore, as at
-Barbadoes; so that the greater number of those received into it were
-from single ships that came to careen. As there was, therefore, less
-necessity for crowding, and as the slighter cases could be admitted,
-there was a less proportion of deaths here than at most of the other
-hospitals.
-
-There were two other establishments for the reception of the sick and
-wounded on this station, but they were only temporary. These were at
-St. Lucia and St. Christopher’s, where the men being received in great
-numbers at a time from large fleets, and as there were accommodations
-only for the most urgent cases, the mortality approached more nearly
-to that of Barbadoes. There died at St. Christopher’s, in the years
-1780 and 1781, in the proportion of one in six, and at St. Lucia, in
-the same time, one in five and a half, or two in eleven. The air of
-the hospital at St. Lucia was remarkably pure, and this degree of
-mortality was owing to the sick having been accommodated in tents and
-huts. In the two last years of the war, when an hospital was built, and
-regularly established, the mortality was not much above one half of
-this.
-
-Some authors have endeavoured to form an estimate of the success of
-practice from the different rates of mortality; but this is extremely
-fallacious; for the fatality of diseases will depend on their violence,
-the proportion of deaths being very different in cases that are slight,
-from what it is in those that are dangerous. We shall take a view,
-however, of the hospital at Barbadoes at another period, in which
-there seemed little or no difference in the violence of the disease,
-and when the superior success seemed to be owing to the hospital’s not
-being so crowded, and to the better attendance and treatment of the
-sick. The following is a view of the diseases that were admitted in
-the last three months of the year 1782, the greater part of which were
-landed from the reinforcement of eight ships of the line that joined
-the fleet at Barbadoes in the beginning of December:
-
-  +--------------------+-----------+-------+----------------+
-  | DISEASES.          | Admitted. | Died. | Proportion.    |
-  +--------------------+-----------+-------+----------------+
-  | Fevers             |       224 |    29 |        {  8    |
-  |                    |           |       | NEARLY {       |
-  | Fluxes             |        17 |     6 |        {  3    |
-  |                    |           |       |                |
-  | Scurvy             |        50 |     5 |        { 10    |
-  |                    |           |       | ONE IN {       |
-  | Ulcers             |        25 |    10 |        {  2½   |
-  |                    |           |       |                |
-  | Other Complaints   |        46 |     8 |        {  6    |
-  +--------------------+-----------+-------+-NEARLY-{-------+
-  |     Total          |       362 |    58 |        {  6    |
-  +--------------------+-----------+-------+----------------+
-
-It happened on this, as on the former occasion, that none were sent on
-shore but such as were very ill, or had contagious complaints, the rest
-being provided with refreshments on board of their ships. There were no
-wounds at this time, but there was a greater proportion of fevers; so
-that the complaints, upon the whole, might be said to be about equally
-dangerous. The mortality now was, however, considerably less, and this
-is to be imputed to the more favourable situation of the hospital,
-which I did not allow to be overcrowded; and the men had all manner of
-justice done them in point of attendance and accommodation.
-
-I shall give another example of the same kind in the hospital at
-Jamaica, when our fleet went there after the battle of the 12th of
-April. All the men accounted for here were landed from the fleet under
-Lord Rodney in May, June, and July, 1782[26].
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    NEARLY   |
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |       224 |    71 |           3 |
-  | Fluxes             |        65 |    23 |           3 |
-  | Scurvy             |        48 |    10 |           5 |
-  | Ulcers             |        92 |    21 |           4 |
-  | Wounds             |        70 |    18 |           4 |
-  | Other Complaints   |        40 |    18 |           2 |
-  +--------------------+-----------+-------+-------------+
-  |     Total          |       539 |   161 |           3½|
-  +--------------------+-----------+-------+-------------+
-
-This uncommon degree of mortality was not owing to the bad air of the
-place, for Port Royal is naturally as healthy as most parts in that
-climate; nor was it owing to bad accommodations, or to neglect of any
-kind; but is imputable entirely to this circumstance, that the hospital
-being extremely small, those only were sent to it who were very ill.
-There were at this time upwards of forty ships of the line at Jamaica,
-and an hospital, containing only three hundred beds, could afford but
-a very inadequate relief. Some officers are unwilling that any man
-should die on board of their ships, for fear of dispiriting the others;
-and many were sent to the hospital, in the most desperate stage of
-sickness, that they might there die.
-
-There cannot be a stronger proof than this of the fallacy of judging
-of the success of practice by the proportion of the deaths; for the
-sick on this occasion were better accommodated, better provided for in
-every respect, and as regularly attended, as at any other period of my
-service in the West Indies, yet the mortality was greater than at any
-other time.
-
-Having given instances of the common rate of mortality in hospitals in
-Europe and the West Indies, I shall next give examples of the success
-we had in North America, when the fleet was there in the autumns of
-1780 and 1782.
-
-
-ACCOUNT of the Sick landed at New York from the West-India Fleet,
-consisting of eleven Ships of the Line, in Autumn, 1780.
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    NEARLY   |
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |        34 |     9 |           4 |
-  | Fluxes             |       229 |    27 |           9 |
-  | Scurvy             |       433 |    40 |          11 |
-  | Ulcers             |        47 |     8 |           6 |
-  | Other Complaints   |        82 |    10 |           8 |
-  +--------------------+-----------+-------+-------------+
-  |       Total        |       825 |    94 |           9 |
-  +--------------------+-----------+-------+-------------+
-
-
-ACCOUNT of the Sick landed at New York from the West-India Fleet,
-consisting of twenty-six Ships of the Line, in Autumn, 1782.
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    NEARLY   |
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |       104 |    14 |           7 |
-  | Fluxes             |       131 |    14 |           9 |
-  | Scurvy             |       617 |    30 |          20 |
-  | Ulcers             |        74 |    10 |           7 |
-  | Other Complaints   |        70 |     4 |          17 |
-  +--------------------+-----------+-------+-------------+
-  |       Total        |       996 |    72 |          14 |
-  +--------------------+-----------+-------+-------------+
-
-The difference of mortality here, from what occurred in the West
-Indies, is partly imputable to climate, and partly to the smaller
-number of acute diseases. In the two accounts last stated, the
-difference in favour of the latter seemed chiefly to arise from the
-superior attention to the sick, and the better treatment of them. It
-was mentioned before, that in autumn, 1782, at New York, they were
-better supplied, both at hospitals and on board of their ships, with
-every thing that could be wished, and that on this occasion almost
-every scheme I had proposed was realised. The extraordinary success
-in the scurvy was owing to the great quantities of vegetables that
-were supplied; for several fields of cabbages had been planted in
-the neighbourhood of the hospital for the use of the sick. This was
-owing to the humane attention of Admiral Digby, who had also caused
-cows to be purchased to supply the hospital with milk. Cleanliness,
-and the separation of diseases, were also strictly attended to; and
-I am persuaded that many of the scorbutic men were saved by keeping
-them separated from the fevers and fluxes; for it has been observed,
-that men ill of the scurvy, or recovering from it, are very apt to be
-infected, particularly with the flux.
-
-It appears, that the disease in which climate makes the greatest
-difference is the flux. It was observable, that though the dysentery
-at this time was more fatal on board of the ships at New York than in
-the West Indies, yet it was less so at the hospital. The cause of this
-seems to be, that the acute state of this disease, of which men die on
-board before there is time to remove them to an hospital, is more fatal
-in a cold climate; but when it becomes more protracted, which is the
-case with most of the cases sent to hospitals, they then do much better
-in a cold than in a hot climate.
-
-I shall here subjoin an account of the numbers that were admitted, and
-died, during the whole war, at the hospitals of the different parts at
-which the fleets I was connected with touched.
-
-  +----------------------+-----------+-------+-------------+
-  | DISEASES.            | Admitted. | Died. | Proportion. |
-  +----------------------+-----------+-------+-------------+
-  |                      |           |       |    NEARLY   |
-  |                      |           |       |    ONE IN   |
-  +----------------------+-----------+-------+-------------+
-  | At Gibraltar         |      2131 |   203 |          10 |
-  |    Barbadoes         |      4604 |   861 |           5 |
-  |    Antigua           |      6099 |   914 |           7 |
-  |    St. Lucia         |      3363 |   478 |           7 |
-  |    St. Christopher’s |       853 |   142 |           6 |
-  |    Jamaica           |     10088 |  1672 |           6 |
-  |    New York          |     17880 |  2179 |           7½|
-  +----------------------+-----------+-------+-------------+
-  |      Total           |     45018 |  6449 |           7 |
-  +----------------------+-----------+-------+-------------+
-
-I have been able to calculate the numbers of deaths from disease in
-this great fleet, both on board and at hospitals, during the period
-of my own service, which was three years and three months, and they
-amounted to three thousand two hundred[27] independent of those that
-were killed and died of wounds.
-
-There died of disease in the fleet I belonged to, from July, 1780, to
-July, 1781, about one man in eight, including both those who died on
-board and at hospitals[28]. But the annual mortality in the West-India
-fleet, during the last year of the war, that is, from March, 1782,
-to March, 1783, was not quite one in twenty[29]. This difference was
-partly owing to the general increase of health in fleets as a war
-advances, partly to some improvements in victualling, and partly to
-better accommodations as well as regulations in what related to the
-care of the sick.
-
-Though the mortality in fleets in the West Indies is, upon the whole,
-greater than in Europe, yet it has so happened, that, in the late war,
-the fleet at home has, at particular periods, been considerably more
-sickly than that in the West Indies was at any one time. I was informed
-by Dr. Lind, that, when the grand fleet arrived at Portsmouth in
-November, 1779, a tenth part of all the men were sent to the hospital.
-It appears[30], that in the years 1780 and 1781, a period at which the
-fleet in the West Indies was most sickly, the medium of the numbers on
-the sick list was one in fifteen, and many of these were very slight
-complaints; whereas, in the fleet alluded to in England, the diseases
-were mostly fevers, and so ill as actually to be sent to the hospital.
-It appears likewise, that there was the greatest proportion of sick in
-our fleet when it was on the coast of America in September, 1780[31].
-This difference is owing to the greater prevalence of the ship fever,
-and of the scurvy, in a cold than in a hot climate.
-
-With regard to the mortality at hospitals, the comparison is greatly in
-favour of those in England. This is owing to the greater regularity,
-and the better accommodation and diet, which an hospital at home
-admits of, as well as to the difference of climate. It has also been
-mentioned, that, on most occasions, the hospitals I attended abroad
-were so limited as to contain only the worst cases, in consequence of
-which there would of course be a greater proportional mortality than
-in the great hospitals of England.
-
-The following is an account of the whole loss of lives from disease,
-and by the enemy[32], in three years and three months, in the fleets
-and hospitals with which I was connected:
-
-  Died of disease[33]       3200
-  Killed in battle           648
-  Died of wounds             500
-                            ----
-           Total[34]        4348
-
-
-
-
-PART II.
-
-OF THE CAUSES OF SICKNESS IN FLEETS, AND THE MEANS OF PREVENTION.
-
-
-
-
-INTRODUCTION.
-
-
-In the year 1780 I printed a small treatise for the use of the fleet,
-containing general rules for the prevention of sickness; and this part
-of the work is chiefly taken from it.
-
-My own opportunities of experience, as exhibited in the preceding
-Part, have been sufficiently extensive to suggest many observations on
-this subject; but as my object is utility, rather than the praise of
-originality, I shall not confine myself to these. Great part of what
-is to be advanced is taken from books[35] and conversation, as well as
-my own experience, my design being to exhibit a concise view of all
-the discoveries on this subject that have come to my knowledge. I have
-assumed nothing, however, from mere report or testimony, having had
-opportunities, from my own observations, of verifying or disproving the
-assertions of others.
-
-More may be done towards the preservation of the health and lives
-of seamen than is commonly imagined; and it is a matter not only of
-humanity and duty, but of interest and policy.
-
-Towards the forming of a seaman a sort of education is necessary,
-consisting in an habitual practice in the exercise of his profession
-from an early period of life; so that if our stock of mariners should
-come to be exhausted or diminished, this would be a loss that could not
-be repaired by the most flourishing state of the public finances; for
-money would avail nothing to the public defence without a sufficient
-number of able and healthy men, which are the real resources of a
-state, and the true sinews of war.
-
-In this view, as well as from the peculiar dependence of Britain on her
-navy, this order of men is truly inestimable; and even considering men
-merely as a commodity, it could be made evident, in an œconomical and
-political view, independent of moral considerations, that the lives and
-health of men might be preserved at much less expence and trouble than
-what are necessary to repair the ravages of disease.
-
-It would be endless to enumerate the accounts furnished by history
-of the losses and disappointments to the public service from the
-prevalence of disease in fleets. Sir Richard Hawkins, who lived in the
-beginning of the last century, mentions, that in twenty years he had
-known of ten thousand men who had perished by the scurvy. Commodore
-Anson, in the course of his voyage of circumnavigation, lost more
-than four fifths of his men chiefly by that disease. History supplies
-us with many instances of naval expeditions that have been entirely
-frustrated by the force of disease alone: that under Count Mansfeldt in
-1624; that under the Duke of Buckingham the year after; that under Sir
-Francis Wheeler in 1693; that to Carthagena in 1741; that of the French
-under D’Anville in 1746; and that of the same nation to Louisbourg in
-1757[36].
-
-That the health of a ship’s company depends in a great measure upon
-means within our power, is strongly evinced by this, that different
-ships in the same situation of service enjoy very different degrees of
-health. Every one who has served in a great fleet must have remarked,
-that out of ships with the same complement of men, who have been the
-same length of time at sea, and have been victualled and watered in
-the same manner, some are extremely sickly, while others are free from
-disease. Is it not naturally to be inferred from hence, that the health
-of men at sea depends in a great measure upon circumstances within the
-power of officers, and, indeed, upon their exertions, much more than
-medical care[37]?
-
-It has appeared in the preceding part of this work, that the diseases
-most prevalent among seamen are fevers, fluxes, and the scurvy. These
-are indeed some of the most fatal that can attack the human body; but
-there is a numerous tribe of complaints, which are also some of the
-most severe scourges of human nature, from which they are in a manner
-entirely exempt.--These are the diseases to which the indolent and
-luxurious are subject, and which so far embitter their life as to
-render their portion of worldly enjoyment nearly on a level with that
-of the poor and laborious. The diseases alluded to are chiefly the
-gout, stomach complaints, hypochondriac and other nervous disorders.
-In all countries it is the better sort of people that are most subject
-to these; for they are owing to the want of bodily exercise, to the
-great indulgence of the senses, and a greater keenness and delicacy in
-the passions and sentiments of the mind. Man being formed by nature for
-active life, it is necessary to his enjoying health that his muscular
-powers should be exercised, and that his senses should be habituated
-to a certain strength of impression. Animal and vegetable nature may
-be aptly enough compared to each other in this respect; for a tree or
-plant brought up in a greater degree of shelter and shade than what is
-suitable to its nature, will be puny and sickly; it will neither attain
-its natural growth nor strength of fibre, nor will it be able to bear
-the influence of the weather, nor the natural vicissitudes of heat and
-cold to which it may be exposed.
-
-It is to be remarked, however, that exercise and temperance may be
-carried to excess, and that in these there is a certain salutary
-medium; for when labour and abstinence amount to hardship, they are
-equally pernicious as indulgence and indolence. This is strongly
-exemplified in seamen; for, in consequence of what they undergo, they
-are in general short lived, and have their constitutions worn out ten
-years before the rest of the laborious part of mankind. A seaman, at
-the age of forty-five, if shewn to a person not accustomed to be among
-them, would be taken by his looks to be fifty-five, or even on the
-borders of sixty[38].
-
-The most common chronic complaints which a long course of fatigue,
-exposure to the weather, and other hardships, tend to bring on, are
-pulmonary consumptions, rheumatisms, and dropsies. It is also to be
-considered, that these complaints, particularly the last, are farther
-fomented by hard drinking, which is a common vice among this class of
-men, and they are led to indulge in it by the rigorous and irregular
-course of duty incident to their mode of life.
-
-With regard to gout, indigestion, hypochondriac complaints, and low
-spirits, there is something in hard labour of every kind that tends to
-avert them, and particularly in that rough mode of it peculiar to a sea
-life. There is also something in the harsh sensations from the objects
-which seamen are in use to see, hear, and handle, which so modifies
-their constitutions and hardens their nerves as to make them little
-liable to what may be called the diseases of excessive refinement,
-such as those above mentioned. I have, indeed, met with such diseases
-at naval hospitals; but I always remarked that they were in landsmen
-who had been pressed, and who had been bred to sedentary and indolent
-occupations.
-
-The diseases above enumerated, as well as most other chronic
-complaints, being the offspring of indolence and luxury, while fevers
-and feverish complaints fall equally on all ranks and descriptions
-of men, it was a saying of some of the ancients, that acute diseases
-were sent from heaven[39]; whereas chronic diseases were of man’s own
-creation. But I shall endeavour in the course of this work to evince,
-that, with regard to seamen at least, acute diseases are as much
-artificial as any others, being the offspring of mismanagement and
-neglect; with this difference, that they are imputable not so much to
-the misconduct of the sufferers themselves, as of those under whose
-protection they are placed.
-
-If I were to add any other complaint to the three already mentioned,
-as most prevalent, and peculiar to a sea life, it would be those foul
-and incurable ulcers which are so apt to arise at sea, particularly
-in a hot climate. The slightest scratch, or the smallest pimple, more
-especially on the lower extremities, is apt to spread, and to become
-an incurable ulcer, so as to end in the loss of a limb. The nature of
-the diet, and the malignant influence of the climate, both conspire in
-producing them.
-
-The diseases most frequent and prevalent at sea have this advantage,
-that they are more the subjects of prevention than most others, because
-they depend upon remote causes that are assignable, and which increase
-and diminish according to certain circumstances, which are in a great
-measure within our power.
-
-The prevention of diseases is an object as much deserving our attention
-as their cure; for the art of physic is at best but fallible, and
-sickness, under the best medical management, is productive of great
-inconvenience, and is attended with more or less mortality. The means
-of prevention are also more within our power than those of cure; for
-it is more in human art to remove contagion, to alter a man’s food
-and cloathing, to command what exercise he is to use and what air he
-is to breathe, than it is to produce any given change in the internal
-operations of the body. What we know concerning prevention is also more
-certain and satisfactory, in as much as it is easier to investigate the
-external causes that affect health than to develope the secret springs
-of the animal œconomy.
-
-This part of the work, therefore, is chiefly addressed to those who
-direct the navy either in a civil or military capacity; for the general
-health of ships depends so much upon the victualling and manning in
-the first instance, and, afterwards, on the degree of discipline and
-order which are kept up, that I am persuaded that a certain degree of
-attention on their part would almost entirely eradicate disease from
-our fleets.
-
-Several remarks in this part of the work will be found so obvious,
-that it might seem superfluous to mention them. But it has been my
-intention to omit nothing that I have heard of or observed as a matter
-of ascertained utility, and, I believe, the most experienced will find
-either something new, or what they had not before sufficiently attended
-to. Though the design of it is that of being extensively useful, yet my
-trouble would be compensated, should it prove the means of health and
-comfort to a single ship’s company; nay, I should not repent my labour,
-could I enjoy the conscious certainty of its being the means of saving
-the life of one brave and good man.
-
-The prevention of disease has relation only to the external causes that
-affect health, and I shall consider these under the four heads of
-
-  I. AIR,
-  II. ALIMENT,
-  III. EXERCISE,
-  IV. CLOATHING.
-
-
-
-
-CHAP. I.
-
-AIR.
-
-
-Under this head I shall not only consider the natural state of the air
-of the atmosphere in point of heat and cold, moisture and dryness,
-purity and corruption, but also the different artificial impregnations
-of it from the holds or other parts of a ship, or from the persons of
-men who have been neglected in point of cleanliness.
-
-The common air of the atmosphere at sea is purer than on shore, which
-gives to a sea life a very great advantage over a life at land. This
-advantage is still greater in the tropical regions, where the land
-air, especially such as proceeds from woods and marshes, is so fatal,
-and where the heat is also considerably less at sea than on shore. But
-this superior purity of the air at sea is more than counterbalanced
-by the artificial means of propagating diseases on board of a ship.
-Since a sea life, however, has this great natural advantage to health,
-the causes of disease peculiar to it are chargeable rather to the
-mismanagement of men than to any thing unavoidable in nature; and we
-are from this encouraged to exert our endeavours in removing them.
-
-The effects of land air, however, are not to be neglected by those who
-are studious of preserving the health of a ship’s company, for seamen
-are exposed to it in various ways while they are in harbour; and this
-is what we shall first treat of.
-
-
-SECT. I.
-
-Of the noxious Effects of LAND AIR in particular Situations.
-
-All the diseases incident to a fleet, except the scurvy, are more
-apt to arise in a harbour than at sea, and particularly the violent
-fevers peculiar to hot climates. There are generally woods and marshes
-adjacent to the anchoring places in the West Indies, and the men are
-exposed to the bad air proceeding from thence, either in consequence of
-the ship’s riding to leeward of them, or of people’s going on shore on
-the duties of wooding and watering. Instances of this, without number,
-might be adduced from the accounts of voyages to all the tropical
-countries. Our fatal expeditions to the Bastimentos, and to Carthagena,
-in former wars, are striking proofs of it; and we have seen the same
-effects, though in a much less degree, while the fleet was at Jamaica
-in 1782.
-
-I have known a hundred yards in a road make a difference in the
-health of a ship at anchor, by her being under the lee of marshes in
-one situation, and not in the other[40]. Where people at land are so
-situated, as not to be exposed to the air of woods and marshes, but
-only to the sea air, they are equally healthy as at sea. There was a
-remarkable instance of this on a small island, called Pidgeon Island,
-formerly described, where forty men were employed in making a battery,
-and they were there from June to December, which includes the most
-unhealthy time of the year, without a man dying, and with very little
-sickness among them, though they worked hard, lived on salt provisions,
-and had their habitations entirely destroyed by the hurricane. During
-this time near one half of the garrison of St. Lucia died, though in
-circumstances similar in every respect, except the air of the place,
-which blew from woods and marshes.
-
-The duties of wooding and watering are so unwholesome, that negroes,
-if possible, should be hired to perform them. In general, however, the
-employing of seamen in filling water and cutting wood is unavoidable,
-but it should be so managed as not to allow them, on any account,
-to stay on shore all night; for, besides that the air is then more
-unwholesome, men, when asleep, are more susceptible of any harm, either
-from the cold or the impurity of air, than when awake and employed.
-
-As the service necessarily requires that men should be on shore more
-or less, however unwholesome the air may be, means are to be used
-to prevent its pernicious impressions on the body. Certain internal
-medicines, such as bitters, aromatics, and small quantities of
-spirituous liquors, tend to preserve the body from its bad effects.
-Of the bitters, Peruvian bark is, perhaps, the best; and there is a
-well-affected instance of its efficacy in the account given by Mr.
-Robertson of a voyage in the Rainbow to the coast of Africa; and by
-the same means Count Bonneval and his suite escaped sickness in the
-camps in Hungary, while half of the army were cut off by fevers. In
-consequence of Mr. Robertson’s representation of the effects of bark
-in curing and preventing the fevers of that climate, the ships of
-war fitted out for the coast of Guinea have been supplied with it
-gratuitously, and Government would find its account in extending this
-bounty to all the tropical stations.
-
-We have seen, in the former part of this work, that the fever produced
-by the impure air of marshes may not appear for many days after the
-noxious principle, whatever it is, has been imbibed; men having been
-sometimes seized with it more than a week after they had been at sea.
-It naturally occurs, therefore, that something may be done in the
-intermediate time to prevent the effects of this bad air; and nothing
-is more adviseable than to take some doses of Peruvian bark, after
-clearing the bowels by a purgative. Some facts, related in the first
-part of this work, show that an interval of ten days or a fortnight may
-elapse between the imbibing of the poison and its taking effect. And,
-in order to guard against the diseases of this climate in general, it
-would be more proper to take some large doses of bark once in either
-of these periods, than to make a constant practice of taking a little,
-as I have known some people do, by which they may also render their
-body in some measure insensible to its good effects. I knew a physician
-of some eminence in the West Indies, who always enjoyed uninterrupted
-health, and he imputed it to his taking from half an ounce to an ounce
-of bark every change and full of the moon, as he thought that fevers
-of the intermitting and remitting kind, were more apt to occur at
-these periods. Whether this idea be well founded or not, the practice
-is proper, upon the other principle that has been mentioned, and the
-phases of the moon will at least serve as an aid to the memory.
-
-The spices of the country, such as capsicum and ginger, for which
-nature has given the inhabitants of the torrid zone an appetite, have
-also been found powerful in fortifying the body against the influence
-of noxious air. Either these, or the bark, or similar substances, of a
-bitter and aromatic nature, given in a glass of spirits to men going
-upon unwholesome duty, have been found to have a powerful effect in
-preventing them from catching the fevers of the climate. The practice
-may be thought too troublesome in the hurry of service in a great
-fleet; and I in general avoid mentioning any thing but what is easily
-practicable, and highly important to the body of seamen at large; but
-such a precaution may be of service at least to officers, or to a
-ship’s company, when service is easy, or on a small scale.
-
-But besides the poisonous effluvia of woods and marshes, the sensible
-qualities of the air are also to be attended to. If I were required to
-fix on the circumstances most pernicious to Europeans, particularly
-those newly arrived in the West Indies, I would say, that they are too
-much bodily exercise in the sun, and sleeping in the open air; and the
-practices most hurtful next to these are, intemperance in drinking,
-and bad hours. The sickness and mortality among new comers may, in
-general, be imputed to some one of these causes. It is in favour of
-this opinion that women are not subject to the same violent fevers as
-the other sex, which is probably owing to their not giving into the
-above-mentioned irregularities.
-
-The last direction I shall mention with regard to the preservation of
-health in a harbour is, that the ship should be made to ride with a
-spring on the cable, that the side may be turned to the wind, whereby
-a free ventilation will be produced, and the foul air from the head,
-which is the most offensive part, will not be carried all over the
-decks, as it must be when the ship rides head to wind.
-
-Having little experience of my own with regard to diseases at sea in
-cold climates, I cannot recommend any particular precautions; but
-Dr. Lind thinks that garlick infused in spirits is one of the best
-preservatives against the bad effects of cold and wet. The French ships
-of war are furnished with great quantities of garlick as an article
-of victualling, and its effects seem to be very salutary. It would
-appear, that substances of this kind are very conducive to health in
-hot climates also. I was informed by Capt. Caldwell, that, when he
-commanded a sloop of war on the coast of Guinea, he was supplied with
-a large quantity of shalots by a Portuguese about the time he left the
-coast, and his men were remarkably healthy on the passage to the West
-Indies, while the other ships in company, who wanted this supply, were
-very sickly.
-
-But besides the obvious and sensible qualities of the air above
-mentioned, there are certain obscure properties which we do not
-understand, and which we find difficult to investigate; for there are
-diseases prevailing in certain places which seem to depend on some
-latent state of the air. Of this kind is the complaint of the liver,
-so common in the East Indies, yet almost entirely unknown in the West
-Indies; and in the West Indies there are certain diseases which prevail
-in one island and not in another; such as the _elephantiasis_[41]
-of Barbadoes, which is an affection of the lymphatics peculiar to
-that island. In the climates of Europe there are also certain obscure
-conditions of the air that favour one epidemic more than another, and
-in some years more than others[42]. All this is very mysterious to us;
-and although we could detect these properties of the air, we probably
-could not prevent their bad effects, since man must every where breathe
-the air, whatever its qualities may be.
-
-
-SECT. II.
-
-Of FOUL AIR from the Neglect of Cleanliness in Men’s Persons--INFECTION.
-
-Nature has wisely so contrived our senses and instincts, that the
-neglect of cleanliness renders a person loathsome and offensive to
-himself and others, thereby guarding against those fatal diseases that
-arise from bodily filth. The noxious air we speak of is generated
-by men keeping the same clothes too long in contact with the body,
-while they are at the same time confined and crowded in small and
-ill-ventilated apartments. Such is the origin of the jail fever,
-otherwise called the ship and hospital fever; and it seems to be with
-reason that Dr. Cullen ascribes the low, nervous fever of Britain to
-a similar origin, being caused, as he thinks, by an infection of a
-milder kind, arising in the clothes and houses of the poor, who, from
-slovenliness or indigence, neglect to change their linen, and air
-their houses.
-
-Man is evidently more subject to disease than any other species of the
-animal creation, owing partly to the natural feebleness of his frame,
-but still more perhaps to the artificial modes of life which his reason
-leads him to adopt. There is no circumstance of this kind by which
-health is more affected than by clothing. Some of the most fatal and
-pestilential diseases are produced and communicated by it; for we see
-that the greater number of fevers, particularly those of the low and
-malignant sort, may be traced to the want of personal cleanliness.
-
-There are few subjects more mysterious and difficult of investigation
-than this of infection. The origin of specific contagions, such as
-the small pox and the venereal disease, seems to be almost beyond the
-reach of a conjecture; and why all the contagions we know, excepting
-that of the bite of a mad dog, should be confined to one species of
-animal, their effects not being communicable to any other, is equally
-unaccountable. Why is the body incapable of being affected more
-than once by certain morbid poisons; and whence comes the striking
-and curious differences of susceptibility to infection in different
-individuals at the same time, and of the same individual at different
-times?
-
-It would appear that the infection of fever, which we are chiefly to
-consider here, does not, like some of the diseases above mentioned,
-depend on the continued propagation of a certain poison, but that it
-may spontaneously arise from a concurrence of circumstances, producing
-a long stagnation of the effluvia of the body on the clothes, for want
-of clean linen, while people are excluded from the free air, as in
-jails, hospitals, or ships.
-
-In order, therefore, to preserve the crews of ships from such diseases,
-means should be taken not only to prevent the introduction of infection
-already existing, but to prevent the generation of it on board.
-
-
-1. Means of preventing the Introduction of Infection.
-
-War being a state of violence and confusion, in which the hurry and
-emergency of service may be such as to render it impossible to put
-in practice all the rules which might be laid down concerning the
-preservation of health, yet it is necessary that those who direct
-the navy, either in a civil or military capacity, should be aware of
-the causes of sickness and mortality, in order to guard against them
-as far as is practicable. From an indolent acquiescence in this idea
-of the hardships and inconveniences of war being unavoidable, I have
-known neglect to arise in the conduct of officers with regard to those
-under their command, as if it was not the duty of a commander to employ
-his utmost attention to alleviate the misfortunes and mitigate the
-sufferings of his fellow creatures; and we have seen that much more
-of the calamities of war arise from disease than from the sword. The
-like excuse might be framed for the neglect of stores and arms, which,
-the hurry of service might equally expose to injury. We see, indeed,
-infinite pains taken to prevent cordage from rotting, and arms from
-rusting; but however precious these may be as the necessary resources
-of war, it will not be disputed that the lives of men are still more
-so; yet, though there is the additional inducement of humanity to
-watch over the health of men, I do not think that this, in general, is
-studied with a degree of attention equal to what is bestowed on some
-inanimate objects.
-
-Ships of war are exposed to infection chiefly by receiving such men
-as have been raised by pressing, who are frequently confined in
-guardships, under such circumstances of bad air and bodily filth
-as tend to generate the most virulent infection. The service also
-requires sometimes that men be received from jails, and they are either
-criminals delivered over by the civil jurisdiction of the country,
-or captives who have been restored by the enemy after a course of
-confinement in their prisons. It may happen too, as we have seen[43],
-that the enemy, who are made prisoners at sea, may have infection about
-them, and will communicate it the more readily that they are strangers.
-
-There are few fevers but what are infectious at some stage or other of
-the disease; but it is not necessary that fever should actually exist
-in order to create infection. In the most violent and pestilential
-fevers, such as have sometimes originated in the jails of England, the
-persons who communicated them were not affected with it themselves[44].
-Infection, like some other poisons, does not affect those who are
-accustomed to it, and therefore those who are in the habit of being
-exposed to it frequently escape its bad effects, especially if it is
-gradually applied, as must be the case with those about whose persons
-it is generated. For the like reason, physicians and nurses are less
-susceptible than others; and strangers, who are accustomed to a pure
-air, are the most susceptible of any. It is observed by Dr. Short,
-that contagious epidemics are more frequent and fatal in the country
-than in London, and this may probably be accounted for on the same
-principle; for every person in a great town is exposed to the breath
-and effluvia of others, and to a variety of putrid exhalations, which
-are unavoidable where multitudes inhabit together; but they are so
-used to them, that they are not affected by them; whereas in the
-country, where people are less accustomed to each other’s company,
-and less used to impure air in general, they are the more readily
-affected when infection is introduced among them. It may even admit
-of a doubt if any society of men, living together, are entirely free
-from morbid contagion. It certainly sometimes happens, that a ship,
-with a long-established crew, shall be very healthy; yet, if strangers
-are introduced among them, who are also healthy, sickness will be
-mutually produced. This principle in the human constitution, by
-which the presence of strangers affects it, is well illustrated by a
-fact[45], founded on the best testimony, that, in one of the small
-western islands of Scotland, which is so remote, that the inhabitants
-are frequently without any communication with strangers for several
-months together; they become so susceptible, in consequence of this
-long interruption of intercourse, that they are seized with a catarrh
-when strangers of any description come among them. It was said before,
-that cleanliness was founded on a natural aversion to what is unseemly
-and offensive in the persons of others; and there seems also to be
-implanted in human nature, for the same purpose, an instinctive horror
-at strangers, as is visible in young children and uncultivated people.
-In the early ages of Rome, one word signified both a stranger and an
-enemy[46].
-
-These observations naturally suggest several useful and practical
-remarks. It would appear that the utmost attention is necessary not
-only to guard against the actual presence of disease, but to be
-jealous of all new draughts of men, especially if they should come
-from guardships, jails, or tenders, and have been turned over from
-ships where disease is known to have prevailed; nay, that it is best
-to avoid mixtures of any kind.
-
-The infection of fevers seems different from most others in this,
-that it is very various in its degrees of virulence. There is reason
-to think that the poison of the small pox, and that of the venereal
-disease, are in their own nature invariable, and that the difference
-of these diseases, in point of malignancy, depends on the constitution
-and other circumstances of those affected; whereas that of fevers
-being of different degrees of activity, and being frequently obscure
-and latent, is, on that account, the more treacherous, and ought to be
-watched with the greater circumspection.
-
-The mode of manning the navy by pressing, I take it for granted, is
-unavoidable; at any rate, it would not become me to arraign a practice
-which has had the public sanction for ages. It is, however, one of
-the principal means both of generating and spreading the seeds of
-disease, in consequence of the indiscriminate seizure of men for the
-public service, and the confinement that is necessary to secure them.
-And as the exigences of the service make it necessary to admit persons
-of every description, there is no other remedy for this evil but to
-annihilate, if possible, the contagion that may thus be conveyed into
-ships of war. This is done by stripping and washing the new recruits
-who may be suspected of importing infection; also by cutting off their
-hair, clothing them with new clothes, and destroying the old, before
-they are allowed to mix with the ship’s company in which they are to
-enter.
-
-Those who have put these methods strictly in practice, have been
-sensible of their great utility; and the most exact attention is
-necessary, as a single infected man, or even any part of his clothing,
-may spread sickness through a whole ship’s company. When we reflect
-what havock an infectious fever sometimes makes in a ship, it will
-appear how very important this fort of attention is; and when the
-cause of the sickliness of particular ships is traced to its source,
-it will generally be found to have originated from taking on board
-infected men at Spithead, or wherever else the ship’s company may have
-been completed.
-
-After the first edition of this part of the work was printed, an
-excellent institution was established at Portsmouth for the prevention
-of infection. A ship was appointed for the reception of the recruits
-of the fleet to which they were carried, to be stripped, washed, and
-provided with new apparel, before they joined their respective ships.
-This had a visible good effect on the health of the fleet; and it was
-planned and executed by Sir Charles Middleton, Comptroller of the Navy,
-whole unwearied assiduity, as well as integrity and ability in that
-important post, claim the highest praise and gratitude from his country.
-
-It follows farther, from the preceding observations, that there is a
-sort of risque in mixing two different sorts of men, even when there
-is no actual disease or suspicion of infection; for, whether it is from
-dormant infection, or merely from the circumstance of change of air,
-such mixtures are known from experience to be sometimes productive
-of sickness. The late Admiral Boscawen was so sensible of this, that
-he avoided it, unless when some evident utility or necessity of
-service made it proper; and upon this principle he used to resist the
-solicitation of captains when they requested to carry men from one ship
-to another upon changing their commands.
-
-One probable reason, among others, for ships of the line being more
-sickly than frigates or smaller ships is, that in greater numbers there
-is a greater chance of men of various descriptions and modes of life
-being mixed together.
-
-
-2. Means of preventing the Production of Infection.
-
-The infection of fever is not always imported from without, but may
-be originally and spontaneously generated on board. The causes of
-this, as mentioned before, are want of personal cleanliness, and also
-confinement and crowding in close apartments.
-
-In order to promote cleanliness, care should be taken that every man,
-on his first entering into the service, be provided with a proper
-change of linen, and that a frequent muster and review be made, in
-order to inspect their persons, and to examine their stock of apparel.
-A true seaman is in general cleanly, but the greater part of men in
-a ship of war require a degree of compulsion to make them so; and
-such is the depravity of many, that it is common enough for them to
-dispose of their clothes for money to purchase spirituous liquors. A
-muster and review, therefore, wherein men should be obliged once in
-the week to present themselves clean before their officers, and to
-produce a certain necessary quantity of clean apparel, would conduce
-both to sobriety and cleanliness. The exertion of authority, and the
-infliction of punishment, is so far from being considered by the men
-as a hardship, that they expect it; and it is the duty of an officer,
-as it is of a parent to a child, to constrain those entrusted to his
-care to perform what is for their good. It is common also for men to
-lay up their clothes in a wet and unwashed state, which in time is
-productive of the most offensive and unwholesome vapours; and this can
-be prevented only by their chests and bags being frequently inspected
-by their superiors.
-
-It must be evident to any one who reflects on this subject, that a
-regulation of this kind is as necessary as any other part of duty; and
-it deserves to be made an article in the public instructions, instead
-of being left to the discretion of officers. This sort of discipline
-is particularly necessary in ships of the line, in which one cause of
-the greater unhealthiness is the difficulty of taking cognizance of
-so great a number; for, unless some regular method, as by muster, is
-established, there will be men who will escape notice, and skulk below,
-indulging in laziness and filth.
-
-The good sense and humanity of many captains in the late war, led
-them to adopt certain methodical regulations for the preservation of
-cleanliness and order. The only public sanction given to this sort of
-discipline, was that of Lord Howe, who gave it in orders to those under
-his command, that each ship’s company should be divided into as many
-divisions as there were lieutenants, and that these should be divided
-into squads, with a midshipman appointed to each; and that the officers
-should be respectively responsible for the good order and discipline of
-the men assigned to them.
-
-It is an excellent custom, and pretty general in the navy, to allow
-the men one day in the week for washing, when the weather and other
-circumstances will admit of it. It would be a farther improvement in
-the rules of the service to supply sope in the same manner as tobacco
-and slops are supplied, that is, to let the men have what quantity
-they want from the purser, who is allowed to charge it against their
-wages[49].
-
-Next to want of cleanliness, the circumstances most apt to give rise
-to infection are, close air and crowding. A certain length of time is
-necessary, in order that these should have this effect, and the longer
-they take place, the more certainly will infection be produced, and it
-will be the more virulent[50].
-
-In order to admit air freely, the ports should be kept open whenever
-the weather will permit this to be done. The great objection to free
-ventilation is the danger of exposing men to the air in cold climates.
-But it fortunately happens, that fire, while it is the most effectual
-means of counteracting the cold air, is also the best means of
-promoting ventilation; for wherever there is fire, there is a constant
-change of air taking place by means of the draught to which it gives
-occasion. This cannot be done with safety and convenience in all parts
-of the ship; but frequent fires in the lower parts of a ship will prove
-extremely salutary by drying up the moisture, and producing a change of
-air, and also in a cold climate by the warmth it produces.
-
-The hammocks and bedding should also be aired by exposing them upon
-deck, especially after the ports have been long shut in consequence
-of bad weather. They cannot be thoroughly aired unless they are
-unlashed; and as this could not be conveniently done daily in men of
-war, it might be done from time to time by the different divisions
-in rotation[51]. When the men come to sleep upon them after these
-operations, they experience the same agreeable sensations as from a
-change of linen; and this must conduce to health as well as pleasure,
-like all other natural and moderate gratifications. It may be farther
-remarked in favour of cleanliness, that it is not only directly
-conducive to health, but is naturally connected with habits of good
-order, sobriety, and other virtues. The most cleanly men are always the
-most decent and honest, and the most slovenly and dirty are the most
-vicious and irregular.
-
-A ship of war must have a much greater number of men on board than what
-are necessary to navigate her; for, besides the marines, a great many
-hands are necessary to man the great guns in time of action. For this
-reason, there is a greater risque of the inconveniences of overcrowding
-than in ships intended for commerce, and therefore much greater
-attention is necessary with regard to ventilation and cleanliness.
-There is a piece of management which tends also in some measure to
-obviate the necessity of crowding. This is to berth the watches
-alternately, by which it is meant, that one half of each watch should
-lie on different sides, whereby they do not sleep so close, and are not
-so much exposed to each other’s breath and to the heat and effluvia of
-each other’s bodies. This has the farther advantage of preserving the
-trim of the ship.
-
-What has been said of the ship and men in general, applies still more
-strongly to the sick, and the berth[52] assigned to them; for there is
-nothing so apt to increase, and even generate, contagion, as a number
-of sick together, unless uncommon attention is paid to cleanliness
-and ventilation. This is so true, that, unless where the complaint is
-very catching, it is best not to separate the sick; for if they are a
-good set of men on board, those who are confined by sickness will be
-better nursed and tended by their messmates than in a sick berth. But
-if the state of infection renders separation necessary, the best part
-for the accommodation of the sick, in a ship of the line, is under the
-forecastle in a warm climate, and on the fore part of the main deck in
-a cold one. When they are under the forecastle, however, they ought
-to occupy only one side, as they would otherwise be disturbed by the
-men who must pass to and from the head, and the men in health would, in
-this case, be exposed also to contagion. As infection is most likely
-to arise among the sick, attention to cleanliness and air is doubly
-requisite where they lie; and it has a good effect to sprinkle hot
-vinegar and diffuse its steams among them once or twice a day.
-
-Thus we see that cleanliness and discipline are the indispensable and
-fundamental means of health, without which every other advantage and
-precaution is thrown away. Government never bestowed more attention
-and expence upon the victualling of the navy than during the late war;
-but it would be to little purpose to provide the most nourishing and
-antiscorbutic diet, the most wholesome and cordial wines, the most
-efficacious remedies, and the most skilful physicians and surgeons,
-if the men are not constrained to keep their persons sweet, their
-clothing and bedding clean, and their berths airy and dry. It is,
-therefore, upon officers more than any others that the health of the
-fleet depends; and I should be excused in the frequent mention I make
-of this, were it known how often I have been the witness of the fatal
-effects of the neglect of these rules.
-
-
-3. Means of eradicating Infection.
-
-When, from a neglect of the means above mentioned, an infectious
-fever comes actually to prevail, and the infection, perhaps, adheres
-obstinately to the ship in spite of cleanliness, good air, and diet,
-and all the other means, which, if employed in due time, would have
-prevented it, then some measures are to be taken for eradicating this
-subtile poison.
-
-The first step towards this is, to prevent the disease from spreading,
-and this is done by separating the sick from the healthy, and cutting
-off all intercourse as much as possible. For this end, it is necessary
-to appropriate a particular berth to contagious complaints, and not
-only to prevent the idle visits of men in health, but to discover and
-separate the persons affected with such complaints as soon as possible,
-both to prevent them from being caught by others, and because recent
-complaints are most manageable and curable. Officers might be very
-useful in making an early discovery of complaints, by observing those
-who droop and look ill in the course of duty; for seamen think it
-unmanly to complain, and have an aversion to be put on the sick list.
-I have heard of a method practised in some ships, of keeping a book on
-the quarter deck for the officer to mark the names of such men as might
-look ill, or might be missed from duty upon calling the roll, in order
-to afford the surgeon a means of finding out those who should be the
-objects of his care.
-
-Those whose profession it is to superintend the health of the ship,
-would find it for their ease and interest, and should consider it as
-their duty, to walk over the different decks once a day, or every other
-day, in order to make an early discovery of those who may be taken
-ill. Though I have laid great stress on the duty of the commander, as
-the proper guardian of health, yet his assiduity will not avail unless
-the surgeon also does his part, by such acts of attention as I have
-mentioned, joined to skill in his profession.
-
-Surgeons are, perhaps, more regarded in our service than in that of
-other nations; but it would be for the public benefit if they were
-still more respected and encouraged. To men of liberal education
-and sentiments, as surgeons ought to be, and generally are, the
-most effectual inducements for them to do their duty are flattering
-attentions, and a certain degree of estimation in the eyes of their
-officers. Liberality of manners, on the part of superiors, is the most
-likely means of encouraging a conscientious performance of duty in this
-profession; for though strict and distant behaviour may operate upon
-the minds of those whose functions are merely mechanical, how can it
-infuse that tender attention to human sufferings, and that sense of
-duty, which may induce a man entrusted with the health and lives of his
-fellow creatures to act his part with propriety and effect?
-
-In order to prevent sickness from spreading, it is not sufficient to
-cut off all personal intercourse. The clothes of men are as dangerous
-a vehicle of infection as their persons; and it should be a strict and
-invariable rule in case of death from fever, flux, or small pox, to
-throw overboard with the body every article of clothing and bedding
-belonging to it.
-
-Upon the same principle, in case of recovery from any contagious
-disease, as it would be too great a waste to destroy the clothes and
-beds, they should be smoked, and then scrubbed or washed before the
-men join their messes and return to duty. This precaution is the more
-necessary, as infection in a ship is extremely apt to be communicated
-by bedding, from the custom of stowing the hammocks in the netting, by
-which they are brought in contact with each other. This, however, is
-an excellent custom, as it not only clears the ship below, and serves
-to form a barricade on the gunwale, but tends to air the bedding; and
-this salutary effect should not be prevented, except in case of rain,
-by the coverings, called hammock-cloths, by the use of which utility is
-evidently sacrificed to an excess of neatness.
-
-It sometimes happens that the number of sick in a ship is so great,
-that it is not possible to take proper and effectual measures on board
-for stopping the progress of disease. But when she can be cleared of
-the sick by sending them to an hospital, no pains should be spared to
-extirpate the remaining seeds of infection.
-
-For this purpose, let their clothing and bedding be sent along with
-them; let their hammocks, utensils, and whatever else they leave
-behind, be smoked, and either scrubbed or washed before they are used
-by other men, or mixed with the ship’s stores; let the decks, sides,
-and beams of their berths, be well washed, scraped, smoked, and dried
-by fire; then let them be sprinkled with hot vinegar, and, finally,
-white-washed all over with quick lime.
-
-Should any officer object to the trouble and inconvenience of all
-this, let him reflect for a moment how much more troublesome and
-inconvenient, as well as noisome and disagreeable, sickness itself
-proves to be; let him reflect that the efficiency of the ship,
-considered as a bulwark of defence, or an engine of annoyance, depends
-on the number of healthy hands, and that his own character is to depend
-on the exertions to be made by them in the day of battle, not to
-mention the attention due from him as a man to the sufferings of the
-objects themselves.
-
-But besides these recent infections, it sometimes happens that the
-seeds of disease adhere to the timbers of a ship for months and years
-together, and can be eradicated only by a thorough cleansing and
-fumigation. Sweeping, washing, scraping, and airing, are not sufficient
-entirely to remove the subtile infectious matter; but they will
-assist and will prepare it to be acted upon by heat and smoke, which
-are the only means to be depended upon. A complete fumigation can only
-be performed when the ship is in dock; and I shall here transcribe a
-method recommended by Dr. Lind.
-
-“It will be proper to remove every thing out of the ship, so that the
-hold may be swept, and, when the men have withdrawn, to light a number
-of charcoal fires in different parts, and to throw a handful or two of
-brimstone on each. The steam of these should be closely confined by
-shutting the ports and hatchways from morning till evening, no person
-in the mean time being allowed to go below, nor for some time after
-opening the ports and hatchways, that the steam may be dispersed.
-
-“In order to purify the men’s clothes, it would farther be proper to
-fumigate the hulk into which they are removed with tobacco once or
-twice a week while their ship is in dock, the men remaining below as
-long as they can bear it.
-
-“The clothes and hammocks of the men should be exposed in the hulk
-to the smoke of the tobacco, and those which are more particularly
-suspected may be hung up the ship, and exposed to the steam of the
-charcoal and brimstone.
-
-“The ship having been already fumigated with tobacco, it will be
-sufficient to use the fumigation of charcoal and brimstone above
-described for three days, and, after the last day’s fumigation, the
-inside of the ship should be well washed with boiling vinegar, and,
-before the men return on board, all the decks should be scraped and
-washed.”
-
-When a ship is at sea, these precautions cannot be taken so completely;
-but if infection is present, or is suspected, then cleansing and
-fumigating may be practised in a less degree. I have known a ship at
-sea fumigated with gunpowder kneaded with vinegar, so as to prevent it
-from exploding, and to make it burn slowly with a spattering flame.
-Flowers of sulphur[53], with about an eighth part of nitre, will
-answer still better. A quantity of these is placed in each interval
-of the guns between decks, every person being turned up, and the
-ports and hatches shut till they are consumed, and till the smoke has
-dispersed. It has also been recommended to burn resinous bodies, such
-as the woods of fir, spruce, and juniper, as the smoke of these is more
-salutary. Upon the same principle, the effluvium of tar is thought
-wholesome; and the cables that are coiled in the lower parts of a ship
-being soaked with tar, like most of the other ropes of a ship, probably
-conduce to the health of a place otherwise dank and unwholesome.
-Fumigation may also be performed by means of tar, either by throwing it
-on red-hot irons, or a wood fire, which may be carried about between
-decks in a pot or moveable grate, or over some cannon balls in a tub,
-or by immersing a red-hot loggerhead[54] in a bucket of tar. If this
-is done in the place occupied by the sick, it will have a still better
-effect; and it will be of service to them to be removed for a short
-time under the half deck or forecastle till this or other means of
-purification are put in practice. In whatever manner fumigation is
-performed, it will be of service to spread out the clothes and bedding
-of the men, or to hang them upon lines, that they may be exposed to the
-heat and smoke.
-
-It will also be of great service to make the men expose their frowsy
-clothes to the sun and wind. If a strong infection is suspected,
-and it cannot be afforded to destroy the clothes, the best means of
-eradicating the poison is to hang them for a length of time over pots
-of burning brimstone in a large cask standing endways, with small
-apertures to admit air enough for the brimstone to burn.
-
-Fire in every shape is to be considered as the principal agent of
-purification, by its heat and the ventilation it occasions, perhaps,
-still more than its smoke. It has already been repeatedly inculcated,
-that the great enemies of infection are ventilation and heat. I have
-mentioned smoke and the effluvia of balsamic bodies, but these are
-not to be depended on; and it is the more necessary to mention this,
-as the attention bestowed on more trifling means may divert the mind
-from a proper regard to what is more essential. It is mentioned by the
-benevolent Mr Howard, that it is the custom in some parts abroad to
-scatter fresh branches of pine or spruce in the hospitals, in order to
-purify the air; but, trusting to this, they neglect the admission of
-fresh air, which is the only effectual method of sweetening the air.
-
-There is reason to think that the open air very soon dissipates and
-renders inert all infections of the volatile kind, and of course the
-warmer the air is the more readily it will have this effect. It is
-accordingly observed, that infection is much less apt to be generated
-about the persons of men, and that it adheres to them for a much less
-space of time in a hot climate than in a cold or temperate one. This
-is a remark, which, so far as I know, has not been made by any author;
-and, till observation suggested it to me, I fancied the reverse to
-be the truth. I have seen so many instances of filth and crowding
-in ships and hospitals in the West Indies, without contagion being
-produced, and which in Europe could hardly have failed to produce it,
-or to render it more malignant, that I am convinced there is something
-in tropical climates unfavourable to the production and continuance of
-infectious fevers[55]. The ships which bring this fever from Europe
-in general get rid of it soon after arriving in a warm climate; and
-nothing but the highest degree of neglect can continue or revive it.
-
-The facts above mentioned brought into my mind what is related of the
-plague at Smyrna and other places, that it disappears at the hottest
-part of the year. It is also curious and important to remark, that the
-true pestilence never has been heard of between the tropics. It is not
-easy to assign the cause of this effect of heat upon infection, as
-every thing relating to this subject is very obscure. We can conceive
-it to be owing to the greater degree of airiness which the heat of
-the climate makes necessary, or to the use of fewer woollen clothes.
-There may be something in the state of the body, particularly in the
-pores of the skin, which disposes them less to imbibe or produce the
-poisonous effluvia, or, when imbibed, it may more readily be thrown out
-by perspiration with the other acrimony of the blood; or more probably,
-as has been hinted above, the virulent matter is of such a degree of
-volatility as to be readily dissipated in a certain degree of heat[56].
-
-There is a fact, which, though seemingly of a contrary tendency, yet
-is in reality in proof of the same opinion. It is, that these same
-diseases disappear in circumstances of great cold. When England was
-last visited by the plague, it disappeared in winter; and the same is
-observed at Moscow and other places. In this case the infectious matter
-is rendered _inert_, but not _extinct_, and the return of heat sets it
-afloat in the atmosphere, so as to expose it to human respiration. Dr.
-Guthrie informs us, that infection is entangled and fixed by the cold
-of winter on the doors and walls of the houses of the Russian peasants,
-and that upon the return of the warm season it is set loose by the
-thaw, and then becoming active, produces diseases.
-
-With regard to the West Indies, the precautions that have been laid
-down are chiefly necessary when a ship newly arrives in the climate;
-for it is during the first three or four months that sickness is apt to
-prevail.
-
-This does not depend upon any thing peculiar to the climate; for I
-have known ships arrive without being visited with any sickness. It
-seems to be owing, for the most part, to that flock of infection and
-disease imported from Europe exerting its effects, and when this has
-spent itself, the men remain in good health, unless exposed to the land
-air or other accidents; for the air at sea in those climates, as well
-as every where else, is extremely pure and wholesome, and there is no
-where that seamen are more healthy or comfortable.
-
-
-SECT. III.
-
-Of the FOUL AIR generated in a Ship.
-
-I mean here to distinguish the unwholesome vapour produced by the
-contents of the ship from the infection produced by the effluvia of
-men’s persons, which was treated of in the last section.
-
-The means of preventing this foul air from being generated are,
-cleanliness, dryness, and ventilation.
-
-All parts of a ship may, if neglected, become dirty, and emit an
-offensive vapour; but the parts under water consisting of the orlop and
-hold, are more particularly so from the materials they contain, and
-from the want of free access to the fresh air; accordingly, there is
-always more or less stench in those parts, even in the best-regulated
-ships.
-
-It was mentioned in the first part of this work, that an opinion was
-entertained by some that no foul air was productive of fevers but
-such as proceeds from the living human body. I alledged that this was
-otherwise, at least in hot climates; and some proofs of this opinion
-were adduced, particularly from the French prizes. Though the neglect
-of personal cleanliness is the principal source of disease, yet
-cleanliness of every kind, and purity of the air in every respect, is
-to be anxiously studied.
-
-With regard to general cleanliness, it is hardly necessary to mention
-sweeping, washing, and scrubbing of the decks; for the natural
-propensity of the English[57] nation to neatness seldom allows any
-neglect of these. Lord Howe, to whose virtues as a man, and abilities
-as an officer, his country is so much indebted, gave it in general
-orders to wash the upper decks every day, the lower decks twice a
-week, and the orlop once a week at least. He also ordered that, every
-washing, smoking, mustering, and review of clothes, or any other means
-taken for the health of the ship, should be marked in the logbook,
-and the reason to be assigned there if omitted at the stated times.
-These rules are a good specimen of the order that ought to prevail in
-every branch of public duty; for it is well known to every experienced
-officer that it is a methodical proceeding of this kind which can alone
-render service either easy or effective.
-
-The loss of men’s lives from the foul air of the well is a common
-accident in ships, and I have been myself witness to several instances
-of it. Where there is the least suspicion of this, a candle should
-previously be let down, and if it should be extinguished, it may be
-concluded that the air is deadly. It becomes safe for men to breathe in
-it by leaving it open for some time, or, more expeditiously, by letting
-down fire in a pot or grate, which soon changes the air, by producing a
-draught of it upwards.
-
-It is a very salutary practice to let down fires frequently into the
-well, both in order to purify the air and to dry the surrounding parts.
-It was formerly mentioned that this was daily done in the Intrepid,
-and the effect of it was to remove the wetness of the ballast and the
-mouldiness which had overspread the sides and beams; and having had
-the effect of sweetening and purifying the air, it seemed to be the
-principal circumstance that tended to make this ship extremely healthy
-from being the most sickly of all the fleet. This precaution, as well
-as every other point of cleanliness, is more necessary in large ships,
-because the mass of foul air, as well as the quantity of corrupting
-materials, is greater[58].
-
-The following fact strongly evinces the good effect of fire and
-smoke:--When it was the custom for frigates to have their kitchens
-between decks, they were much more healthy than in the present
-construction, in which they have them under the forecastle, where the
-heat and smoke are dissipated without being diffused through the ship,
-and causing a draught of air upwards, as formerly. The men derived then
-also great benefit and comfort from having a large fire, round which
-they might assemble to warm and dry themselves in a sheltered place.
-I leave it to those who preside in the construction of the navy to
-determine how far it would be advisable to return to the old manner
-of construction. The French ships of the line have their kitchens and
-ovens between decks, and this must tend to counteract the effects of
-their want of cleanliness. The Dutch ships of the line have their
-kitchens on the orlop deck, which must be still more conducive to the
-general purity of the air.
-
-Moisture is pernicious both in itself and as the instrument of
-putrefaction. All the complaints, called colds, are more owing to wet
-than cold; and moisture may be the means of producing, or at least of
-exciting dangerous fevers, when they would not otherwise appear. It
-besides contributes greatly to the production of scurvy. Ships built
-of ill-seasoned wood are found to be very unhealthy on account of the
-moisture contained in it. The moisture of timber arises not only from
-being used too soon after being felled, but also, as I am informed,
-from being stripped of its bark and outer surface when piled and
-exposed to the weather in dock yards. This method of smoothing and
-piling the wood is only a late practice; and the advantage in point
-of convenience and neatness seems to be more than overbalanced by the
-detriment it thereby receives.
-
-A wet hold diffuses moist vapour all over the ship; and it was a rule
-with some of those commanders whom I observed to be most successful
-in preserving the health of their men, not only to have daily fires in
-the well, but to bail out the water when the pumps could not exhaust it
-all, and never to allow it to collect to more than the depth of a few
-inches. It is, therefore, very doubtful whether it is a good practice
-to let in water, as is very commonly done in order to sweeten the
-hold, for the same sweetness will be preserved if it is kept strictly
-dry. If it should happen, indeed, that there should be a great deal of
-putrid matter in the lower parts of the ship, from previous neglect or
-unavoidable leakage, it may be adviseable to let in a quantity of water
-in order to loosen and wash off what is offensive, and then to pump it
-out.
-
-There is a circumstance in the first fitting out of a ship well worth
-attention, as highly conducive to the dryness and cleanness of the
-hold. I mean the choice of the ballast; for that which is called
-_shingle_, consisting all of pebbles, is far preferable to that which
-is sandy and earthy, as it does not so readily soak and retain the
-moisture and filth. Water or fluid of any kind readily subsides in it,
-and should any putrid matter be entangled in it, there will be less
-difficulty in washing it out.
-
-The decks should not be washed so often when the weather is moist as
-when it is fine, as it will be more difficult to dry them, and more
-harm may arise from the moisture than benefit from the cleanness.
-Washing should also be performed very early in the morning, even in the
-best weather, in order that there may be time for the decks to become
-dry in the course of the day. It is after a general washing that the
-moveable fires, formerly described, are most proper and useful.
-
-Every contrivance should be fallen upon to change the air in the
-orlop and hold. Ventilators and windsails[59] are well adapted for
-this purpose, and should be used as frequently and for as long a
-time as possible. It has also a good effect in cooling the air in
-the lower parts of a ship in the West Indies, to lift the gratings
-of the hatches, raising them on their edges, and lashing them to the
-staunchions. It contributes likewise to cleanliness and coolness to
-keep the decks as clear as possible from[60] chests and other lumber,
-which are in the way of sweeping and washing, and prevent also the free
-course of the air.
-
-Particular attention to ventilation is necessary in frigates, for
-almost all that part in which the men sleep is excluded from the air,
-and they are therefore very uncomfortable in the West Indies unless
-small scuttles are cut in the sides. But if this should be objected to
-as weakening or endangering the ship, there is a good contrivance for
-the same purpose, which I met with on board of the Nymphe frigate.
-It consists of a square wooden pipe, of about nine inches in the side
-coming from between decks, running along the side of the ship, and
-opening over the gunwale of the forecastle. There was one on each side.
-
-
-SECT. IV.
-
-Means of guarding against INFECTION and BAD AIR.
-
-Infection never prevails to such a degree, as to affect every person
-indiscriminately who is exposed to it. Even where the plague and
-small-pox prevail to the greatest degree, there are some persons who,
-though susceptible of these diseases, yet escape them. There are
-certain other infections of a weaker nature, as was before observed,
-and these will remain entirely inactive, till they find constitutions
-so disposed as to be fit subjects of their action. The seeds of disease
-may be compared to those of vegetables, which lye dormant, unless they
-happen to fall into a situation peculiarly adapted for exciting their
-activity. It is very difficult to account for this uncertainty in the
-operation of infection, but it is extremely providential, that under
-the most calamitous state of sickness, there are always some who are
-in health and who survive, for the necessary purposes of life. If this
-were not the case, it might happen that every person on board of a ship
-might perish from sickness in the course of a voyage, a circumstance
-which I believe has never been known to happen.
-
-There is an endless variety in the constitution of the human frame,
-both in mind and body, as well as in the features of the face. There
-are, perhaps, no two individuals in the world in whom the same effect
-precisely is produced by the same food, air, medicine, poison, or
-passions of the mind. The different effects of infection, therefore,
-upon different people, seem to depend, in many cases, on peculiarities
-of constitution too obscure to be explained; but there are also known
-circumstances which resist or encourage its effects.
-
-The great power of habit[61] in taking off the effect of infection,
-has already been mentioned, and it would appear that novelty gives
-an increased energy and activity to all impressions, as well as those
-on the senses. If a person, therefore, escapes the first attack of
-infection, he will be more likely to continue exposed to it with safety
-in future.
-
-There are certain precautions necessary to be attended to by those
-who are unavoidably exposed to contagion, particularly in the first
-instance. Those who can afford a full diet, and a liberal use of wine,
-have been observed to resist infection better than those who use food
-and drink that is meagre and watery. It is also a good rule not to
-go among the sick, nor otherwise to expose one’s self to infectious
-air, with an empty stomach; for whether it is that the body is then
-more susceptible, or that the pores of the skin and lungs are in a
-more highly absorbing state, so as with greater readiness to inhale
-the poison of disease, it is certain that a person in that situation
-is more apt to catch harm from foul air of any kind. Whatever else
-weakens and exhausts the body, renders it also more susceptible of
-noxious impressions. Under the head of weakening powers, I comprehend
-not only what empties the body of its fluids, such as loss of blood, or
-a diarrhœa, but intoxication, fatigue, fasting, watching, and certain
-affections of the mind, such as care and grief.
-
-Cold and moisture may also be enumerated among the causes that invite
-the attack of infectious diseases. They are of themselves simply
-productive of catarrhs, rheumatisms, and the like disorders; but if
-an infection should be accidentally present when the body is exposed
-to them, then instead of these complaints, the disease peculiar to
-that infection will be produced[62]. This was illustrated in the last
-reinforcement we had from England; for while bad fevers were breaking
-out in most of the other ships, the [63]Union was affected with those
-complaints only which are simply the effects of cold and moisture. It
-would be more proper, perhaps, to say, _exposure to the air_, than to
-call it _cold_; for exposing the naked body to the open air, even in
-the warmest climate, is prejudicial to health. This holds at least with
-regard to Europeans who are accustomed to clothing, however the natives
-of hot climates who are naked, may expose themselves with impunity.
-
-It is of the greatest consequence to ascertain the extent of the
-influence of infection, for the means of avoiding and preventing it
-will very much depend upon this. It is now known, that infection
-extends itself to a very small distance. There are, indeed, some
-morbid poisons, such as that of the bite of a mad dog, and that of
-the venereal disease, which require actual contact to make them
-take effect. Others are more volatile, and seem to he inhaled by the
-breath, or absorbed by the skin, but these do not extend far. That
-of the plague[64] does not reach above a few yards, and that of the
-small-pox and of fevers is probably equally limited. This discovery is
-very valuable, by ascertaining the limits of danger; for when a person
-imagines he runs the same risk when at a considerable distance from the
-seat of disease, as if he were in contact with the person affected,
-he will be apt to expose himself wantonly and unnecessarily to the
-infection.
-
-It seems to be owing to the ignorance of the extent of its influence,
-that the plague has in general been so fatal; for in consequence of
-the opinion that the whole surrounding atmosphere was affected, it
-was vainly attempted to purify it by large fires in the open air, or
-by [65]firing off artillery, instead of trusting to the separation of
-the sick so as to avoid their near approach, and to the confinement
-of those in health to their own houses, which are all the precautions
-necessary to prevent its progress.
-
-
-
-
-CHAP. II.
-
-Of ALIMENT.
-
-
-SECT. I. Of SOLID FOOD.
-
-The most unnatural circumstance in a sea life is the food which men
-use, and the disease most peculiar to it is one which is owing chiefly
-to the nature of the aliment; for though other causes conspire in
-aggravating the scurvy, the depraved state of the INGESTA is the main
-and fundamental cause of it.
-
-It is this disease that is most fatal to seamen next to fevers. It
-was formerly as fatal, if not more so; but some modern improvements
-have rendered it less frequent and violent. The habitual use of salt
-provisions, besides producing evident symptoms of scurvy, begets
-such a state of the constitution, that, upon the least scratch being
-received, particularly on the lower extremities, a large and incurable
-ulcer ensues; and this circumstance, trifling as it appears, is the
-cause of losing an incredible number of men to the service, especially
-in the West Indies. The greater part of the food of a ship’s company
-is necessarily salted meat. Biscuit and pease, though of a vegetable
-nature, are hard of digestion; and though they qualify the animal food,
-they do not answer the purpose of fresh vegetables. Though officers
-have a supply of live stock even for the longest voyages, it would be
-impracticable to carry a quantity sufficient to preserve a whole crew
-from the scurvy. But certain articles have of late been introduced
-into use, of a durable and portable nature, which so qualify the salt
-provisions, that they can be used without inducing this disease. These
-are either such as are articles of common diet, viz. melasses and sour
-krout, or those which are intended only for the sick and recovering,
-such as portable soup and the preserved juice of lemons and oranges.
-
-It is one of the most ancient and real grievances in the service,
-that there has not been a sufficiently ample supply of nourishment
-and cordials for the weak and recovering. This complaint is made by
-[66]Dr. Cockburn, who was physician to the fleet in the end of the
-last century; and it is a complaint that has not yet been entirely
-redressed, nor has the subject been considered with the attention it
-deserves. The only improvement in the sea victualling that I know of
-from that time till of late, has been the use of raisins for puddings,
-and the occasional use of vinegar, which is an article extremely
-salutary, and was looked upon as the great preservative of health in
-the Roman armies.
-
-After the force of disease has been subdued at sea, men are frequently
-lost by relapses, or pine away in dropsies and other chronic
-complaints, for want of being supported by some cordial and nourishing
-diet. It is mentioned in my memorial to the Admiralty, how insufficient
-the small quantity of surgeon’s necessaries are; and it is recommended
-that a large quantity of certain species of refreshment should be put
-in the purser’s charge, which, being substituted for the common sea
-victualling while men are ill or recovering, would cost Government
-little or nothing. Besides the articles already mentioned, it was
-recommended to set apart a quantity of the best wines, and to be
-provided with brown sugar, dried fruits, barley, rice, sago, and salep.
-To these might be added eggs, which, if greased and put in salt, may
-be preserved fresh for a great length of time. Carrots and other roots
-might also be preserved for the longest voyages by means of sugar; and
-green vegetables might in like manner be preserved by means of salt.
-But of all the articles, either of medicine or diet, for the cure of
-the scurvy, lemons and oranges[67] are of much the greatest efficacy.
-They are real specifics in that disease, if any thing deserves that
-name. This was first ascertained and set in a clear light by Dr. Lind.
-Upon what principle their superior efficacy depends, and in what
-manner they produce their effect, I am at a loss to determine, never
-having been able to satisfy my mind with any theory concerning the
-nature and cure of this disease, nor hardly indeed of any other. An
-ingenious treatise has been published on this subject by Dr. Milman,
-to which I refer the reader, meaning to confine myself in this work
-chiefly to what is practical.
-
-Every person who has beheld with attention and feeling the tedious and
-languishing series of suffering which the sick and recovering endure
-for want of the means of supporting and recruiting their strength and
-spirits, must wish that those who preside in the civil department of
-the navy would seriously consider this subject, and complete the reform
-that has already been begun.
-
-With regard to the victualling of men in health, a most commendable
-attention has been paid to the improvement of it. The ordinary articles
-of victualling have not only been of excellent quality, but some new
-articles have been added, from which the greatest benefit has been
-derived. The chief of these are sour krout and melasses. The latter was
-first brought into use by Captain Ferguson in the beginning of the late
-war. He ordered it to be served with rice to the men who were affected,
-or threatened with the scurvy, in the ship under his command. The
-benefit experienced from it in this and other instances was so great,
-that during the last two years of the war it was made a regular article
-of sea victualling, and substituted in place of a certain proportion of
-oatmeal[68].
-
-As bread is one of the principal articles of diet, the utmost care
-should be taken in preserving it, and great advantage would arise
-from stowing it in casks that are water tight, instead of keeping it
-in bags, or letting it lie loose in the bread room. Captain Cook, by
-this method, and by giving it a cast in the oven in the course of the
-voyage, preserved his biscuit found in every respect for more than
-three years. But the greatest improvement in this article of diet would
-be to have, in the form of flour, a greater proportion of what is now
-allowed in bread. The flour might be made into puddings, and seems, in
-this form, to be more nutritious and antiscorbutic than biscuit which
-has undergone a strong force of fire. This sort of mess would be still
-more proper and agreeable now that melasses is a stated article of
-diet. Flour, by being well pressed and rammed, will keep as long as
-biscuit, and it can be stowed in one fifth part of the space; it will,
-therefore, cost much less in freight than the same quantity of it in
-that form, and it may be baked abroad if necessary[69]. Malt, by being
-well rammed, may also be preserved for a great length of time.
-
-Of all the former articles of sea victualling, there was none more
-abused than oatmeal. The quantity allowed to each man was twice as much
-as he could consume, and the overplus went to the purser’s profits,
-or was wasted by being given to the hogs, or even wantonly thrown
-overboard. Melasses have, with great advantage, been substituted for
-part of it, in the proportion of eleven pounds for two gallons of
-oatmeal. The first trial of melasses was in the[70] Foudroyant, and it
-answered so well, that, in a cruise under Admiral Geary in 1780, this
-was the only ship free from the scurvy, and out of two thousand four
-hundred men that were landed at the hospital with this disease, there
-were none from this ship. It appears to be so similar in its nature
-and effects to essence of malt, that it seems hardly worth while for
-Government to be at the expence of providing the latter.
-
-A certain proportion of barley has also of late been substituted for
-part of the oatmeal, which being more light and palatable, makes a
-pleasing variety, particularly to the sick and recovering. Captain Cook
-carried wheat with him, and found it to answer equally well. Might not
-potatoes also be a proper and salutary substitute, as they will keep
-a considerable length of time in a warm climate, and they have been
-successfully employed in their raw state for the cure of scurvy? It
-would not be right, however, to abolish oatmeal entirely; for there is
-a certain preparation of it which is an antiscorbutic of equal efficacy
-with any whatever, except the juice of lemons and oranges. This is
-flummery, or sowins, which is prepared by letting oatmeal and water
-stand together till they grow acidulous, and then boiling them into a
-jelly. I know of some well-attested instances of the crews of ships
-being saved from the scurvy by this alone.
-
-Butter is a good article of victualling in so far as it renders that
-part of the diet which consists of grain and vegetables more palatable,
-and thereby induces men to eat more. But as it is extremely corruptible
-in a warm climate, hardly any being used by the seamen but what is
-more or less rancid, it should never be sent to a tropical station.
-Greater quantities of it are condemned than of any other article of
-victualling, and it is therefore the most expensive to Government.
-There are certain articles that are the natural produce of the
-West-India islands, which may be substituted for it with the greatest
-advantage. These are sugar and cocoa[71], which, during the last year
-of the war, were served in place of butter with great success, and
-this proved an alteration in diet not only salutary, but agreeable
-to the seamen, whose inclinations are always to be consulted in such
-changes[72].
-
-When a ship is in port, encouragement should be given to the sale
-of roots, greens, fruits, and sugar. The men have a good custom of
-exchanging part of their bread, beef, and pork, for what they can
-get from the shore; but as they in general prefer spirituous liquors
-to the above-mentioned articles, the greatest care and vigilance
-should be used to preclude men from such opportunities of injuring
-themselves[73]. Every ship should be furnished with a seine, and other
-implements for fishing, when in harbour.
-
-When captures are made, in which there are such articles as sugar,
-wine, rice, or fruits, it would be much better in many cases to allow
-the immediate use of them at sea, where the men may be disposed to
-scurvy or other diseases, than to wait for the conversion of them into
-money.
-
-Though it has been my object to introduce as many articles of diet as
-possible, independent of salt provisions, it does not follow that these
-are in themselves unwholesome. They are pernicious by being made almost
-the sole and exclusive article; but if used in moderate quantity,
-they are even in some respects well adapted for the food of seamen.
-The nature of their life gives them a strong digestion: in their
-duties they not only employ violent exercise, but use more muscles
-and a greater variety of postures and motions than men of any other
-profession. To such constitutions may not food of a refractory nature
-and hard of digestion have even an advantage over what is more delicate
-and digestible?
-
-It does not appear that it is the salt quality of the provisions used
-at sea that makes them productive of scurvy, but the want of their
-native juices and of the nutritious principle. A small quantity of
-salt is necessary to make all food palatable and wholesome, in so much
-that it is reckoned one of the necessaries of life. All animals have a
-craving for sea salt, and nature has kindly made it the most abundant
-and universal of all saline bodies. Food, without this seasoning, not
-only comes to be loathed, but the want of it renders the animal weak
-and flabby. As it not only assists digestion, but invigorates all the
-bodily functions by stimulating and bracing the fibres, it is in some
-cases a valuable medicine. It is remarkable that men are very apt to
-tire of a long continuance of fresh provisions[74], but never of what
-is salt; and even under the scurvy the latter will be relished, and
-sometimes preferred to most other kinds of food. It has been a practice
-with some to make the scorbutic men drink sea water; but though it
-is not attended with any manifest benefit, I never heard that it
-aggravated the disease.
-
-I was told by the gentlemen of the army at New York in 1780, that the
-soldiers in cantonments were not near so subject to agues as the people
-of the country; and the only difference in their mode of life was,
-that the former had in their allowance a certain, proportion of salt
-provisions.
-
-In an unhealthy country I should think a free use of salt, as well
-as spice[75], would be salutary; and when ships are in port it would
-perhaps be better to allow a certain proportion of salt provisions,
-because it would not only be wholesome and agreeable, but the men’s
-constitutions would probably be more reconciled to an entire salt diet
-when necessary: but I would except from this the crews of such ships
-as have newly arrived from a long cruise or voyage, in which it may be
-necessary to alter the constitution as quickly as possible by a diet
-entirely fresh.
-
-Nothing that I have collected from my own observation, or that of
-others, has been neglected under this head, except one particular
-caution with regard to the preparation of the victuals. The large
-utensils employed to boil the provisions are made of copper, and it
-sometimes happens from neglect that these are allowed to contract a
-rust, which is one of the most active poisons we know. The neglect
-consists chiefly in allowing any thing acid, or what is liable to
-become acid, such as gruel or burgoo, to remain for a length of time
-without being washed out; for when victuals have been prepared in
-the boilers thus uncleaned, they produce the most violent effects,
-even to the loss of life, as once happened in a ship belonging to our
-fleet[76].
-
-
-SECT. II. Of DRINK.
-
-As the solid part of sea diet is very dry and hard, and as the salt it
-contains is apt to excite thirst, a freer use of liquids than at land
-is necessary, particularly in a hot climate.
-
-It has been the custom, as far back as we know, to allow seamen the
-use of some sort of fermented liquor. We need hardly inquire if this
-is salutary or not; for it would be impossible at any rate to withhold
-it, since it is an article of luxury, and a gratification which the
-men would claim as their right. There is a great propensity in seamen
-to intoxicating liquors, which is probably owing to the hardships
-they undergo, and to the variety and irregularity of a sea life. But
-there is reason to think that all sorts of fermented liquors, except
-distilled spirits, are conducive to health at sea.
-
-There is no doubt that malt liquor is extremely wholesome and
-antiscorbutic. The common quantity of small beer allowed daily is so
-liberal, that few men make use of their whole allowance; and there is
-no objection to the constant use of it, except that it is apt to spoil
-in the course of a few weeks, and that upon foreign stations the stock
-can seldom be renewed. One of the greatest improvements that could
-be made in the victualling of the navy would be the introduction of
-porter[77], which can be preserved in any climate for any length of
-time that may be necessary.
-
-Spruce beer seems to possess similar and equal virtues with malt liquor
-and it has this advantage, that the materials of it can at all times
-be carried about and used occasionally. It agrees with malt liquor in
-being a fermented vegetable sweet, the principal ingredient of it being
-melasses. The other ingredient, from which it takes its name, being a
-balsamic substance, seems to be more medicinal and antiscorbutic than
-hops, and is therefore, perhaps, preferable to malt liquor. There have
-been sufficient proofs of its virtues in single ships; and all the men
-of war that go to America and the West Indies might be conveniently
-supplied with it. Admiral Pigot provided a sufficient quantity for the
-whole fleet; but the peace coming on prevented the trial of it.
-
-The most salutary kind of drink next to malt liquor, and spruce beer,
-is wine. The benefit which the fleet derived from it at different
-times, and the advantage it has over spirits has been often taken
-notice of in the former part of this work. It seems to be owing to this
-that the French fleet sometimes enjoys superior health to ours, and
-is less subject to the scurvy[78]. Wine is also preferable to every
-other medicine in that low fever with which ships are so much infested;
-and there is no cordial equal to good wine in recruiting men who are
-recovering.
-
-Spirits differ from wine in this respect, that they are a mere chemical
-liquor, incapable of assimilation with our fluids, having lost in
-distillation the native vegetable principle in which the whole of its
-nutritious quality and great part of its medical virtue resides.
-
-The abuse of spirituous liquors is extremely pernicious every where,
-both as an interruption to duty, and as it is injurious to health. It
-is particularly so in the West Indies, both because the rum is of a bad
-and unwholesome quality, and because this species of debauchery is more
-hurtful in a hot than in a cold climate.
-
-It is with reason that the new rum is accused of being more unwholesome
-than what is old; for, being long kept, it not only becomes weaker and
-more mellow by part of the spirit exhaling, but time is allowed for the
-evaporation of a certain nauseous empyreumatic principle which comes
-over in the distillation, and which is very offensive to the stomach;
-therefore, though this is the produce of the West-India islands, yet
-what is supplied there is inferior to that which is brought from
-England.
-
-It was originally the custom to serve seamen with their allowance of
-spirits undiluted. The method now in use, of adding water to it, was
-first introduced by Admiral Vernon in the year 1740, and got the name
-of _grog_. This was a great improvement; for the quantity of half a
-pint, which is the daily legal allowance to each man, will intoxicate
-most people to a considerable degree, if taken at once in a pure state.
-
-The superiority of wine over spirits in any shape was so conspicuous,
-that towards the end of the war the fleets in the West Indies and
-North America were supplied with nothing but wine, and with a success
-sufficient to encourage the continuance of the same practice in future.
-
-
-Of WATER.
-
-As water is a necessary of life, and as the health and comfort of men
-at sea depend upon its quality, it deserves particular attention.
-
-Spring water is to be preferred to running or stagnated water; for,
-unless it is taken at the source, or near it, it is apt to be
-impregnated with decayed vegetable and animal substances, such as
-leaves, grass, wood, and dead insects. This inconvenience is greatest
-in a hot climate, where every thing teems with life, and where the
-materials of putrefaction are both more abundant and more prone to
-corruption. This is the most pernicious kind of impurity; for the
-mineral impregnations common in springs are seldom, in any degree,
-unwholesome, and do not tend, like the other, to make the water
-corrupt. At many of the West-India watering places the water is found
-stagnated just above high-water mark; and care should be taken to go
-higher up to take it where it is running.
-
-The purest water is apt to spoil by producing a putrid glare upon
-the inner surface of the cask which contains it. There is a great
-difference in this respect between a new cask, especially if made of
-moist wood, and that cask which has been hardened and seasoned by age
-and use. Several contrivances have been proposed for preparing the
-vessels that hold the water; but none have been found by experience so
-effectual as letting them stand for some time full of sea water; and it
-is a great advantage of this method, that it is so easily practicable.
-
-It is in few places we meet with water such as that of Bristol,
-which, in clean vessels, may be kept for any length of time. We may
-consider all water kept in wooden vessels as more or less liable to
-putrefaction; but there is a substance, which is neither rare nor
-costly, that effectually preserves it sweet. This is _quick lime_,
-with which every ship should be provided, in order to put a pint of it
-into each butt when it is filled. It has the advantage of not being
-injurious to health; but, on the contrary, is rather friendly to the
-bowels, tending to prevent and check fluxes. In the year 1779 several
-ships of the line arrived in the West Indies from England, and they
-were all afflicted with the flux, except the Stirling Castle, which
-was the only ship in which quick lime was put into the water. Nor does
-it spoil the water for any culinary purpose. Its action in preventing
-putrefaction consists, in part at least, in destroying vegetable and
-animal life. An addition of putrescent matter is produced in water by
-the generation of small insects; and the glare that collects on the
-sides of casks, and also what collects on the surface of the water, is
-a species of vegetation of the order called by naturalists _algæ_[79].
-Quick lime is a poison to this species of vegetable life as well as to
-insects: but upon whatever principle it depends, the property of it in
-preserving water sweet is so well ascertained, that it is inexcusable
-ever to neglect the use of it.
-
-Quick lime is equally efficacious for this purpose, whether slacked or
-unslacked; and though the latter form is more convenient for stowage,
-by having less weight and bulk, yet the other is to be preferred for
-the sake of safety; for if water should by chance reach the unslacked
-lime, a great degree of heat is thereby produced, which has been known
-to give occasion to the most formidable accidents.
-
-The only other objection I know of to the use of quick lime is, that it
-converts the water into a lime water, rendering it thereby disagreeable
-to the palate and stomach: but the quantity necessary to preserve it
-makes but a very weak lime water; for part of the lime is precipitated
-by the mephitic air, or the aerial acid, as it is otherwise called, of
-which there is some contained in the water. The accidental exposure to
-the atmosphere, which also abounds with this sort of air, tends farther
-to lessen the acrimony of the quick lime[80].
-
-There are other substances which have been found useful in correcting
-bad water. Alum and cream of tartar, as antiseptic bodies, have been
-employed for this purpose. Vinegar and the vegetable acid juices and
-fruits, such as tamarinds, may be used occasionally to take off the
-putrid offensive taste which may have arisen in case the use of quick
-lime has been neglected. In the fleet under Sir Charles Saunders, the
-water of the river St. Lawrence having been found to produce fluxes,
-this quality was removed by throwing four pounds of burnt biscuit into
-each cask before it was used. But there is nothing so effectual, and
-subject to so few inconveniences, as quick lime.
-
-The next method to be mentioned of purifying water is filtration,
-which not only separates the gross impurities, but removes the putrid
-smell and taste. It is performed with a dripping stone, which is a
-convenient contrivance for officers, but cannot furnish a supply for a
-whole ship’s company.
-
-When the water of wells or brooks is found loaded with mud, the
-following expeditious method of filtration, described by Dr. Lind, has
-been practised with success:--Let a quantity of clean sand or gravel
-be put into a barrel placed on one end, without the head, so as to
-fill one half or more of it, and let another barrel, with both ends
-knocked out, of a much smaller size, (or let it be an open cylinder of
-any kind) be placed erect in the middle of it, and almost filled with
-sand or gravel. If the impure water be poured into the small barrel or
-cylinder, it will rise up through the sand of both barrels, and appear
-pure above the sand of the large one in the interval between it and the
-small one.
-
-But when water is offensive in consequence of being long kept, the most
-effectual and expeditious method of sweetening it is by exposing it
-to the air in as divided a state as possible. Boiling will not expel
-the putrid effluvia contained in water; but such is the attraction of
-air for this offensive matter, that the water need only be thoroughly
-exposed to it to be rendered quite sweet. This is best done by a
-machine invented by Mr. Osbridge, a lieutenant of the navy. It consists
-of a hand pump, which is inserted in a scuttle made at the top of a
-cask, and by means of it the water, being raised a few feet, falls
-through several sheets of tin pierced like cullenders, and placed
-horizontally in a half cylinder of the same metal. The purpose of it is
-to reduce the water into numberless drops, which being exposed in this
-form to the open air, is deprived of its offensive quality. The same
-method will serve to separate the superfluous quick lime in the water.
-It is a machine very deservedly in common use, and the working of it is
-a moderate and salutary exercise to men in fair weather.
-
-The following contrivance will be found to afford a sufficient supply
-of sweet water to particular messes, and may be considered as an
-artificial and more expeditious sort of dripping stone.--Let the
-narrow mouth of a large funnel be filled with a bit of sponge, over
-which let there be a layer of clean gravel or sand covered with a
-piece of flannel, and over the whole another layer of sand. Muddy or
-offensive water being poured upon this, runs or drops out clear; and
-care must be taken to change the sand, sponge, &c. frequently, as they
-will become loaded with the impurities of the water[81].
-
-There should be in every ship an apparatus for distilling water in
-case of distress. This consists merely of a head and worm adapted to
-the common boiler, and distillation may go on while the victuals are
-boiling. More than eight gallons of excellent fresh water may be drawn
-off in an hour from the copper of the smallest ship of war[82]. I refer
-for a more particular account of all this to the works of Dr. Lind,
-who was the original inventor and recommender of this method.
-
-This invention seems to have escaped others so long, from the idea that
-the _desideratum_ in freshening sea water was some substance to be
-added to it while under distillation. No such substance is necessary,
-and, the more simple the mode of distillation, the fresher the water
-will prove.
-
-Rain water at sea is always pure and wholesome, and may be saved
-occasionally by means of a sail or awning.
-
-
-
-
-CHAP. III.
-
-Of CLOTHING.
-
-
-Nature has made man so defenceless, that even the rudest nations, in
-the hottest climates, in general, adopt some sort of covering to guard
-themselves from the weather. We may affirm, that clothing is the most
-artificial circumstance in the life of man; and there is none, of which
-the errors subject him to more inconvenience and hardship. Insensible
-perspiration is performed by the pores of the skin, and being one of
-the most important functions of the body, the suppression of it seems
-to be one of the principal causes, or at least one of the most frequent
-attendants on feverish and inflammatory complaints; and one of the most
-common causes of this suppression is the application of cold to the
-skin.
-
-In order to keep up perspiration, it is necessary that the orifices
-of the pores of the skin should be bathed, as it were, in the vapour
-already secreted from them; and clothing seems to act in confining
-this, as well as in preventing the escape of the natural heat and the
-access of the external air. Though the air should not be cold, it will
-check perspiration by carrying off this vapour and drying the skin.
-In the warmest climates exposure of the skin to the external air is
-unsafe; for it not only produces a feverish and uneasy sensation at
-the time, but occasions the most dangerous internal disorders. In
-consequence of the great sensibility and sympathy of the body, and from
-the pores of the skin being open in a warm climate, exposure is in some
-respects even more dangerous than in a cold one. Nothing is more apt to
-bring on the locked jaw and tetanus than sleeping in the open air; and
-it was observed in Jamaica, that when it was the custom to wear cotton
-and linen clothes, the dry belly-ache was much more common than now
-that it is the custom to wear woollen cloth.
-
-We know besides, that the pores of the skin can absorb not only the
-moisture that floats in the atmosphere, but a variety of foreign
-bodies, whether noxious or medicinal, which may be applied to their
-orifices; and as the air is in certain places loaded with noxious
-matter, may not clothing be considered as a filter, as it were, to
-separate the impurities of the air before it comes in contact with the
-surface of the body?
-
-It is therefore every where of the utmost consequence that sufficient
-and suitable clothing should be provided.
-
-It would certainly be for the benefit of the service that an uniform
-should be established for the common men as well as for the officers.
-This would oblige them at all times to have in their possession
-a quantity of decent apparel, subject to the inspection of their
-superiors. It would also be less easy to dispose of their clothes for
-money without detection, and desertion would also thereby be rendered
-more difficult.
-
-It is of great consequence that the purser should lay in a sufficient
-stock of clothing and bedding suited to the climate for which the
-ship is destined, in order that there may be a sufficient supply
-after having been on a distant station for a certain length of time.
-I have known men suffer the greatest inconvenience and hardship, and
-infectious diseases kept up, from the neglect of this.
-
-The greatest evil connected with clothing is the infection generated
-by wearing it too long without shifting; for to this cause we have
-attributed the jail, hospital, or ship fever. The great importance of
-cleanliness appeared when we were treating of infection, from whence we
-may judge of what consequence it is that men should be provided with a
-shift of linen, as that part of the clothing which is in contact with
-the skin is most likely to harbour infection[83].
-
-As clothing is not the gift of nature, being left to man’s own reason,
-it is subject to caprice, and thereby productive of inconvenience
-and disease. The necessity of it depends very much upon habit, like
-every thing else relating to the human body, and therefore sudden and
-unseasonable changes of apparel are very unsafe to health. It is also
-found that a partial exposure of the body is more pernicious than a
-general exposure. If I were writing for the more delicate part of the
-world, I should illustrate this by the danger of exposing the feet
-alone to cold or wet. It is seldom that seamen are susceptible to so
-great a degree, for their hardy and exposed life steels them against
-such impressions. But there is another circumstance which renders it of
-the utmost consequence to defend the feet against external injury. It
-frequently happens, that, without any visible symptoms of scurvy, the
-constitutions of seamen are such, that, upon the least scratch being
-received on the feet or legs, a large spreading incurable ulcer arises;
-which sometimes ends in the loss of a limb; but at any rate disables
-them from duty till a cure can be effected by the use of a fresh and
-vegetable diet, or a change of climate. Next to acute diseases and
-scurvy, this is the most destructive complaint incident to a sea life,
-particularly in a hot climate; and I have known great numbers of good
-men thereby lost to the service. It is, therefore, of the utmost
-consequence that men should not only be supplied with shoes, but be
-obliged to wear them, which is found to require a degree of compulsion;
-for in the West Indies it is observed that seamen always wish to go
-barefooted.
-
-Since the first edition of this work was published, I have been
-favoured with several valuable remarks on this subject, by Captain
-Caldwell, an officer of great humanity and experience. Among other
-remarks, he observes, that the different articles of clothing supplied
-to sailors are, in general, too slight, and of too small a size, which
-renders them expensive and inconvenient to large men. The trowsers, he
-observes, should be much thicker, and larger, as the least shower goes
-through them; and, in a cold climate, those made of _fear-nought_[84],
-which do not cost more than the others, should also be allowed. What
-a situation are men in when topsails are reefing in the winter season
-while it rains, when cold and wet, with their trowsers sticking to
-them, (which would not be the case if they were of flannel) and it is
-not practicable that they should have change of clothing for every time
-they are obliged to be wet? Thick, double-milled caps are much wanted
-in bad weather to cover the head and ears. Dutch caps do not keep out
-the weather, and will not stay on the head. It is commonly remarked
-that the men who wear the thickest linen shirts are the most healthy.
-
-Men, upon first entering into the service, are allowed the advance of
-two months wages, in order to provide necessaries: but this, inadequate
-as it is for a long voyage, is not extended to pressed men. It is also
-argued against making large stoppages in seamen’s wages; that, by
-diminishing what they have to receive when paid off, a discouragement
-is thereby given to the service. But as we see men deserting from men
-of war when several years wages are due to them, the most reasonable
-and effectual encouragement seems to be to render their lives as
-comfortable and healthy as possible.
-
-But why might not most of the articles mentioned be supplied
-gratuitously? In favour of which Captain Caldwell makes use of an
-argument frequently inculcated in this work, viz. that so much
-advantage would accrue to Government by preserving the health and lives
-of men, and so much would be saved in hospitals, as would much more
-than reimburse the extraordinary expence[85].
-
-
-
-
-CHAP. IV.
-
-Of EXERCISE.
-
-
-It commonly happens in a ship of war that a great proportion of the
-hands is landsmen; for, besides the men required to navigate the ship,
-a great number is necessary to fight the guns, as well as for other
-duties, and their health may be affected by the want of exercise.
-
-It has been observed before, that one use of frequent reviews and
-musters in a numerous crew is, to call forth men that would otherwise
-be overlooked, to oblige them to come into the open air, to keep
-themselves clean, and to prevent them from indulging in filth and
-laziness. It is observed, that seamen are in general less subject
-to scurvy than marines and landsmen, which seems to be owing to the
-greater activity of their life and alacrity of their minds.
-
-There is an essay on the causes of the pestilence, by an anonymous
-author, published at Edinburgh in 1759, in which this disease is said
-to be entirely the offspring of idleness, and he illustrates this by
-its being more apt to arise in besieged towns than any other situation;
-and he alledges that a false alarm of the plague will actually produce
-it by throwing people idle, as was the case, he affirms, when the
-plague was last at Messina.
-
-There are always numbers who have been pressed into the service, to
-whom a sea life is new, and who are therefore prone to indolence, low
-spirits, and self-neglect. Men of this description are by far the most
-apt to fall into the scurvy; and next to the quality of the food,
-there is nothing contributes more to promote the scurvy than such a
-disposition. It is indeed both a cause and a symptom of this disease,
-and therefore idleness and _skulking_ should be rigidly discouraged,
-unless the complaint is so far advanced as to render it cruel and even
-impossible to force men to take exercise.
-
-The Conqueror, of 74 guns, one of our squadron in the last year of the
-war, was an instance of a ship in which only the prime seamen were
-attacked with the scurvy, and this is to be accounted for upon the same
-principle, for it proceeded from their having been exempted from the
-duty of pumping, in which the inferior classes of men were constantly
-employed, owing to the leaky state of the ship.
-
-As low spirits and indolence have such an unfavourable effect upon
-health, it would be wise, as well as benevolent, to promote whatever
-produces jollity, contentment, and good humour, so far as is consistent
-with sobriety and regularity. There are certain rough sports which are
-now almost in disuse; and whoever would revive and encourage them,
-would perform a useful office to the service.
-
-A sea life frequently demands violent temporary exertions, from the
-uncertainty of the weather, and other incidents; so that men are more
-exposed to extreme fatigue and sudden calls of duty in this than in
-any other situation of life. Nothing tends more to shorten life than
-excessive bodily labour and watching; and it is for this reason that
-seamen in general are short lived, and that their countenance and
-general appearance make them appear older than they really are by
-several years. This is remarkably the case when a seaman comes to be
-upwards of forty and it has been mentioned before, that a person not
-acquainted with this circumstance will make a mistake of ten years in
-guessing at the age of a seaman from his looks.
-
-Fatigue being therefore frequently the means of bringing on disease
-and breaking the constitution, as much tenderness is due to men as is
-consistent with the necessary duties of service. This is a circumstance
-in which young officers are apt to forget themselves; and they should
-take care how they _call all hands_ wantonly, and oblige men to make
-exertions beyond their strength, especially as this will be submitted
-to more readily by sailors than any other set of men, from the
-generous alacrity of their nature.
-
-It would be well if it could be rendered convenient at all times,
-except in cases of danger or emergency, to put the men at three watches
-instead of watch and watch. By the former arrangement they have eight
-hours sleep and rest; by the latter only four hours are allowed, which
-is not sufficient for refreshment, nor is there time for them to get
-dry, in case they have been exposed to wet.
-
-It would be a good rule to have as few men as possible out of bed in
-the night-time, unless where active service renders it necessary; for,
-if unoccupied, they lie about the decks, fall asleep, and catch cold.
-In such situations, might not all the topmen but one remain on the
-forecastle, where they might take exercise, which they could not do
-aloft? I am indebted for this remark to the Rev. Mr. Ramsay, who joins
-to a great knowledge of the sea service a warm and disinterested zeal
-for its prosperity, and has been so good in several other instances as
-to communicate to me the results of his experience and observation.
-
-The good effects resulting from the indulgent treatment of men are,
-that it encourages them to enter into the service, and to do their duty
-with cheerfulness and resolution. There is something more daunting to
-the mind of man to see his companions suffering under oppression and
-languishing in disease, or perishing miserably from sores or sickness,
-than in the terrors of fire and sword, which, as we have seen, make
-the least part of the calamities of war. The good treatment of seamen,
-in so far as it regards their health, is by no means incompatible with
-strict discipline. Indeed strictness and even severity is necessary
-with seamen; for it is observed with regard to men who are used to
-arbitrary government, that they cannot bear indulgence and relaxation.
-But the steady enforcement of discipline and regularity is so far from
-being akin to cruelty, that it tends to prevent both sickness and
-the commission of crimes, consequently rendering the infliction of
-punishment less frequent and necessary. The chief excellence in the
-character of an officer seems to consist in uniting strict discipline
-with indulgence and humanity.
-
-
-CONCLUSION.
-
-The subject of the preceding remarks has been the prevention of
-diseases and it has appeared that the means of this are not so much in
-the province of the medical profession as of those who are entrusted
-with the direction of the navy in a civil or military capacity; and
-that with regard to cure and recovery also, a great deal depends upon
-them, by their having it in their power to make a suitable provision
-of proper diet and cordials. The great importance of the subject will
-plead my excuse for again calling to mind, that such attentions are
-not only dictated by humanity, but would be the greatest wisdom in an
-œconomical and national light, considering how expensive it is to
-_replace_ men and to support invalids, not to mention that it is upon
-the health and lives of men that every public exertion essentially
-depends, and upon which may depend not only the character of officers,
-but the national character in the day of battle.
-
-It must be confessed, that though there is still room for improvement,
-the navy is now on a better footing with regard to the health and
-comfort of seamen than it appears to have been in former times. The
-victuals were in general in the late war of excellent quality; the
-civil branch has shewn in many instances a readiness to adopt the means
-and to furnish the articles that were recommended for the health of the
-men[86]; and most of the commanders whom I have the honour to know are
-humane, attentive, and intelligent.
-
-To conclude; there is no situation of life in which there is room for
-more virtues, more conduct and address, than that of a sea officer.
-The men are thrown upon his humanity and attention in more views than
-one: they are subject to a more arbitrary exertion of power than the
-constitution of the date authorities in civil life, Englishmen giving
-up into his hands, from considerations of public expediency, that which
-they hold most dear, and of which they are most jealous, their LIBERTY.
-It is the character of seamen to be thoughtless and neglectful of
-their own interest and welfare, requiring to be tended like children;
-but from their bravery, utility, and other good qualities, they seem
-entitled to a degree of _parental_ tenderness and attention from the
-state they protect and the officers they obey.
-
-
-APPENDIX TO PART II.
-
- In order to exhibit a concise view of the most material observations
- contained in this part of the Work, a Memorial, delivered to the Board
- of Admiralty in October, 1781, is here subjoined.
-
-
-MEMORIAL,
-
- Proposing Means for preventing the Sickness and Mortality prevailing
- among His Majesty’s Seamen in the West Indies.
-
-I have for the two last years attended a squadron, consisting seldom
-of less than twenty ships of the line, in quality of physician to the
-fleet at Barbadoes and the Leeward Islands. I received, by the order of
-the Commander in Chief, a monthly return from the surgeon of each ship,
-setting forth the diseases, deaths, and other circumstances of the
-respective ships companies. I also superintended the hospital of the
-place where the fleet happened to lie when in port. These advantages
-have afforded me an intimate knowledge of the nature and causes of the
-sickness and mortality among the seamen, both on board of their ships
-and in hospitals.
-
-It appears by my returns, that there died in the course of the twelve
-months preceding July last, on board of ships, seven hundred and
-fifteen seamen and marines, of whom only fifty-nine died in battle
-and of wounds. There died in the same time in hospitals eight hundred
-and sixty-two: so that out of twelve thousand one hundred and nine
-men, which is the sum total of the complement of twenty ships of the
-line, there have perished in one year one thousand five hundred and
-seventy-seven, that is nearly every seventh man.
-
-There were also sent to England in the same year, three hundred and
-fifty men, disabled by lameness and chronic complaints, the greater
-part of whom will be for ever lost to the service.
-
-The degree of sickness is very different at different times; but it
-appears by the returns, that, at a medium, there has been one man in
-fifteen on the sick list.
-
-Having employed all the attention of which I was capable to find out
-the causes of this sickness and mortality, in order, if possible, to
-point out the means of prevention, I flatter myself with being able to
-assign the most general causes, and to propose some effectual remedies.
-
-When it is considered that sickness is almost entirely confined to
-ships of two and three decks, and that some of these are as healthy
-as frigates and merchant ships, though in the same circumstances of
-service with others that are extremely sickly, we are led from hence to
-infer, that sickness is not in its own nature unavoidable, and we are
-encouraged to hope, that the attainment of general health is within
-the compass of human management.
-
-I humbly and earnestly solicit attention to some of the most material
-observations and conclusions which have occurred in the course of a
-service, which, though short, has been extensive; and whatever is here
-proposed has this recommendation, that it is easily practicable, and is
-no addition to the public charges.
-
-First, I hardly ever knew a ship’s company become sickly which was well
-regulated in point of cleanliness and dryness. It is the custom in some
-ships to divide the crew into squads or divisions under the inspection
-of respective officers, who make a weekly review of their persons and
-clothing, and are answerable for the cleanliness and regularity of
-their several allotments. This ought to be an indispensable duty in
-ships of two or three decks; and when it has been practised, and at
-the same time ventilation, cleanliness, and dryness below and between
-decks, have been attended to, I have never known seamen more unhealthy
-than other men. The neglect of such attentions is a never-failing cause
-of sickness.
-
-I would, therefore, with all becoming deference, suggest, that such
-a regulation, instead of being left to the discretion of officers,
-should be made a part of the public instructions. From some commanders,
-who already practise these rules, the advantage of them comes to be
-known; and would not a public sanction not only render them general
-and permanent, but facilitate the duty of the officer, by making such
-a regulation appear a matter of legal necessity, instead of his own
-arbitrary act?
-
-Secondly, Scurvy is one of the principal diseases with which seamen
-are afflicted, and this may be infallibly prevented, or cured, by
-vegetables and fruit, particularly oranges, lemons, or limes. These
-might be supplied by employing one or more small vessels to collect
-them at different islands, and such an expedient would prevent much
-sickness, and save many lives. I am well convinced that more men would
-be saved by such a purveyance of fruit and vegetables, than could
-be raised by double the expence and trouble employed on the imprest
-service; so that policy, as well as humanity, concur in recommending
-it. Every fifty oranges or lemons might be considered as a hand to the
-fleet, inasmuch as the health, and perhaps the life, of a man would
-thereby be saved.
-
-Thirdly, The use of wine, in place of rum, has been found extremely
-conducive to health. In the course of my observation I have met with
-the most unquestionable proofs of the benefit that would arise from
-this substitution. It is a farther reason for such a change, that good
-rum is seldom or never supplied in the West Indies.
-
-Fourthly, The necessaries provided for the sick by the present
-establishment are not at all adequate, especially on a distant station,
-where the supply is not regular, and the quantity at best is such as
-can contribute but little to their comfort and recovery. An ample
-provision might be made for the sick, without any additional expence,
-in the following manner:
-
-It is a rule in the service, that though men are sick, their ordinary
-allowance of salt meat and other victuals is nevertheless served out,
-and is either used by the other seamen, who stand in no need of it, or
-is wasted. Now, if the pursers were instructed to provide themselves
-with certain species of necessaries, such as Madeira wine, sugar, rice,
-and dried fruits, to serve to the sick, in place of rum, and the common
-provisions of the ship, such a regulation would be productive of the
-very best effects, in recovering the health, and preserving the lives
-of those men who have the misfortune to be taken ill in a situation
-necessarily destitute of most of the comforts that can alleviate their
-sufferings. I cannot help here applauding a late regulation, by which
-melasses are substituted for part of the oatmeal; for the quantity of
-the latter heretofore legally allowed was so much greater than what was
-necessary, that one half of it has commonly been wasted.
-
-It is to be observed, in general, with regard to the West Indies, that
-ships on service are to be considered, in a great measure, in the light
-of ships constantly at sea; for, excepting the island of Barbadoes,
-there is no other port in which fresh meat and vegetables can be
-procured in any quantity, and therefore sour krout, melasses, and such
-other articles of antiscorbutic diet as can be supplied on board, are
-absolutely necessary. Fleets could hardly exist here, were it not that
-a warm climate is naturally more unfavourable to the scurvy than a cold
-one.
-
-Fifthly, Though the health of a ship’s company depends chiefly on
-diet, and that discipline and order which is the business of officers,
-yet much depends also on the medical art, particularly in the West
-Indies; and as surgeons frequently cannot do justice to the men without
-wronging themselves, in a country where the price of every thing is
-exorbitant, and medicines often unsound, Government would find its
-account in supplying gratuitously some of the most costly articles,
-particularly Peruvian bark in a fresh state, from time to time, from
-England.
-
-Sixthly, It is now the general custom to send every sick person on
-shore to an hospital, where there is frequently worse air and worse
-accommodation than on board, from overcrowding the apartments.
-Contagious diseases, though not so common as in Europe, are here
-often mixed with those that are not so, whereby numbers are infected
-and carried off; and, besides this, the land air is infinitely more
-unwholesome in the West Indies than the air at sea or in a road. The
-scurvy is perhaps not at all contagious, nor is it very difficult of
-cure; but a number of cases of it terminate fatally from the flux
-or fever, caught either by contagion in hospitals, by the noxious
-influence of land vapours, or by intemperance. I beg leave, therefore,
-humbly to suggest, that as few sick as possible of any disease, but
-what is contagious, be sent to hospitals, and that some method be
-established for the supply of vegetables and other refreshments to the
-sick on board of their ships.
-
-Seventhly, Crowding, filth, and the mixture of diseases, are the great
-causes of mortality in hospitals. There should be a space of five
-hundred cubic feet allowed for each man; and in general the sick had
-better remain on board than be crowded beyond that degree; or relief
-should be provided to the hospital by an hospital ship, which, for
-reasons already given, is preferable to any accommodation on shore; and
-such an institution would be more particularly proper for the reception
-of convalescent men.
-
-I would beg leave, therefore, earnestly to recommend that cleanliness,
-the separation of diseases, and a competent space, be regularly
-enjoined and strictly enforced in hospitals; and in order to make this
-more practicable in the great scale of service now going on, I would
-farther propose that hospital ships be established for the reception
-of the sick or recovering. I know from extensive experience and close
-observation, that these circumstances are more essential than even
-medicine and diet.
-
-These are a few remarks extracted from a series of observations, and
-derived from great opportunities of experience. Many other remarks
-would suggest themselves; but I purposely confine myself to what is
-highly important, and easily practicable, with little or no addition to
-the public expence. Some of the improvements recommended are indeed an
-immediate, and all of them will be an eventual, saving to the public.
-
-The alterations that have been proposed are,
-
-1st, The establishment of a certain method and discipline, in order
-to secure regularity and cleanliness among the men, and to render the
-ships clean and dry.
-
-2dly, The supply of fruit and other vegetables for the cure of the
-scurvy.
-
-3dly, The substitution of wine[87] for rum.
-
-4thly, The provision of an adequate quantity of necessaries for the
-sick.
-
-5thly, The gratuitous supply of certain medicines.
-
-6thly, The curing of certain diseases on board instead of sending them
-to hospitals; and,
-
-Lastly, The preventing of filth, crowding, and the mixture of diseases
-in hospitals, by proper regulations, and by establishing hospital ships.
-
-I beg leave again to call to mind, that 1518 deaths from disease,
-besides 350 invalids, in 12,109 men, in the course of one year, is an
-alarming waste of British seamen, being a number that would man three
-of His Majesty’s ships of the line; and what I advance is from a real
-conviction that a due attention to the above-mentioned propositions
-would save more than two thirds of the seamen that would otherwise die
-in that climate. It was to set this in a proper light that I requested
-leave to quit my duty during the absence of the greater part of the
-squadron in the hurricane months; and should any thing I propose meet
-with public approbation, and be carried into effect, I should esteem it
-a recompence far above any other gratification I can derive from the
-service.
-
-  LONDON,
-  October 13, 1781.
-
-  To the Right Hon. the Lords Commissioners
-  of the Admiralty.
-
-       *       *       *       *       *
-
-Next year the following Supplement to the preceding Memorial was sent
-to the Board of Admiralty:
-
-
-SUPPLEMENT to the MEMORIAL delivered last Year to the Board of
-Admiralty.
-
-Since my return to my duty on this station, additional experience has
-afforded me farther practical confirmation of the utility of the former
-proposals.
-
-The great squadron employed on this station has, by the attention of
-the Commissioners of Victualling, and also of the Commander in Chief,
-been supplied with most of the articles recommended, in such quantities
-as to prove their efficacy; and indeed the small degree of mortality in
-comparison of former times, is a sufficient demonstration of this.
-
-I beg leave to give an instance in the Formidable of the great and
-salutary effects of the proposed improvements. This ship left England,
-furnished not only with sour krout and melasses, in common with most
-others in the squadron, but what was peculiar to herself was, an entire
-supply of good wine in place of spirits; and an experiment has been
-made in this instance, under my own eye, to ascertain what degree of
-health it was possible to attain in a great ship in this climate. With
-the above advantages, together with good discipline and medical care,
-no man[88] died of disease from December, 1781, to May, 1782, and
-only thirteen were sent to hospitals, whose complaints were small pox
-and ulcers. In the months of May and June last, when at Jamaica, there
-died of disease in this ship, three men, and seventeen were sent to the
-hospital, most of whom had contracted their sickness on board of French
-prizes.
-
-In the rest of the fleet the health was in proportion to the wine and
-other refreshments, and the cleanliness, good order, and discipline
-observed.
-
-In the squadron I attended the last five months, which seldom
-consisted, during the last three months of that time, of less than
-forty ships of the line, there have died of disease about 350 men,
-and about 1000 have been sent to hospitals; a degree of sickness and
-mortality which, though not greater than what frequently prevails
-in Europe, I am persuaded would have been still less, had the
-improvements proposed been complied with in a manner more extensive and
-complete, and had the general rules of discipline and cleanliness been
-kept up with due and equal strictness throughout the fleet.
-
-This last article, which, being the most important, I have placed
-first in the preceding memorial, it is only in the power of supreme
-authority to enforce; and my additional experience and observation have
-so far confirmed me in the opinion of the utility of this, as well as
-the other articles, that I hope to be again pardoned for repeating my
-humble and earnest solicitations that these regulations may be farther
-extended and enforced.
-
-  FORMIDABLE,
-  At Port Royal, Jamaica,
-  July 16, 1782.
-
-
-
-
-PART III.
-
-DESCRIPTION AND TREATMENT
-
-OF THE
-
-DISEASES
-
-MOST COMMONLY OCCURRING IN
-
-FLEETS IN HOT CLIMATES.
-
-
-It was mentioned in the Introduction to this work, that though my
-opportunities of experience were extensive, several obstacles had
-prevented me from making observations so accurately as could have been
-wished. These were chiefly the bad accommodation of the sick at some
-of the hospitals, and the shortness of our stay at any one place,
-which seldom exceeded six weeks or two months, and prevented me from
-completing such observations as I have happened to be engaged in.
-But having practised among great numbers, observations necessarily
-arose from the comparison of so many cases; and amidst the variety of
-situations connected with the emergencies and hardships of war, nature
-is seen in certain portions and under certain trials which are not
-met with in common life. I shall therefore describe the diseases such
-as they occurred, and shall add such remarks on practice as I could
-ascertain.
-
-The following observations shall be confined chiefly to what I have
-called the sea epidemics, viz. Fevers, Fluxes, and the Scurvy.
-
-
-
-
-CHAP. I.
-
-Of FEVERS.
-
-
-Though it is impossible to refer every particular case of fever to a
-distinct class, on account of the mixed and anomalous symptoms that
-arise, yet there are certain distinguishing features which afford
-sufficient ground for dividing them into different kinds, and such a
-division will at least serve to facilitate description, and to afford
-room for laying down the outlines of practice.
-
-The fevers which occurred most frequently on board of ships, and
-at naval hospitals belonging to the fleet in which I was employed,
-were the infectious ship fever, (which is the same with the jail and
-hospital fever) the bilious remitting fever, and the malignant yellow
-fever.
-
-
-1. Of the infectious SHIP FEVER.
-
-This does not occur so frequently in hot as in cold climates, both
-because it is the disease of ships newly fitted out, which they seldom
-are in the West Indies, and because there is something in the warmth
-of a climate which prevents the production of contagion, as has been
-formerly remarked. But as great fleets arrived from time to time in
-the West Indies from Europe, with numbers of men labouring under this
-fever, there were sufficient opportunities of making observations upon
-it.
-
-It has been so well described by Sir John Pringle, Dr. Lind, and other
-writers, that it is unnecessary to enter into a minute detail of all
-its different appearances in its several stages; and I shall content
-myself with recounting some of the most distinguishing symptoms, and
-with marking the peculiarities that arose from the influence of the
-climate.
-
-This fever is extremely various in its symptoms and in its degree of
-malignity and fatality. We are told in some of the histories of the
-jail distemper, that, upon its first attack, few escaped that were
-seized with it; but that afterwards it grew more mild; and it has been
-already observed, that the contagious poison of fever differs from that
-of small pox and other specific infections, by varying in its degrees
-of virulence.
-
-There are, however, certain characteristic symptoms pretty constant in
-this fever in all its forms.
-
-One of the most remarkable of these is a greater degree of muscular
-debility than what takes place in other fevers, and it deserves to
-be mentioned first, as being one of the most constant. It is also a
-tolerably true index of the degree of malignity, the danger being
-in proportion to this symptom. In the more advanced stages of the
-fever, a tremor of the hands, and of the tongue when put out, is a
-constant symptom, and seems to be connected with this weak state of the
-muscular fibres. I have seen, however, extreme debility without tremor
-in cases too of the greatest danger, and it was observable in these
-that there was little or no delirium.
-
-Another striking character of this fever is the delirium of a
-particular kind which usually attends it. Sensation and reason are
-here in a state uncommonly depraved; and it is in this sort of fever
-oftener than any other that we find a total deprivation of them in the
-symptom called _coma_. The delirium is seldom of a wild, ungovernable
-kind, such as occurs in inflammatory continued fevers, in the violent
-paroxysms of intermitting and remitting fevers, or in inflammations
-of the brain. It is, however, connected with great suffering; and
-this consists in anguish rather than pain, shewing itself by outward
-tremor, agitation, and what is called the _floccorum collectio_; also
-by sighing, mumbling, and moaning, symptoms always indicating danger.
-
-Delirium is a symptom, to the nature and appearances of which I have
-been particularly attentive, in consequence of a painful and diligent
-attendance upon some cases in which I was particularly interested from
-friendship and affection, and in which this was a remarkable symptom.
-It seems chiefly to consist in a false reference of our sensations,
-whether external or internal; and this is in no sort of fever more
-evident than in this. When any painful impression, for instance, is
-made by an external body, the patient, if in a state of delirium, does
-not refer it justly to the part affected; but the general agitation and
-incoherence of sentiments will be aggravated for the time. I have known
-a degree of heat applied to the extremities sufficient to blister them,
-yet the part did not shrink, though the raving and general uneasiness
-were increased. In like manner, with regard to internal sensations,
-when an irritation is excited to expel the urine or _feces_, the mind
-does not recognize it as such, but from a sense of uneasiness, probably
-mistaken for something else, an effort is made to relieve nature,
-which is done without a proper consciousness, and certain symptoms
-are produced which are well-known marks of danger in this fever. In
-watching those who have been under the influence of delirium, I have
-observed it increase when any particular want of nature urged, and
-this would continue for some time, the patient being incapable of
-procuring himself immediate relief on account of the false reference
-of sensation that has been mentioned; but he would become calm after
-voiding the urine or _feces_, or after receiving something to drink,
-according to the particular want that was present at the time. So
-great is the disorder in the common course of sensation in this fever,
-that a person ill of it has been even unconscious of inflammations of
-vital parts, which, in the natural state of the nerves, would have
-excited the most acute pain, and would have been distinctly referred
-to the part affected, but were not discovered nor suspected till
-inspection after death[89]. I remember one case in which there were
-found large erosions, and even holes in the intestines, without any
-preceding complaint that could have led to suspect such an appearance.
-It would appear that the motions excited in the brain and nerves in
-such cases, instead of producing the sensations naturally belonging to
-them, serve to excite disagreeable emotions of a different kind, in
-which delirium consists. It seems to be from the same depraved state
-of sensation, that when a phthisical person is seized with this sort
-of fever, his cough is for the time suspended. I have seen the same
-circumstance occur in a maniacal case. From a like cause it sometimes
-happens in dangerous cases of fever, that in the height of delirium the
-_epiglottis_ loses its natural irritability, so that liquids in the
-act of swallowing are apt to get into the windpipe, so as to excite
-coughing and threaten suffocation, as I have observed in some cases
-that came under my care.
-
-All these different forms of delirium are signs of a body extremely
-disordered in its functions, and forbode great danger.
-
-The next symptom I shall mention as most characteristic of this sort
-of fever is, the spots known by the name of _petechiæ_ and _vibices_,
-which, though far from being constant, are, perhaps, more peculiar to
-it than any other symptom. They occur only in the latter stages of
-the disease, and in cases of considerable danger. The common opinion
-concerning their cause is, that the blood is in such a dissolved state,
-that the red part of it is effused into the cellular membrane. The
-appearance in such bodies as I have inspected, seems to favour this
-opinion; for there was hardly any coagulation of the blood in the great
-vessels, and instead of those firm substances, called _polypi_, in
-the heart, there were only soft grumous bodies, which were so tender
-in their consistence, that, upon being handled, they, as it were,
-dissolved. Since the improved method of treating these fevers has been
-generally adopted, this symptom seldom occurs; for in most cases it may
-be called an artificial symptom, chiefly arising from close apartments
-and the heat of bed clothes.
-
-It may be considered as a peculiarity of this fever, that it is more
-indefinite in its crisis than most others. In continued fevers of the
-inflammatory kind, there are frequent attempts at remission, there are
-certain periodical exacerbations, and there is generally a distinct
-crisis marked by a freedom of the secretions and turbid urine: but in
-the fever of which we are treating, though the patient is generally
-somewhat worse towards the evening and during the night, its course is
-more equable, and the transition from sickness to health is insensible
-and gradual, being seldom marked with any perceptible crisis.
-
-The symptom next to be taken notice of, though a minute one, is very
-constant and characteristic in this sort of fever. It is a peculiar
-heat in the skin, communicated to the hand of another person. It is
-usual to grasp the wrist of the patient after feeling his pulse, in
-order to examine the state of the skin in point of heat and moisture;
-and in doing this a glow of heat is impressed on the palm of the hand,
-which lasts for some hours, if one should neglect so long to wash the
-hands. I have never met with this symptom in any of the sporadic fevers
-of England, though I am informed it sometimes occurs in these.
-
-The fever we are treating of differs also from the sporadic nervous
-fever of England, and from most others of the continued kind, in
-being attended with a more copious secretion of bile, which, when
-thrown up, is generally green, or, as it is otherwise called, of a
-porraceous colour. This symptom takes place in all climates; but is
-more remarkable in a hot climate, as might be expected.
-
-These are the chief characteristic symptoms of this fever. I shall next
-point out such modifications of it as occurred in the West Indies from
-the influence of climate.
-
-In the first place, when this fever prevailed on board of any ship
-that arrived from a northern climate, it was soon after succeeded by,
-or, as it were, converted into, a dysentery; for those ships that
-arrived either from England or North America with the greatest stock of
-feverish infection, were the most subject to fluxes, after being two or
-three months in the West Indies. This was formerly made use of as an
-argument, to prove that the dysentery proceeds from the same cause with
-fever, taking a different determination, from circumstances of climate
-and constitution.
-
-Secondly, It sometimes happens that men, under the influence of this
-infection, are more apt than others to be affected with symptoms
-peculiar to the climate upon their first arrival. A very striking
-instance of this has been mentioned in the case of men that were
-pressed into the Formidable at New York, some of whom had the common
-ship fever on the passage; others, upon our arrival at Barbadoes, were
-seized with the yellow fever, and were the only men in the fleet who
-had it at that time. There was another instance in the recruits brought
-from England by the Anson, who were seized with a fever on board of
-the Royal Oak; and in this fever the skin and eyes were yellow, though
-without any symptoms of malignancy[90].
-
-Thirdly, It happened in some ships[91] that the infection was kept up
-for several months after arriving in the climate, from a neglect of
-cleanliness, or the want of an opportunity of removing those who were
-infected to an hospital. It did not in these take a dysenteric turn, as
-in most of the other ships, but differed from the ship fever of colder
-climates, as above described, in some particulars, which I shall here
-enumerate. All the symptoms were milder: it was more protracted, and
-less dangerous. In the beginning there was but little difference, only
-the symptoms were less violent; but in the succeeding period of the
-disease the pulse deviated very little from the natural standard, and
-the skin felt cold and clammy. The tongue was white; and this did not
-seem so much owing to any fur covering it, as to its being itself of
-a pale, lifeless colour, as well as the face, and it appeared larger
-in size than natural. The teeth were clogged with a white fur. Those
-affected with this fever were subject to faintings, and had a constant
-uncomfortable languor and listlessness. Most of them had a deep-seated
-pain in the occiput, and an oppression at the stomach, but without any
-inclination to vomit. The unfavourable symptoms were _coma_, _delirium_
-and a yellowness of the skin. I never remember to have seen _petechiæ_
-in any of them. The favourable symptoms were a warm moisture, or a
-miliary eruption on the skin, and a gentle _diarrhœa_, which, however,
-if neglected, was in danger of degenerating into an incurable flux.
-A great number were seized with this fever in the Alcide, in July,
-1783, and what is remarkable, most of them had the tape worm, as I
-was informed by Mr. Telford, the surgeon of that ship, who frequently
-obliged me with valuable remarks; and he observed also, that it
-was evidently infectious, and that the skin communicated the same
-disagreeable feeling to the hand as was mentioned above.
-
-Though the inflammatory fever does not often occur in hot climates,
-yet, as it is of great consequence to distinguish it in all cases from
-the infectious fever of which we are treating, it may not be improper,
-nor uninstructive, here to point out the most remarkable differences.
-There is more resemblance in their symptoms, especially towards the
-beginning, than might at first be supposed; and as it is very material
-to avoid error with regard to the practice, which, in these two sorts
-of fevers, ought to be very different, and even opposite, I have taken
-particular pains to discriminate them.
-
-The continued inflammatory fever is very uncommon in the West Indies;
-but in the form in which I have met with it in North America and
-England, there are cases in which the blood is sizy during the whole
-course of the disease, even without local affection, though, in
-general, there is more or less rheumatism, or pulmonic inflammation.
-The symptoms which chiefly distinguish such cases from the fever before
-described are, a greater degree of muscular strength, a more violent
-delirium, pale urine, a more parched tongue and skin, greater heat
-and thirst, and a pulse more frequent and strong, with a particular
-sharpness. There is another symptom sometimes occurring, which I
-consider as strongly characteristic of a fever of an inflammatory
-nature. This is a watery diarrhœa, without _fæces_ and without gripes,
-the stools consisting chiefly of the drink as it was taken in. There
-seems here to be a suspension of the power of absorption as well as
-secretion in the bowels, in consequence of a general spasm on the
-extreme vessels; for there is hardly even bile or mucus in the stools.
-There is also a particular appearance of the mouth connected with this
-type of fever, which is better learned by the eye than by description.
-It consists chiefly in a want of moisture on the lips, and a dryness
-and shining appearance of the teeth. With these symptoms, it will be
-found that the patient will bear the lancet in very advanced stages of
-the disease. These fevers seldom occur but in a sporadic way, unless
-when there is some peculiarity of season, as at New York in autumn,
-1782. They are also more frequent among the better than the lower sort
-of people.
-
-By comparing these symptoms with those of the infectious fever above
-described, there will appear an obvious difference in their nature, and
-evident reasons for varying their treatment.
-
-
-TREATMENT of the SHIP FEVER.
-
-When the body is thrown into disorder by an attack of fever, the first
-step to be taken is to clear the stomach and bowels of their crude and
-acrid contents, consisting either of the food imperfectly digested,
-or the depraved natural secretions. So great is the disturbance
-produced by such offending matter, that, when nature is freed from
-this embarrassment, the functions of the body are frequently by this
-alone restored to their proper exercise, and a remission produced. It
-seems probable also, that this evacuation proves salutary not only
-by removing the morbid stimulus, but by preventing the absorption of
-corrupted or ill-concocted juices into the mass of blood, which would
-tend still farther to derange the functions of life. But perhaps
-the circumstance that first suggested the utility of evacuating the
-stomach, as the first step in the cure of fevers, was the nausea so
-common in the beginning of them, which may be considered as a natural
-indication of this practice. It farther appears rational, that, as
-acute diseases generally come on suddenly, and find the body in a
-state of repletion from the recent _ingesta_, the most obvious means
-of relief should be to free the bowels, and particularly the stomach,
-from what is foreign and oppressive to it. It seems also probable, that
-the _nausea_ and the act of vomiting have a salutary effect independent
-of evacuation; for I have seen relief produced from these when nothing
-was evacuated. Such, indeed, is the great and universal influence and
-sympathy of the stomach, that the operation of vomiting affects every
-fibre of the body, and has been known to resolve tumours in the most
-distant parts. An early administration of an emetic is therefore the
-first step to be taken in the treatment of this as well as most other
-fevers.
-
-If it is given in small divided doses, it will most probably evacuate
-the bowels downwards; and the most convenient form for this purpose is
-a solution of emetic tartar. If it should not have this effect, some
-brisk purgative medicine should be given soon after the operation of it.
-
-I mention these evacuations before blood letting; for though this ought
-to be first in those cases in which it is proper, it is here seldom
-necessary, and we may pronounce it to be a remedy very ill adapted
-to this sort of fever, particularly in a hot climate. It sometimes
-happens, however, that there is violent head-ach, pain of the back
-and limbs, with a throbbing pulse; and these symptoms may in the very
-beginning not only justify, but require the losing some blood before
-the administration of the emetic or purgative.
-
-The next means of relief I shall mention, and also the most probable
-means of cutting short the disease, is to excite universal sweat.
-This being an imitation of nature, is founded on reason as well as
-experience; for it is by sweating that the fit of an intermittent
-is relieved and terminated; and continued fevers in general, if not
-always, begin with a fit of the same kind. A dry skin, accompanied
-with heat, is one of the most constant as well as troublesome and
-uneasy symptoms in all fevers; and it would appear from the peculiar
-heat of the skin in this sort of fever, that there is either a more
-than common acrimony of the matter of perspiration, or something
-peculiar in the mode of circulation on the surface of the body.
-Sweating does not seem to operate entirely by the evacuation of
-acrimony, for no relief is procured by it if it is partial; and it
-is evident from a number of facts that the state of the brain and
-_viscera_ depends on that of the external surface of the body; for a
-free state of the pores of the skin, provided it is general, tends more
-than any other circumstance to relieve internal pain, and also to take
-off delirium. The good effect of sweating seems, therefore, chiefly to
-depend on a general relaxed state of the small vessels on the surface
-of the body; and it ought to be effected, if possible, by gentle,
-soothing means, and not by such regimen and medicines as heat the body
-and accelerate the circulation. This intention is best answered in the
-beginning by moderate doses of antimonial medicines, and either James’s
-powder or tartar emetic may be employed. The first is a more certain
-sudorific, being less apt than the other to run off by the bowels;
-and its effect will be still more certain, if accompanied with a mild
-opiate, rendered diaphoretic by _Spiritus Mindereri_, which will both
-prevent the antimonial from acting roughly, and will determine its
-operation to the skin. A sweat kept up by these means, together with
-plentiful warm dilution, from twelve to twenty-four hours, is the most
-probable means of bringing about a complete remission of the fever;
-and in this case a fresh accession is to be prevented by the immediate
-administration of the bark.
-
-These are the means proper for stopping the fever in the beginning,
-or tending to render its future progress more safe; and though, with
-this view, free evacuations have been recommended, yet, if the fever
-should go on, great caution is necessary in this respect in the future
-treatment, debility being the symptom chiefly to be guarded against.
-Purgatives may, indeed, be occasionally necessary, in consequence of
-accumulations of bile taking place; but, in general, the evacuations by
-stool should not be more frequent than in health; and some of the cases
-which were most unmanageable and fatal, were those in which there was
-a spontaneous _diarrhœa_. With regard to blood letting, it is always
-hurtful after the first two days, unless some inflammatory affection of
-a vital part should arise.
-
-The natural evacuation, which may with most safety and advantage be
-solicited and encouraged in this disease, is, that by perspiration;
-and it is observable, that in those cases for which nature does most,
-there is a universal warm sweat, which has generally a very offensive
-smell, and seems to be a salutary effort of the constitution to cure
-the disease. Where this takes place, little medical assistance is
-necessary, except to keep it up chiefly by warm dilution; and there is
-no circumstance in which the judgement of a physician is shewn more
-than in discerning those cases in which his chief business is to look
-on, where nature, being equal to the task, ought not to be disturbed by
-the active and officious interposition of art. We should not, however,
-aim at producing a profuse sweat, except with a view to effect a
-remission immediately after the first evacuations. In the course of the
-disease, it is only necessary to keep up a gentle moisture or softness
-of the skin.
-
-The head being particularly affected in this sort of fever, the patient
-is extremely restless and delirious, especially at night; and there is
-a medicine which has a most pleasing effect in procuring both rest and
-perspiration. This is a combination of an opiate with an antimonial
-medicine, which was administered in the evening with great success;
-and the sudorific effect is rendered more certain by the addition of
-some saline neutral, especially _Spiritus Mindereri_[92]. I tried
-pure opiates in the early stage of this, fever, but found them not to
-answer; though in the low[93] fevers of England, and in the advanced
-stages and convalescent state of this fever, they are extremely safe
-and useful. Pure laudanum is also given by Dr. Lind, at Haslar, with
-great success in the height of the disease; but in the West Indies
-there is a greater tendency to acrid excretions, and the effect of pure
-opium in causing a retention of these, seems to be the cause of its
-disagreeing in that climate in the first stage of this fever.
-
-It may here be observed, that the addition of a little neutral salt
-alone will sometimes so qualify the operation of opium, as to prevent
-its bad effects, such as the increase of febrile heat and delirium, and
-the stupor and head-ach which, when given alone, it frequently induces
-the following day. I have generally employed nitre with this intention;
-but this does not seem so well adapted to this disease as some other
-neutral salts, as it tends too much to lower the powers of life.
-
-But with a view to perspiration, the _Spiritus Mindereri_ is the most
-effectual neutral medicine when conjoined with an opiate, and there
-is not, perhaps, a more safe and pleasing diaphoretic known than a
-combination of it with syrup of poppies[94]. There is some neutral salt
-in Dover’s powder, and this has more effect than could be expected
-from so small a quantity of an inert medicine; for I know from trials
-of my own, as well as those of others, that ipecacuanha and opium
-given together, in the proportions prescribed in that powder, will
-not have the same effect as when joined with the neutral salt. This
-is an instance of those useful combinations of medicines which can be
-discovered only by experience, but which every physician ought gladly
-to adopt in practice upon good testimony and fair trial, though he may
-not be able to account for their effects, nor to explain their mode of
-operation.
-
-There is nothing more important than plentiful warm dilution; and the
-infusion of sauge, or any such light aromatic, is rather more proper
-than farinaceous decoctions, or any compositions in which there is wine
-or spirits. Success in this, as well as other diseases, depends on
-attention to nursing as much as upon medicine; for what would it avail
-here to administer medicines for promoting perspiration, unless they
-were assisted with fluids to allay thirst, to dilute the acrimony in
-the first passages and in the vessels, and to furnish the materials of
-free perspiration?
-
-But however desirable it may be to procure sweat, this is not to be
-attempted by close rooms and bed clothes, nor by hot medicines, such
-as volatile salts, serpentary, spirituous tinctures, or aromatics.
-These, according to the testimony of Sydenham, tend to increase the
-heat and delirium, and to produce _petechiæ_, miliary eruptions, or
-local inflammations. In the intervals of the anodyne diaphoretic above
-described, _Spiritus Mindereri_ and small doses of camphor, with
-proper dilution, may be safely employed to procure a soft skin.
-
-The only other means I shall mention with this view is, the application
-of warm moisture to the surface of the body, which may be done by
-soaking the feet and hands in warm water, or by fomenting the feet and
-legs with stupes[95]. These operations have the effect of bringing on
-a general relaxation on the skin, thereby taking off febrile agitation
-and delirium, and inducing sleep. I sometimes, with seeming benefit,
-ordered cataplasms to be applied to the feet, merely of the emollient
-kind, without mustard or any other acrid substance, being intended to
-relax, and not to stimulate.
-
-In the use of pediluvia and fomentations, there is a difference worth
-attending to between the practice in this fever, and that in the
-inflammatory fever before described, for they are as hurtful in the
-latter as they are beneficial in the former. I have observed, in
-general, that they have a bad effect in all cases where there is sizy
-blood, particularly where the breast is affected.
-
-Delirium is one of the most constant and alarming symptoms in this
-disease, and the removing of it depends much upon the attendants as
-well as the physician. It has been said before, that it depended on
-a false apprehension of the impressions or natural sensations. When
-a person, for example, labours under delirium, and is affected with
-thirst, the minds is either so agitated with other objects, that
-this sensation is overlooked, or, instead of producing a craving for
-drink, it excites some other disagreeable emotion in consequence of
-the disordered state of _sensorium_. This last seems to be probable
-from the cessation of delirium, which will take place upon any natural
-want being satisfied; I have seen a temporary stop put to the patients
-raving by making him drink, or upon his discharging his urine or
-_feces_; for he is then unconscious of thirst and other natural wants,
-is therefore ignorant of the means of satisfying them; and when he
-does so, he fancies he is about something else which is the subject of
-his delirious thoughts. This observation leads to a material practical
-purpose; for it follows from it, that unremitting attention should be
-given to the patient’s feelings and all his possible wants, as those
-natural notices and instinctive cravings which occur in health are now
-wanting, in consequence of the depraved state of sensation.
-
-Most of the remarks that have hitherto been made apply to the earlier
-stages of the disease. The principal remedies applicable in the more
-advanced stages are, blisters, Peruvian bark, opium, and wine.
-
-I have found what Dr. Lind says concerning the efficacy of blisters
-confirmed by my own experience, especially in those fevers in which
-there was great delirium, _coma_, and head-ach; but I have not
-experience enough to say whether they were as useful in the beginning
-of the disease in the West Indies as he found them to be in England.
-
-The men that were brought from the ships to the hospitals were affected
-with the disease in various stages; but as we had in general a very
-inaccurate history of the several cases, the method of treatment
-upon their first admission was pretty nearly the same in all; and it
-consisted, in the first place, in washing their face, hands, feet, and
-legs, with warm water and vinegar, from which they derived the greatest
-comfort, being commonly very dirty. There ought to be a [96]warm bath
-at every naval hospital kept in constant readiness; for there are so
-few conveniences on board of a ship for preserving bodily cleanliness
-among the sick, that the surface of the body becomes loaded with
-filth, so that the operation of the warm bath could not fail to be
-highly comfortable and salutary as the first step to their cure when
-brought on shore. We had generally very indistinct information about
-the state of their bowels, as well as other circumstances, on account
-of their delirium; but it was at any rate useful, or at least safe,
-to give them a clyster. They were enjoined plentiful dilution; and if
-they were low, some wine and water was allowed. In the evening, the
-anodyne diaphoretic medicine was administered, and a blister applied
-to some part of the body. In consequence of this method, we seldom
-failed to find the patients better next morning; and it was tried in
-such numbers, that the efficacy of it was sufficiently ascertained. It
-happened in some cases, that these means were omitted, and a comparison
-of these with the others served to ascertain the true efficacy of the
-medicines; the stationary state of the symptoms, when the disease
-was thus left to itself, sufficiently proving the propriety of the
-treatment above described.
-
-It is an important question to what circumstances of this fever the
-Peruvian bark is adapted. An early and indiscriminate use of it is
-recommended in some late publications, upon the authority of which
-I tried it without regard to the stages or symptoms, and without
-any prejudice either for or against the practice; but I found that
-this powerful remedy was in danger of doing much harm, unless great
-attention was paid to circumstances, in order to ascertain the proper
-seasons for giving it. The symptoms that forbid the use of bark are
-chiefly foul bowels, hard pulse, sizy blood, great delirium, dry
-tongue, a hot and dry skin, and inflammatory affections of the viscera.
-It was found extremely pernicious in an early stage of the disease
-previous to evacuations; and the object of practice at this time should
-be to relieve the habit by means of these, in order to produce a
-general relaxation of the secretions, and to render the skin cool and
-soft, thereby paving the way for the bark.
-
-It is not necessary, however, especially in the advanced stages of the
-disease in this climate, to wait for an absolute remission, in order to
-administer the bark. In a cold or temperate climate it will seldom be
-found advisable to give it in any period of this fever; but in a hot
-climate it is sometimes admissible where there are symptoms of general
-debility, such as a small pulse and muscular weakness, even though the
-frequency of the pulse, delirium, and a dry skin and tongue, should
-indicate some degree of fever. It may be remarked, by the bye, that a
-dry tongue is a fallacious symptom, for it may happen in consequence of
-the patient’s breathing through the mouth instead of the nose, without
-any fault in the secretions of the _fauces_. The symptom which forbids
-the use of the bark more absolutely than any other is an inflammatory
-or dysenteric state of the bowels, in which cases it seems to be
-invariably pernicious.
-
-Where it happens that we are extremely anxious to throw in the bark,
-as we usually are in the West Indies, where fevers are very rapid
-and dangerous, and yet the symptoms seem hardly to admit its use, it
-was very commonly tried either in conjunction with some antimonial
-medicine or neutral salt, or these were given alternately with it, in
-order to soften and qualify its effects by preventing it from heating
-or otherwise aggravating the symptoms. Antimonial wine or _Spiritus
-Mindereri_ were conveniently employed with this intention.
-
-With regard to the quantity of bark to be given, it may be proper in
-doubtful cases of this kind to begin with small doses, in order to feel
-how far it agrees or not; but in general it may be laid down as a rule
-with regard to this medicine, that, where it is really proper, and the
-medicine to be depended on, it is to be given in as large doses and as
-frequently as the stomach will easily bear it.
-
-The next remedy mentioned was opium. It is a medicine more admissible
-and useful in this than any other kind of fever. The same cautions
-nearly apply in the administration of it as have been given with
-regard to the Peruvian bark. The caution with regard to foul bowels is
-particularly necessary in a hot climate, where an over secretion of
-bile is so apt to take place. When, the Boreas frigate arrived from
-England in March, 1783, there was a very bad fever of the infectious
-kind on board, some cases of which being sent to the hospital at St.
-Lucia, were treated unsuccessfully with bark and opium, which I had
-been induced to try upon the authority of the authors above alluded
-to. I attributed this want of success to the neglect of previous
-evacuation; for, upon inspecting the bodies, the intestines were found
-full of bilious _feces_. I profited from this, and was more successful
-in the other cases. It were to be wished that physicians could oftener
-bring themselves to confess their errors in practice, and their
-writings would be more instructive; for it is of consequence to know
-what we are to avoid as well as what we are to follow.
-
-It has been mentioned that the best effects arise from the conjunction
-of an antimonial with an opiate; but, in this sort of fever,
-antimonials, and even most of the neutral salts, are hurtful after the
-first stage, and opiates may after this be given alone or combined with
-camphor. With regard to the precise period of leaving off antimonials,
-it must be left to discretion, and the constitution of the patient is
-the best guide. There is so great a difference in patients in this
-respect, that all practical precepts should be qualified by a due
-discrimination of constitutions. Absolute and dogmatical rules are so
-far from applying in the practice of physic, that there are some cases
-of the same disease that require a treatment even opposite to what
-is in general most adviseable. This may be very aptly illustrated by
-the small pox, of which there are cases that ought to be treated very
-differently from the general method laid down by Sydenham, and in which
-cordial medicines are highly proper and necessary. This difference
-in diseases themselves seems to be one great cause of the difference
-of opinion among physicians on practical points, each party finding
-some countenance in experience for their general doctrine, do not
-make allowance for the varieties that exist in nature; so that, in one
-sense, both may be said to be in the right. If the patient is not very
-much sunk, and if there are bilious symptoms, or an obstinate dryness
-in the skin, a few grains of James’s powder may be given with advantage
-even in an advanced period of the disease. If a hot and dry skin should
-at this period be the only troublesome symptom, it will be more safely
-and effectually removed by camphor combined with something opiate and
-the _Spiritus Mindereri_, which is the only neutral now admissible,
-than by antimonials, which, at this time, would be in danger either of
-ruffling the patient by their operation on his stomach and bowels, or
-of weakening him too much either in this way, or by exciting profuse
-sweats. Evacuant medicines of every kind being then improper, clysters
-are the only laxatives to be employed in case the state of the bowels
-require them.
-
-Having mentioned camphor, it may be proper here to remark, that it is
-a medicine of which I have found it extremely difficult to ascertain
-the virtues and effects; and in consequence of this ambiguity, I
-believe there are few articles of the materia medica more abused in
-practice. In all inflammatory affections, and in the beginning of all
-fevers where there is much heat and thirst, I think I have observed it
-to aggravate the symptoms. It seems in no case to be more proper than
-at certain periods of this fever, and especially when there happens
-to be spasmodic pains of the stomach, or tremors and cramps in the
-extremities.
-
-In this advanced stage of the fever, in which the most common symptoms
-are weakness, restlessness, tremors, and low delirium, no medicine
-was found so much to be trusted to as opium, which here acts as a
-cordial as well as an anodyne and antispasmodic. It may be given, in
-the camphorated julep, in the form of tincture, from five to ten drops
-every six or eight hours, or some of the officinal compounds, such as
-the theriaca or mithridate, may be employed with advantage. I have
-thought also, that, at this period, castor conjoined with opium seemed
-to improve its virtue. This was first suggested to me by Mr. Crudie,
-an ingenious German surgeon, whom I employed as an assistant at the
-hospital at St. Lucia; and since I have been physician to St. Thomas’s
-hospital, I have found the most pleasing effects, in similar cases,
-from a composition used there, the principal ingredients of which are
-opium and castor[97].
-
-In this state of the fever I have also used with advantage the
-decoction of Peruvian bark and serpentary, as recommended by Sir John
-Pringle; and when the skin is cold and the circulation is very languid,
-as is sometimes the case, volatile salts and powder of serpentary may
-very properly be employed.
-
-But in the advanced state, and in the worst forms of this disease,
-there is perhaps no medicine superior to wine. This was given either
-pure, or diluted with water for common drink, and sometimes to the
-quantity of a quart in twenty-four hours. In delicate people, such as
-we meet with in private practice, the quantity ought to be less.
-
-There is this caution necessary with regard to the use of wine, that
-when the fever is gone off, and only extreme debility remains, the free
-use of it is not safe nor proper; for, in a weak and exhausted state,
-a person is more apt to be [98]heated and intoxicated by any fermented
-liquor, than in health, or even in the preternatural and disturbed
-state of actual disease, such as occurs in this fever.
-
-After the disease is removed, a long state of weakness is apt to
-succeed, especially in a warm climate. The most proper remedies,
-then, are bitters, such as decoctions of Peruvian bark, infusions
-of quassia bark, gentian, or camomile flowers. These answer better
-than the bark in substance, which is now apt to nauseate and load
-the stomach, and the patient is apt to take an aversion to this and
-whatever else he took in a state of sickness. The best strengthening
-medicines are such as comfort the stomach and create appetite; and we
-may mention Huxham’s tincture of bark, in small doses, and a moderate
-use of wine, as the most proper for these purposes. Where colliquative
-sweats take place, elixir of vitriol is serviceable, and with this
-intention I have joined it, with evident advantage, to the evening
-anodyne, which, without such a corrector, tends rather to aggravate
-this symptom. I have known assafœtida prove a useful stimulus to the
-stomach at this time, and it may even be used while the fever subsists,
-especially where the secretions of the fauces are scanty. This medicine
-is recommended by Sir John Pringle in the same circumstances. But I
-consider the prudent use of opiates, particularly at bedtime, as the
-most effectual cordial and strengthening medicine in this convalescent
-state.
-
-But with regard to the management of the sick at this time, as much
-depends on diet as medicine. Nothing has been said concerning this in
-the acute state of fever, because no nourishment is then necessary. In
-that state there is a loathing of all food, and the powers of digestion
-and assimilation seem to be then suspended, so that alimentary
-substances become not only an useless load, but offensive and hurtful
-by turning acid or putrid. It is likewise evident from fact, as well
-as reason, that nature, in this situation, does not require sustenance;
-for we frequently see people labouring under fevers who do well and
-recover, though they have been entirely without nourishment for a
-length of time in which the like abstinence in a state of health would
-have proved fatal. The friends and attendants of the sick, from a
-prejudice not unnatural, but not considering the difference between
-health and that state of derangement which takes place in fever, are
-for ever wishing to supply the patient with nourishment, and every
-physician meets with trouble in counteracting this officiousness.
-Nevertheless, when the fever draws out to a considerable length, and
-the principal symptom is that state of weakness which, in low fevers,
-runs insensibly into that of convalescence, then it is necessary to pay
-the utmost attention to nourishment, and nothing tends more to insure
-and hasten recovery than the assiduous administration of light and
-nourishing food, the same cautions being observed which have just been
-mentioned with regard to cordials. One of the greatest hardships of a
-sea life is the want of those articles of diet that are suitable to a
-recovering state, and many lives are lost from this circumstance, after
-the force of the disease has been subdued[99].
-
-With regard to the peculiar form, before described[100], which this
-fever assumes a few months after ships have been in a hot climate, we
-found camphor, volatile salts, and serpentary, the best remedies. As
-there was a remarkable coldness of the skin, I was induced in one case
-to try the hot bath, and with good effect, from which it seems probable
-that a short stay in a bath, of a heat from 96° to 100°, so as to have
-its warming and stimulating, without its relaxing effects, would answer
-well in fevers of this kind.
-
-
-2. Of the BILIOUS REMITTING FEVER.
-
-This is peculiar to tropical climates, and arises in the same
-situations in which intermitting fevers arise in temperate and cold
-climates. It seldom arises at sea, unless where there has been previous
-exposure on shore, of which some examples have been mentioned in the
-first part of the work. It may generally be traced to the air of woods
-or marshes; and in our fleet hardly any men were attacked with it but
-those who were employed in the duties of wooding and watering.
-
-The most distinguishing symptom is a copious secretion of bile which
-attends it. Its course, in general, is shorter than that of the fever
-before described; and though the symptoms are more violent, they are
-not so equal and steady, owing to the tendency there is to remission.
-The symptoms are particularly violent at the beginning, in so much
-that some of the men, after being exposed upon duty to the heat of
-the sun and the air of marshes and woods, would become frantic, being
-seized almost instantaneously with _delirium_ resembling madness. This
-fever, when it arises merely from the effluvia of woods and marshes,
-has a natural tendency to remit; nay, some fevers at St. Lucia,
-proceeding from this cause, were of the pure intermitting form from
-the beginning. But in many of those that arose at Jamaica little or
-no remission was to be perceived; and it was distinguished from the
-ship fever by the bilious vomits and stools, more violent delirium,
-and head-ach, and by being attended with less debility. The greater
-tendency to the continued form at this time was probably owing to this
-circumstance, that the men who were exposed to the land air in wooding
-and watering, were then exposed also to such causes as naturally
-produce continued fevers, such as infection, the foul air of the
-French prizes, intemperance, and hard labour. There was in some cases
-a yellowness of the eye, and even of the whole skin, but without the
-other symptoms that characterise the yellow fever, properly so called.
-
-In cases that proved fatal, the symptoms, for some time before death,
-resembled very much those of the fever before described at the same
-stage. There was either _coma_ or constant delirium, great seeming
-anguish, the mouth and tongue very dry, or with only a little ropy
-slime, a black crust on the teeth, picking of the clothes, and
-involuntary stools.
-
-
-TREATMENT OF THE BILIOUS REMITTING FEVER.
-
-The measures proper to be taken in the beginning of all fevers are
-pretty nearly the same. There is little difference in the first
-treatment of this from that of the ship fever, except that blood
-letting is here more frequently proper, and that a more free evacuation
-of the bowels is necessary on account of the more copious secretion of
-bile.
-
-In full and athletic habits the disease very commonly begins with
-pains in the limbs, back, and head, with a strong throbbing pulse; in
-which case it is proper first of all to let blood at the arm. This
-is also highly proper and necessary in those cases mentioned above,
-in which the patient becomes suddenly frantic. But though the cases
-requiring blood-letting are more frequent in this sort of fever than
-that already treated of, yet great caution and nice discernment are
-necessary with regard to it, in all cases, in a hot climate. As fevers
-in such a climate run their course faster, the symptoms succeeding each
-other in a more close and hurried manner, greater expedition, as well
-as discernment, are required in timing the different remedies than
-what are necessary in a cold climate. Blood letting unseasonably and
-injudiciously employed either endangers life, or has a very remarkable
-effect in protracting recovery, by the irrecoverable weakness it
-induces.
-
-With regard to the evacuation by the bowels, it has already been
-mentioned in another part of the work, when on the subject of
-prevention, that, before the fever comes on, there is a languor and
-general feeling of indisposition, and that then an emetic and a
-purgative, followed by some doses of the bark, were the most likely
-means of preventing the attack of the disease. If the fever has
-properly begun, which is announced by a _rigor_ taking place, then no
-time is to be lost in procuring evacuation; and, after blood letting,
-if the symptoms should require it, the best medicine is tartar emetic,
-which, if given in small divided doses, at short intervals, will most
-probably evacuate the whole intestines by vomiting and purging, and may
-even prove sudorific. But it will nevertheless be proper to administer
-a purgative medicine soon after; and what we found to operate with most
-ease, expedition, and effect, was, a solution of purging salts and
-manna, either in an infusion of sena, or in common water, or barley
-water, with some tincture of sena added to it.
-
-The next step towards procuring a remission is, to open the pores
-of the skin, which is best done by small doses of James’s powder or
-emetic tartar, assisted by the common saline draughts, which will be
-given with most advantage in the act of effervescence, or by _Spiritus
-Mindereri,_ together with plentiful warm dilution. I once, by way of
-comparison, tried the two antimonial preparations above mentioned in
-a number of men ill of this fever, who were sent to the hospital at
-one time, giving emetic tartar to one half, and James’s powder to the
-other, and their effects were so similar, that I could perceive no
-reason for preferring the one to the other. Antimonial medicines seem
-better adapted to this than any other sort of fever, and may be more
-freely given in it.
-
-These are the most likely means of bringing about a remission; and if
-this is effected, nothing remains to be done but to throw in as much
-Peruvian bark as the stomach will bear.
-
-But whether from a fresh accumulation of bile, or some other
-circumstance, it may happen that the fever is kept up; and in this
-case there is commonly a sense of weight or uneasiness about the
-_hypochondria_, which seems to indicate that the redundant bile is in
-the gall bladder or ducts of the liver. In this case a repetition of
-evacuants is necessary, and calomel will be found to answer remarkably
-well as a purgative, its stimulus being so extensive as to loosen
-and bring away bile when the saline purgatives, such as that above
-mentioned, had failed of having that effect. I have known these to
-pass through the intestines without relieving the uneasy sensation
-about the stomach as calomel is found to do; and it will be still more
-effectual for this purpose, if given alone in a dose, from five to ten
-grains, and followed some hours afterwards by some other purgative.
-After this, antimonial medicines are again to be had recourse to; and
-these, as well as purgative and neutral medicines, are safe and useful
-in a more advanced stage of this fever than they are in the ship fever;
-for the strength is not so apt to sink, and the state of the bowels
-requires them more. Antimonials, however, are to be used sparingly and
-cautiously as the fever advances; for I have known them, when given
-only a few days after the first attack, to have the effect, in some
-constitutions, of making the stomach swell, and of producing a general
-sense of heat and uneasiness.
-
-After the evacuations of the bowels, the anodyne diaphoretic may be
-very seasonably given in the manner formerly mentioned; for it will not
-only tend to sooth and procure sleep after the commotion that has been
-excited, but by its gentle sudorific effect will assist in completing
-the remission.
-
-The principal point of management in the fevers of this climate is, to
-throw in the Peruvian bark in proper season. I formerly took occasion
-to differ from the opinion of those who alledge that little or no
-discrimination is necessary with regard to the circumstances in which
-bark is proper in continued fevers. I made fair and unprejudiced trials
-of this, but always found that some sort of remission, especially
-towards the beginning of the disease, was necessary, in order to make
-the use of this medicine safe and proper. The greatest vigilance is
-indeed required that the administration of it be not omitted when
-it is at all adviseable, as the course of fevers is very quick and
-critical in this climate. I have watched many nights with some friends
-in whose health I was particularly interested, to catch the hour when
-it might be allowable to give it; and where the propriety of it was
-somewhat ambiguous, it was usual to qualify it either by conjoining
-some antimonial or neutral salt with the first doses, or by giving them
-alternately with it, as has been formerly mentioned.
-
-Under the use of these means, the favourable symptoms are, a warm moist
-skin, a strong steady pulse, with the pulsations under a hundred in a
-minute, a natural countenance, and being free from delirium. But if the
-fever should not yield during the first week, but takes an unfavourable
-turn, the pulse then becomes more small and frequent, there is a
-general agitation, the tongue is tremulous when put out, there is great
-thirst and delirium, with a dry and hot skin. In these circumstances,
-besides the continuation of the antimonials in smaller doses, with the
-anodyne diaphoretic, and the occasional use of purgatives, blisters
-now become proper; and we found also camphor combined with nitre an
-excellent medicine at this period of the disease.
-
-Should the patient survive to the end of the second week, the treatment
-then comes to resemble more and more that of the infectious fever
-already described. Bark may be given, though there should be no proper
-remission, and cordials and opiates may be more freely used. Attention
-to the state of the bowels will still be necessary, since repeated
-accumulations of bile are apt to occur even in the most advanced
-stage, and gentle emetics of ipecacuana, as well as laxatives, may
-be necessary. For the same reason also, greater caution is requisite
-in the use of pure opiates than in the infectious ship fever before
-treated of. In order to keep the bowels soluble, it was a very usual
-practice, and found very useful, to conjoin a few grains of rhubarb
-with each dose of the bark.
-
-
-3. Of the YELLOW FEVER.
-
-The fever last treated of may be said to be peculiar to a hot climate;
-but the hot seasons of temperate climates produce something resembling
-it. That now to be described never occurs, so far as I know, except
-under the influence of tropical heats. Such a fever is indeed known
-without the tropics; for it is very common in Carolina in the hot
-season; but there the heat is even greater than that of the West
-Indies. In order to produce it, there must be, for some length of
-time, a heat seldom falling below seventy-five degrees on Fahrenheit’s
-thermometer.
-
-Though it differs from the fever last described, both in its causes and
-symptoms, it is not meant to say that it is so distinct as to form a
-separate species of disease, like the measles and small pox. Unless the
-characters of fevers are strongly marked, it is difficult, and even
-impossible, to refer them to any particular species; and the different
-concurrence of causes and constitutions is so various, that great
-numbers of ambiguous cases occur.
-
-With regard to the cause of the yellow fever, it differs from the
-bilious remittent in this, that the air of woods and marshes is not
-necessary to produce it; for it most commonly arose from intemperance
-or too much exercise in the heat of the sun. It was observable,
-however, that it was more apt to arise when, besides these causes,
-men were exposed to unwholesome air, particularly the foul air of
-ships, whether from infectious effluvia, or proceeding merely from the
-putrefaction that takes place in neglected holds.
-
-It is also remarkable with regard to it, that it is confined almost
-entirely to those who are newly come from a cold or temperate climate.
-The same remark is made by the French, who therefore call it _fievre
-de matelot_[101], considering it as peculiarly incident to those who
-have newly arrived from a long voyage. It would appear also, from what
-has been formerly mentioned[102] that those men, who have been exposed
-to that sort of infection that prevails in ships in cold climates are
-more particularly the subjects of the yellow fever when they arrive in
-a hot climate. It is farther in proof of the same opinion, that there
-are medical gentlemen, natives of the West Indies, who have hardly
-ever seen it, their practice lying at a distance from any sea-port
-town where strangers usually arrive. Of these strangers, those who are
-young, fat, and plethoric, are most apt to be attacked; and more of our
-officers in proportion were seized with it than common men.
-
-It has been said, that it never attacks either the female sex or
-blacks. This is in general, though not absolutely, true; for I knew
-a black woman, who acted as nurse to some men ill of this fever at
-Barbadoes, who died with every symptom of it.
-
-This fever assumes various forms, according to the peculiar
-constitutions of different men, and other circumstances; but
-in the following description I shall enumerate the most common
-appearances:--In general it begins with short alternate chills and
-flushes of heat, seldom with those rigors which constitute the regular
-cold fit, and with which most other fevers begin. These are immediately
-succeeded by violent head-ach, pain in the back, universal debility,
-sickness, and anguish at the stomach. There is commonly, in the
-beginning, a good deal of bile on the stomach, which is thrown off by
-vomiting, either natural or excited by an emetic. Those men who were
-taken ill of this fever in the Alcide, in the end of the year 1781, had
-a sore throat in the beginning; but this is not a common symptom.
-
-In the course of this disease there is by no means a free secretion
-of bile, and least of all in those cases that are most violent, and
-prove the soonest fatal. In cases that are more protracted, and less
-desperate, there are frequent accumulations of it, as appears by the
-vomits and stools[103].
-
-The eye in a few hours takes a yellow tinge, which soon after extends
-more or less over the face and whole skin. This is a symptom so
-striking and constant, that it gives name to the disease, though
-it is not absolutely either peculiar or essential to it. There is
-something contagious in this symptom, which seems somewhat singular,
-and difficult to be accounted for. It was observed in the Royal Oak
-and Alcide to extend to men who were but slightly indisposed; and at
-the hospital it spread to men in the adjoining beds, without imparting
-any malignity to their diseases.
-
-There is something very peculiar in the countenances of those who
-are seized with it, discernible from the beginning by those who are
-accustomed to see it. This appearance consists in a yellow or dingy
-flushing or fullness of the face and neck, particularly about the
-parotid glands, where the yellow colour of the skin is commonly first
-perceived. There is also in the eye and muscles of the countenance a
-remarkable expression of dejection and distress.
-
-One of the most constant and distinguishing symptoms of this fever is
-an obstinate, unremitting, and painful _pervigilium_, which is the more
-tormenting, as the patient is extremely desirous of sleep. It is seldom
-that even a _delirium_ comes to his relief to make him forget himself
-for a moment; but he continues broad awake, night and day, with his
-reason and senses sound, in a state of the most uneasy agitation.
-
-But the most distinguishing symptom, and that which is expressive of
-the greatest danger, is, an unconquerable irritability in the stomach,
-which can be brought to bear nothing. An almost incessant retching
-takes place, which commonly, on the third day, ends in what is called
-the _black vomit_, the most hopeless of all the symptoms attending it.
-When this is examined, the colour is found to be owing to small dark
-flakes, resembling the grounds of coffee, and seems to be blood which
-had oozed from the surface of the stomach, a little altered. Indeed
-pure blood is sometimes thrown up, and we know that the red globules
-enter the smaller order of vessels, and issue by them; for bleeding at
-the nose is a common symptom about this time; and some relate that it
-also escapes by the ears and pores of the skin, which I never saw, but
-can readily believe it. At the same time, the stools grow black, and
-the urine is frequently of a very dark colour, which seem to be owing
-to the same cause. I never remember to have seen any one recover after
-these symptoms came on.
-
-There seems to be a general _error loci_ of the more tenacious and
-globular parts of the blood into the smaller order of vessels, to which
-the yellow colour is in a great measure owing; and when any part of the
-skin is ever so little pressed upon, a damask red colour remains for
-some time, the small vessels readily admitting the red globules. It
-is certain that a yellow colour of the skin may be produced by such an
-_error loci_, without any suspicion of the presence of bile. We have an
-illustration of this in the ecchymosis which follows upon an external
-contusion. In this case the red part of the blood is mechanically
-forced either into the smaller order of vessels, or into the cellular
-membrane, which occasions a livid appearance, and in the course of the
-recovery the same parts become yellow, probably in consequence of some
-of the gluten of the blood assuming this colour after the red parts
-have been removed by absorption or otherwise.
-
-In the worst form of this disease there is all along an uncommonly
-distressing sensation of universal anguish, particularly about the
-stomach, where there is a sense of burning heat, which, as the
-miserable sufferers themselves express it, becomes unspeakable torture.
-
-A sense of weight at the breast, deep and frequent sighing, and a great
-failure of muscular strength, are dangerous symptoms in all stages of
-the disease.
-
-Upon the first attack the skin is extremely hot and dry, and the pulse
-hard and frequent; but the external heat soon becomes very little
-different from the usual standard of health, and the skin feels soft
-and moist. There sometimes happens an eruption of small pustules, with
-white heads, on the trunk of the body, which is a favourable sign; and
-I have seen a head-ach disappear upon this breaking out. The pulse does
-not serve as an index of danger; for, after the hurry of the first
-attack, it becomes very moderate in point of frequency, varying from
-eighty to a hundred pulsations in a minute, and is natural in point of
-regularity and strength.
-
-In these circumstances this fever differs from that which was last
-described; and it also differs from it in being attended with little
-delirium. I have seen cases in which the senses were not affected from
-beginning to end; and I never observed that violent and incessant
-delirium which attends other dangerous fevers.
-
-The state of the _fauces_ is also different from that of most other
-fevers, for there is no excessive thirst. The tongue is somewhat white
-and foul; but I do not remember ever to have seen it black and dry.
-
-A want of action in the bowels, and an insensibility to purgative
-medicines, indicate great danger; and, next to the black slimy stools,
-one of the most unfavourable symptoms is, when the _feces_ are like
-white clay, as I have seen in some cases that ran out to the length of
-a week before they proved fatal. When the black vomit and stools occur,
-death commonly happens on the third or fourth day. A bilious diarrhœa
-spontaneously coming on, is a very favourable symptom.
-
-In more unpromising cases the urine is scanty, and in the last stage
-of life it becomes of a very dark colour, as was mentioned before. A
-plentiful secretion of urine is a very favourable circumstance, and
-seems to be one of nature’s methods of curing the disease; for such
-cases are observed to terminate well. I remember one case in particular
-in which several quarts were made daily for several days together,
-and it was of a very dark saffron colour, but looked green where
-the surface was in contact with the side of the pot. I inspissated
-a small quantity of it, and found a large residuum, which was very
-deliquescent, and seemed to be all saline. In a hot climate the urine
-does not shew that separation and deposition which denote the crisis
-of fevers in cold climates, and this is perhaps owing to there being
-less mucilage and more alkali in the former, on account of the more
-putrescent state of the fluids. Upon adding a little vinegar to the
-urine in the case above mentioned, it became turbid like the critical
-urine of the fevers of Europe.
-
-At the approach of death, cold clammy sweats come on; the pulse
-continues regular and of a certain degree of strength, but grows
-gradually slower. I have counted it at forty pulsations in a minute.
-The patient is frequently sensible to the last moment; nor does the
-countenance sink into what is called the _Hippocratic_ appearance. In
-other cases I have seen, at this time, _coma_, and not infrequently
-convulsions. Broad livid spots sometimes also appear on the skin.
-Extreme muscular debility, a great difficulty of deglutition, and a
-dimness of the eye-sight, are likewise common symptoms in the last
-scene.
-
-The different stages which lead to dissolution following each other
-thus rapidly, there is not that gradual failure of the powers of nature
-that usually give warning of approaching death; but the springs of life
-run down, as it were, at once, the wretched sufferer expires, and is
-happily delivered from the most extreme misery of which human nature is
-capable.
-
-Such is the general train of symptoms in this fever, taken entirely
-from my own observation; but great varieties occur both in the symptoms
-and duration, so great indeed, that it is hardly recognisable for the
-same disease. I shall give specimens of such anomalous cases in two
-that occurred at Port Royal, on board of the Canada, in July, 1782.
-
-A lieutenant of that ship had been subject, for four days, to fits of
-retching, without any bilious discharge or pain in the stomach; and,
-except a white tongue, he had no symptom of fever in that time, nor
-any thing to prevent him from doing his duty. On the fourth day, when
-I first saw him, he began to complain of a fixed pain in the pit of
-the stomach, which was not very violent, and about the same time a
-yellowness began to appear on the white of the eye. He took a laxative
-medicine, which had the desired effect, and some volatile spirits, with
-some drops of thebaic tincture in simple mint water, for the pain in
-his stomach. He had a good night. Next day the complaint of the stomach
-was better; but there was great muscular debility. He had several
-natural stools; and as there seemed little indication but debility,
-he took nothing that day except an infusion of some bitters and
-aromatics in wine. As he did not want for appetite, he eat some broth
-and chicken; and nothing to give any alarm happened this day, except a
-short qualm, in which he was faint, with a sense of cold, feeling to
-himself, as he said, as if he should have expired. In the afternoon he
-began to have black-coloured stools, which was the first symptom that
-clearly betrayed the nature of the disease. He was then ordered as much
-Peruvian bark as he could take with red wine, and these his stomach
-bore. Decoction of bark was also given him in clysters. He had a strong
-voice, and was quite sensible, but grew weaker and weaker with frequent
-returns of the qualms, and he expired that evening before ten o’clock.
-
-I have not the least hesitation in ranking this case with the fevers
-last described, though so many of the usual symptoms were wanting. This
-gentleman, though of a lively, active disposition, was of a slender
-make, and of a dingy, doughy complection, and his case gave me the
-idea of a disease attacking a constitution which, not having powers
-to struggle with it, is overwhelmed without making resistance[105].
-In those robust, plethoric habits, which are most commonly attacked,
-there is a sufficient degree of strength to excite the violent symptoms
-before enumerated.
-
-A few days after this gentleman’s death, another officer of the same
-ship was taken ill with the same sort of fever, and it was also
-attended with several unusual symptoms. Neither his skin nor eyes were
-yellow; the skin was hot and dry throughout the disease, and during
-the three first days there was a diarrhœa, which was neither bilious,
-putrid, nor mucous, but consisted in watery stools. There were no
-gripes, nor any local pains whatever; but I never remember to have
-seen more suffering from that general anguish, particularly about the
-stomach, which attends this sort of fever. On the third night he began
-to vomit and purge blood, which soon terminated in that dark-coloured
-discharge which is a symptom so characteristic and fatal in this
-disease. He continued sensible till within eight hours of his death,
-which happened on the fourth night. The pulse was full and pretty
-strong during the whole course of the disease; but there was all along
-great debility and frequent sighing, symptoms that ought always to
-create alarm.
-
-
-TREATMENT OF THE YELLOW FEVER.
-
-I feel this as the most painful and discouraging part of this work, the
-yellow fever being one of the most fatal diseases to which the human
-body is subject, and in which human art is the most unavailing.
-
-It seems hardly to admit of a doubt that there are particular instances
-of disease, in their own nature, _determinedly fatal_, that is, in
-which the animal functions are from the beginning so deranged, that
-there are no possible means in nature capable of controlling that
-series of morbid motions which lead to dissolution. Of this kind
-appear to be the greatest number of cases of the plague, many of the
-malignant small pox, and some of fevers, particularly of that kind
-now under consideration. It is extremely difficult to ascertain such
-cases from observation; and it may be said that the opinion of the
-existence of them is favourable to ignorance and indolence. But, on the
-other hand, it may be questioned if more harm is not likely to arise
-in medicine by being too sanguine and officious, than by a diffidence
-of art and trusting to the powers of unassisted nature? Were we
-thoroughly acquainted with the animal œconomy, we should perceive _à
-priori_ in what instances the seeds of disease would either operate
-so as necessarily to terminate in death, or when they were within the
-command of art. But we can derive little or no information from this
-source, on account of our great ignorance of the secret operations
-of the living body; so that the only grounds of judging are our
-observation and experience concerning the usual event of disease, and
-the effects of remedies. Though these are circumstances attended with
-great uncertainty and ambiguity, yet I believe it will be admitted as
-the opinion of the most chaste and experienced observers, that there
-do really exist diseases whose course cannot be diverted by any means
-that can be employed. This opinion, I have said, is, in one view,
-extremely discouraging; yet, to the mind of a feeling and conscientious
-practitioner, who must often find his best endeavours baffled in many
-diseases as well as this, and who might be apt to look back and accuse
-himself of some fault or omission, it affords this satisfaction to
-his reflections, that the want of success may have been owing to
-something in the nature of the disease, and not to his want of skill
-and attention.
-
-But though the fatality of this disease is discouraging, let us not
-despond, but rather redouble our diligence in observing what assistance
-and relief nature may admit of.
-
-It is proper in this as in every other fever of this climate, to begin
-the cure by cleansing the first passages. This does not produce the
-same relief as in the common bilious fever, probably because there is
-a less free secretion of bile, and therefore less oppression from the
-collection of it.
-
-With regard to blood-letting, the most that can be said in its favour
-is, that if there should be a hard throbbing pulse, with violent pain
-in the head and back, it is _safe_ in the first twelve hours. This
-limitation is necessary, at least with regard to common seamen, who do
-not bear evacuations so well as officers and others, who are used to
-a better diet, and to whom the loss of blood has, in some cases, been
-found useful in the early stage of this fever. It is, however, in all
-cases extremely dangerous, except in the circumstances mentioned above.
-The blood is said to shew a buff in the beginning of the disease, but
-in the second stage, it is mentioned by a French author[106], that it
-hardly coagulates or separates. But even the appearance of a buff,
-without considering other circumstances, does not always argue the
-propriety of blood-letting[107].
-
-The great object in the cure of this fever is, to bring the stomach to
-bear the bark. There are here wanting most of the circumstances that
-in the other cases forbid the use of it; for there is no preternatural
-quantity of bile in the stomach and intestines, nor is there a hot and
-dry skin, nor violent delirium. The only obstacle to its administration
-is the great irritability of the stomach, which is the most fatal
-symptom of the disease; and the principal part of the management
-of the patient consists in the prevention or removal of this. The
-stomach is to be treated with the utmost tenderness and attention. One
-gentle emetic at the beginning is all that is allowable; and as fresh
-collections of bile are less apt to occur, the repetition of it is less
-necessary.
-
-It is best to abstain altogether from antimonial medicines, and to
-render every thing, whether food, drink, or medicine, as grateful as
-possible. The liquid most apt to stay upon the stomach is the juice of
-the acid fruits of the climate, such as[108] oranges and lemons. It
-happens frequently, however, that acids come to be loathed extremely,
-so as to nauseate the stomach and to encourage retching. In this case
-I have found a composition of wine and water with lemon juice and
-nutmeg, sweetened with sugar, and given warm, to be a very grateful
-and salutary drink. The patient sometimes prefers the decoction of
-farinaceous substances to every other liquid; and in one case in
-particular, which did well, the patient was led by taste to prefer warm
-water gruel to every thing else, and the great quantity he drank seemed
-to have a considerable share in his recovery, by keeping up a warm
-moist skin and producing a great flow of urine.
-
-In order to check vomiting, the saline draught, in the act of
-effervescence, has been employed with evident advantage; but in most
-cases this symptom is so obstinate as to discourage all attempts to
-remove it. I have known magnesia in mint water have a visible effect in
-soothing the stomach, particularly when given immediately after some
-acid beverage.
-
-I was informed by Dr. Young, physician to the army, that he found
-an infusion of chamæmile flowers one of the best medicines in this
-vomiting; and a surgeon of one of the line-of-battle ships informed
-me, that he also found advantage from it in alleviating this symptom.
-The French author above mentioned affirms, that milk, boiled with
-some flour or bread, given in the quantity of a spoonful at a time,
-and frequently repeated, had more effect than any thing he tried in
-stopping the vomiting in this fever. I have seen this symptom relieved
-by fomenting the stomach with stupes wrung from the decoction of bark,
-and sprinkled with camphorated spirits and tincture of bark[109].
-
-But nothing I have ever seen tried had so great an effect in removing
-this irritability of stomach as a blister applied to it externally;
-and it is a remedy which, so far as I know, has not been hitherto
-recommended. In other fevers, when the head was not particularly
-affected, I preferred this part for the application of a blister, for
-it is in some respects more convenient than between the shoulders, and
-the stomach is the part more affected perhaps than any other in all
-fevers. But in this fever I was led to apply it to this part, both
-from its being affected in an uncommon degree, and from observing,
-upon inspecting the bodies of those who died, that the only morbid
-appearance that could be discovered was an inflammatory suffusion on
-the inner membranes of the stomach.
-
-I have employed opiates both externally and internally to allay this
-symptom, but without the effect that might have been expected from so
-powerful a sedative.
-
-As the stomach will seldom, even in the most favourable cases, bear
-such a quantity of bark as to subdue the disease, it must be exhibited
-in every other way that can be thought of, such as by clyster and by
-external fomentation, both of which I have employed with good effect. I
-used to order a pint of decoction of bark to be injected every three or
-four hours, and the fomentation to be employed nearly as often. I have
-heard of the decoction of bark being used as a warm bath with success;
-but I cannot decide concerning this practice from my own experience.
-
-I have no other internal remedy to recommend; for whatever power of
-retention the stomach may have should be employed in taking bark. If it
-should become tolerably retentive, camphor will be found of service;
-and if given in the evening with an opiate, perspiration and sleep will
-probably be procured, by which the patient will be greatly relieved.
-
-Blisters to the thighs and legs seemed to coincide with the general
-intention of cure, and they appeared to be of advantage in the cases in
-which they were tried.
-
-
-4. Of the Effects of Flowers of Zinc and White Vitriol in the Cure of
-obstinate INTERMITTENT FEVERS.
-
-It frequently happens in the West Indies that intermittent fevers are
-so obstinate as to resist the common means of cure by the Peruvian
-bark; so that these complaints become extremely distressing to the
-medical practitioner as well as to the patient. Indeed this was a
-difficulty that occurred so often, that I was sometimes tempted to
-think, either that the great reputation of this medicine is not so
-well founded as is commonly believed, or that the bark generally in
-use in these times is not of so good a quality as that employed by the
-physicians who first established its character.
-
-But, in the first place, the experience upon which its reputation was
-first built was in a temperate climate, where very few agues are found
-to resist it when properly administered. In the next place, there is
-reason to believe that, in fact, the medicine itself now commonly in
-use is not equally powerful with what was first employed; and a species
-of it, called the Red Peruvian Bark, has lately been discovered, or
-rather, perhaps, revived, which is certainly of a superior quality,
-and has been found to cure intermittents in which the common sort had
-failed[110].
-
-However this may be, it is an undoubted fact that obstinate agues are
-much more frequent in the West Indies than in Europe; and something to
-supply the insufficiency of the bark seemed to be a _desideratum_.
-
-I was informed by Dr. Hendy, of Barbadoes, that he had found the
-flowers of zinc to answer in cases of intermittent fever, in which
-even the bark and every other remedy and mode of treatment had failed.
-It was found very successful in the like cases, both in my own trials
-at the hospitals, and by the surgeons of the men of war to whom I
-recommended the use of it. In order to judge what may be expected
-from it, I shall give a specimen of its success in some cases, at the
-hospital at St. Lucia, of which I kept an accurate account, in the
-months of February and March, 1783.
-
-About the time the fleet arrived there, six cases of intermittent
-fevers were sent to the hospital from different ships. One was of six
-weeks continuance, and had been some times of the tertian, sometimes of
-the quartan type. Two were quartans; one of which was of two months,
-the other of eight months duration. Two were regular tertians; of which
-one had only had two fits, but was a relapse after a week’s exemption
-from an attack of several weeks. The other was of three months
-continuance, attended with an eruption on the hands and arms. The
-sixth case was a quotidian of three weeks, attended with a cough of the
-same standing, and joined with sea scurvy.
-
-In all of them the bark had been given at some period or other; and the
-flowers of zinc were now tried in all, except the last. In three out
-of the five this medicine had the most visible good effects. In one
-the disease was so speedily removed, that there was only one fit after
-the first day of taking this medicine, and the other two had recovered
-perfectly after it had been used for seven days.
-
-In these cases there can be little or no ambiguity with regard to the
-real efficacy of the medicine, as the disease had lasted from two
-to six months, and there was no other circumstance of change in the
-situation or treatment of the patients that could account for their
-recovery.
-
-Of the two cases in which it failed, one was the tertian of three
-months, attended with the eruption; the other was the relapsed tertian
-of three days.
-
-With regard to the dose, I began with giving it in the quantity of two
-grains thrice a day, which, in some, produced the desired effect, and
-without the least sensible operation on the stomach or bowels. If this
-dose did not stop the fits after a few days trial, it was increased to
-three grains, which, in some, would produce a little sickness. I found
-that four grains ruffled the stomach a good deal; but if the patient is
-gradually habituated to it, even more than this may be given without
-inconvenience.
-
-In those cases in which it was successful it was not found necessary to
-give more than two grains at a dose, except in one of them, in which
-three were given the day before the fit ceased. In the two unsuccessful
-cases the medicine had a fair trial for a fortnight; but one of them
-getting no better, and the other seeming to get worse, it was left off.
-
-The cases to which this medicine is adapted are those that have
-extremely distinct remissions, with no symptoms of bile nor any local
-affection. When agues come to be long protracted, they are frequently
-what may be called nervous; that is, consisting of certain morbid
-motions that seem to be induced by habit, after the original cause is
-removed, and with a tolerable enjoyment of appetite, sleep, and all the
-functions of life, during the intermission.
-
-The two cases in which the zinc failed recovered by the use of the
-bark. This had been unsuccessfully tried before, and its good effects
-now might either depend on its having been left off for some time,
-whereby the body recovered its sensibility to its virtues, or it might
-be in consequence of administering it in ardent spirits with a few
-grains of capsicum and ginger, additions which I found to improve its
-effects in other cases, and is a mode of giving it well suited to this
-climate.
-
-The zinc was not tried in the sixth case, on account of the local
-affection and the remission being short and imperfect.
-
-The white vitriol, being a salt of zinc, might be supposed to possess
-the same virtues; and it would appear to do so from some facts[111]
-that were reported to me in the West Indies, and also from some trials
-made by me at St. Thomas’s hospital since I came to England.
-
-Though this is a medicine of very considerable powers, I do not mean to
-put it in competition with the bark, by proposing it as a substitute
-for it, or by representing it as superior to it in all circumstances;
-but only to propose it as a valuable subsidiary in particular cases.
-The account I have given is faithfully extracted from a diary of
-my practice; and were I to say more in its favour than the future
-experience of others may warrant, I should do more harm than service
-to its reputation. Many good medicines have had their characters hurt
-by being over-rated by the first proposers of them, who are naturally
-sanguine and partial, without, perhaps, intending to deceive. But
-when others find that their virtues do not come up to what has been
-asserted, they are apt to run into the other extreme, and explode them
-altogether; so that what was given out as good for every thing, is now
-found to be good for nothing[112].
-
-
-
-
-CHAP. II.
-
-Of FLUXES.
-
-
-These seem to arise in the same circumstances, and to be owing to
-the same general causes, as fevers. They may, in some sense, be
-considered as fevers, attended with peculiar symptoms in consequence
-of a determination to the bowels, just as fevers in cold climates are
-sometimes attended with rheumatism and catarrh. We have seen, in the
-first part of this work, that the dysentery arose chiefly in those
-ships which had been subject to fevers.
-
-This determination to the bowels is owing to a variety of causes, but
-is chiefly connected with external heat; for it is most common in hot
-climates, and towards the end of summer or in the autumns of cold
-climates, owing probably to a greater acrimony of the secretions of the
-intestines, and particularly of the bile. Dysenteries arise in camps
-also at the same seasons, and in the same circumstances as bilious
-fevers[113].
-
-Besides climate and season, the other circumstances determining to
-the one disease more than the other are, 1. A difference in the
-constitutions of different men; for in the same ship it sometimes
-happens that both diseases prevail equally, though all the men are
-using the same diet and breathing the same air. 2. The nature of the
-occasional cause. A dysentery, for instance, is more likely to arise
-from an irregularity in eating or drinking; a fever from being exposed
-to the weather, particularly marsh effluvia. 3. The particular species
-of infection that may happen to be introduced. Suppose, for example,
-that a ship’s company is predisposed to acute distempers, and one man
-or more ill of the dysentery should be brought on board, this will
-become the prevailing disease, as happened in the Torbay in August,
-1780. If the like number of fevers should be introduced, then fevers
-will be the prevailing disease.
-
-These two diseases may therefore be considered as _vicarious_,
-the one substituting itself for the other according to particular
-accidents, and both proceeding from the same general causes; and
-this is no new idea of mine, but seems to have been Dr. Sydenham’s,
-when he calls the dysentery a _febris introversa_. It may be farther
-added, that dysentery is the latest form in which this cause, which
-is common to both, can exert itself; for it is a disease more within
-the reach of art; and some of the most dangerous symptoms attending
-fevers, particularly _delirium_, seldom occur in dysentery. When it
-proves fatal, it is in consequence of violent local affection, and
-that in general after it has taken a chronic form. When an incipient
-fever turns into a dysentery, all the symptoms, and particularly the
-head-ach, delirium, and _coma_, if there should be any, are immediately
-relieved. And the most favourable cases of the yellow fever are those
-in which a bilious diarrhœa comes on, while the most fatal are those
-in which the bowels are so torpid as to be insensible to any stimulus
-either from their own contents or from medicine.
-
-I shall not enter into a minute description of this disease in all its
-stages, as this has been so ably executed by Sir John Pringle, Sir
-George Baker, and other authors, but shall only give a sketch of some
-of the most remarkable symptoms, particularly such as are peculiar to
-the climate and manner of life, so as to explain the varieties that may
-be necessary in the mode of treatment.
-
-The fluxes that arose in the fleet were either what may be called the
-acute idiopathic dysenteries, or a dysenteric state of the bowels from
-neglected diarrhœas, which was most apt to occur in the convalescent
-state of fevers, or in men labouring under the scurvy. The body is more
-susceptible of infection in a state of weakness from these or any other
-causes; and in hot climates the dysentery seems to be more infectious
-than fevers; for at hospitals it was so frequently communicated to men
-who were ill of other complaints, that it was in these the principal
-cause of mortality. For this reason, I was at more pains with regard to
-this disease than any other, in keeping those who were ill of it in a
-separate ward.
-
-I have met with some violent and untractable cases which proved
-fatal in the acute state; but, in general, this disease draws out to
-a chronic form in this climate, and does not prove mortal for many
-weeks. The usual cause of death appears, from the inspection of the
-bodies, to be an ulceration of the great intestines, particularly
-of the descending colon and the rectum. This part of the intestinal
-tube is most affected from its being the receptacle of all the acrid
-secretions from the rest of the canal; and it is naturally more subject
-to congestions of the fluids and incurable ulcers, as appears from
-the rectum being so liable to the hæmorrhoids and the _fistula_. This
-ulceration of the great intestines is so common, that, out of eight
-cases which I inspected after death, seven had this appearance. The
-case in which there was none was not so much a case of dysentery as
-of inflamed bowels, brought on by the man having drank to excess of
-spirits while he was recovering from a dysentery. The acute _tormina_
-which always occur in the first days of the disease seem owing to an
-inflammation, which terminates in ulcers; and these being constantly
-irritated by the sharp humours, produce the _tenesmus_, which is the
-symptom most essential to dysentery in the after part of the disease.
-Any diarrhœa may in this manner become dysenteric. During the acute
-griping at the beginning, the stools are loose and copious; but as
-soon as the tenesmus takes place, they are scanty, which is most
-probably owing to the spasmodic strictures in the great intestines,
-in consequence of irritation upon their excoriated surface. The
-inflammatory state is more lasting and violent in a cold than a hot
-climate, the gripings are more severe, and the danger is also greater
-in this stage of it.
-
-The state which the great intestines fall into in old dysenteries
-seems to have something in it peculiar to itself: the several coats
-become thick and spongy; their texture is obliterated and destroyed;
-and they become of a black or very dark purple colour. This, however,
-cannot be called mortification; for the fibres of the gut do not lose
-their tenacity, nor is there that putrid and dissolved state in which
-gangrene consists; but it advances in time to such an extreme state
-of disease as to be entirely incapable of recovering its natural
-appearance and functions, and proves therefore the cause of death.
-
-The greater frequency and obstinacy of these chronic fluxes in hot than
-in cold climates seems to be owing to the same weakening of the powers
-of life which make recovery in general so tedious, and particularly
-that of wounds and ulcers. The greater quantity of acrid bile will also
-tend to keep up the ulceration. Dysenteries have this disadvantage,
-that the Peruvian bark, which is the most powerful restorative in other
-complaints of this climate, is here found to be inadmissible on account
-of the heat, thirst, and other febrile symptoms, which it seldom fails
-to induce in all stages of this disease.
-
-
-TREATMENT of FLUXES.
-
-There are few diseases in which a prudent employment of art is more
-useful, or in which early means of relief are more requisite than in
-this[114].
-
-Where the dysentery is the original disease, and when the patient is
-robust and plethoric, with acute pain and a strong pulse, blood-letting
-may be practised with advantage in the beginning of the complaint. But
-there is no part of the practice in this disease in which the climate
-and manner of life makes a greater difference than in this; for in a
-temperate climate it frequently happens that repeated blood-letting is
-necessary; but in a hot climate, where the fibres are relaxed, and in
-the constitutions of seamen, whom we seldom or never find plethoric,
-the inflammatory symptoms requiring this evacuation do not run so high,
-nor continue so long.
-
-It is in all cases of the utmost consequence to administer as early as
-possible a brisk saline purgative. An ounce and a half or two ounces
-of purging salts may be dissolved in a quart of barley water or water
-gruel, and given warm in cupfuls, at small intervals, till a free
-and copious evacuation is produced. If there should be much fever,
-or sickness at stomach, two grains of emetic tartar will be a great
-improvement of this medicine; and there will be this farther advantage
-from its use, that if the stomach should be loaded with bile, in which
-state it is more irritable, an evacuation upwards will also be excited
-to the great relief of the patient.
-
-This early and seasonable measure will, in many cases, put a stop
-to the disease, especially if the patient is thrown into a sweat
-immediately after the bowels have been thus thoroughly evacuated. It
-is of great service in this disease to promote free perspiration, and
-even a plentiful sweat, which may be effected with great advantage by
-giving, at bed time, a medicine composed of opium, ipecacuana, and a
-little neutral salt, accompanying it with plentiful warm dilution.
-Nothing tends more to relieve griping and tenesmus than a general,
-warm moisture on the skin. The ipecacuana, which is an ingredient in
-this medicine, is one of the best anti-dysenteric remedies we know;
-the opium procures rest; and this, joined to the sudorific effect of
-the whole, not only gives a temporary relief, but tends to carry off
-the disease. It is most properly given in the evening; for there would
-be this inconvenience in constantly encouraging a sweat, that if the
-tenesmus should return, it would either be checked by the patient
-getting frequently out of bed, or there would be danger of his catching
-cold. I am well aware that we cannot be too cautious with regard to the
-use of opium in the beginning of this disease; but it is admissible
-more early in a hot climate than a cold one, as the inflammatory
-symptoms are less violent and can be sooner subdued; besides, it
-becomes an entirely different medicine when conjoined with the other
-ingredients that have been mentioned.
-
-The best medicine in the day time we found to be small doses of
-ipecacuana alone twice or thrice a day; and if there should be fresh
-collections of bile, small doses of the saline purgative will be
-necessary. Ipecacuana in this intention, may be given in the dose of
-two grains in athletic constitutions, such as those of seamen; but
-in the more delicate constitutions, such as are commonly met with in
-private practice, one grain is a sufficient dose. I have found manna
-and tamarinds a good addition to this medicine in the earlier stages of
-the disease, where there was much bile; but in a more advanced stage
-of it they are apt to produce gripings and flatulence.
-
-The marks of a redundance of bile are, a sickness at stomach, a sense
-of scalding at the anus when the stools are passing, and the yellow
-or green colour of the stools themselves. It is apt also to excite
-symptoms of fever, such as a foul tongue, a hot and dry skin, with
-thirst. When collections of it are suspected in this disease, it is
-best to evacuate it by vomiting, for it is thereby prevented from
-irritating the bowels, and from arriving at the inflamed parts with,
-perhaps, increased acrimony, acquired in passing through the whole
-length of the intestines.
-
-Some gentlemen of the fleet informed me that they found oil of almonds
-a useful addition to the purgative. Others as well as myself made a
-practical comparison of the saline purgative with that composed of
-rhubarb and calomel, as recommended by Sir John Pringle, and we gave
-the preference to the former, as more easy, speedy, and effectual in
-its operation, especially in the first stage. Cases may occur, however,
-in which the other may be more advisable; for where there is a sense
-of weight about the stomach, which most probably arises from the
-biliary organs being clogged with bile, and where emetics have failed
-to remove it, or the weakness of the patient may render them improper,
-then calomel has the best effect: for it was formerly observed, that
-it tends to loosen the secretions, and to stimulate the more distant
-excretories, such as the biliary ducts.
-
-It is very important to caution young practitioners concerning the
-employment of opium in all stages of this disease, but especially in
-the beginning; for though it is an excellent remedy when seasonably
-and judiciously employed, it is very liable to abuse, particularly
-in the hands of the inexperienced, who may be tempted to give it
-improperly from an anxiety to relieve; but as more harm may arise from
-an unseasonable administration of it than could be compensated by the
-best-timed use of it, it is best to err on the side of caution and
-omission. The principal caution to be observed with regard to this
-remedy is, to premise suitable evacuation, such as blood-letting, if
-necessary, but more especially purging. It is always pernicious to give
-it in its pure state during the _tormina_, so common in the first days.
-By these I mean the abdominal gripings, which denote inflammation, and
-are entirely different from the _tenesmus_, which is a more constant
-and characteristic symptom of the disease, and seems to arise from
-irritation and spasms of the rectum and colon.
-
-It was in this disease that I first observed the good effects of a
-small quantity of neutral salt in taking off the inconveniencies
-attending opium, such as the feverish heat and confusion of the
-head, which it is apt to produce in many constitutions; and as the
-administration of the anodyne coincided with the evening dose of
-ipecacuana, I was led to adopt a form similar to that of Dover’s
-powder, but with only half the quantity of opium; or, it was given
-in a liquid form, by combining twenty drops of thebaic tincture and
-a drachm of ipecacuana wine, with nitre from five to ten grains, in
-any simple vehicle in form of a draught. There is a very observable
-difference, in some cases, between opium given in a liquid and in a
-solid form; and the former is much more certain in its effect when the
-intention is to procure speedy and effectual ease.
-
-I have observed great benefit from the use of external remedies in
-dysentery, and these have, perhaps, been too much neglected by authors
-and practitioners. The warm bath is of great service, especially where
-the gripes and tenesmus are severe, and where the fever has been taken
-off by previous evacuation. Fomentations or warm applications of any
-kind to the abdomen give temporary relief; and it will be found of
-advantage to keep those parts, at all times, well defended from the
-cold air. Blisters to the abdomen were also found of use, and likewise
-acrid liniments, composed of oil, volatile spirits, and tincture
-of cantharides. Where the stomach has been much affected, I have
-perceived relief from fomenting it with stupes, upon which thebaic
-tincture and camphorated spirits were sprinkled, as recommended by Dr.
-Lind. I was once affected with a bad dysentery in the West Indies,
-and I thought myself much relieved by the warm bath and a blister.
-Strangury is not an uncommon symptom in this disease, independent of
-cantharides, and the most sensible and effectual relief is derived from
-fomentations to the pubis and perinæum, as I also experienced in my own
-case.
-
-What has been hitherto said regards chiefly the acute dysentery; but
-the most frequent and troublesome complaint that occurred at the
-hospital, was the same disease in what may be called its chronic state.
-
-There is a considerable variety of symptoms in all the stages of this
-disease, but particularly in the more advanced or chronic state, so
-that a corresponding variety is necessary in the modes of treatment,
-and there are few diseases in which there is more room for exercising
-the judgement.
-
-In all stages of it an accurate discernment is necessary with regard
-to the use of opiates, and great part of the practice here consists in
-timing these well. They are least admissible in the beginning, where
-evacuation is the principal object; but as the disease advances they
-become more and more allowable and useful. The principal cautions
-necessary in their administration are, 1. To premise sufficient
-evacuation, so that the intestines may not be loaded with bile,
-_scybala_, or any other irritating matter at the time of giving the
-opiate. 2. To obviate the effects which an anodyne has of causing a
-retention of the contents of the intestines. This may be done, either
-by giving something purgative along with it, or after it has produced
-its quieting effect. The former method seems preferable; for as soon as
-the effect of the opiate is over, the purgative is ready to act; and
-in this way it is so far favourable to the operation of the purgative
-that large feculent stools will be discharged: whereas, had the
-purgative been given alone, it would have been more apt to produce
-scanty griping stools, attended with tenesmus. Rhubarb answers well in
-such cases, and may be given in a dose from twelve to twenty grains,
-according to the age and constitution. 3. To prevent feverish heat
-and delirium. This was proposed to be done in the first stage of the
-disease, by combining it with ipecacuana and a little neutral salt.
-With the same intention, it may now be joined with a few grains of Dr.
-James’s powder, or _vitrum ceratum antimonii_, in which form it would
-not be so strongly sudorific, an effect not so much required in the
-chronic as in the acute state.
-
-The principal causes that keep up the flux, and render it so obstinate,
-are, 1. A too great secretion of bile, either continual or frequently
-recurring. 2. Ulcers in the great intestines. 3. A lienteric state of
-the bowels. 4. A retention of _scybala_.
-
-The first cause is much less frequent than might be expected by those
-who fancy that every disease of this climate proceeds from bile.
-When there does occur a redundancy of bile, there is more occasion
-for the employment of evacuant medicines, and more need of caution
-in that of opiates. A medicine that will dispose the liver, or the
-circulating system in general, to form less bile, is a _desideratum_ in
-physic; but, in case of an excessive flow of it, emetics and mercurial
-purgatives, as has been already mentioned, are the best means of
-evacuating it; and care should be taken that it be discharged before it
-accumulates too much, or becomes acrid by too long retention.
-
-In order to obviate that irritation in which tenesmus consists, some
-benefit was found from the injection of emollient and anodyne clysters,
-to wash off and dilute the acrimony, and to sooth and heal the parts. A
-strong infusion or decoction of linseed or starch may first be given to
-the quantity of near a pint, to be evacuated after a short retention,
-and then a few ounces of the same, with thirty or forty drops of
-laudanum, to be retained for a length of time, in order to procure
-rest. Instead of this last, I have known a small quantity of warm
-milk, with syrup of poppies, used with advantage in private practice.
-
-I was at first tempted to think that a very frequent injection of such
-clysters would be very useful, by washing and healing the colon and
-rectum, and preventing farther exulceration. But besides the objection
-arising from the tenderness of the parts, which, in some cases, renders
-the operation itself painful, I found that if they were given oftener
-than once a day, they rather increased the uneasiness, and made the
-patient feel languid and exhausted; so true it is that no practical
-rule can be established from reason alone without being brought to the
-test of experience. The rectum seems to have a peculiar sensibility,
-and a remarkable consent with the whole system; for a stool will
-induce syncope, or even death, in a state of great debility. Clysters
-may be pernicious, even though they produce no evacuation of _feces_;
-and Sydenham has remarked, with respect to other diseases, that their
-unseasonable or too frequent use greatly debilitates and disturbs the
-patient. When not abused, however, they are of the most eminent service
-in this and other complaints.
-
-Certain medicines, which have been called _sheathing_, have been
-recommended to be taken by the mouth. Of this kind are mucilage, oil,
-and wax. I have made trial of mucilage, such as starch, without any
-sensible effect, probably because it loses its qualities by the powers
-of digestion before it reaches the part upon which it is intended
-to act. With regard to oil, I have hardly enough of experience of
-my own to decide; but some of the surgeons of the fleet informed me
-that they found advantage from combining it with the purgatives. I
-was discouraged from using it by finding that it was apt, in the West
-Indies, to become rancid on the stomach, and, for this reason, I
-seldom, in any case, employed the castor oil, which, though produced in
-that climate, seems to answer better as a medicine in Europe. But since
-my return to England I have used, with great benefit, at St. Thomas’s
-hospital, a medicine, composed of tincture of rhubarb and oil, in old
-dysenteries, attended with discharges of blood. I took the hint of this
-from finding it of great service in deep-seated piles, as recommended
-by Dr. Griffith[115]. It is necessary to combine something purgative
-with the oil, otherwise it might be altered by digestion, or absorbed,
-or might become rancid by too long retention in the first passages. Wax
-is a body not changeable by digestion, and seems therefore well suited
-for the purpose of sheathing the bowels; and I have found advantage
-from the preparation of it recommended by Sir John Pringle[116], on the
-authority of Dr. Huck. I have also seen some advantage in old fluxes,
-in St. Thomas’s hospital, from the use of spermaceti, given with an
-equal quantity of conserve of roses and half as much absorbent powder,
-agreeably to a form in use at that hospital.
-
-The climate has a great influence in preventing these ulcers from
-healing, upon the same principle that it prevents the cure of external
-sores and wounds, so that there are cases that admit of no cure but
-from a change of climate. I have seen in some cases of old dysentery,
-small, round, ill-conditioned ulcers break out on the surface of the
-body, which seemed to proceed from the same general habit that produced
-those of the intestines. There was something peculiar in the appearance
-of those external sores, being like small round pits, as if a part of
-the skin had been removed by caustic, and with little or no discharge.
-In a case of this kind, which proved fatal, I found the whole surface
-of the great intestines beset with small ulcers, not unlike those on
-the skin.
-
-Since the first edition of this work was published, I have met with a
-pamphlet, written by Dr. Houlston, of Liverpool, in which the friction
-of mercurial ointment on the abdomen is recommended as a cure for
-old fluxes; and I have tried this practice in some very obstinate
-cases in St. Thomas’s hospital with evident success. In these cases
-it is probable the disease is kept up by a vitiated state of some of
-the various secretions belonging to the intestinal canal, which the
-mercurial alternative tends to correct.
-
-The next cause that was mentioned of the long continuation of fluxes,
-was a lienteric state of the bowels. This consists in a great
-irritability of the whole alimentary canal, whereby all the _ingesta_
-are transmitted so fast, that there is no time for assimilation. Liquid
-aliment, such as broth, is particularly subject to this inconvenience.
-There are few cases of long-protracted fluxes in the West Indies,
-without this symptom in some degree.
-
-The remedies that are here found of most service are such as counteract
-irritability or relaxation. It is in cases where this is the prevalent
-symptom that opium may be most freely used. Frequent and small doses of
-the compound officinals, such as theriaca, pulvis e bolo compositus, or
-diascordium, have been found of service. Though the relaxation would
-seem here to indicate the Peruvian bark, yet I have hardly ever known
-it employed in any form in this or any other stage of the disease,
-without being hurtful. But there are other bitters not only safe but
-useful in restoring the tone of the bowels; of this kind are simaruba,
-quassia, and chamomile flowers. The first has been reckoned a specific
-in this sort of flux; but though its powers are undeniable, it will
-be found frequently to fail[117]. I have also used, with advantage, a
-tincture of gentian and cinnamon in Port wine. Something aromatic has
-a good effect when added to the bitter, being adapted to prevent or
-obviate flatulence, which is a common and troublesome symptom in this
-complaint.
-
-That class of remedies which may be called pure astringents, might seem
-at first sight well calculated for cases of this kind. Of this sort are
-the _terra Japonica_ and _extractum campechense_; but though I have
-seen evident benefit from this last, there are few cases in which such
-medicines are found by experience to be of material service. Where the
-cause consists in simple relaxation, they will effect a cure; but it
-more frequently happens that the disease is kept up by a vitiated state
-of the secretions, or a depraved action of the bowels.
-
-The absorbent earths are a more useful remedy in this form of the
-disease. They have, perhaps, a restringent effect independent of their
-power of absorbing acid. It is certain, however, that great part of
-their use consists in the destruction of acid, which is very apt to
-be generated in that depraved state of digestion which takes place in
-advanced fluxes, particularly in this lienteric state of the bowels. In
-the early and acute state the vegetable purgatives, such as cream of
-tartar, tamarinds, and manna, are proper; but in this advanced stage
-they are hurtful by the acidity and flatulence which they produce, and
-both the food and medicines should be so calculated as to avert and
-correct those inconveniencies. There is something in vegetable acids
-extremely unfriendly to a weak state of the bowels in general, tending
-to bring on spasmodic gripings, and preventing a healthy digestion and
-assimilation, as we know in the case of heartburn, and of those who
-make use of vinegar to check corpulency, by preventing the formation
-of blood. Vegetable acids, however, are admissible where there is
-a redundancy of bile, or where the excrements are putrid; and Dr.
-Zimmerman recommends tamarinds as a useful medicine in what he calls
-the putrid dysentery.
-
-Lime water has been recommended in old flaxes, and I tried it in
-several cases; but, except in one, I could not perceive any benefit
-from it.
-
-Absorbents may very properly be combined in prescription with some of
-the compound-officinal opiates, and a medicine will thereby be formed,
-which will have at once the advantage of an anodyne, a bitter, an
-astringent, a carminative, and absorbent. As these earths have little
-or no taste, they may also be added, with propriety, to the common
-drink, as in the form of the chalk julep, or _decoctum album_. It
-may be thought that here and elsewhere I have not been so particular
-as I ought to be concerning the forms and doses of medicines; but
-circumstances, such as age, constitution, and symptoms, make these,
-in a great measure, discretionary; and any one who is sufficiently
-conversant with physic to be entrusted with the charge of the sick,
-will have sufficient judgement to vary his practice accordingly. It
-has, therefore been my object rather to give the general principles of
-treatment than the particular forms of medicines.
-
-A proper regulation of diet, as well as medicine, is of the utmost
-consequence in this disease. A free indulgence of animal food is
-pernicious, particularly in the first stage of it. In the chronic
-state, a moderate use of it is allowable, and in the lienteric state
-it answers better in a solid form than that of broth, which is apt to
-gripe and to run quickly through the bowels. The best general articles
-of diet are farinaceous bodies; and these are greatly improved by
-being toasted brown before they are used. It was observed, in a former
-part of this work, that the flux was supposed to have been prevented,
-in the fleet commanded by Sir Charles Saunders, by throwing burnt
-biscuit into the water used by the crews of the ships. It is a good
-practice to put a well-burnt toast into all that the patient drinks,
-and toasted bread, or panada made of toasted bread or biscuit, is one
-of the best articles of diet. Brackish water ought to be avoided, as it
-ruffles the bowels when in so delicate a state. Fermented liquors are
-improper, except when the disease is advanced, and where weakness and
-relaxation are the prevailing symptoms. Malt liquor will hardly ever
-agree, on account of its acidity and flatulence. Of wines, Port is to
-be preferred as the most strengthening; Madeira as the least subject
-to acidity; and, for the common men, no drink of the fermented kind is
-safer than a moderate quantity of spirits diluted with water.
-
-Warm clothing is of the utmost consequence in this disease, and
-external warmth of the abdomen tends greatly to sooth the bowels. I
-have seen good effects from a warm gum plaster constantly worn on that
-part. Though cold is in general hurtful and unsafe, I have nevertheless
-known the sailors, who, by their habits of life, are commonly heedless,
-bathe in the sea when labouring under what they call the white flux,
-without any bad effects.
-
-It sometimes happens that this disease baffles every effort both
-of medicine and diet, so that a change of climate becomes the only
-resource.
-
-The last cause of habitual flux that was mentioned was the retention
-of _scybala_, which keep up the irritation and tenesmus. It is very
-natural to neglect purgative medicines when there seems already to be
-too great a discharge by the bowels; but there is this inconvenience
-from omitting them for a length of time, that those hard lumps of
-feces, called _scybala_, are apt to collect in the cæcum and cells of
-the colon, as I have seen upon inspecting the dead bodies; and the
-fibres of the intestines being weakened, their natural strength is not
-sufficient to expel them without being stimulated by a purgative. It is
-therefore necessary to give some evacuant medicine from time to time,
-even though there should be no griping nor any marks of acrimony in
-the intestines. Rhubarb is allowed to be one of the best medicines for
-this purpose; and I have also known a combination of salts and sena
-have a good effect after a long neglect of purgative medicines. It is
-probable, from the durable effects produced, that these do not operate
-merely by the expulsion of _scybala_; and we can conceive that they may
-be of service by the removal of certain depraved fluid secretions, or
-that they may stimulate the vessels to a more healthy action and a more
-natural secretion. Be this as it will, experience teaches that in all
-fluxes it is of advantage to interpose from time to time some purgative
-medicine.
-
-From the preceding view of the variety of causes which tend to keep up
-this disease, it will appear that great judgement and discrimination
-are necessary in varying the practice according to circumstances; and
-there is no disease in which there is room for more attention and
-nicety in adapting the different remedies to the different symptoms.
-We can hereby also account for the various characters that different
-remedies have had, some having been extolled by one practitioner
-while they have been pronounced insignificant by another; for no one
-remedy will suit all the various cases of this disease. As it is of
-the greatest consequence to distinguish these cases, I have been more
-particular and diffuse on this article than any other; and having
-laboured under this complaint myself, I was naturally led to take
-a greater interest in its treatment, and had also thereby a better
-opportunity of making observations on it.
-
-
-
-
-CHAP. III.
-
-Of the SCURVY.
-
-I shall not be so minute either in the description or treatment of the
-scurvy, as of the preceding diseases. A detail of this kind would lead
-to unnecessary prolixity and repetition; for the prevention and cure
-of it consisting in diet rather than medicine, have been fully handled
-in the former parts of this work; and the subject, in the descriptive
-as well as the practical part, has, in a manner, been exhausted by Dr.
-Lind. With regard to the theoretical part, I refer the reader to the
-ingenious treatise lately published by Dr. Milman.
-
-It has appeared that the principal source of scurvy is a vitiated or
-scanty diet, and that it is very much promoted by cold, moisture,
-filth, sloth, and dejection of mind. Hard labour has been assigned
-by some as a cause; but this is not conformable to my observation
-in general, and what has been related to have happened in the
-Conqueror[118], more particularly led me to be of a contrary opinion.
-
-The principal differences of the symptoms of the scurvy in hot and
-cold climates, so far as I have observed, are, that in the former the
-livid hardness on the extremities is an earlier symptom, and in the
-latter the gums are sooner affected, and the difficulty of breathing is
-a more frequent and more uneasy symptom. This difficulty of breathing
-is one of the most fatal symptoms, and is most frequent in those cases
-in which there are the fewest external marks of the disease, and is
-probably that form of the complaint which attacks a vital part by a
-sort of translation from the extremities.
-
-There is a remarkable symptom sometimes attendant on this disease which
-has escaped authors, and is mentioned in Mr. Telford’s Report, page 23.
-This is the _nyctalopia_, or weakness of the eye-sight, which was also
-common in the garrison of Gibraltar[119], among those who were affected
-with the scurvy, a disease that prevailed much during the late siege of
-that place.
-
-With regard to the cure, enough has been said in the preceding parts
-of this work to prove that fresh vegetables are the most effectual
-antiscorbutics. I shall here mention a fact farther in proof of this,
-which has not before been taken notice of. When the fleet arrived at
-Barbadoes in May, 1781, part of the soldiers, who served as marines,
-were affected with the scurvy, and being sent to the army hospital,
-where, at that time, no fresh animal food was allowed, they recovered
-much faster by being confined to vegetable articles, than the seamen
-who were fed upon fresh animal food without any fresh vegetables.
-
-It has farther appeared, that there is something in a particular class
-of fruit of the lemon and orange kind, which far surpasses every other
-remedy, whether dietetic or medicinal. Numberless instances have
-occurred, in the preceding part of this work, of men having recovered
-at sea from using the juice of this fruit alone, even under all the
-inconveniences of a sea diet. When the juice is intended to be kept for
-a length of time, it should be expressed and bottled, a small quantity
-of spirits being added to preserve it for if fire is used in preparing
-it, as in the form of a rob, I know for certain that its virtues will
-be thereby very much impaired. It is very difficult to say upon what
-principle these fruits act, for no sensible effects are produced by
-them except a small increase of some of the secretions.
-
-It ought to be mentioned here as a fact of great consequence, though
-very little known, and never, I believe, published before, that
-the juice of limes and lemons is the best detergent of any external
-application that has yet been tried in scorbutic ulcers. Nothing was
-found so effectual in preventing these from spreading, and in disposing
-them to heal, as an emollient poultice with[120] lemon or lime juice
-sprinkled on its surface; or it was applied by soaking in it the lint
-with which the sore was dressed, and also as a lotion, in which case
-it was used diluted with two or three times its quantity of water; for
-if used pure, it was found too irritating, and was apt to bring on a
-fungous disposition. This precaution is particularly necessary with
-regard to limes, the juice of which is a much more concentrated acid
-than that of lemons. Mr. Lucas, surgeon of the Conqueror, favoured me
-with several valuable remarks in proof of this practice. A poultice
-was always found a good application in these cases, by its power of
-absorbing the acrimonious discharge, which would otherwise irritate the
-neighbouring parts. I have been informed by a navy surgeon, who served
-in the former war, that he has known the most obstinate ulcers cured
-by applying a paste of oatmeal and water, the surface of which was
-sprinkled with Goulard’s preparation of lead.
-
-The fleet was furnished with essence of malt; but its powers were so
-inconsiderable, that some of the surgeons denied that it had any. In
-trials, however, that were made in an early state of the disease, it
-was found to have a sensible effect in checking and removing it. It
-was also found of evident use in the bad ulcers so apt to arise in
-scorbutic habits, and in this intention was superior to the Peruvian
-bark as an internal alterative. Indeed, in those ulcers that were truly
-scorbutic, the bark was found to be of very little use; and, next to
-what has been already mentioned, joined to the advantages of diet,
-opium was found of the greatest service in disposing these, as well as
-all other ill-conditioned sores of hot climates, to heal.
-
-I have mentioned the scorbutic habit as distinguished from the scurvy,
-but there seems to be no difference except in degree; for a person may
-be laid to labour under the disease before it betrays itself by any
-obvious symptom, and it must have gathered a certain degree of force
-before visible symptoms are produced. The chief mark of this latent and
-incipient stage of the disease is that incurable state of ulcers that
-has been mentioned, whether they appear spontaneously or in consequence
-of slight accidents. There is another mark of this scorbutic habit
-which is not mentioned in any description of the disease I have ever
-seen. It is a soft, indolent tumour which arises under the skin on a
-part which has received a small blow, or contusion, so slight as not to
-break the skin. It most commonly appears about the elbow or fore-arm,
-and generally disappears without any inconvenience, what it contains
-being absorbed. A surgeon, who opened one of them, (a practice,
-however, not to be approved of) informed me that it consisted of
-fluid blood. We may also reckon a languor, or sense of weight, as one
-of those marks of scurvy which occur before the more obvious symptoms
-appear.
-
-In this state of the disease, the articles of lesser powers, such
-as malt and melasses, may be of service by preventing its farther
-progress, or the appearance of actual symptoms, and by restoring the
-constitution.
-
-In some of the early stages of this disease the effervescing mixture
-of acids with fixed alkali may probably also be of use. I never could
-perceive any sensible benefit in those cases in which I tried it,
-though some of the gentlemen of the fleet reported to me that they
-thought it of service.
-
-There is no article of the _Materia Medica_ yet known that possesses
-any considerable power over this disease without the assistance of
-proper diet. With this assistance, however, it is found, that whatever
-tends to increase the fluid secretions, hastens very much the recovery
-of the scorbutic patient. I have observed a very striking instance of
-this in the effects of a spontaneous diarrhoea; for I have seen those
-hard livid swellings on the legs, that form one of the most constant
-symptoms of this disease, almost disappear, and the hams, from being
-contracted, become flexible in the course of twelve hours after the
-purging came on. I have endeavoured to imitate this with purgatives,
-but never with the same effects as the natural looseness. A free
-flow of urine is also found to promote the recovery, and vinegar of
-squills is one of the most effectual medicines in this intention. It
-is likewise of singular service to excite sweat; for an obstruction
-of perspiration seems to be one of the principal constituents of the
-disease. The goose skin, which is an early and constant symptom of this
-disease, seems to be owing to a constriction of the exhaling vessels.
-Dover’s powder has been employed with advantage as a sudorific, with
-decoction of the woods drank warm, and plentiful warm dilution.
-Camphor, combined with nitre, has been found one of the best remedies,
-and it acts both as a diaphoretic and diuretic.
-
-Such external applications as relax the skin are found also to forward
-the cure. The contraction of the hams and the livid hardness of the
-calves of the legs are relieved by emollient cataplasms. Burying the
-legs in the earth, which has a sensible good effect, seems to act on
-the same principle, for it makes the parts sweat profusely.
-
-There can be no doubt that in the scurvy there takes place in certain
-parts of the body a stagnation of the humours in the small vessels,
-particularly of the lower extremities, and that it is to this
-circumstance that the livid hardness of the fleshy parts of the legs
-is owing. The effect of medicine in removing this, must be to restore
-the action of those torpid vessels, so as to bring the stagnated
-fluids again into circulation[121] Purgatives seem to act upon it as
-they do in the dropsy, by exciting absorption. The irritation of the
-bowels and their increased secretion thus affecting the minute vessels
-in all parts of the body, is the result of that sympathy or balance
-established between every part of the system, in order to support the
-harmony and effect the purposes of the animal œconomy.
-
-It has long appeared to me, that the scurvy is owing rather to a defect
-of nourishment than to a vitiated state of it. In fact, that sort of
-food which is supposed most commonly to induce the scurvy, is, in most
-cases, not putrid, but is in an unnatural and depraved state by being
-drained of its juices, which run off in brine; and perhaps some of the
-more subtile and nutritious parts are wasted by evaporation. It is not
-found that salt of itself has any effect in inducing the scurvy, and
-indeed it can be induced under a state of diet in which there is no
-salt, as we know from some instances quoted by Dr. Lind; and some cases
-are related by Dr. Monro and Dr. Milman, in the Medical Transactions,
-which are in proof of the same opinion. But the case most in point to
-prove that it depends on a defect of aliment, is that of Dr. Stark,
-who, by way of experiment on himself, reduced his diet to the least
-quantity he could subsist upon, and was thereupon affected with the
-symptoms of the sea scurvy. I have also known some symptoms of it arise
-in old people in consequence of long abstinence, owing to the want of
-appetite.
-
-It would appear that the aliment we take in acts in two ways in
-increasing the vigour of the body. First, by assimilation, whereby it
-affords the matter of which the solids of the body are made, in order
-to carry on growth in youth; and to repair the waste of parts in adult
-age. A very small quantity of matter is necessary for these purposes;
-and as a proof of it, we see people supported equally well with very
-different quantities and qualities of food. Secondly, Food is necessary
-as a stimulus, either by a power it has of soothing the nerves of the
-stomach, and the other surfaces to which it is applied, or by its
-volume in distending the intestines and blood vessels. It is upon this
-principle that luxury renders the great quantities of food we take
-in necessary; and those species of food which satisfy most by their
-stimulus are by no means such as are the most nutritious. It is also
-upon this principle, that in cases of accidental hardship from want
-of food, or in barren and inclement countries where food is scarce,
-the body is supported, in some measure, by what contains little or no
-nutritious matter, such as pure water, or the bark of trees powdered
-and kneaded into a sort of bread, as we are told of the inhabitants of
-Lapland.
-
-There are other familiar and well-established facts, which prove, that
-either from the influence of disease, from habits of life, or the
-nature of particular animals, life can go on for a length of time with
-little or no aliment. This is the case in fevers, in sea-sickness,
-in certain singular cases that have been recorded[122], in torpid
-animals, and in animals of cold blood. Though a man in health will die
-if deprived of food for a very few days, it does not follow that this
-is owing to the want of matter to repair the waste of the body. The
-craving for food, and the faintness from long abstinence, arise from
-the want of the accustomed stimulus, especially in those who are used
-to live well; and a person feels himself most refreshed by food and
-drink when newly taken in, and before it can be applied to the purpose
-of nutrition.
-
-As there is a continual waste and decay, however, both of our fluids
-and solids, some degree of reparation is absolutely necessary,
-especially to animals of warm blood; and such _ingesta_ as would
-give the stimulus of food, without being possessed of any nutritious
-principle, would indeed continue life for a certain time; but disease
-would ensue. The provision used at sea answers, in a great measure, to
-this description; for unless the powers of digestion and assimilation
-are remarkably strong, salt beef and biscuit, which have been long
-kept, do not contain much more nourishment than saw-dust, or the bark
-of a tree, and the disease induced by this diet is the scurvy.
-
-The nature and symptoms of the scurvy countenance this opinion: for
-as the means of renewing the animal matter of our bodies is withdrawn
-under this course of diet, nature, in consequence of an accommodating
-principle, observes a sort of frugality, and the animal œconomy adopts
-such measures as may be productive of the least possible waste and
-corruption of the fluids. Accordingly all the secretions become scanty;
-and, in particular, one of the first symptoms of this disease is a
-suppression of perspiration, as appears by the goose-skin that attends
-it. There is a paucity of urine. There is also a great languor in
-the circulation, which may be considered either as a means adopted by
-nature to prevent that vitiated and effete state of the fluids which a
-brisker action might induce; or it may happen from a want of that due
-supply of nourishment necessary to produce a vigorous action of all the
-functions.
-
-We have a proof of this general languor not only from the great
-aversion to motion, and the great disposition to syncope, but from
-the inspection of the dead body, from which it appears that the
-whole circulating system, being more flaccid and less elastic, is
-subject to preternatural distention. The heart is accordingly found
-enlarged in bulk, the size of the cavities being increased; and in
-the extremities, where the circulation is naturally most languid,
-the small vessels carrying the colourless part of the blood, are so
-far enlarged as to admit the red part of it, as appears by the livid
-colour; and where this is the case, these vessels being unable to
-carry on the circulation, a stagnation ensues, as is evident in those
-livid appearances most common about the calves of the leg, which feel
-like a hard cake. I have examined those parts in the dead subject, and
-found a want of fluidity in the contents of the vessels, but could not
-discover any thing like _eechymosis_; from which I concluded that the
-colour was owing to an _error loci_, and the hardness to stagnation and
-coagulation of the fluids, and a want of action of the vessels.
-
-The incurable state of ulcers, so common in this disease, is also
-what we might expect from the defect of fresh assimilated juices; for
-where a breach is made, either by nature or accident, in the solids,
-particularly of the extremities, the proper suppuration is prevented by
-the depraved state both of the fluids and vessels; and we cannot expect
-that renewal of solid parts in which healing consists, where both the
-instruments and materials of its formation are so defective.
-
-I shall conclude what I have to say on this subject, by shortly
-considering whether or not this disease is ever contagious.
-
-There is something in the nature and history of the scurvy that
-would lead us at once to pronounce that it is not infectious; for
-the external causes on which it depends are so obvious, and seem so
-adequate to account for its appearance and prevalence upon certain
-occasions, as at first sight to exclude every other external cause.
-
-But it seems extremely unphilosophical to deny the reality or
-possibility of any thing in Nature, from our supposed knowledge of the
-means and causes she employs, particularly in a branch of science so
-obscure as the animal œconomy. Could we, therefore, prove the point
-as a matter of fact, it would be in vain to deny it, from our fancied
-acquaintance with Nature’s modes of operation.
-
-The facts which give a suspicion of the scurvy being infectious are,
-1st, What is related by Dr. Lind, that the sea scurvy spread at one
-time from the naval hospital to the people of the adjacent country.
-2dly, There occurred several instances, in the first part of this
-work, of this disease prevailing to a much greater degree in some[123]
-particular ships than others, though upon the most accurate inquiry
-there was found no difference in the diet, or any other external or
-predisposing cause adequate to account for this. We can conceive, that
-those ships having accidentally a few men, whose constitutions were
-remarkably predisposed to this disease, might catch it earlier than in
-other ships, and communicate it to the rest of the crew.
-
-The only practical inference that would lie from the establishment
-of this fact would be, that when the disease begins first to appear,
-the men affected should be separated from the rest; and this is a
-good practice, whether this opinion is true or not; for such men
-ought to be put in one mess, in order that they all may live upon the
-same antiscorbutic articles of diet, and that they may more easily be
-debarred from the use of their common provisions, of which this disease
-does not make them lose the relish.
-
-
-
-
-CHAP. IV.
-
-Of the WOUNDS received in the Actions of April, 1782.
-
- Loss in the Battle and from Wounds--Fatality of the locked
- Jaw--Treatment of it--Some Ships more subject to it than
- others--Different from other Cases of Tetanus--It is not cured by the
- Removal of the Part--It may come on after the Part is cured--Effect of
- Climate in producing it--Accidents from the Wind of a Ball--Accidents
- from the Explosion of Gunpowder--Means of preventing them--General
- Observations on Sores and Wounds.
-
-
-Though surgery was not properly in my department, yet, having had
-a fair opportunity of collecting facts concerning this branch of
-practice, I thought it my duty to pay some attention to it.
-
-The whole number of men wounded in the actions of April, 1782, amounted
-to eight hundred and ten.
-
-Of these, sixty died on board before the end of the month, five in the
-course of the following month, and two in June.
-
-There were ninety-seven wounded men sent to the hospital at Port Royal,
-of whom there had died twenty-one when the fleet left Jamaica on the
-17th of July.
-
-So that the whole loss of men in the battles of April, and their
-consequences, is as follows:
-
-  Killed outright                         266
-  Died of their wounds on board            67
-  Died of their wounds at the hospital     21
-                                          ---
-                                 Total    354
-
-Of those who died on board, fifteen[124] were carried off with the
-Symptoms of the locked jaw; but of those sent to the hospital, only
-one. The reason that so few in proportion were affected with it in the
-hospital may have been, that none of the wounded were landed till near
-the end of the third week after the principal action. The danger of
-this symptom was then, in a great measure, past, though I have known
-it to take place in every period from the second or third day till the
-fourth week.
-
-Only three men in the whole fleet recovered from this alarming
-complaint; and as it is interesting to know every thing relating to so
-desperate a symptom, I shall give a short account of each.
-
-The first was a seaman of the Montagu, who had his thigh wounded by
-a splinter which carried away part of the integuments and _membrana
-adiposa_, and lacerated in a small degree the _vastus externus_
-muscle. The wound did extremely well till the 23d day, when the jaw
-became almost entirely fixed, and the whole muscles of the wounded
-side were thrown into frequent spasms. Mr. Young, the surgeon, who
-was always anxious and assiduous in his duty, consulted with me, and
-we had immediate recourse to the warm bath, which gave a degree of
-instantaneous relief, and was repeated twice a day for half an hour.
-He was sensibly better every time; in nine days was entirely free of
-the symptom, and continued afterwards to do well. The only other means
-taken for this man’s recovery, besides what were used with the other
-wounded men, were from three to five grains of opium, which he took
-every day, in divided doses.
-
-The next was a seaman of thirty years of age, belonging to the
-Magnificent, who had the _humerus_ broken and shattered by a splinter
-which entered the deltoid muscle. Several large portions of bone were
-extracted, and the artery was laid bare on the inside. On the fifth day
-there came on a large ichorous discharge, with a low quick pulse and
-depressed spirits, and the jaws began to close, with pain and stricture
-on both sides about the articulation of the lower jaw. He had every day
-since the accident taken half an ounce of Peruvian bark, combined with
-opium or rhubarb, according as it made him loose or costive. This was
-continued, and the part externally was kept constantly moist all round
-with volatile liniment, to which a fourth part of _tinctura thebaica_
-was added. Next day the jaw was almost entirely fixed, so that it was
-with difficulty that a little wine and water could be introduced with a
-spoon. Mr. Harris, the surgeon, now wisely determining to do something
-vigorous in this unpromising situation, beat up twelve ounces of opium
-moistened to the consistence of a cataplasm with the thebaic tincture,
-and applied one half to each side of the jaw. The patient this day
-swallowed a pint of the bark decoction with half an ounce of nitre, and
-took a diaphoretic draught of twenty drops of thebaic tincture and
-thirty of antimonial wine. He had also the smoke of tobacco thrown up
-his nostrils.
-
-On the third day after the attack he could open his mouth half an
-inch. The cataplasms were taken off, beat up afresh with the tincture,
-and applied anew. The bark and other medicines were continued. On the
-fourth day the stricture and pain of the jaw went entirely off, but the
-cataplasm and volatile liniment were applied for three days longer. The
-wound produced a laudable discharge, every symptom became favourable,
-and he continued to recover.
-
-The only other person who recovered from this symptom was a man in the
-Bedford. Several died of it on board of this ship; and as the same
-means of relief were skilfully employed in all the cases by Mr. Wickes,
-the surgeon, the success seemed owing more to something favourable in
-the man’s constitution, than any thing peculiar in the treatment, which
-consisted in the administration of the warm bath, opium and camphor,
-with mercurial friction on the jaw.
-
-This accident affected some ships remarkably more than others,
-particularly the Barfleur and Bedford, though their wounds had nothing
-peculiar, nor were in a greater proportion than in the rest of the
-fleet. Four were carried off by it in each of these ships. It has
-formerly been observed, that great ships acquire peculiar habits, or
-dispositions, which incline the constitutions of the men to one disease
-more than another. This complaint took a run in some particular ships
-last year also after the battle of the Chesapeak; and I have known it
-prevail in some particular hospitals more than others. In the present
-instance, it may have been owing either to something peculiar in the
-constitution, or air of the ships; or we can conceive it to be owing
-to some sort of nervous sympathy, just as the _epilepsy_[125] has been
-known to spread from one boy to another, at a school, in consequence
-of imitation, dread, horror, or some such delicate nervous or mental
-affection. We have in yawning an example of a spasmodic affection
-spreading from one person to another. If this is the case in the locked
-jaw, those affected by it should be removed from the presence of the
-other wounded men, lest the idea of the sufferings of others should be
-so fixed in their mind, or so impress them with the fear of the like,
-as to invite the attack of the same complaint.
-
-Though the locked jaw, in consequence of wounds, resembles frequently
-in its symptoms the tetanus which arises without any external accident,
-yet there are many cases of the former which differ materially from
-the violent symptoms of the other, as described by authors. In most
-cases of the locked jaw from wounds the spasms are not so general, so
-violent, nor attended with such exquisite pain. It sometimes happens
-that the convulsive twitchings are even accompanied with a sort of
-pleasure, as in the case of a lieutenant of the Montagu, whose case was
-related to me by Mr. Young, the surgeon of that ship, a man of skill
-and observation in his profession, and upon whose fidelity and accuracy
-I could perfectly rely. This officer had been wounded in the elbow at
-the battle of St. Christopher’s by a splinter, whereby the capsular
-ligament of the joint was injured. On the ninth day, symptoms of the
-locked jaw came on, and soon after the whole muscles of the wounded
-side were affected with frequent convulsive twitchings, which, as he
-himself said, afforded a pleasant sensation, exciting laughing like an
-agreeable titillation. He died on the fourth day after it came on, and
-had no pain to the last.
-
-The locked jaw from accident differs also from other cases of tetanus,
-in respect to its cure; for the latter has been successfully treated by
-cold bathing, as is related by Dr Wright[126] and Dr. Cochrane[127];
-but it is acknowledged by the latter that this treatment did not answer
-when the complaint proceeded from a wound.
-
-It is to be remarked, that the locked jaw did not take place in those
-cases in which the wounds had a foul and gangrenous appearance more
-than others; for those that digested and cicatrized favourably, were
-equally apt to be affected by it; and though amputations are most
-liable to this symptom, the slightest injuries, even a scratch, will
-sometimes bring it on.
-
-It would be difficult, therefore, to establish any particular treatment
-that would tend to prevent accidents of this kind; but Mr. Bassan,
-surgeon of the Arrogant, one of the line-of-battle ships engaged on the
-12th of April, mixed laudanum with the dressings of all the wounds, and
-no locked jaw occurred.
-
-In the Bedford there occurred a curious circumstance concerning this
-complaint. In one of the cases that proved fatal, the symptoms did not
-come on till the wound was so far healed that all dressing had been
-laid aside.
-
-Mr. Wood, surgeon of the hospital at Jamaica, informed me, that in
-cases of the locked jaw from injuries to small members, such as
-fingers, he had tried the effect of amputating the part after the
-symptoms had come on, but without any effect in putting a stop to them.
-
-Would it not appear, from the two last mentioned facts, that this
-symptom is not kept up, nor even takes place in the first instance,
-from an immediate present irritation, but that the constitution comes
-to be so modified, or receives such an impulse, as it were, that
-the complaint runs its course independent of the presence of that
-_stimulus_ which excites it?
-
-It would be difficult to assign a satisfactory reason why this accident
-is more frequent in hot than in cold climates. The effect of external
-heat upon the living body is not to raise its temperature even when the
-heat of the air exceeds that of the body[128]; so that we are to seek
-for the effects of it in some of those affections peculiar to animal
-life. And as the outward temperature of the air does not affect the
-general mass of the body, all the effects produced by it must depend
-on impressions made on the external surface of the body and lungs; and
-the skin, which may be considered as a large expanded tissue of nervous
-fibres endowed with universal sympathy and great sensibility, affects
-every organ and every function of the body, according to the state of
-the air in contact with it, whether cold or hot, moist or dry, pure or
-vitiated. This sympathetic sensibility of the skin is chiefly affected
-by the state of the perspiring pores on its surface; for it is only
-when these are open that the impression of the air on the skin produces
-catarrhs, rheumatisms, and internal inflammations in cold climates;
-and the external temperature in hot climates being such as to keep
-the pores almost always open, this seems to be a principal reason
-of that universal irritability prevailing there, and of the general
-sympathy that prevails between every part, particularly as connected
-with the organs of perspiration[129]. This readiness of one part to be
-affected by another in hot climates is well illustrated by the sudden
-translation of certain diseases. I have seen, for instance, a catarrh
-cease, and be converted, as it were, into a diarrhœa, and this as
-quickly disappearing, a pain in the foot would arise, like an attack of
-the gout. All this would happen in the space of a few hours.
-
-But, in cold climates, wounds are by no means exempt from the locked
-jaw; for it sometimes occurs in England, where I have seen it even in
-the winter season[130].
-
-Since my return to England I have received some new and useful
-information on this subject in conversing with Dr. Warren, physician
-to the King; and as any observations derived from so much acknowledged
-skill and sagacity must be valuable, I shall here relate what he was so
-kind as to communicate to me.
-
-This eminent physician, in attending a case in which he was nearly
-interested, and in which his endeavours were rewarded with success,
-found the greatest benefit from opium and the warm bath. The opium was
-given in the form of tincture, in moderate, but pretty frequent, doses.
-The bath was composed of milk and water, and the addition of milk was,
-no doubt, an improvement; for there is something in this as well as
-oil extremely soothing to the human nerves. Dr. Warren had intended to
-make trial of a bath of oil in case this had failed. He mentioned the
-following observation, with regard to the external application of oil,
-which could only have been suggested by that anxious attention that was
-paid to the case. It was found, that the uneasiness arising from the
-spasm was allayed by constantly drawing a feather wetted with oil over
-the temples, which had an evident effect in lulling the pain and spasm;
-for when this operation was left off, there was an immediate recurrence
-of these symptoms[131].
-
-It would appear, therefore, from this as well as the former cases,
-that opium and the warm bath are the only remedies yet known which
-are of service in this complaint, and much will depend on the
-judicious management of them. The method of administering the opium,
-recommended by Dr. Warren, seems to be the most judicious, especially
-in constitutions not habituated to this medicine.
-
-There is a certain medium in giving opium, by which its best effects
-are obtained, for in an under dose it will produce disturbance instead
-of rest; and when it is given in large quantities it frequently
-defeats the very end for which it is given, by throwing the body into
-convulsions which terminate in death. The rule for judging of the
-proper limits of this dose is, by its effect in inducing that stupor
-or insensibility which renders the senses incapable of irritation; for
-in this, as well as in every other case of disease, the cure seems
-ultimately to be the work of nature, the effect of medicine being only
-a secondary operation, by which it removes some obstacle to the natural
-efforts of the constitution. Though a dose of opium greater than
-ordinary is required to produce this insensibility in cases of spasm,
-and though the constitution in that situation will bear more, yet even
-here it may be given to excess; and by beginning with small quantities,
-and giving it in frequent rather than large doses, the constitution
-will thereby be better reconciled to it, and it will also with more
-convenience admit of that gradual increase which is peculiarly
-necessary with this medicine. These ideas were suggested to me by Dr.
-Warren; and it may be farther added, in recommendation of his method,
-that the liquid form is preferable to the solid, as the effects of it
-will sooner be seen, and a better judgement can be formed how far it is
-proper to push it.
-
-Great attention is also necessary in regulating the heat of the bath;
-for if it is not sufficiently warm, it will not have the effect of
-producing a due relaxation; and if it should be too hot, it will
-stimulate too much, and will have the farther inconvenience of making
-the patient very faint in a short time. It cannot be well regulated
-without a thermometer, and 93° upon Fahrenheit’s scale is perhaps the
-best temperature. I have kept a patient in a bath of that heat for six
-hours, which he could not have endured for half an hour had the heat
-been three or four degrees higher.
-
-The circumstance next in consequence, in the cure of this complaint,
-is the keeping up a moisture on the skin, and guarding the surface of
-the body from the access of the air. This is particularly necessary
-with regard to the part itself, which should be constantly enveloped in
-warm, anodyne, and emollient applications. The good effects of this is
-particularly exemplified in the case which recovered under the care of
-Mr. Harris, who gave the diaphoretic medicine, composed of antimonial
-wine and laudanum, and applied the anodyne cataplasm to the external
-_fauces_. It was remarked, that the locked jaw was most incident to
-those wounded men who lay in parts of the hospital where they were
-exposed to a current of air; and the cases of tetanus that most usually
-occur in the West Indies, independent of wounds, are those of slaves
-who fall asleep in the night-time in the open air.
-
-Since the first edition of this work, there has appeared an Essay on
-the Locked Jaw by Dr. Rush, physician to the American army in the late
-war, in which he recommends, from his own observation, Peruvian bark,
-wine, and blisters, and to dress the wounds with mercurial ointment, in
-the cure of this complaint. From some trials I have since made of the
-bark in St. Thomas’s hospital, I have reason to think well of it as a
-remedy in this disease.
-
-There is a singular species of accident to which engagements at sea
-are liable, the WIND OF A BALL, as it is called. If a cannon ball in
-its flight passes close to any part of the body, it renders it livid
-and numb for some time[132]. It is most dangerous when it approaches
-the stomach; and there was an instance of a man in the last battle,
-who, upon a ball passing close to his stomach, dropped down dead
-instantaneously, without the least visible marks of injury. Another,
-in consequence of a ball passing close to his belly, remained without
-sense or motion for some time, and a large livid tumor arose on the
-part, but he recovered. I attended a man at the hospital at Barbadoes,
-who had the buttons of his trowsers carried off by a cannon ball,
-without its having touched the body. The _pubis_ was livid and swelled
-for some time after: he suffered exquisite pain from strangury, which
-seemed to proceed from a _paralysis_ of the bladder, for he voided no
-water without a catheter for near three months, after which time he
-recovered. I know a brave young officer[133] in the army, who had his
-epaulette carried off by a cannon ball at Charlestown, in consequence
-of which the shoulder and adjacent parts of the neck were affected
-for some time. A like accident happened to a marine officer in one of
-the late engagements; but in neither of these was the head materially
-affected, nor is it so apt to be affected in this way as the stomach.
-I never knew death the consequence of the wind of a ball on the head;
-though an officer[134] in the Sultan, at the battle of Grenada, was so
-stunned by a shot passing near his temple, as to be insensible for some
-time, but he recovered entirely in a few hours[135].
-
-The class of wounds most peculiar to a sea engagement are scorches from
-the accidental explosion of gunpowder; and in most of the campaigns
-in which I have served they have been very frequent and fatal. Few
-accidents, however, of this kind happened in the late engagements; so
-that we had but little experience of this sort of wounds in April,
-1782. But on former occasions they were very frequent, and the best
-application to the burnt parts was found to be linseed oil, which
-some of the surgeons mixed with lime water, others with cerusse, and
-both compositions answered well. Opium was found of great use in
-alleviating pain and procuring rest, care being taken to guard against
-costiveness by the use of clysters. In the battles of 1780 and 1781,
-one-fourth part of the whole killed and wounded was from this sort of
-accident; but on the 9th and 12th of April, 1782, only two accidental
-explosions of gunpowder happened in the whole fleet, by one of which
-one life was lost, by the other, two. This difference was owing partly
-to greater experience and habits of caution acquired in the course
-of the war, and partly to certain improved methods in working the
-artillery introduced by Sir Charles Douglas, which, like all his other
-valuable improvements, tend to give facility and expedition, as well
-as to save the lives of men. The circumstances which tend to prevent
-explosions are, 1st, The wetting of the wads, which prevents their
-inflaming and blowing back when they fight the weather side of the
-ship; a circumstance which, without this precaution, gives occasion
-to a number of accidents by the burning parts catching the loose
-powder, or setting fire to the cartridges. 2dly, The use of goose-quill
-tubes and small priming boxes, made of tin, instead of the large horns
-formerly in use, whereby great quantities of powder were scattered
-about and exposed to accidental fire. 3dly, The use of locks, which was
-practised with great success in several ships, and was found to make
-the operation both more safe and more expeditious.
-
-It frequently happens that men bleed to death before assistance can
-be procured, or lose so much blood as not to be able to go through
-an operation. In order to prevent this, it has been proposed, and on
-some occasions practised, to make each man carry about him a garter,
-or piece of rope-yarn, in order to bind up a limb in case of profuse
-bleeding. If it should be objected, that this, from its solemnity, may
-be apt to intimidate common men, officers at least should make use of
-some such precaution, especially as many of them, and those of the
-highest rank, are stationed on the quarter deck, which is one of the
-most exposed situations, and far removed from the cockpit, where the
-surgeon and his assistants are placed. This was the cause of the death
-of Captain Bayne, of the Alfred, who, having had his knee so shattered
-with a round shot, that it was necessary to amputate the limb, expired
-under the operation, in consequence of the weakness induced by loss
-of blood in carrying him so far. As the Admiral, on these occasions,
-allowed me the honour of being at his side, I carried in my pocket
-several tourniquets of a simple construction, in case accidents to any
-person on the quarter deck should have required their use.
-
-It sometimes happens, however, that no hæmorrhage arises from a limb
-being carried off by a ball. The surgeon of the Fame related to me an
-instance of this, in which the thigh was cut through by a shot near
-its upper part, all except a little flesh and skin, and yet not the
-least hæmorrhage followed. This may have been owing to the limb being
-entirely severed, or nearly so, whereby the vessels contracted more
-easily than if they had been partially divided. All that was done for
-this man was to remove the limb, and to saw off the jagged end of the
-bone. He survived six days, still without bleeding, and died of the
-locked jaw.
-
-I was informed by several of the surgeons, that the method of taking up
-the vessels by the _tenaculum_ was found to answer extremely well; and
-many of them imagined that the locked jaw was not so apt to be brought
-on by this mode of operation as by that of the needle. But it is hardly
-to be attempted in time of action, for want of steadiness and a good
-light, and it was chiefly at the hospitals that this practice was found
-so successful.
-
-Mr. Alanson’s method of amputation by a great retraction of the
-muscles, so that the fleshy parts shall meet over the bone and unite
-in the first intention, was attended with great success in the West
-Indies, particularly at the hospital at St. Lucia, under the care of
-Mr. Bulcock.
-
-It may be remarked, that though all sores and wounds in the foot and
-leg are difficult of cure in a hot climate, I have observed, that,
-where the constitution is good, those in the thighs, arms, trunk, and
-head, are rather more easy of cure than in Europe, and that parts
-divided by incision very readily unite by the first intention. In
-reasoning upon this, it may be said, that as healing depends on a
-certain degree of vigour in the powers of life, this should not err
-either on the side of excess or defect. If it is too great, as in the
-case of a hale, plethoric constitution in a cold climate, too much
-inflammation is apt to be excited; and if too feeble, as happens in
-a hot climate, in the lower extremities, which are far removed from
-the source of life and circulation, the salutary effort is not strong
-enough to generate new organised parts. But in the trunk of the body,
-in such a climate, the powers of the animal œconomy are in that just
-medium which is most favourable to this operation of nature.
-
-
-THE END.
-
-
-APPENDIX
-
-TO
-
-PART III.
-
-It has been suggested to me, that it would add to the utility of this
-Work to subjoin a list of the remedies best suited to the practice of
-physic at sea, with their quantities, and to give a set of formulas
-for the direction of young practitioners. I have accordingly made out
-a gross computation of the requisite quantities of the most useful
-and necessary articles of the Materia Medica, and also a few of the
-most commodious and simple forms of administering some of the most
-efficacious remedies for the most common diseases.
-
-It is of consequence every where, but especially on board of a ship,
-to simplify practice, as much as possible, with regard to the number,
-the preparation, and the administration of medicines. Where a great
-number of compound medicines are given, it is extremely difficult to
-ascertain, by accurate and satisfactory observations, what are their
-real effects; and as there are not conveniences at sea for great
-pharmaceutical nicety, the plainest forms should be adhered to. And as
-all operations are rendered more practicable and easy by being reduced
-to a stated method, this is an additional inducement for studying
-plainness and simplicity in preparing and administering remedies. This
-uniformity is more attainable in the public service than in private
-practice; for in the former all the patients are of one sex, they are
-all adults, and they are generally of robust constitutions.
-
-In the list hereto subjoined the articles are distinguished into
-PRINCIPAL and SECONDARY; and when a surgeon considers how limited his
-funds are, I hope he will not think that I have made a disproportionate
-assortment in reducing the number and quantities of the latter, my view
-in this having been that he may better afford an ample proportion of
-such medicines as are really efficacious and indispensable in the cure
-of diseases. It may be affirmed, without vanity or arrogance, that the
-printed list of articles with which the navy surgeons are enjoined to
-supply themselves is very injudicious considering the present improved
-state of the medical art; and it is of great importance that the
-due proportion of each article should be ascertained as nearly as
-possible, that no unnecessary expence may be incurred, and that the
-chest may not be encumbered with unnecessary articles.
-
-There are no simple distilled waters in the following list, as they
-are very corruptible, and too bulky to carry to sea. Their place is
-supplied by a small quantity of oil of mint, which may be occasionally
-added to common water, in the proportion of a drop to an ounce. There
-are no tinctures inserted, except laudanum, the traumatic balsam, and
-compound spirit of lavender, as the surgeon, having a proper supply of
-spirit of wine or rum, may make them on board of the ship.
-
-In the following list the surgical articles are not enumerated. There
-is a new article which I beg leave to recommend, as it has lately been
-found extremely useful, and is now used in large quantities in the
-hospitals in London. This is linseed meal for poultices. The surgeon
-should also be provided with a sufficient quantity of linseed oil, as
-it has been found to be one of the best ingredients in dressings for
-scorches. See page 540.
-
-The quantity of each article is adapted to an hundred men for one year,
-so that a calculation can easily be made for any number of men, and for
-any length of time.
-
-
-  ASSORTMENT OF MEDICINES
-
-  TO BE
-
-  CARRIED TO SEA,
-
-  FOR
-
-  ONE HUNDRED MEN, FOR ONE YEAR.
-
-
-PRINCIPAL ARTICLES.
-
-Peruvian bark, ten pounds, and if the ship is destined for a hot
-climate, twenty pounds. This article should be provided by the Public.
-See p. 359.--Calomel, two ounces and a half--_a_ Emetic tartar, one
-ounce and a half--Ipecacoanha, four ounces--Opium, one ounce--_b_
-Purging salts, ten pounds--Senna leaves, two pounds.
-
-
-SECONDARY ARTICLES.
-
-Aloes, half an ounce--Ammoniacum, two ounces--Balsam of copaiva,
-three ounces--_c_ Traumatic balsam, four ounces--Camphor, three
-ounces--Cantharides, one ounce--Capsicum, three drachms--Castor, an
-ounce and a half--Chamæmile flowers, or hops, two pounds--Cinnamon,
-an ounce--Prepared chalk, or oystershells, six ounces--Conserve of
-roses, half a pound--_d_ Cordial confection, two ounces--_e_ Cathartic
-extract, half an ounce--Extract of hemlock, three ounces--Extract of
-logwood, one ounce--Gentian, five ounces--Ginger, three ounces--Gum
-arabic, four ounces--Gum guaiacum, three ounces--Powder of jalap,
-one ounce and a half--_f_ Laudanum, four ounces--Linseed, one
-pound--Magnesia, six ounces--Manna, eight ounces--Whole mustard seed,
-half a pound--Myrrh, four ounces--_g_ Crude mercury, two ounces--
-
-
-_Names in the last Edition of the London Pharmacopœia._
-
-_a_ Antimonium tartarisatum.--_b_ Either Glauber’s salts, natron
-vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s
-salt answers better in a hot climate, being less deliquescent
-from the heat and moisture of the climate.--_c_ Balsamum benzoes
-compositum.--_d_ Confectio aromatica;--_e_ Extractum colocynthidis
-compositum.--_f_ Tinctura opii.--_g_ Hydrargyrus.
-
-_a_ Corrosive sublimate, an ounce--Nitre, eight ounces--Oil of
-almonds, one pint--_b_ Castor oil, half a pint--Linseed oil, three
-pints--Essential oil of mint, one ounce--_c_ Jamaica pepper, four
-ounces--_d_ Blistering plaster, ten pounds--Quaffia, eight ounces--Salt
-of hartshorn, two ounces--_e_ Salt of steel, half an ounce--_f_ Salt of
-wormwood, ten ounces--Castile sope, half a pound--Sarsaparilla, three
-pounds--Serpentary, four ounces--Spermaceti, four ounces--Rectified
-spirit of wine, one pint--_g_ Weak spirit of vitriol, half a pint--_h_
-Volatile aromatic spirit, half a pint--_i_ Spirit of Mindererus,
-two pints, or the volatile salt and vinegar may be kept separately,
-and added occasionally--Spirit of turpentine, four ounces--Dried
-squills, half an ounce--Flowers of sulphur, one pound--Golden sulphur
-of antimony, half an ounce--Cream of tartar, one pound--Vinegar, six
-pints--_j_ White vitriol, six drachms--Wormwood, one pound--_k_ Flowers
-of zinc, two drachms.
-
-
- NECESSARIES _to be put in charge of the Purser, and served out to the
- Sick in place of the common sea provisions. See page 358._
-
-BARLEY, three hundred pounds--Eggs, greased and put in salt, twenty
-dozen--Extract of spruce, twelve pounds--Lemon juice clarified, and
-preserved by adding to it a small proportion of ardent spirits, five
-gallons--Raisins, fifty pounds--Rice, two hundred pounds--Coarse sugar,
-one hundred pounds--Sago, twenty pounds--Salep, ten pounds--Portable
-soup, fifty pounds--Tamarinds, ten pounds--Best white wine, three
-hundred gallons--Best red wine, one hundred gallons.
-
-
-_Names in the last Edition of the London Pharmacopœia._
-
-_a_ Hydrargyrus muriatus.--_b_ Oleum ricini.--_c_ Pimento.--_d_
-Emplastrum cantharidis.--_e_ Ferrum vitriolatum.--_f_ Kali
-præparatum.--_g_ Acidum vitriolicum dilutum.--_h_ Spiritus ammoniæ
-compositus.--_i_ Aqua ammoniæ acetata.--_j_ Zincum vitriolatum.--_k_
-Zincum calcinatum.
-
-
-
-
-FORMULÆ QUÆDAM
-
-MEDICAMENTORUM
-
-IN MEDICINA FACIENDA APUD NAUTAS
-
-ACCOMMODATIORES.
-
-
-IN FEBRE CONTINUA.
-
-
-PULVIS EMETICUS COMMUNIS.
-
- ℞. Pulveris radicis ipecacoanhæ grana decem, antimonii tartarisati
- grana duo, misce.
-
-
-MISTURA CATHARTICA COMMUNIS.
-
- ℞. Foliorum fennæ uncias sex, aquæ ferventis libras sex. Macera donec
- pene refrixerit & adjice vel natri vitriolati vel magnesiæ vitriolatæ
- libram unam cum semisse. Dein cola & admisce tincturæ sennæ uncias
- octo. Dosis est ad uncias tres.--Interdum conducit adjicere singulis
- dosibus, vel pulpæ tamarindo um semunciam, vel mannæ semunciam, vel
- antimonii tartarisati semigranum, vel pulveris jalapìi grana decem.
-
-
-ENEMA COMMUNE.
-
- Aquæ marinæ tepidæ uncias duodecim.
-
-
-POTUS COMMUNIS.
-
- Decoctum hordei.--Conveniat adjicere singulis libris pro re natà, vel
- pulpæ tamarindorum unciam dimidiam, vel crystallorum tartari drachmam
- unam, vel nitri scrupulum unum, vel acidi vitriolici diluti guttas
- decem, vel succi limonum unciam unam, vel gummi arabici scrupulos
- duos, vel vini uncias quatuor, vel frustum panis tosti.
-
-
-VINUM EMETICUM.
-
- [136]℞. Antimonii tartarisati scrupulos duos, aquæ ferventis uncias
- duas, vini albi uncias octo. Solve antimonium in aquâ & adde vinum.
- Assumatur drachma una omni quadrante horæ, donec vel vomitus cieatur,
- vel alvus moveatur. Deinde assumatur semi-drachma sextâ quâque horâ.
-
-
-PILULA FEBRIFUGA.
-
- ℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi Dris.
- James drachmam unam, conservæ rosæ quantum latis sit. Simul contunde
- & divide in pilulas duodecim. Deglutiatur una quartâ vel sextâ quâque
- horâ.
-
-
-MISTURA SALINA ET ANTIEMETICA.
-
- ℞. Kali præparati drachmam unam, succi limonum, vel aceti, vel acidi
- vitriolici quantum satis sit ad saturandum salem, aquæ puræ uncias
- sex. Bibatur tertia pars ter die.--Conducit pro re nata adjicere,
- vel pulveris antimonialis grana quinque, vel acidi vitriolici diluti
- guttas quinque, vel cretæ præparatæ scrupulum unum, vel aquæ menthæ
- semunciam.--Interdum conducit sumere hanc misturam statim postquam
- Kali & succus limonum mixta fuerit, scilicet in ipsâ ebullitione. Hoc
- imprimis utile est quando vomitus vel nausea molestus sit, & licet
- adhibere magnesiam vice Kali, & acetum vice succi limonum.
-
-
-[137]PILULA DIAPHORETICA.
-
- ℞. Opii purificati grana duodecim, antimonii tartarisati grana sex,
- conservæ rosæ semi-drachmam, farinæ glycirrhizæ, vel tritici quantum
- satis sit. Contunde simul & divide in pilulas viginti quatuor.
- Devoretur una horâ somni. Interdum prosit dare unam bis die.
-
-
-[138]MISTURA SEDATIVA.
-
- ℞. Misturæ camphoratæ uncias sex, tincturæ opii guttas viginti Misce.
- Bibatur tertia pars ter die.--Aliquando conducit admiscere singulis
- dosibus aquæ ammoniæ acetatæ drachmas tres, vel vini emetici guttas
- triginta.
-
-
-[139]BOLUS SEDATIVUS.
-
- ℞. Confectionis aromaticæ scrupulum unum, opii purificati grani
- quartam partem, castorei Russici grana decem, tincturæ opii guttas
- quatuor. Misce. Assumatur sextâ quâque horâ.
-
-
-BOLUS SERPENTARIÆ COMPOSITUS.
-
- ℞. Pulveris serpentariæ Virginianæ grana decem, camphoræ grana
- quatuor, confectionis aromaticæ quantum satis sit. Assumatur ter
- die.--Interdum conducit addere pulveris corticis Peruviani drachmam
- dimidiam, vel superbibere decocti corticis Peruviani uncias duas.
-
-
-ELECTUARIUM AD CONVALESCENTES.
-
- ℞. Pulveris corticis Peruviani, florum chamæmeli, singulorum unciam
- unam, pulveris zinziberis scrupulos duos, syrupi quantum satis
- fit. Dosis est circiter drachma ter die.--Interdum adjiciantur vel
- rubiginis ferri drachmæ tres, vel pulveris terpentariæ Virginianæ
- drachmæ duæ.
-
-
-IN FEBRE INTERMITTENTE.
-
-Adhibeantur in initio eadem medicamenta ac in initio febris continuæ.
-Deinde
-
-Sumatur corticis Peruviani drachma una, secundâ vel tertiâ quâque horâ,
-vel etiam singulis horis, absente paraxysmo febrili.--Interdum confert
-dare singulas doses ex spiritûs vini tenuis (_rum_ dicti) unciâ unâ.
-
-Si cortex frustra adhibeatur fauste adhiberi possint medicamenta infra
-præscripta.
-
- [140]℞. Zinci calcinati semi-drachmam, conservæ rosæ quantum satis
- fit. Contunde simul & divide in pilulas quindecim. Sumatur una ter
- die, augendo dosim si premerit morbus & si ferat ventriculus.
-
-
-Vel,
-
- ℞. Zinci vitriolati grana duodecim aquæ puræ uncias tres Sumatur
- tertia pars ter die augendo dosim si opus fuerit & si ferat
- ventriculus.
-
-
-Vel,
-
- [141] ℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas sex.
- Misce. Sumatur paucas horas ante paroxysmum.
-
-
-Vel,
-
- [142] Cortice Peruviano frustra dato, aliquando conferat dare ægro
- quotidie, vel calomelanos, vel pilularum ex hydrargyro quantum &
- quamdiu sufficiat ad levem ciendum ptyalismum, & deinde instituere
- curam de integro cum cortice Peruviano.
-
-
-Vel,
-
- [143] Sumantur tincturæ
-
-
-
- IN DIARRHŒA SIMPLICI.
-
-
- BOLUS AD DIARRHOEAM.
-
- ℞. Cretæ præparatæ scrupulum unum, pulveris rhabarbari grana
- quindecim, pulveris corticis cinnamomi grana sex, opii purificati
- granum dimidium, tincturæ opii guttas quinque, syrupi quantum satis
- fit. Semel sumatur.
-
- ℞. Misturæ cretaceæ (Pharm. Lond.) cum duplici gummi arabico libram
- unam, tincturæ opii guttas decem. Absumatur totum partitis vicibus
- nychthemero, incipiendo duodecim horas post datum medicamentum
- novissime præscriptum.--Interdum adjiciatur tincturæ cinamomi uncia
- dimidia.
-
-
-IN CHOLERA MORBO.
-
- ℞. Decocti hordei vel avenæ libras tres, pulveris gummi arabici unciam
- unam cum semisse, tincturæ opii guttas triginta. Hauriatur quam primum
- libra una, & deinde libra dimidia omni horâ usque ad levamen mali.--Si
- parabilis fuerit caro vitulina, vel pullus, jusculum tenue ex altero
- utro factum vice decocti supra dicti adhibeatur.
-
-
-IN DYSENTERIA ACUTA.
-
-Sumat æger quamprimum emeticum commune.
-
- ℞. Decocti hordei libras duas, salis cathartici unciam unam cum
- semisse, antimonii tartarisati grana duo. Misce. Hauriatur tepide
- primò libra dimidia, & deinde unciæ quatuor omni horâ donec alvus
- copiose & iteratim dejecerit.
-
- ℞. Pulveris ipecacoanhæ grana duodecim, conservæ rosæ quantum satis
- fit. Contunde simul & divide in pilulas duodecim. Sumatur una ter die.
- Si æger vehementer febricitârit satius erit dare ter die vini emetici
- drachmam unam ex cyatho amplo decocti hordei tepidi.
-
- [144]℞. Pulveris ipecacoanhæ grana duo, pulveris opii purificati
- exsiccati granum unum, nitri grana octo. Misce. Sumatur horâ somni.
-
-
-ENEMA EMOLLIENS.
-
- ℞. Amyli unciam dimidiam, aquæ puræ uncias decem. Coque ad idoneam
- spissitudinem.
-
-
-Vel,
-
- ℞. Seminum lini drachmas sex, aquæ puræ uncias duodecim. Coque per
- quadrantem horæ & cola liquorem pro enemate.
-
-
-ENEMA ANODYNUM.
-
- ℞. Enematis emollientis uncias quatuor, tincturæ opii guttas
- quadraginta. Misce.
-
-
-IN DYSENTERIA CHRONICA.
-
-
-BOLUS CATHARTICUS.
-
- ℞. Pulveris rhabarbari grana quindecim, calomelanos grana quinque,
- conservæ rosæ quantum satis fit ut fiat bolus. Mane sumendus, &
- repetendus post paucos dies si opus fuerit.--Vice hujus interdum
- conducat dare misturæ catharticæ communis uncias duas.
-
-
-SOLUTIO CAMPECHENSIS.
-
- ℞. Extracti ligni Campechensis drachmam unam cum semisse, tincturæ
- cinamomi unciam unam. Tere simul & admisce aquæ puræ uncias quinque.
- Sumatur uncia una ter die.
-
-
-DECOCTUM AMARUM.
-
- ℞. Corticis simaroubæ vel quassiæ drachmam unam, aquæ puræ libram unam
- cum semisse. Decoque ad libram unam. Absumatur totum quotidie tribus
- vicibus. Adjici possint singulis dosibus pro ratione symptomatum, vel
- cretæ præparatæ scrupulus unus, vel pulveris ipecacoanhæ granum unum,
- vel tincturæ cinamomi drachmæ duæ, vel tincturæ opii guttæ quinque.
-
- [145]In casibus rebellibus confert illinere quotidie hypogastrium
- unguenti ex hydrargyro drachmâ dimidiâ.
-
- Sit pro potu communi in hoc morbo aqua pura, frusto panis recens tosti
- adjecto, & pauxillo spiritus vini tenuis (_rum_ dicti) admixto. Sit
- pro victu communi salab, vel farina tritici in pulmentum tenue ex aquâ
- purâ cocta.
-
-
-IN INTESTINIS INFLAMMATIS.
-
-[146]SOLUTIO SALIS CATHARTICI.
-
- ℞. Decocti hordei libram unam, magnesiæ vitriolatæ uncias duas. Misce
- ut fiat solutio. Bibatur, post sanguinis missionem, uncia una omni
- semihorâ donec alvus bis dejecerit.
-
- Adhibeantur hypogastrio cucurbitulæ cruentæ, vel hirudines plures.
- Applicetur ibidem epispasticum satis amplum. Injiciatur enema cum oleo
- & pauxillo sale cathartico.
-
-
-IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus æstuosis _DRY
-BELLY ACHE_ dicto.
-
-[147]PILULÆ CATHARTICO-ANODYNÆ.
-
- ℞. Extracti colocynthidis compositi drachmam dimidiam, opii granum
- unum & dimidium, olei menthæ guttam unam. Contunde in massam & divide
- in pilulas decem. Sint pro una dosi. Paucas post horas, si alvus non
- rite responderit, exhibeantur misturæ catharticæ unciæ duæ, vel[148]
- olei ricini uncia una, & repetantur ut opus fuerit.--Interdum in hoc
- malo divexat vomitus cui auxilio est, mistura antiemetica. Vide page
- 551.
-
- Perfricetur hypogastrium oleo tepido.
-
- Ineat æger in balneum tepefactum ad 93° therm. Fahren. per horam unam
- vel etiam diutius.
-
- Denique suffletur in anum fumus nicotianæ.
-
-
-Vel,
-
- ℞. Nicotianæ drachmas duas aquæ puræ ferventis libram unam.--Fiat
- infusum & cola pro enemate.
-
-
-IN HÆMORRHÖIDE.
-
-
-BOLUS HÆMORRHOIDALIS.
-
- ℞. Florum sulphuris drachmam dimidiam, conservaæ rosæ, vel pulpæ
- tamarindorum quantum satis fit. Assumatur bis die.
-
- Si sanguinis ex ano profluentis magna fuerit vis, & præcipue si ex
- alto fonte effluxerit, valde proderit medicamentum infra præscriptum.
-
- [149]℞. Olei lini recens expressi drachmas sex, tincturæ rhabarbari
- drachmas duas. Misce. Sumatur bis die.--Vice olei lini adhibere licet
- olei amygdalæ unciam dimidiam, cum mucilaginis gummi arabici drachmis
- duabus.
-
-
-IN ALVO ASTRICTA.
-
-PILULÆ LAXANTES.
-
- ℞. Aloes socotrinæ drachmam unam, syrupi quantum satis sit. Contunde
- & divide in pilulas viginti. Sumantur duæ pro re natâ.--Aliquando
- conducit adjicere vel pulveris zinzberis vel pulveris capsici grana
- quindecim, vel olei menthæ guttas decem.--Vice aloes licet adhibere
- extractum colocynthidis compositum.
-
-
-ELECTUARIUM ECCOPROTICUM.
-
- ℞. Pulveris jalapii unciam dimidiam, pulpæ tamarindorum unciam unam,
- pulveris zinziberis semi-drachmam, syrupi _melasses_ dicti quantum
- satis sit. Sumatur circiter drachma pro re natâ.--Interdum prosit
- adjicere crystallorum tartari drachmas duas.
-
-
-IN CATARRHO.
-
-
-LINCTUS.
-
- ℞. Conservæ rosæ unciam unam, mucilaginis gummi arabici unciam
- dimidiam, olei amygdalæ drachmas duas, succi limonis, vel acidi
- vitriolici quantum satis sit ad gratum saporem conciliandum. Misce.
- Sumatur pauxillum sæpius.--Interdum adjiciatur vel salis nitri drachma
- una, vel tincturæ opii guttæ decem.
-
- Sit pro potu communi decoctum hordei in quo coquatur uvarum passarum
- uncia una, & sub finem cocturæ seminum lini drachmas duas pro singulis
- libris decocti.
-
- Si febricitârit æger, sumantur mistura salina & pilula febrifuga ter
- die.
-
-
-IN PLEURITIDE ET PERIPNEUMONIA.
-
- ℞. Decocti hordei libras duas, pulpæ tamarindorum quantum satis-fit ad
- gratum saporem, nitri drachmam unam. Misce. Hauriatur affatim pro potu
- communi. N. B. Si tamarindi moverint alvum sæpius quam semel aut bis
- die adhibeatur vice ejus syrupus _melasses_ dictus.
-
- Sumatur mistura salina & pilula febrifuga sextâ vel quartâ quâque horâ.
-
-
-IN HÆMOPTÖE.
-
-Hauriat æger infusi rosæ uncias tres quater die. Interdum adjiciatur
-vel tincturæ opii guttæ quatuor, vel nitri grana decem.
-
-
-HAUSTUS OLEOSUS.
-
- [150]℞. Olei amygdalini, aquæ menthæ simplicis singulorum unciam unam,
- manræ drachmas tres. Misce. Sumatur ter die. Sæpe conducit adjicere
- singulis dosibus tincturæ opii guttas quatuor vel quinque.
-
-
-IN TUSSI ASTHMATICA.
-
-
-PILULÆ PECTORALES.
-
- [151]℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis drachmas
- duas, pulveris radicis scillæ grana sex opii purificati grana tria,
- syrupi _melasses_ dicti quantum satis sit. Contunde simul & divide in
- pilulas quadraginta octo. Sumantur quatuor bis die.
-
-
-IN ASTHMATE A DIATHESI HYDROPICA PROVENIENTE.
-
-
-PILULÆ SCILLITICÆ.
-
- ℞. Radicis scillæ aridæ grana duodecim, conservæ rosæ quantum satis
- sit. Contunde simul & divide in pilulas duodecim. Sumatur una vel duæ
- bis vel ter die.
-
-
-Vel,
-
-[152]HAUSTUS DIURETICUS.
-
- ℞. Aquæ puræ unciam unam & dimidiam, pulveris scillæ aridæ grana duo,
- tincturæ lavendulæ compositæ guttas trigintæ, kali præparati grana
- decem. Misce. Sumatur bis vel ter die.--Interdum adjicere liceat
- haustui vespertino tincturæ opii guttas viginti.
-
-
-Vel,
-
-
-BOLUS CÆRULEUS CUM SCILLA.
-
- [153]℞. Pilularum ex hydrargyro grana quinque vel usque ad decem,
- pulveris radicis scillæ grana duo. Misce. Sumatur horâ decubitûs, per
- tres vel quatuor noctes consequentes.
-
-
-IN RHEUMATISMO ACUTO.
-
-
-MISTURA DIAPHORETICA.
-
- ℞. Aquæ puræ uncias tres, aquæ ammoniæ acetatæ unciam unam & dimidiam,
- pulveris antimonialis grana quindecim. Sumatur tertia pars ter
- die.--Interdum adjiciantur nitri grana quinque singulis dosibus.
-
- Bibatur affatim decoctum hordei tepidum, cum nitri scrupulis duobus in
- singulis libris.
-
-
-HAUSTUS SUDORIFICUS.
-
- ℞. Misturæ camphoratæ unciam unam & dimidiam, aquæ ammoniæ acetatæ
- unciam dimidiam, vini emetici guttas quadraginta, tincturæ opii guttas
- viginti. Misce. Sumatur horâ somni, vel etiam sæpius sed cum dimedia
- tinctura.
-
-
-IN RHEUMATISMO CHRONICO.
-
- ℞. Tincturæ guaiaci volatilis drachmas duas. Sumatur ex cyatho potûs
- communis ter die. Vel sumatur gummi guaici semidrachma super bibendo
- haustum ex salis cornu cervi serupula aquæ unciis tribus.
-
- ℞. Pulveris ipecacoanhæ compositi (Pharm. Lond.) scrupulum unum.
- Sumatur hora somni alternis noctibus.
-
- In casibus rebellibus pro remedio efficaci compertum est dare quotidie
- calomelanos granum unum vel grana duo.
-
-
-IN HYDROPE.
-
-
-PULVIS HYDRAGOGUS.
-
- ℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana
- quindecim, pulveris zinziberis grana quinque. Misce fiat pulvis,
- fumatur alternis diebus.
-
-
-MISTURA DIURETICA.
-
- ℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias duas,
- kali præparati drachmam unam. Misce. Hauriamur unciæ tres bis
- die.[154]Vice infusi gentianæ licet adhibere infusum absynthii.
-
-
-TINCTURA SCILLÆ. Pharm. Lond.
-
-Sumatur drachma una bis die ex haustu potûs communis.
-
-
-PILULA EX ELATERIO.
-
- ℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur in
- pilulas sex. Sumatur una bis die.
-
- [155]Ægro licet, imo prodest hoc morbo laboranti bibere ad libitum ex
- liquore aliquo siti extinguendæ accommodato, veluti aquâ hordei cum
- crystallis tartari.
-
-
-IN ERYSIPELATE.
-
- [156]℞. Pulveris corticis Peruviani drachmam unam. Sumatur omni horâ
- vel interpositis duabus vel tribus horis.
-
-
-IN MORBO VENEREO.
-
-
-1. IN GONORRHOEA.
-
-Hauriatur ad libitum infusum lini, vel decoctum hordei cum gummi
-arabici drachmis sex in singulis libris.
-
-Sumantur calomelanos grana duo quotidie per viginti circiter dies.
-
- [157]℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati granum
- unum. Misce. Injiciatur pauxillum in urethram bis vel ter die.
-
-
-IN GONORRHOEA BENIGNA.
-
- ℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ guttas
- triginti. Misce. Sumatur bis die.
-
-
-2. IN ULCUSCULIS.
-
-In initio feliciter adhibetur causticum.
-
- ℞. Calomelanos drachmam dimidiam, conservæ rosæ quantum satis sit.
- Contunde in massam & divide in pilulas triginta. Sumatur una quotidie,
- vel interdum dimidia ter die, ut cieatur ptyalismus modicus. Perstet
- æger in usu medicamenti hujus per dies acto postquam sanata fuerint
- ulcuscula.
-
- Pro medicamento topico, utile erit inspergere ulcusculum cum pulvere
- hydrargyri nitrati.
-
-
-3. IN BUBONE.
-
-Illinatur artus lateris affecti infra inguen cum unguenti ex hydrargyro
-drachmâ dimidiâ quotidie.
-
-Si abierit bubo in ulcus mali moris omittatur pro tempore usus
-hydrargyri & sumatur quotidie [158]opii purificati granum unum primo
-semel, dein bis, denique ter die vel etiam sæpius, & pulveris corticis
-Peruviani drachma una ter quaterve die.--Interdum conducit sumere
-pulveris sarsæparillæ drachmas duas ter die, vel extracti cicutæ grana
-tria ter die, augendo paullatim usque ad grana decem.
-
-
-4. IN VERA LUE, anginâ scilicet osteocopiis, exostosibus & defædatione
-cutis.
-
-Illinantur membra quotidie cum unguenti ex hydrargyro drachmis duabus
-quotidie usque dum cieatur ptyalismus[159] per dies triginta ad
-minimum vel donec evanuerint symptomata.--Interdum vice litûs adhibere
-conveniat vel calomelanos granum unum ter die, vel pilularum ex
-hydrargyro grana quinque bis die, vel
-
- ℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram
- unam. Fiat solutio, & sumatur uncia dimidia bis die. In ulceribus
- tonsillarum pernotabili est auxilio suffitum ex cinnabare in fauces
- inhalare semel vel bis quotidie.
-
- Si ulcera mali moris exorta fuerint in quavis corporis parte, eadem,
- ut jam de bubone dictum est, fiant.
-
-
-IN SCORBUTO MARINO.
-
-Sumat æger quotidie succi limonum unciam unam ter quaterve die.
-
- ℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi _melasses_
- dicti libras sedecim pondere, extracti pini uncias octo pondere,
- spumæ vel fæcis cerevisiæ libras duas mensurâ. Misce & agita valide
- cum baculo, dein sinatur abire in fermentationem, ut fiat cerevisia,
- deinde servetur in vase clauso. Ut diutius servari potest, proderit
- admiscere spiritûs vini tenuis Gallici, vel qui _rum_ dicitur, libras
- duas aut tres. Si infirma fuerint viscera adjicere juvabit vel lupuli
- vel summitatum absinthii vel quassiæ, vel zinziberis quantum satis
- sit. Hauriat æger libras duas quotidie.
-
- ℞. Farinæ avenaceæ libras tres, aquæ puræ congios quatuor. Misce.
- Macera donec liquor fiat acidulus, dein effunde dimidium & adjiciatur
- par copia aquæ puræ, & coque ad idoneam spissitudinem, ut cogatur in
- pulmentum. Sit pro victu assiduo cum vini & sacchari non purificati,
- vel syrupi _melasses_ dicti quantum sufficiat ad gratum saporem
- conciliandum.
-
- Ad alvum solvendam commode adhiberi potest electuarium eccoproticum
- cum crystallis tartari. Vid. p. 556.
-
-
-THE END.
-
-
-
-
-INDEX.
-
-
-  A.
-
-  ABSORBENTS useful in fluxes, 491, _& seq._
-
-  _Action_, close, the advantages of it, 103, _& seq._
-
-  _Air_, superiority of that at sea, 225.
-    --Noxious effects of it at land in a hot climate, 227.
-    --Extent of its influence, 228.
-
-  _Alcide_, sickly on the passage to America, 36.
-    --Subject to various forms of fevers, 39.
-
-  _Aliment_, want of proper, chief cause of scurvy, 300.
-    --Increases the vigour of the body in two ways, 510.
-
-  _America, North_, hotter in summer than the West Indies, 30.
-    --Fleet goes there to avoid the hurricanes, 35, 146.
-    --Uncommon season there, 156, _& seq._
-
-  _Amputation_, the number that died of it at Barbadoes, 190.
-
-  _Amputation_, Mr. Alanson’s method of performing it, 543.
-
-  _Antimonials_, best adapted to bilious fevers, 420.
-    --A caution with regard to them, 422.
-
-  _Army_ at St. Lucia, diseases in it, 127.
-    --Mortality in it, 27, 228, _& seq._
-
-  _Asthma_, climate in the West Indies favourable to it, 97.
-
-
-  B.
-
-  _Barbadoes_, more refreshments at it than any other island, 27.
-    --Ravaged by a hurricane, 41.
-    --Composed of coral rock, 89.
-    --Conjecture concerning its origin, _ibid._
-
-  _Barfleur_, fevers on board in consequence of recruits from a French
-        jail, 142.
-
-  _Bark, Peruvian_, its effects in preventing fevers, 230, _& seq._
-    --When useful in continued fevers, 390, _& seq._, 402, 422, _& seq._
-
-  _Bark, Peruvian, red_, some account of it, 457.
-
-  _Barricading a ship_, what meant by it, 21.
-
-  _Bath, warm_, of use in the dysentery, 480.
-    --In the locked jaw, 522.
-    --Its proper temperature, 535.
-
-  _Battle_, the ardour of, favourable to health, 22, 77, 101.
-    --Number killed in, 209.
-    --Loss in those of April, 1782, 520.
-
-  _Bedding_, utility of airing it, 260.
-
-  _Bile_, a defect of it in the worst cases of yellow fever, 429,
-     _& seq._
-    --Theoretical disquisition on its influence in fevers, _ibid._
-
-  _Bile_, the marks of a redundance of it in dysenteries, 477.
-    --Its tendency to prolong fluxes, 483, _& seq._
-
-  _Blindness_ from the scurvy, 24, 501.
-
-  _Blisters_ of use in the ship fever, 399.
-    --For removing irritability of stomach in the yellow fever, 453,
-      _& seq._
-    --Of service in dysentery, 480, _& seq._
-
-  _Blood_, a remark concerning the buff upon it, 450.
-
-  _Bloodletting_, cautions with regard to it in ship fevers, 388.
-    --In bilious fevers, 418.
-    --In the yellow fever, 450.
-
-  _Butter_, objections to its use, 310.
-
-
-  C.
-
-  _Calomel_, in certain cases, the best purgative, 421.
-
-  _Camphor_, estimate of its virtues, 407.
-
-  _Catarrh, epidemic_, one in Europe affected men at sea, 157.
-    --Communicated by strangers not affected with it themselves, in one
-      of the Western Islands, 244.
-
-  _Causes_, a combination of them necessary to produce diseases, 126,
-      _& seq._
-
-  _Chronic complaints_ brought on by hardship, 218.
-
-  _Cleanliness_ the principal means of health, 254, 337.
-
-  _Clothing_, its great influence upon health, 238.
-    --Advantages and disadvantages of it, 334, _& seq._
-
-  _Cocoa_ substituted, with advantage, for butter, 311.
-
-  _Cold_ favourable to infection, 258.
-
-  _Cold_ hurtful in all climates, 297.
-
-  _Colica pictonum_, forms of medicines adapted to it, 555.
-
-  _Coma_, a symptom in the ship fever, 373.
-
-  _Commission, Ships long in_, most healthy, 54, 79, 93, 167.
-
-  _Constitution_, the great variety of it, 294.
-    --Regard to be had to it in practice, 406.
-
-  _Coppers_, cautions with regard to them, and instance of poison from
-      neglect of them, 317, _& seq._
-
-  _Cordials_, a caution with regard to them, 410.
-
-  _Crowding_, bad effects of it, 192.
-
-  _Cruises_ to windward of Martinico, 48, 180.
-    --Near Jamaica, 120.
-    --How long they ought to be continued
-  consistent with health, 148, _& seq._
-    --A long one off St. Domingo, without the scurvy appearing, 154,
-        _& seq._
-
-  _Cullen, Dr._, his opinion of the origin of nervous fevers, 237.
-    --His great merit, 445.
-
-
-  D.
-
-  _Delirium_, a remarkable symptom in the ship fever, 373.
-    --Explanation of it, _ibid._, _& seq._
-    --Means of removing it, 398, _& seq._
-    --Sudden and violent in bilious fevers, 416.
-
-  _Diaphoretic_, what safest and best, 395.
-
-  _Diet_, a table of the daily allowance of it in the navy, 311.
-    --A method of providing what is suitable to the sick, 335.
-
-  _Diet_, a caution with regard to it in convalescent fevers, 358.
-
-  _Diet_, what best in fluxes, 494, _& seq._
-
-  _Dilution_, the great advantage of it, 391, _& seq._
-
-  _Discipline_, advantage of, to health, 348, 355.
-
-  _Diseases_, list of all those on board of the fleet, 94.
-    --What sorts seamen are most subject to, and most exempt from, 216.
-
-  _Diseases_, acute, tend naturally to wear themselves out, 70.
-    --Imputed anciently to supernatural influence, 220.
-    --Owing to neglect, _ibid._
-
-  _Dropsy_, medicines adapted to it, 558.
-
-  _Dysentery_ depends on the same cause as fevers, 36.
-    --Arises in the Prince George from cold weather, 79.
-    --More fatal in its acute state in a cold than a hot climate, 155.
-
-  _Dysentery_, appearances upon dissection, 471, _& seq._
-
-  _Dysentery_, forms of medicines adapted to it, 553.
-
-
-  E.
-
-  _Earthquakes_ frequent in the West Indies, 88.
-
-  _Effluvia_, what kind of them produce diseases, 134, _& seq._
-
-  _Elephantiasis_, peculiar to Barbadoes, 235, _& seq._
-
-  _England_, health of the fleet there compared to that in the West
-      Indies, 67, _& seq._
-    --Fleet there more sickly at particular periods than in the West
-      Indies, 208.
-
-  _English_, their cleanliness only of modern date, 282.
-
-  _Erasmus_, his account of the causes of pestilential diseases in
-      England, 282.
-
-  _Erysipelas_, Peruvian bark the best medicine in it, 558.
-
-  _Exercise_, the advantage of it, 343.
-
-  _Exercise_ in the sun very pernicious, 233.
-
-  _Expeditions_, list of, frustrated by disease alone, 214.
-
-  _Explosions_ of gunpowder, frequent and destructive, 539.
-    --Means of preventing them, 540.
-
-
-  F.
-
-  _Fatigue_ tends to shorten life, 346.
-
-  _Fevers_ depend on the same cause as fluxes, 36, _& seq._
-    --More prevalent in port than fluxes, 113, 127.
-    --Assume a different type upon the importation of infection, 182.
-    --Difference of its infection from that of some other diseases,
-        244, 249.
-
-  _Fever, ship_, description of it, 371.
-    --Treatment of it, 386.
-
-  _Fever, inflammatory_, principal symptoms of it, 384.
-
-  _Fevers, intermittent_, some unusual remedies for them, 456, _& seq._
-    --Forms of medicines adapted to them, 552.
-
-  Fires, the most effectual means of sweetening the air of a ship, 117.
-    --The most powerful means of destroying infection, 276, _& seq._
-
-  _Flour_ preferable to bread for exportation, 307.
-
-  _Fluxes_ depend on the same cause as fevers, 36, _& seq._
-    --Prevail least when fevers most violent, 44, 113.
-    --Apt to arise in ships soon after their arrival in the West Indies,
-        19, 84, 183.
-    --More frequent at sea than in port, 113.
-    --More frequent in ships that have been subject to fevers, 183.
-    --Why so frequent and fatal at West India hospitals, 192, _& seq._
-    --Observations on them, 466.
-    --Treatment of them, 473.
-
-  _Formidable_, extraordinary degree of health on board of her, 107,
-        128, 365.
-    --Causes of it, 72, 108.
-    --Fever arises in her from men lent to another ship, 128.
-    --From pressed men, 161.
-
-  _French ships_, their discipline and œconomy inferior to British, 114.
-
-  _Frigates_ more healthy than ships of the line, causes of this, 54,
-        _& seq._
-    --More healthy when their fire place was between decks, 287.
-    --A contrivance for ventilating them, 292.
-
-  _Fumigation_, method of performing it, 270, _& seq._
-
-
-  G.
-
-  _Gibraltar_ relieved by Lord Rodney, 19.
-    --Admissions and deaths at the hospital there, 187, 205.
-
-  _Gibraltar_ man of war, account of her, 53.
-
-  _Grosislet Bay_, description of it, 28.
-
-  _Gunpowder_, accidents from it, 190, 539, _& seq._
-
-  _Guthrie, Dr._, his observations on infection in Russia, 279.
-
-
-  H.
-
-  _Habit_, effect of it in resisting infection, 294.
-
-  _Hæmorrhages, internal_, oil and tincture of rhubarb of eminent
-      service in them, 486, _& seq._
-
-  _Hæmorrhage_, a limb sometimes carried off without any ensuing, 542.
-
-  _Hæmorrhoids_, medicines adapted to them, 555.
-
-  _Hardship_ impairs health and shortens life, 218.
-
-  _Heat_ communicated to the hand, a symptom of the ship fever, 378,
-      _& seq._
-
-  _Hemisphere, Northern_, a cold summer general all over it, 157.
-
-  _Herodotus_, his account of the clothing and health of the ancient
-      Ægyptians, 284.
-
-  _Hospitals_ not so proper for the sick as their own ships, 60.
-    --Account of diseases sent to them, 185.
-    --At Gibraltar, 187.
-    --At Barbadoes, 189, 197.
-    --At St. Christopher’s, 195.
-    --At St Lucia, _ibid._
-    --At Jamaica, 198.
-    --At New York, 201, _& seq._
-    --General view of them all, 205.
-    --Proportion of deaths in them no criterion of the success of
-        practice, 195, 200.
-
-  _Hurricane months_, 28.
-
-  _Hurricane_, a violent one in the West Indies--its good effect on the
-     health of the inhabitants, 40, _& seq._
-
-  _Hypochondriac_ complaints do not affect the laborious part of
-     mankind, 219.
-
-
-  I.
-
-  _Jaw, locked_, account of those affected by it in the battles of
-      April, 1782, 520, _& seq._
-    --Its symptoms different from those of the tetanus, 526.
-    --Wherefore most frequent in hot climates, 529, _& seq._
-
-  _Indolence_ a cause of scurvy, 345.
-
-  _Infection_, the obscurity of and difficulty of investigating it, 238.
-    --Various ways in which it is introduced into a ship, 241.
-    --It may arise without the presence of fever, 242.
-    --Habit renders people insensible to it, _ibid. & seq._
-    --It never affects all indiscriminately who are exposed to it, 245.
-    --It does not pass from one species of animal to another, 249.
-    --How to prevent the production of it, 254.
-    --Means of eradicating it, 264.
-    --Method of guarding against it, 293.
-    --Less frequent in hot climates than cold, 276.
-
-  _Inflammatory_ complaints most frequent in ships where no infection,
-      172.
-
-  _Inoculation_, conjecture concerning the cause of its safety, 247.
-
-  _Intermittent fevers_ sometimes arise on board of a ship, 32.
-    --Some unusual remedies for them, 456, & _seq.q._
-
-  _Intestines_, great, the principal seat of the dysentery, 470.
-
-
-  L.
-
-  _Labour_ necessary to health, 217.
-    --Pernicious if in excess, _ibid._
-    --What diseases it tends to avert, 219.
-    --Scurvy prevented by it, 344.
-
-  _Land wind_ at Jamaica, 119.
-    --Not at the small islands, _ibid._
-
-  _Lemon juice_, extraordinary instance of its efficacy in scurvy, 86.
-    --The most effectual remedy in scurvy, 303.
-
-  _Lemons and limes_, their juice the best detergent in scorbutic
-     ulcers, 502, _& seq._
-
-  _Lientery_, a symptom in obstinate fluxes, 489.
-
-  _Limes_, instance of their great antiscorbutic effect, 56.
-
-  _Liver_, inflammation of it seldom known in the West Indies, 95.
-    --But appeared at New York in men belonging to the West-India fleet,
-      156.
-
-
-  M.
-
-  _Magnesia_, given with acids, removes sickness of the stomach, 452.
-
-  _Malt liquor_, the utility of it, 320.
-
-  _Malt, essence of_, a weak antiscorbutic, 57, 504.
-    --Of service in the beginning of scurvy, 146, 164.
-
-  _Manners, Lord Robert_, his death lamented, 520.
-
-  _Marshes_, their exhalations cause fevers, 43.
-
-  _Melasses_, method of using it, 305.
-    --Great utility of it, 308.
-
-  _Mixing of men_, bad consequences of, 252, _& seq._
-
-  _Moisture_, the bad effects of it, 288.
-
-  _Mortality_, method of calculating the proportion of it, 88.
-    --Greater at sea from the want of an hospital and of proper
-      diet, 143.
-    --In the fleets and hospital at different periods, 205.
-    --In the army in the West Indies, 206.
-    --In England, 207.
-    --Total in the fleet for three years and three months, 209.
-
-  _Mortification_, an uncommon instance of it in the shoulder, 83.
-
-
-  N.
-
-  _Necessaries_, Surgeons, their quantity very inadequate, 302.
-
-  _New York_, the fleet therein 1780, 38.
-    --in 1782, 150.
-
-  _Nyctalopia_, a symptom of the scurvy, 24, 501.
-
-  _Nymph_ frigate, account of her health, 164.
-
-
-  O.
-
-  _Oatmeal_, the abuse of it, 308.
-
-  _Observations_, the difficulty of making them, 9.
-
-  _Officers_, more affected by foul air than common men, 116, 137.
-
-  _Opium_, advantage of combining with antimonials, 392.
-    --With neutral salts, 395.
-    --Its use in continued fevers, 404, 408.
-    --Cautions and directions with regard to it in fluxes, 476, 479.
-    --Its use in ulcers, 504.
-    --The best method of giving it in the locked jaw, 532, _& seq._
-
-  _Osbridge_, Lieut, his ingenious contrivance for sweetening water,
-      331.
-
-
-  P.
-
-  _Pediluvia_ hurtful in inflammatory fevers, 397.
-
-  _Petechiæ_, a symptom in the ship fever, 377.
-
-  _Phthisis pulmonalis_, not so common in the West Indies as Europe, 97.
-    --but more rapid, _ibid._
-
-  _Phœnix_, Spanish Admiral’s ship, her excellent materials and
-      construction, 53.
-
-  _Pigeon Island_, remarkable proof of its healthiness, 228, _& seq._
-
-  _Plague_, its infection does not spread far, 298.
-    --Means of preventing it from spreading, _ibid._ and 299.
-    --Never known in tropical climates, 277, _& seq._
-
-  _Porter_, its effect in preventing scurvy, 320.
-
-  _Potatoes, raw_, a remedy for scurvy, 60.
-    --Proposed as an article of victualling, 309, _& seq._
-
-  _Prudent_, effects of soaking her timbers in pickle, 81.
-
-  _Pulmonic_ complaints, medicines adapted to them, 556.
-
-  _Putrefaction_, simple, effluvia of it may produce fevers, 134,
-      _& seq._
-
-
-  Q.
-
-  _Quick lime_, the best preservative of water, 326, _& seq._
-
-
-  R.
-
-  _Recruits_, new raised, the cause of sickness, 180.
-
-  _Returns_, intention of them, 6, 7.
-    --Specimens of them, 23.
-    --Method of forming them into tables, 24.
-
-  _Rheumatism_, forms of medicines adapted to it, 557.
-
-  _Royal Oak_, cause of her health, 80.
-    --Method of curing the scurvy on board, 81.
-
-  _Ruby_, remarkably healthy, 167.
-
-
-  S.
-
-  _St. Lucia_, woody, mountainous, and rainy, 27.
-    --Proportion of deaths at the hospital there, 195.
-
-  _Salt_, the good effects of it in diet, 314.
-
-  _Sandwich_, health of, on her first arrival, 19.
-
-  _Scorches_, great numbers killed and wounded in this manner, 190.
-
-  _Scurvy_, in a cruise to windward of Martinico, 49.
-    --In a cruise near Jamaica, 121.
-    --High degree of it in the Nonsuch, _ibid._
-    --On the passage to New York, 148.
-    --Why less of it in the ships last from England, 147.
-    --Its rapid progress in the latter part of a cruise, 148, _& seq._
-    --Method of curing it on board of the fleet at New York, 151.
-    --Numbers that died of it according to Sir Richard Hawkins, 214.
-    --In Commodore Anson’s Squadron, _ibid._
-
-  _Scurvy_, observations on it, 499.
-    --What meant by the latent state of it, 505.
-    --The best remedies for it, 506, _& seq._
-    --In what manner the nature of the diet induces it, 509.
-    --Whether it is infectious, 516.
-
-  _Seasons_ in the West Indies, account of them, 28, _& seq._
-
-  _Ships_, new, not more unhealthy than others, 19, 52.
-    --Disadvantage in changing their commanders, 80.
-    --Why large ones most sickly, 128, 133, 253.
-
-  _Shingle ballast_, the advantage of it, 289.
-
-  _Shoes_ of great use to seamen, 339.
-
-  _Sick_, what the best place for them in a ship, 262.
-
-  _Sickness_, method of calculating the proportion of it, 90.
-
-  _Situation_, effects of the difference of it upon health, 28.
-
-  _Small-pox_ very prevalent in the fleet, 85.
-
-  _Sope_ supplied on board of the fleet, 145.
-    --Its great utility, 151, 257.
-
-  _Sour krout_, manner of using it, 305.
-
-  _Splinters_ more destructive than balls, 103.
-
-  _Spices_ good against noxious air, 230.
-
-  _Spruce beer_, the great advantage of it, 320.
-
-  _Strangers_ communicate disease to each other without any apparent
-      previous disease, 243.
-
-  _Surf_, danger from it in watering at St. Lucia, 88.
-
-  _Surgeons_, a greater proportion of mortality among them and their
-      mates, 134.
-    --Advantage of encouraging them, 266.
-
-  _Sweating_ of use in curing the ship fever, 388, _& seq._
-    --In the dysentery, 475.
-
-  _Sweet vegetables_ more antiscorbutic and medicinal in their natural
-      state, 58.
-
-
-  T.
-
-  _Tables_, method of forming them, 90.
-
-  _Tenaculam_ recommended in amputation, 543.
-
-  _Thermometer_, general range of it in the West Indies, 29.
-    --Observations on it at Port Royal, 124.
-
-  _Thucydides_, his observations on the plague at Athens, 296.
-
-
-  U.
-
-  _Ulcers_ keep pace with scorbutic and feverish complaints, 132.
-    --Proportion of them, 150.
-    --Very frequent in the Barfleur, _ibid._
-    --Great effect of a cold climate in diminishing them, 156.
-    --Form a considerable part of sea complaints, 221.
-    --Apt to arise in scorbutic habits, 339, 500, 505.
-
-  _Uniform_ for common seamen recommended, 336.
-
-  _Union_ remarkably healthy, 167.
-    --Subject only to inflammatory complaints, 173, 297.
-
-  _Urine_, appearance of it in the yellow fever, 437, 440, _& seq._
-
-
-  V.
-
-  _Venereal disease_, the medicines best adapted to the various forms
-      of it, 559.
-
-  _Vernon_, Admiral, health of his fleet compared with Lord Rodney’s,
-      131, 198.
-    --The first who caused the spirits allowed the seamen to be
-      diluted, 324, _& seq._
-
-  _Victory_, 12th of April, 1782, 99.
-    --Its effects on the health of the men, 101, _& seq._
-
-  _Ville de Paris_, sickness and mortality on board after being
-      captured, 115.
-    --Foundered, 210.
-
-  _Vinegar_, use of it in the navy, 302.
-    --In the Roman armies, _ibid._
-
-  _Vitriol, white_, used as a remedy in intermittent fevers, 462.
-
-  _Vomit, black_, the most dangerous symptom in the yellow fever, 436.
-
-
-  W.
-
-  _Wall, Dr._ recommends opium in low fevers, 393.
-
-  _War_, why fleets most sickly in the beginning of it, 69.
-
-  _Warren, Dr._, his successful treatment of a case of the locked jaw,
-      532.
-
-  _Water_ of springs preferable to running water, 324.
-    --Quick lime the best preservative of it, 326.
-    --Various other means of correcting it, 329.
-    --Distillation from sea water recommended, 332.
-
-  _Watering duty_ dangerous and unwholesome, 88, 118.
-
-  _Well_ of a ship, great danger of foul air in it, 285.
-    --Method of preventing it, _ibid._
-
-  _Wind of a ball_, the effects of it, 537.
-
-  _Wine_, the great advantage of it in the French fleet, 322.
-    --Superior to spirits, 324.
-    --Its utility in continued fevers, 410.
-
-  _Women_, why not so subject to acute diseases in the West Indies as
-      men, 234.
-
-  _Wounds_, number that died of, 209.
-    --Account of those received in April, 1782, 520.
-
-
-  Y.
-
-  _Yams_ used in place of bread, 76.
-
-  _Yellow fever_, 425.
-
-  _Yellowness_ of the skin not always a symptom of malignity, 181.
-
-
-  Z.
-
-  _Zinc_, effects of it in obstinate intermittent fevers, 456.
-    --Cases in which it is proper, 461.
-
-
-
-
-FOOTNOTES:
-
-[1] These were the Conqueror, the Cornwall, and the Boyne, which were
-so damaged in the battles, that they were obliged to bear away for St.
-Lucia.
-
-[2] The following may serve as a specimen of these returns:
-
-
-STATE of HEALTH of His Majesty’s Ship ALCIDE. Carlisle Bay, Barbadoes,
-1st June, 1781.
-
-  +--------------------+--------------------+----------------------+
-  | Sick now on Board. | Died in the course | Sent to the Hospital |
-  |                    |   of last Month.   |   in the course of   |
-  |                    |                    |     last Month.      |
-  +--------------------+--------------------+----------------------+
-  |  Fevers        4   |    Of Fever 1      |   Ill of Scurvy 35   |
-  |    Flux        5   |                    |                      |
-  | Scurvy        26   |                    |                      |
-  | Catarrh and }  7   |                    |                      |
-  | Rheumatism  }      |                    |                      |
-  |              --    |                    |                      |
-  |      Total    42   |                    |                      |
-  +--------------------+--------------------+----------------------+
-
-REMARKS.
-
-During the course of last month we had one hundred and fourteen of
-the men, who contracted the scurvy in the late long cruise, recovered
-by the use of limes, which were procured at Montserrat. A pint of
-wine, with an equal quantity of water, made agreeable with sugar and
-tamarinds, is served to each patient daily. The regimen is exactly the
-same as mentioned last month.
-
-Since we came into port, very few have been seized with scurvy, but
-several complain daily of fluxes and feverish complaints, none of which
-seem at present to be of any consequence.
-
-Four patients have last month complained of an almost total blindness
-towards evening, accompanied with head-ach, vertigo, nausea, and a
-sense of weight about the precordia. The pupil is then extremely
-dilated, but contracts readily when a strong light is presented to it.
-Two of them had the scurvy in a high degree, one of them slightly,
-and the other seemed entirely free from it. I am not well acquainted
-with the nature or cure of this disease, which I believe is called
-Nyctalopia by some systematic writers.
-
-I gave those who were affected with it an emetic, which brought up a
-great deal of bile, and relieved the symptoms both of the head and
-stomach. This encouraged me to a repetition of it, which seemed also to
-be attended with benefit. I likewise applied blisters behind the ears,
-and gave bark and elixir of vitriol, with the antiscorbutic course, to
-those that required it.
-
-I can form no probable conjecture concerning the cause of this disease.
-I have observed a dilation of the pupil in scorbutic patients, and they
-complained of a cloud before their eyes, with imperfect vision, which
-disappeared as the scurvy went off.
-
-  WILLIAM TELFORD.
-
-  To Dr. BLANE,
-  Physician to the Fleet.
-
-
-[3] Although this hurricane, in itself and its consequences, was so
-destructive to the lives and health of men, yet, with regard to the
-inhabitants on shore, it had a surprising and unexpected effect in
-mending their health. I wrote an account of this hurricane to the late
-Dr. Hunter, who communicated it to the Royal Society, and the following
-passage is extracted from it:
-
-“The consequences of this general tumult of nature, on the health
-of man, was none of the least curious of its effects. I made much
-inquiry on this head, not only of the medical gentlemen who had the
-charge of hospitals, and of the physicians of the country, but of the
-inhabitants, and every one had some cure to relate either of themselves
-or their neighbours, in a variety of diseases. Nor could I find that
-either those who were in health, or those who were ill of any disease
-whatever suffered from it, otherwise than by its mechanical violence;
-but, on the contrary, that there was a general amendment of health.
-This is a fact, which I could neither credit, nor would venture to
-relate, were it not supported by so many concurring testimonies. It had
-a visible good effect on the acute diseases of the climate. The chronic
-fluxes, of which there were then some at the naval hospital, were
-cured or much relieved by it. But the diseases upon which it had most
-evident and sensible effects, were pulmonic consumptions. Some recent
-cases of phthisis, and even the acute state of pleurisy, was cured by
-it; and in the advanced and incurable state of it, the hectic fever
-was removed, and remarkable temporary relief afforded. A delicate lady
-of my acquaintance, who was ill of a pleurisy at the time, and passed
-more than ten hours in the open air, sitting generally several inches
-deep in water, found herself free of complaint next day; had no return
-of it; and when I saw her a few weeks after, was in much better health
-and looks then usual. The people observed that they had remarkably keen
-appetites for some time after, and the surviving part of them became
-uncommonly healthy; some of both sexes, whom I had left fallow and thin
-a few months before, looking now fresh and plump.
-
-It is very difficult to account for this, as well as every thing else
-in the animal œconomy; but it was probably owing in part, at least, to
-the very great coldness and purity of the air from the upper regions
-of the atmosphere. Great agitation of mind sometimes also produces
-a revolution in health; and we know that the effect of external
-impressions in general is very different when the mind is vacant, from
-what it is when occupied and interested by objects, whether of pleasure
-and satisfaction, or of danger and suffering.”
-
-[4] In order to ascertain more exactly the degree of sickness in each
-month, a column was afterwards added to the form of the returns,
-expressing the number taken ill of the several diseases in the course
-of the month.
-
-[5] I was informed by Captain Caldwell, that when he commanded the
-Hannibal, of 50 guns, his crew was so much afflicted with the scurvy,
-in a passage of nine weeks from St. Helena to Crookhaven, in Ireland,
-that ninety-two men were confined to their hammocks in the last stage
-of that disease, though they had been supplied with sugar at St.
-Helena, and served with it on the passage. They remained three weeks at
-Crookhaven; at the end of which time every man was fit for duty: and
-though they had fresh provision, they had no fresh vegetables, so that
-their cure is to be ascribed to the use of lemons and oranges, which
-the Captain very humanely ordered to be purchased for them from on
-board of a foreign ship that happened to put into the same harbour.
-
-[6] See Appendix to Part II.
-
-[7] They were the Formidable and Namur, of 90 guns; the Arrogant,
-Conqueror, Marlborough, Hercules, and Fame, of 74 guns; the Yarmouth,
-Repulse, Prothée, Anson, and Nonsuch, of 64 guns.
-
-[8] These were the Prince George, of 90; the Bedford, Canada, and Royal
-Oak, of 74; the America and Prudent, of 64 guns.
-
-[9] This is a term in use for the different articles of seamen’s
-cloathing, particularly shirts and trowsers.
-
-[10] The mortification in the shoulder, mentioned above, was somewhat
-singular. It happened to a man in the Yarmouth, who, after being for a
-week ill of a fever and flux, was one day, early in the morning, seized
-with a pain in the upper part of the right arm, which immediately began
-to mortify. He soon after became convulsed, and died the same day about
-two o’clock.
-
-[11] Earthquakes are frequent in the West Indies, and perhaps proceed
-from a weaker operation of the same cause that originally produced
-the islands themselves, which seem all to have been raised from the
-sea by subterraneous fire. There are evident vestiges of volcanoes in
-them all, except Barbadoes; but there are other unequivocal marks of
-this island having been raised from the bottom of the sea; for it is
-entirely formed of coral, and other sub-marine productions, of which
-the strata are broken, and the parts set at angles to each other, as
-might be expected from such a cause. There is, perhaps, at all times
-in the caverns of the earth, elastic vapour struggling to vent itself,
-and when near the surface, it may sometimes overcome the incumbent
-masses of matter, and produce certain convulsions of nature. In the
-account of the hurricane which I wrote to Dr. Hunter, I gave reasons
-for believing, from the testimony of the inhabitants, that hurricanes
-are attended with earthquakes; and if a conjecture might be advanced
-concerning the cause of this, it might be said, that as the atmosphere
-is lighter at that time, by several inches of the barometer, the
-elastic vapour, confined by the weight of the incumbent earth and
-atmosphere, being less compressed, may exert some sensible effects,
-producing a sort of explosion.
-
-[12] Since the publication of the first edition of this work I have
-been informed that this complaint is not so rare on shore as in the
-fleet, which may be partly owing to the greater coolness of the air at
-sea, and partly from the seamen not having been a sufficient length
-of time in the climate to be affected with this disease, as few of
-them had been more than two years from England. But as this affection
-of the liver was very common in the fleets and naval hospitals in the
-East Indies, it is evident that there is a great difference of the
-climates in this respect. It is worth remarking, that it sometimes
-breaks out in the West-India Islands like an epidemic. The complaint,
-for instance, was very little known in the island of Grenada, till
-about the year 1785, when it became very frequent in a particular
-quarter of the island; and the gentleman who sent the description of
-it to England alledged, that there were the most unequivocal proofs of
-its being contagious. It was most successfully treated by very copious
-bloodletting, and in exciting a salivation by mercury. See Dr. Duncan’s
-Medical Commentaries, Decad. 2, vol. I.
-
-[13] Dr. Lind, on the authority of Mr. Ives, surgeon to Admiral
-Matthews.
-
-[14] London Gazette, _June_, 1781.
-
-[15] This is well illustrated by the manner in which Captain Nott,
-of the Centaur, was killed in Fort-Royal Bay. This brave man, having
-carried his Ship nearer the enemy than the rest of the line, but
-nevertheless at a great distance, had his signal made to keep the line,
-and having gone into his cabin, as it is said, to examine the import of
-the signal, a cannon ball struck him in the groin, and it was so far
-spent, that it stuck in his body. It tore away a whole plank of the
-ship’s side, the splinters of which killed a young gentleman, the only
-person near him.
-
-[16] I have seen an account of the diseases of the army at St. Lucia
-for a whole year, kept by Mr. Everard Home, an ingenious gentleman
-belonging to the army hospital, and it appears, that, during ten
-months out of the twelve, the dysentery was the predominant disease.
-This seems to contradict the opinion, that the land air is more apt
-to occasion fevers than fluxes; but it is to be remarked, that the
-sickness of the soldiers on this island was not so much owing to the
-malignant influence of the air, the situation of the garrison being
-high and airy, as to the bad accommodations and provisions, together
-with hard labour.
-
-[17] See Essay on the Yellow Fever, by Dr. Hume, in a Collection of
-Essays published by Dr. D. Monro.
-
-[18] Campbell’s Lives of the Admirals, Vol. IV.
-
-[19] The late Dr. William Hunter.
-
-[20] See Appendix to Part II.
-
-[21] Captain Samuel Thompson.
-
-[22] As my own stay at different ports was short, and as my own
-knowledge could not extend beyond that period, Dr. Farquarson, First
-Commissioner of Sick and Wounded Seamen, very politely gave me leave
-to inspect the books of the different hospitals at his office, and I
-collected from them the fate of all the men that were landed.
-
-[23] It is proper to mention, that the name of the disease in the
-hospital books being taken from the ticket sent on shore with each sick
-person, great accuracy is not to be expected, as this is frequently
-done in a careless manner. My returns were made with great exactness;
-and, in the latter part of the war, the hospital books may also be
-depended upon in this respect, the tickets, at my request, having been
-made out with accuracy.
-
-[24] In this, and the other tables, the smaller fractions are neglected.
-
-[25] See the last chapter of Part III.
-
-[26] In the year 1741, the fleet under Admiral Vernon was at Jamaica at
-the same time of the year; and the following is the account of the men
-sent to the hospital in May and June:
-
-  +--------------------+-----------+-------+-------------+
-  | DISEASES.          | Admitted. | Died. | Proportion. |
-  +--------------------+-----------+-------+-------------+
-  |                    |           |       |    NEARLY   |
-  |                    |           |       |    ONE IN   |
-  +--------------------+-----------+-------+-------------+
-  | Fevers             |       957 |   255 |           3½|
-  | Fluxes             |       267 |    73 |           3½|
-  | Scurvy             |       314 |    41 |           7½|
-  | Other Complaints   |       167 |    26 |           6 |
-  +--------------------+-----------+-------+-------------+
-  |       Total        |      1703 |   395 |           4 |
-  +--------------------+-----------+-------+-------------+
-
-There was on board of this fleet about two thirds of the number of men
-that was on board of the fleet in 1782. I cannot ascertain how many
-died on board of the ships in Admiral Vernon’s fleet; but the deaths at
-the hospital alone are somewhat more than what happened to our fleet
-both on board and at the hospital.
-
-[27] I was enabled, after coming to England, to ascertain the deaths
-in that part of the squadron from which I happened at any time to be
-absent, by having leave from the Navy Board to inspect the ships’ books
-deposited at their office.
-
-[28] See Appendix to Part II.
-
-[29] The mortality of the army in the West Indies is much greater; for
-it appears by the returns of the War Office, that there died in the
-year 1780, two thousand and thirty-six soldiers, which being calculated
-by the numbers on the station, and those who arrived in the convoy in
-March and July, the annual mortality is found to be one in four. The
-greatness of this mortality will appear in a still stronger light, when
-it is considered that those who serve in the army are the most healthy
-part of the community. When I was at the encampment at Coxheath in the
-year 1779, I was politely favoured with a sight of the returns, both of
-the general officers and physician, and it appeared that in an army of
-ten thousand and eighty-nine men, there died, from the 10th of June to
-the 2d of November, forty-three, exclusive of twelve who died of small
-pox. This being calculated, is equal to an annual mortality of one in
-a hundred and nine; and it was not half so much in the encampment of
-the former year. It appears by Mr. Simpson’s tables, that the mortality
-of mankind in England, from the age of twenty to forty-five, which
-includes the usual age of those who serve in the navy and army, is one
-in fifty.
-
-[30] See Table II.
-
-[31] See Table II.
-
-[32] None are comprehended but those who were killed or wounded
-in battles in which the whole fleet was present, this account not
-including those who fell in single actions in frigates or other ships.
-
-[33] It would appear, that, anciently, though the slaughter in battle
-was greater than in modern times, yet that disease was still more
-destructive than the sword. One of the oldest testimonies to this
-purpose is in the History of Alexander’s Expedition, by Arrian--τους
-μεν ἐν ταῖς μαχαις ἀπολωλεκασιν, ὁι δε ἐκ των τραυματων ἀπομαχοι
-γεγενημενοι, ὁι πλειοῦς δε νοσω ἀπολωλεσαν.--Arrian. Hist. Alex. Exped.
-
-  Lib. v. cap. 26.
-
-
-[34] Upwards of three thousand were also lost at sea in ships of war
-belonging to the same fleets in the hurricane of October, 1780, and in
-the storm in September, 1782, in which the Ville de Paris and the other
-French prizes were lost on their passage to England.
-
-[35] The authors from whom I have borrowed have been chiefly Dr.
-Lind and Capt. Cook. To the former we are indebted for the most
-accurate observations on the health of seamen in hot climates; of the
-improvements made by the latter, an excellent compendium may be seen in
-Sir John Pringle’s Discourse before the Royal Society, on the occasion
-of adjudging a prize medal to Capt. Cook for his paper upon this
-subject.
-
-[36] In the late war sickness alone was not the cause of want of
-success in any instance, except in the last action in the East Indies,
-in which so many men were ill of the scurvy, that there were not hands
-enow to manage the guns.
-
-There is another fact in history, which, though not so applicable to
-this subject as those above recited, forcibly evinces how important a
-study the health of men ought to be in military affairs. When Henry V.
-was about to invade France, he had an army of fifty thousand men; but
-owing to a sickness which arose in the army, in consequence of some
-delays in the embarkation, their number was reduced to ten thousand at
-the battle of Agincourt. The disease of which they chiefly died was the
-dysentery.
-
-  RAPIN.
-
-
-[37] It is not meant by this to insinuate that every commander is
-absolutely accountable for the health of his ship’s company, and
-censurable when they are sickly; for this may depend on his predecessor
-in command, or a stubborn infection may have prevailed from the
-original fitting out or manning of the ship which he may not have
-superintended.
-
-[38]
-
-        Οὐ γαρ ἐγωγέ τι οῗδα κακώτερον ἄλλο θαλάσσης,
-        Ανδεά τε συγχεῦαι, εἰ καὶ μάλα καρτερὸς εἴη.
-
-      ΟΜΗΡ. ΟΔΥΣ. Θ.
-
-
-        Dire is the ocean, dread in all its forms!
-        Man must decay, when man contends with storms.
-
-      POPE.
-
-
-[39] Wherever causes are obscure, superstition naturally ascribes
-them to some preternatural influence; and what seemed farther to have
-encouraged this, anciently, was, that violent epidemics occurred most
-frequently in camps and at sieges where great political conjunctures
-were likely to arise, in which superior powers were supposed to
-interest themselves. Thus we read in Homer of fatal diseases being sent
-as punishments by the gods. But the pestilential diseases so often
-mentioned by poets and historians as prevailing in cities and armies,
-were probably nothing else but fevers, produced partly perhaps by the
-scarcity and bad quality of provisions, but probably still more by
-corrupted human effluvia, which was very apt to he produced by the
-want of personal cleanliness, to which the mode of cloathing among the
-ancients would more particularly subject them, especially in camps and
-besieged towns.
-
-[40] If the experiments of modern philosophy are to be depended on,
-they go a certain way to account for the unwholesomeness of air from
-woods in hot climates, and in wet weather; for Dr. Ingenhousz found
-that the effluvia of plants in the night time, and in the shade, are
-more poisonous in hot than in cold weather; but though there is a
-salubrity in the effluvia in sunshine, the heat of the weather makes
-no difference with regard to this. He found also that vegetables, when
-wet, yield an unwholesome air.
-
-It is difficult to ascertain how far the influence of vapours from
-woods and marshes extend; but there is reason to think that it is to a
-very small distance. When the ships watered at Rock Fort, they found
-that if they anchored close to the shore, so as to smell the land
-air, the health of the men was affected; but upon removing two cables
-length, no inconvenience was perceived. I was informed of the following
-fact, in proof of the same, by the medical gentlemen who attended the
-army in Jamaica:--The garrison of Fort Augusta, which stands very near
-some marshes, to which it is to leeward when the land wind blows, was
-yet remarkably healthy; but it became at one time extremely sickly upon
-the breaking in of the sea in consequence of a high tide, whereby the
-water which was retained in the hollows of the fort produced a putrid
-moisture in the soil, exhaling a vapour offensive to the smell, and
-with all the noxious effects upon health commonly arising from the
-effluvia of marshes.
-
-[41] Dr. Hendy has lately published an ingenious treatise upon this
-disease.
-
-[42] See Sydenham’s Works.
-
-[43] See Part I. Book II. Chap. VI.
-
-[44] We have a proof of this fact in particular, in the account of the
-jail distemper, which broke out at the Old Bailey in the year 1750.
-
-[45] See Martin’s History of the Western Islands, and Medical
-Communications, Vol. I. page 68.
-
-[46] There are some contagious diseases which cannot be propagated but
-by their own peculiar infections, as has been before observed, just
-as the seeds of vegetables are necessary to continue their several
-species; so that if the infectious poison were lost, so would the
-disease. Of this kind are the small pox, and the other diseases to
-which man is subject but once during life. There are other diseases
-which produce infection without having themselves proceeded from it. Of
-this kind are fevers and fluxes.
-
-But there is no infection of any kind, however virulent, that affects
-indiscriminately all persons exposed to it. If a number of persons,
-who never have had the small pox, are equally exposed to it, some will
-be seized, while others will escape, who will be affected at another
-time, when they happen to be more susceptible. It is doubtful how far
-the habit of being exposed to such specific infections renders the
-body insensible to them, as was said with regard to fevers; but there
-is another principle of the animal œconomy laid down and illustrated
-by Mr. Hunter, which goes at least a certain length in explaining
-this variable state of the body with respect to its susceptibility
-of infectious diseases. This principle is, that the body cannot be
-affected by more than one morbid action at the same time. If a person
-is exposed to the small pox, for instance, while he labours under a
-fever, or while he is under the influence of the measles, he will not
-catch the first till the other has run its course. It may happen,
-therefore, that people escape the effect of contagion in consequence
-of being at the time under the influence of some other indisposition,
-either evident or latent: and supposing the body to be exposed to a
-number of noxious powers at the same time, one only could take effect.
-But it seems difficult to explain why some of those who are actually
-seized, and who have previously been to all appearance in equally good
-health, shall have it in a very mild degree, while in others it will
-be malignant and fatal. This is very remarkable with regard to the
-small pox, which are in some cases so slight, that they can hardly be
-called a disease, while in others they are so malignant, as hardly to
-admit of any alleviation from art. May not this, in some measure, be
-explained from some of the principles above mentioned, in the following
-manner:--The small pox, in their mildest form, are attended with little
-or no fever, which, therefore, is not essential to them; and when we
-see them attended with various forms of fever, and thereby prove fatal
-even in the most hale constitutions, we ought not to attribute this to
-any thing in the nature of the small pox, but rather to say, that they
-have served as an agent in exciting a fever, for which there happened
-to be some previous latent disposition, that would not otherwise have
-exerted itself, and that this disposition, or contamination, as it
-may be called, may have been induced by some past exposure to morbid
-effluvia, which either from habit, or some other circumstance, may not
-have been sufficiently powerful to excite the constitution to fever
-without some such stimulus. Any other occasional circumstance producing
-disturbance or irregularity in the functions of the body, may, in like
-manner, excite any particular kind of fever to which the body may at
-that time be disposed. Thus the amputation of a limb will have this
-effect; also exposure to cold or fatigue, and intemperance in eating or
-drinking.
-
-It would appear from these considerations, that there are certain
-circumstances, or temporary situations of constitution, which invite
-infection, and render its effect more certain and violent in one case
-than another. There are artificial methods, however, of obtruding it,
-as it were, upon the constitution, though not particularly disposed, or
-even though averse to receive it; and may not this, in some measure,
-account for the greater safety of some diseases when communicated by
-inoculation, than when caught in the natural way?
-
-But these, as well as many other facts in animal nature, do not admit
-of a satisfactory explanation upon any principle as yet known. Even the
-most common operations of the body, such as digestion and generation,
-when considered in their causes and modes of action, are so obscure and
-mysterious, as to be almost beyond the reach of rational conjecture. A
-little reflection will teach us the utmost modesty with regard to our
-knowledge of such things; for nature seems to have innumerable ways
-of working, particularly in the animal functions, to which neither
-our senses can extend, nor perhaps could our intellects comprehend
-them. Had we not, for instance, been endowed with the sense of sight,
-nothing could have led us even to suspect the existence of such a
-body as light; and there may be numberless other subtile and active
-principles pervading the universe, relative to which we have no senses,
-and from the knowledge of whose nature and exigence we must for ever
-be debarred. We have, indeed, become acquainted with electricity by
-an operation of reason; and animals have lately been discovered to
-which the electric fluid serves as a medium of sense through organs
-calculated to excite it, and to receive and convey its impressions.
-
-But there are few subjects we can study that are more subtle and
-obscure than the influence of one living body on another. There is a
-familiar instance of the great subtilety of animal effluvia, and also
-of the fineness of sense in a dog’s being able to trace his master
-through crowds, and at a great distance; and we can conceive that
-infectious matter may adhere, and be communicated in a similar manner.
-We have endeavoured to illustrate the great obscurity of its operation
-by an allusion to generation, digestion, and other animal functions,
-with which it is equally obscure and inexplicable. It is similar to
-generation in this, that its influence does not pass from one species
-of animal to another; for the poison of the plague, that of the small
-pox, that of fever, and the venereal disease, do not affect brutes[47],
-nor do the infectious diseases of brutes affect different species of
-them, nor the human species. The only exception to this, that we know
-of, is the bite of a mad dog.
-
-From these facts, and also from what was formerly mentioned of
-contagion not affecting indiscrimately all that may be exposed to
-it, it would appear that some nice coincidence of circumstances is
-necessary to modify an animal body, so as to receive its action. There
-must be a sort of unison, as it were, or sympathy, betwixt different
-living bodies, so as to render them susceptible of each other’s
-influence.
-
-It is none of the least curious facts with regard to infection, that
-there are some species of it by which the body is liable to be affected
-only once in life. When this is considered, it is indeed conformable to
-what happens in the course of the disease itself; for, unless there was
-in the body a power of resisting it, there could be no such thing as
-recovery. Where the disease actually exists, the continued presence of
-the poison, which is also infinitely multiplied, would infallibly prove
-fatal in all cases, unless the living powers were to become insensible
-to it[48].
-
-[47] Hunter’s Experiments.
-
-[48] Mr. Hunter’s Lectures.
-
-[49] It is sincerely to be wished that this were adopted, and it is
-surprising that an article so salutary and necessary, and so difficult
-to be procured on foreign stations, should not have been the object
-of public attention, rather than a mere article of luxury, such as
-tobacco. But in order that it might not be a matter of choice with
-seamen, it would be worth while to supply them with it at prime cost,
-or even as a gratuity, and then they might be compelled to use it
-for the purpose of cleanliness. There are other articles of less
-importance, but being necessary to enable men upon foreign stations to
-keep themselves neat and clean, deserve to be made the object of public
-instruction. These are handkerchiefs for the neck, thread, worsted,
-needles, buckles, and knives.
-
-[50] At the time I am writing this, (March 8th, 1785) there has
-occurred a fact which proves the effect of time in generating
-infection. There now prevails a contagious fever in several of
-the hospitals in London, and, among others, in that to which I am
-physician. In another hospital it has been so violent, that there has
-been a vulgar report that the plague had broke out in it. The same
-fever also prevails among the poor at their own houses. The cause
-of it seems to be, that the cold weather has been uncommonly long
-and severe; for the frost began early in December, and the cold has
-hitherto been more like that of winter than spring. The thermometer
-all this month has varied from 30° to 35°. Cold is favourable to
-infection, by preventing ventilation; for people exclude the air in
-order to keep themselves warm, and the poor in particular do so on
-account of their bad clothing, and their not being able to afford fuel
-to make good fires. Heat is the great destroyer of infection, and seems
-to act by evaporating, and thereby dissipating it; and the effect of
-fires in apartments is to produce a constant change of air, thereby
-preventing its stagnation and corruption, and the accumulation of
-unwholesome effluvia. With this view, a chimney is of great use, even
-though no fire should be kept in it, as it serves for a ventilator.
-But if an aperture were to be made in an apartment merely with a view
-to ventilation, it should be placed in that part of the wall next the
-ceiling; for foul air naturally tends upwards, and the external air
-entering at the top of a room, would not be so apt to subject those
-within to the effect of cold, as it would not blow directly upon them.
-There would also be this advantage in jails, that apertures in this
-situation would not be so liable to be forced for the purpose of escape
-as if they were nearer the floor; and in hospitals they would be out
-of reach of those who, wishing to indulge in warmth, at the expence
-of pure air, might be induced to shut the windows. But an external
-communication with the air any where is of the utmost importance; and
-it is observable in Mr. Howard’s account of prisons, that the jail
-distemper was most frequently to be met with where there was no chimney.
-
-[51] It is of some consequence to attend to the materials of the
-seamen’s beds; for, instead of flock, they are frequently fluffed with
-chopped rags, which, consisting of old clothes, emit a disagreeable
-smell, and may even contain infection.
-
-[52] By a _berth_ is understood the interval between two guns, or any
-space between decks, which is sometimes formed into a sort of apartment
-by means of a partition made of canvass.
-
-[53] It is remarkable that this method of purifying was practised in
-the most ancient times, as we learn from the following passage in
-Homer, where Ulysses is represented fumigating the apartments of his
-palace in which the suitors had been slain:
-
-        Τὴν δ᾿ἀπαμειζόμενος προσεφη Πολυμητις Ὀδυσσευς
-        Πυρ νυ̃ν μοι πρώτιστον ἐνὶ μεγάροισι γενέσθω.
-        Ως ἔφαθ’. ουδ’ἀπιθησε φιλη τροφος Ἐυρυκλειος
-        Ἠνεγκεν δ᾿ ἄρα πυρ και θηιον. αυταρ Ὀδυσσευς
-        Ἒυ διεθέιωσεν μέγαρον και δῶμα και ἀυλήν.
-
-      ΟΜΗΡ. ΟΔΥΣ. Χ.
-
-        Bring sulphur straight, and fire, the Monarch cries;
-        She heard, and at the word obedient flies.
-        With fire and sulphur, cure of noxious fumes,
-        He purg’d the walls and blood-polluted rooms.
-
-      POPE.
-
-This practice was probably founded in superstition, rather than the
-knowledge of nature. That some divine influence should be ascribed to
-fire was very natural, as the principal deities of the ancients were
-only personifications of the elements; and it is worthy of remark, that
-their name for sulphur signifies _something divine_ το θεῖον, which
-was probably owing to its being found in those chasms of the earth, in
-Sicily and Italy, which were supposed to communicate with the infernal
-regions; for the whole Greek mythology relating to these was taken
-from the phænomena attending the subterraneous fires in those parts.
-It is curious farther to remark, in other instances, how facts useful
-to mankind, the truth of which has been confirmed in later times by
-the more enlightened knowledge of nature, were first suggested by some
-superstitious circumstance. Thus the wound received by Sarpedon could
-not be cured, according to the Poet, till, by divine intimation, he was
-desired to apply to it the rust of the spear with which it had been
-inflicted, in consequence of which it healed. But the weapons in those
-days were made of brass, so that the rust of the spear must have been
-the _ærugo æris_, which has been found by the experience of modern
-surgery to be one of the best detergents in ill-conditioned sores.
-It is probably, from a false analogy, founded on some such incident,
-that an idea prevails among the vulgar, which has become proverbial,
-that some part taken from the offending body is good in all external
-injuries. Thus some part of a mad dog is said to have a virtue in
-curing his bite. Herein may be seen the difference of that knowledge
-which is suggested by superstition, and that which is acquired by the
-observation of nature.
-
-[54] A loggerhead is a large round mass of iron, with a long handle to
-it.
-
-[55] A fact, related in Anson’s Voyage, is also strongly in proof
-of the same opinion. When the rich Spanish prize was taken, it was
-necessary to crowd the prisoners into the hold, for fear of an
-insurrection, which was to be dreaded from their numbers; yet, when
-they arrived in China, none of them had died, nor had any disease broke
-out. They suffered only in their looks, being wan and emaciated to a
-great degree.
-
-[56] It may be brought as a farther proof of a warm climate being
-unfavourable to every sort of infection, that though the itch is very
-common in ships and hospitals in Europe, I do not remember ever to have
-met with it in the West Indies, except in ships newly arrived from
-England.
-
-[57] This circumstance, in the character of the English, is only of
-modern date; for we learn from Erasmus, who was in England about
-two hundred and fifty years ago, that they were then extremely
-slovenly. The following passage is extracted from a letter he wrote
-to a physician in York, after his return to Holland:--“Conclavia
-solâ fere strata sunt argillâ, tum scirpis palustribus, qui subinde
-sic renovantur ut fundamentum maneat aliquoties annos viginti sub se
-fovens sputa, vomitus, mictum canum et hominum, projectam cerevisiam et
-piscium reliquias, aliasque sordes non nominandas.” He adds, that the
-windows were very ill calculated for ventilation, and imputes to the
-closeness and filthiness of the houses the frequent and long continued
-plagues with which England was infested, and particularly the sweating
-sickness, which, he says, seemed peculiar to this country. He mentions
-that his own country had been freed from the pestilence by certain
-changes that the State had made in the houses, in consequence of the
-advice of some learned man. Erasm. Lib. xxii. Epistol. 13.--It is
-probable that the greater number of those epidemics, called plagues,
-were only bad infectious fevers. What would contribute still more to
-the production of infection was the want of linen, which was hardly in
-use in those days. The disappearance, or at least the great diminution
-of such complaints in modern times, particularly in London, has been
-ascribed to the great increase in the proportion of vegetable food; but
-it is certainly more owing to the improvement in personal cleanliness,
-and to the greater spaciousness and neatness of houses. As a farther
-proof of this, it may be mentioned that in the charity, called
-the Charterhouse, in London, founded by Henry the Eighth, for the
-maintenance and education of poor boys, their sustenance is all animal
-food, as it was at the original institution, yet they are extremely
-healthy. The same observation applies to Winchester school, which was
-founded some ages before that.
-
-There are some passages in ancient history in confirmation of the same
-opinion. Herodotus relates, that the ancient Egyptians were the most
-healthy of all the nations, except the Libyans, and he imputes this to
-the invariableness of their weather, and the serenity of their sky.
-But he mentions in another part of his works, that they were also the
-most cleanly of all people, not only in their household utensils, but
-in their persons, and that their clothing was chiefly of linen, which
-it was one of the principal studies of their life to wash and keep
-clean--ἑιματα δε λινεα φορεουσι ἀιει νεοπλυτα ὲπιτηδευοντες τουτο
-μαλισα. Herodot. Euterp. 37.--It is remarkable that he makes no mention
-of the plague, though he gives a very minute account of the country
-from his own observation, from whence it may be naturally inferred,
-that it did not then exist there, though Egypt is now so subject to it,
-that the plague is supposed by many to be an endemial disease in it.
-It would appear also from another passage in this historian, that he
-uses the word λοιμος, which we translate _plague_ in a loose sense to
-signify any violent acute distemper; for he relates that a great part
-of the army of Xerxes, in their retreat from Greece, perished by the
-_plague_ λοιμου and dysentery, in consequence of famine. Herod. Lib.
-viii. cap. 115.
-
-[58] It is proper also to observe here, that those ships which are
-built of winter-felled timber are much drier than those built of what
-is summer felled; and this circumstance should have been mentioned
-with regard to the Montague, for the cause of her healthiness,
-notwithstanding her being a new ship, was probably from being built of
-winter-felled timber. It should, therefore, be strictly enjoined to
-fell the wood in winter; for those who are employed to do it have an
-interest in doing it in summer, on account of the value of the bark.
-
-[59] A windsail is a long cylinder of canvass, open at both ends, kept
-extended with hoops, and long enough to reach from the lowermost parts
-of the ship through all the hatchways into the open air.
-
-[60] It is not necessary that seamen should have chests, for bags or
-wallets answer their purpose equally well, and are much more convenient
-in respect of stowage.
-
-[61] Since the first edition of this work, I have met with a fact in
-confirmation of this principle, with regard to the cutaneous complaint
-called the _ring-worm_. This had prevailed in a private school in the
-neighbourhood of London, which I visited, but it had to all appearance
-become extinct; yet it nevertheless affected those boys who were newly
-sent to the school.
-
-[62] It is mentioned by Thucydides, that while the plague raged at
-Athens, the people were affected with no other disease; from which it
-would appear that those persons who would otherwise have been attacked
-with some particular indisposition, were seized with the plague in
-place of it. Vide note p. 247.
-
-[63] Part I. Book II. Chap. VI.
-
-[64] It is related by the travellers into Turkey, that the Christians
-save themselves from it, merely by shutting themselves up in their
-houses, and the inhabitants, who sleep on the open roofs of the houses,
-do not catch it even from those of the adjacent buildings, though the
-wall that separates them is of no great heighth.
-
-[65] Vide Opera Ambrosii Parei.
-
-[66] See Essay on Sea Diseases.
-
-[67] Limes, shaddocks, and perhaps all the other fruits of that class,
-possess the same virtues; but I have most frequently observed good
-effects from lemons.
-
-[68] In the course of the passage from England to the West Indies in
-February, 1782, the following directions for using the sour krout and
-melasses were given in public orders by the Admiral to the different
-ships of the squadron:
-
-“The allowance of sour krout made by the public boards in England, is
-two pounds to each man every week; and the Admiral orders that from a
-pound and a half to two pounds (beginning with the lesser quantity,
-and increasing as the men may find it palatable) be boiled with every
-gallon of pease on a pease day. The cooks are desired not to wash it,
-nor to put it into the coppers till the pease are sufficiently broken.
-“Half a pound is directed to be issued raw to each man on beef days,
-and a quarter of a pound on pork days. It is recommended that the
-allowance of vinegar be saved, particularly on meat days. When sour
-krout runs short, the pease and beef days to have the preference; when
-shorter still, the pease days. Melasses having been allowed in lieu of
-part of the oatmeal, in the proportion of eleven pounds to two gallons,
-the Admiral directs, that a pound of melasses be boiled with every
-gallon of oatmeal on Mondays, Wednesdays, and Fridays, mixing it and
-stirring it round with the burgoo immediately after it is drawn off.
-He directs that half a pound of melasses be issued with every three
-pounds of flour over and above the common proportion of raisins; and
-to prevent any abuse, it is directed that the purser’s steward pour
-it into the platter with the flour of which the pudding is made. The
-Admiral forbids the use of pease in lieu of oatmeal, as has sometimes
-been the practice.”
-
-These rules were suggested by Sir Charles Douglas, captain of the
-fleet, whose benevolence is equal to his known professional skill; and
-he had ascertained the utility of the preceding directions when captain
-of the Duke in the former part of the war.
-
-[69] In the French ships of war there is an oven large enough to supply
-not only all the officers and sick, but part of the crew, with soft
-bread every day. The advantages attending the use of flour in place
-of bread are so great and obvious, that the former will probably, in
-time, be substituted entirely for the latter. There is a proof of its
-being practicable to use it in place of bread in British ships of war,
-even with their present conveniences, communicated to me by Captain
-Caldwell. When he commanded the Agamemnon, of 64 guns, at New York, in
-the end of 1782, there happened to be no bread in store to supply that
-ship on her passage to the West Indies, and flour was given in place
-of it. The men, without any inconvenience, were able to bake it into
-bread for themselves, and it proved so salutary, that Captain Caldwell
-ascribed the uncommon degree of health which his men enjoyed to the use
-of the flour. The only objection that can be made to it is the greater
-consumption of wood occasioned by baking; but this may be obviated by
-adopting the grates invented by Mr. Brodie, in which the ovens are
-heated by the same fire with which the victuals are boiled.
-
-[70] Mr. Napeane, afterwards Under Secretary of State, was at that time
-purser of the Foudroyant, and acted a very benevolent and disinterested
-part, by being instrumental in introducing this reform in the navy
-victualling.
-
-[71] Half a pound of cocoa, and as much sugar, was allowed in place of
-a pound of butter.
-
-[72] TABLE, exhibiting the daily Allowance of Provisions for each Man
-in the Navy.
-
-  ---------+---------+------+----------------------------------------+---------
-           | Biscuit.| Beer.| Beef.| Pork.| Pease.| Oatmeal.| Butter.| Cheese.
-           | lbs.    |galls.| lbs. | lbs. | Pint. |  Pint.  |  ozs.  |  ozs.
-  ---------+---------+------+------+------+-------+---------+--------+---------
-  Sunday   |    1    |   1  |      |   1  | half  |         |        |
-  Monday   |    1    |   1  |      |      |       |    1    |    2   |    4
-  Tuesday  |    1    |   1  |   2  |      |       |         |        |
-  Wednesday|    1    |   1  |      |      | half  |    1    |    2   |    4
-  Thursday |    1    |   1  |      |   1  | half  |         |        |
-  Friday   |    1    |   1  |      |      | half  |    1    |    2   |    4
-  Saturday |    1    |   1  |   2  |      |       |         |        |
-  ---------+---------+------+------+------+-------+---------+--------+---------
-
-This has continued from the last century till the alterations above
-mentioned, all of which, except the introduction of vinegar, have been
-made in the three last years of this war. When the stock of small beer
-is exhausted, half a pint of spirits is allowed daily, diluted with
-four or five times its quantity of water. When wine is supplied, the
-daily allowance of it to a man is one pint.
-
-[73] Instead of leaving this to the management of the men themselves,
-it might be done with greater advantage to them by instituting short
-allowance in the following manner:--Let a certain proportion, suppose
-one third, of the salt provisions, bread, and pease, particularly the
-first, be stopped, and let the amount of this, for the whole crew
-be thrown into one estimate. Let the agent victualler pay into the
-purser’s hands the value of these provisions in money, at the contract
-price, with such a discount as will allow for the use of the money. Let
-the purser, in return, give him a receipt, as if for so much provisions
-checked. This money, being distributed in the name of short allowance,
-will enable the men to purchase vegetables, and the provisions will be
-saved for a time of want, or for a cruise.
-
-[74] The sailors in the squadron of Commodore Anson never murmured more
-under any of their hardships than when they were fed with fresh turtle
-for a length of time in the South Sea.
-
-[75] Since the first edition of this work was printed, I have met with
-a book published by Mr. Fletcher, a navy surgeon, in which he mentions
-that spices, being antiseptic bodies, might be substituted for part
-of the salt in curing provisions, and this would, no doubt, be an
-improvement in the sea victualling. The quantity of spice he proposes
-for every barrel of beef or pork is four ounces of black pepper, and
-as much allspice, and also eight ounces of nitre in powder. It may be
-farther alledged as an advantage of spice over salt, that it would be
-less apt to run into brine, which robs the meat of the greater part of
-its nourishment.
-
-[76] This accident happened in the Cyclops frigate in September, 1780.
-Mr. Gordon, the surgeon, favoured me with the following account of it:
-
-“Mr. Smith, an officer, John Barber and Anthony Wright, seamen, having
-eat some victuals prepared in a foul copper, complained soon after
-of violent gripes, giddiness, and vomiting, and they had a few loose
-stools. There was intense heat; the pulse was quick, full, and hard; a
-tremor of the hands and tongue, and wildness of the eyes. The looseness
-was soon succeeded by obstinate costiveness, tension of the abdomen,
-difficult breathing, and loss of deglutition. In the night, towards
-the morning, there came on insensibility, with an increase of all the
-symptoms, except the heat. The body was violently convulsed, with cold
-clammy sweats and coldness of the extremities. The abdomen subsided a
-short time before they died, and, before they expired, a small quantity
-of greenish matter, mixed with phlegm, issued from the mouths of two of
-them.
-
-Thirty three other men were put upon the sick list with similar
-symptoms in a less degree, and some of them continued on the list for
-five or six weeks before they perfectly recovered.”
-
-It is not said what means were attempted for the recovery of these men;
-but, besides emetics and milk, or oil, a dilute solution of the fixed
-alkali in water has been recommended against this poison.
-
-[77] I was furnished by Dr. Clephane, physician to the fleet at New
-York, with the following fact, as a strong proof of the excellence of
-this liquor:
-
-In the beginning of the war two store ships, called the Tortoise and
-Grampus, sailed for America under the convoy of the Dædalus frigate.
-The Grampus happened to be supplied with a sufficient quantity of
-porter to serve the whole passage, which proved very long. The other
-two ships were furnished with the common allowance of spirits. The
-weather being unfavourable, the passage drew out to fourteen weeks,
-and, upon their arrival at New York, the Dædalus sent to the hospital
-a hundred and twelve men; the Tortoise sixty-two; the greater part
-of whom were in the last stage of the scurvy. The Grampus sent only
-thirteen, none of whom had the scurvy.
-
-[78] We have a remarkable proof of this in comparing the fleet under
-the command of Admiral Byron with that under the Count d’Estaing, when
-they both arrived from Europe on the coast of America in the year 1778,
-some of the British ships having been unserviceable from the uncommon
-prevalence of scurvy, while the French were not affected with it.
-
-[79] See an article in Rozier’s Journal de Medicine for July, 1784, by
-Dr. Ingenhousz.
-
-[80] Since I came to England I have met with a pamphlet published by
-Mr. Henry, of Manchester, in which an ingenious method, founded on
-chemical principles, is proposed for separating the quick lime from
-water; but I fear it is too nice and complex to be brought into common
-practice. It would certainly be worth the trouble; but there are so
-many duties in a ship of war to call off the attention of the men, and
-they are so little accustomed to nice operations, that it would be
-difficult to persuade officers to attend to it and enforce it. If a
-sufficient quantity should not be precipitated by the air in the water,
-and by the accidental exposure to the atmosphere, it might be more
-effectually exposed to the air by Osbridge’s machine, to be described
-hereafter, or by a long-nozzled bellows, and if a small impregnation
-should be left, this is rather to be desired than avoided.
-
-[81] See Dr. Lind on the Health of Seamen.
-
-[82] The want of this apparatus may be supplied, in case of exigency,
-by a contrivance mentioned by Dr. Lind, consisting of a tea-kettle with
-the handle taken off, and inverted upon the boiler, with a gun barrel
-adapted to the spout, passing through a barrel of water by way of
-refrigeratory, or kept constantly moist with a mop.
-
-In this place I cannot help mentioning also, that in case of great
-extremity it has been found that the blood may be diluted, and thirst
-removed, by wetting the surface of the body even with sea water, the
-vapour of which is always fresh, and is inhaled by those pores of the
-skin whose natural function it is to imbibe moisture, of which there is
-always more or less in the common air of the atmosphere.
-
-[83] When we consider that linen was not in use among the ancient
-Romans, we might be apt to wonder that they were not more unhealthy;
-but their substitute for this was frequent bathing, which not only
-served to remove the _sordes_ adhering to the surface of the body, but
-to air that part of the clothing which was usually in contact with
-the skin. The washing of the bodies of men suspected of infection
-upon their first entrance into a ship, has already been mentioned,
-and I have known some commanders who made their men frequently bathe
-themselves with great seeming advantage.
-
-[84] A coarse woollen stuff so called.
-
-[85] He makes the following computation of the additional expence for
-each man in some of the articles that have been mentioned:
-
-                                           £. _s._ _d._
-  For 3 handkerchiefs, at 1s. 6d.           0   4   6
-  12 pounds of sope, at 6d.                 0   6   0
-  1 knife, at 1s.                           0   1   0
-  1 pair of buckles, at 9d.                 0   0   9
-                                          -------------
-                                            0  12   3
-
-  Suppose 3 shirts a year, the difference   0   2   3
-  3 pair of trowsers, ditto                 0   2   3
-  1 milled cap                              0   2   0
-                                           ----------
-                                 Total   £. 0  18   9
-
-
-[86] See Part I.
-
-[87] Had I then known the salutary effects of porter and spruce beer,
-of which I have since been convinced, I should have proposed them as
-substitutes for rum.
-
-[88] The authenticity of this fact, as well as every other assertion in
-this work relating to the mortality in the fleet, may be proved from
-the ship’s books, deposited at the Navy Office.
-
-[89] I fancied that my reasoning on this subject was in a great measure
-new; but I lately met with the following passages in Celsus and
-Hippocrates, which seem to be illustrative of the same idea:--Quibus
-causa doloris, neque sensus ejus est, his mens laborat. Celsus, Lib.
-ii. cap. vii. which is nearly a translation of the following aphorism
-of Hippocrates:--[Greek hOkosoi poneontes ti tou sômatos, ta polla tôn
-ponôn ouk a sthanontai, touteoisin hê gnômê noseei]. Hippoc. Aphor.
-Lib. ii. Aphor. 6.
-
-The same principle is ingeniously explained by Mr. Hunter in his
-Lectures.
-
-[90] See page 181.
-
-[91] See pages 125 and 126.
-
-[92] The form of administering this medicine was to add twenty drops of
-thebaic tincture, from half a grain to a grain of emetic tartar, and
-from five to ten grains of nitre, to two ounces of water or camphorated
-julep, of which one half was given about two hours before the common
-hour of rest, and the remainder at that hour. If spiritus Mindereri is
-preferred to the nitre, it may be given from two drachms to half an
-ounce for a dose, and it is better to administer it separately; for if
-it should not be exactly neutralized, it may decompose the antimonial,
-and render it inactive.
-
-[93] Since the publication of the first edition of this work, there has
-appeared a small tract on the treatment of low fevers, by Dr. Wall,
-of Oxford, and as his ingenuity and learning give him a just claim to
-the high rank he holds in his profession, attention is due to what he
-advances. The principal scope of the work is to recommend, from his own
-observation, the early use of opiates in those fevers, and the Doctor’s
-authority, as well as my own experience, convince me of the propriety
-of this practice in many cases occurring in this country, particularly
-among the lower sort of people, for whom spare diet and hard labour
-render evacuations less necessary than among the better sort. The
-inferior class of people are also more subject to this sort of fever
-from their houses and persons being less clean, and their apartments
-being worse ventilated; so that practice in these, as well as other
-cases, is to be varied according to the constitution and previous
-habits of life.
-
-[94] I first learned this, as well as many other useful and practical
-facts, from Mr. Farquhar, Surgeon in London, who has laid me under the
-greatest obligations by communicating many of his observations, derived
-from the most extensive experience and a truly penetrating sagacity.
-
-[95] I owe this piece of instruction, as well as many others, to Dr.
-Cullen’s Lectures.
-
-[96] In a review of Haslar hospital made in person by that excellent
-officer, Vice-admiral Barrington, in 1780, it was very judiciously
-proposed, among other salutary improvements, that there should be two
-apartments for the reception of the sick upon their first landing; one
-wherein they should be stripped of their dirty clothes, and another in
-which they should go into the warm bath, and put on the hospital dress,
-that they might not carry infection into the wards.
-
-[97] The following is the form of it, and it was first introduced by
-Mr. Whitfield, apothecary to the hospital, under the name of Bolus
-Sedativus:--℞. Confection. Damorat. [dram]ss. Castor. Russic. pulv.
-[scruple]ss. Tinct. Thebaic. g^{tt.} iv. Syr. sim. q.s. Fiat bolus
-sexta quaque hora sumendus.
-
-[98] Great nicety is required in all cases with regard to the times
-and doses of cordials; for it by no means follows that these should
-be in proportion to the lowness and loss of strength. This is well
-illustrated by Mr. Hunter in his Lectures, where he explains the
-distinction between the powers of the body and its _actions_. There
-must be a certain degree of strength to bear the excitement occasioned
-by stimulating and strengthening medicines or diet; for nothing is
-more pernicious, or even fatal, than that any part or function should
-make exertions beyond its strength; and there is the more danger in
-ill-timed remedies of this kind, as a state of weakness is generally a
-state of irritability.
-
-[99] See a method proposed for obviating this, page 358.
-
-[100] Page 381 et seq.
-
-[101] Sailor’s fever.
-
-[102] See pages 161, 181, and 380-1.
-
-[103] I have in the whole of this work been extremely cautious in
-reasoning concerning causes, from an opinion that they are very
-obscure, and that the theoretical part of physic is very imperfect
-and fallacious. This is perhaps in no instance more remarkable than
-in those opinions that prevail concerning the nature and influence of
-bile in producing diseases. An increased secretion of bile commonly
-attends the feverish complaints of hot climates, and those of the
-hot seasons of temperate and cold climates. It is not unnatural,
-therefore, to impute the disease then prevailing to this redundancy of
-bile: but, upon considering the matter more closely, it will appear
-to be rather a concomitant symptom, or effect, than a cause of those
-fevers; for, in the first place, in those cases in which there is
-the greatest secretion of bile, as in the _cholera morbus_, there is
-no fever. The only danger in this disease arises from the violent
-irritation produced in the bowels by such an extraordinary quantity of
-this secretion which commonly passes downwards; though I have seen it
-prove fatal when it flowed into the stomach, and produced perpetual
-retching and excoriation of the fauces; but in this case also without
-any fever. Secondly, in the most fatal of all fevers, in the West
-Indies, there are no marks of an increased secretion of bile, but,
-on the contrary, a preternatural defect of it, as appears by its not
-being evacuated either by stool or vomiting, by the white stools which
-sometimes attend the yellow fever, and by its not appearing in the
-first passages, nor in its own receptacles after death. Perhaps also
-that state of the bowels which renders it so difficult to procure
-stools may be in part owing to the want of this natural stimulus. It
-is nevertheless true, that in the intermitting and remitting fevers of
-hot climates and seasons there is perhaps always an accumulation of
-bile at the beginning, and an increased secretion of it during their
-course. It is farther true, that this adds to the patient’s uneasiness,
-and aggravates the symptoms, and that the cure consists partly in the
-evacuation of the bile. But it is also true, that in the very worst
-sort of fevers in hot climates it is a favourable symptom where the
-secretion of the liver is restored and increased, a bilious diarrhœa
-being one of the most auspicious symptoms that can occur in a yellow
-fever; and in those that are protracted and afford hopes of recovery,
-there is generally a gush of bile from time to time.--We may therefore
-lay down the following positions: 1. That in cases in which bile is
-most freely and copiously secreted no fever exists, as in _cholera
-morbus_. 2. That in the worst sort of fevers there is no preternatural
-secretion of bile, but, on the contrary, a defect of it. 3. That
-nevertheless there is an uncommon quantity of bile secreted in most
-of the fevers of hot climates, and that part of the cure consists in
-evacuating it.
-
-I am extremely diffident, as I have said, in all matters depending
-on our supposed knowledge of the animal œconomy; but the preceding
-circumstances seem to countenance the following reasoning:--The bile,
-according to Dr. Maclurg, who has given one of the best dissertations
-on its nature and properties, is composed of two parts; the gross
-part, which is coagulable by acids, and that part in which the
-bitter principle resides. The first constitutes the principal part
-in point of quantity, and seems to be that portion of the mass of
-fluids which loses the property of sound healthy blood, by a tendency
-to putrefaction, and is thrown out by this secretion. I will not
-undertake to vouch for the truth of this, but shall assume it as true
-in the following reasoning:--According to this theory, therefore, the
-greater part of the bile is what may be called the effete part of
-the circulating mass, or perhaps only of the red globules or gluten,
-the watery and saline part, which passes off by urine being the
-corrupted part of the serum. This part of the bile being very liable to
-putrefaction, the bitter part is considered by Dr. Maclurg as intended
-to correct this, and also to answer some good purpose in digestion.
-One of the effects of the bile in this operation is to extinguish
-acidity, whether proceeding from substances taken in, or generated in
-the stomach. The blood in all climates, and in all situations of life,
-is subject to have part of it thus corrupted, which, being separated
-from the common mass by the liver, is mingled and discharged with
-the common _feces_; but external heat continued for any length of
-time tends to augment this corruption of the fluids, and therefore
-to increase the secretion of bile; and it has been observed both by
-myself and others, that the bile found in those bodies that have been
-inspected after death, in consequence of fevers in hot climates, is
-less bitter, and not so penetrating to the fingers, being therefore
-deficient in the antiseptic principle. But since external heat makes
-no alteration in the degree of temperature of the fluids themselves,
-this effect must take place through the medium of the solids, in
-consequence of that general languor and want of energy which too much
-external heat induces in the functions, particularly in that power
-by which the living body preserves itself from putrefaction. Now if
-this portion of the blood, thus altered and depraved, is readily
-secreted and speedily thrown out, as in _cholera morbus_, no harm
-befals the constitution, nor any inconvenience but what arises from
-the irritation of the _primæ viæ_. But this may not take place if the
-body should be otherwise deranged; for the removal of this noxious
-matter from the mass of blood depends upon a due irritability of the
-blood vessels, the liver, and the bowels, whereby they are stimulated
-to contract, and thereby expel it. According to the principle of Mr.
-John Hunter, (whose deep and industrious researches into the animal
-œconomy place him high in the list of those few on whom nature has
-bestowed real genius, and who are capable of adding something new to
-the stock of human knowledge,) there is in a state of health a relative
-habitude or mutual harmony existing between the solids and fluids,
-whereby they stimulate and produce actions in each other, in which
-the healthy state of the functions consists, whether employed in the
-formation of what is found, or the expulsion of what is noxious: so
-that where it happens that the solids have a morbid insensibility to
-the impressions of corrupted and acrimonious fluids, the retention
-of these adds still more to the general derangement. To illustrate
-this, it may be observed, that the stomach and bowels, when they are
-endowed, as it were, with their natural perception, immediately expel
-any preternatural accumulations of bile that may take place; but when
-they are insensible to this stimulus through disease, no effort is made
-to relieve nature till it is excited by medicine. The same reasoning
-may be applied to the various vessels and ducts. Thus when we see the
-liver gorged with bile, without any free excretion of it into the gall
-bladder, as I have sometimes found to be the case upon inspecting the
-body in some of the worst cases of fever, would it not appear that the
-gall ducts have lost that natural irritability whereby the bile is
-expelled? Or, in consequence of a depraved state of action, connected
-with febrile affection, may it not happen that the absorbents, which,
-in their natural state, only absorb particular substances, and in a
-given quantity, will suffer a change in this natural action, and absorb
-whatever happens to be applied to their orifices? In case of jaundice,
-the bile, which is perhaps not at all absorbed in a state of health, is
-taken up in large quantities, and mingled with the mass of blood, which
-proves a seasonable relief in the state of accumulation and distension
-occasioned by the obstruction. This may happen in cases of fever, not
-indeed as a relief to nature, but from a depraved state of irritability
-in the lymphatics, induced by disease. Though no increased quantity
-of bile, therefore, is found in the gall bladder, there may have been
-an increased excretion of it, a preternatural absorption having been
-excited. So that it may admit of a question whether the colour of the
-skin, in the yellow fever, is owing to this, or if the idea of it given
-in the text[104] is more just; but in either case it seems probable
-that the extreme tendency to putrefaction in the whole body is owing
-either to the presence of bile, in consequence of absorption, or the
-retention of something in the blood from a defect of its secretion.
-
-This reasoning concerning the bile in hot climates may, in some sort,
-be illustrated by what happens to the urine in cold climates. The
-urine is the vehicle of an excrementitious part of the blood, of which
-an increased proportion is generated in certain fevers, and if it is
-thrown out in the form of high-coloured, turbid urine, the fever will
-most probably be slight and short; but if it becomes pellucid, or
-_crude_, as it is called, the general derangement will be increased,
-the fever will be more violent and dangerous, and the first sign of
-returning health will be a turbid appearance and sediment.
-
-If the reasoning in the above discussion should appear to some readers
-unsatisfactory, or ill connected, I can only say that if it is
-deserving of this character, I am willing to have it considered not
-only as an illustration, but an example of the nicety and fallacy of
-theoretical disquisitions.
-
-[104] See page 437-8.
-
-[105] I have been very cautious of admitting any theory into this work;
-but I cannot help adopting the doctrine of my much-valued master, Dr.
-Cullen, on this point, viz. that a great part of the symptoms of fever
-arise from reaction, or that effort which nature makes to overcome
-the morbid cause. I am happy in any opportunity of acknowledging my
-obligations to this learned professor, to whom the medical world in
-general is so much indebted, as well for the rational views of the
-animal œconomy, which he teaches, as for that spirit of study and
-inquiry which he infuses into the minds of his pupils.
-
-[106] M. Desportes, who wrote a treatise on the diseases of St. Domingo.
-
-[107] There is a difference in the appearance of the blood when sizy,
-perhaps not sufficiently insisted on by practical writers; for though
-there should even be a very thick buff, yet, if the surface is flat,
-and the _crassamentum_ tender, no great inflammation is indicated, in
-comparison of that state of the blood wherein the surface is cupped,
-the _crassamentum_ contracted so as to afford the appearance of a large
-portion of _serum_, and where it feels firm and tenacious, though
-perhaps but thinly covered with buff. This is a distinction well worth
-attending to in practice; for it is in these last circumstances that
-blood-letting gives most relief, and where the patient will bear the
-repetition of it with most advantage.
-
-[108] See the same observation in Mr. Hume’s Essay on this Disease,
-published by Dr. Donald Monro.
-
-[109] The state of the stomach is very much affected by that of the
-external surface of the body; and it is sagaciously observed by
-Sydenham, that the stomach being commonly very irritable in the plague,
-the most effectual means of making it retain what was administered
-internally was to excite a sweat.
-
-[110] The red bark was brought to England in a Spanish prize in the
-year 1781, and a very accurate account of its medical and chemical
-properties was published the year after by Dr. William Saunders, of
-Guy’s hospital. None of it had been brought to the West Indies before
-the peace, so that I had no opportunity of trying it in that climate.
-
-[111] Mr. Telford related to me, that he had cured several
-intermittents that had baffled the bark, by means of white vitriol,
-whilst he was surgeon of the Yarmouth in 1779. He gave it in doses of
-five grains every four hours in the intermission, and was successful in
-every case except two, in which the patients were far advanced in the
-dropsy.
-
-He met with several cases of the same kind in the Alcide, in 1782,
-in which he was successful with the flowers of zinc, after having
-given large quantities of bark to no purpose. He preferred, however,
-the white vitriol, as being milder in its operation, and less apt to
-disagree with the patient’s stomach.
-
-He did not employ either of them in the recent state of the disease,
-nor does he assert that they are universal or infallible remedies; but
-only alledges, that he has experienced the most evident good effects
-from them in an advanced stage of the disease, and a reduced state of
-the patient, where the common remedy had failed.
-
-[112] Dr. Huck Saunders, whose recent loss the world has reason to
-regret on account of his experience and sagacity as a physician, as
-well as his virtues as a man, communicated to me, in conversation, some
-observations on the cure of obstinate intermittents, which deserve to
-be mentioned here. When he was physician to the army at the Havannah
-he cured a number of agues which had resisted the bark, by giving two
-ounces of the vinous tincture of rhubarb and six drams of the tincture
-of sena seven or eight hours before the fit. This being repeated two or
-three times, carried off the disease. He also informed me, that he had
-met with agues in England which did not yield to the bark; but, upon
-leaving it off, and putting the patients on a course of mercury, they
-were cured upon returning to the use of the bark.
-
-Arsenic has also been found to be an effectual remedy in intermittent
-fevers. I was informed by Dr. Huck Saunders, that when he was in North
-America, in the war before the last, there was an expedition undertaken
-against the Cherokee Indians, whose country is extremely subject
-to agues; and as an adequate quantity of bark would have been very
-cumbersome where light service was necessary, Mr. Russel, who had the
-medical management of the expedition, provided a great number of pills,
-containing each one eighth part of a grain of arsenic, by the proper
-use of which he was enabled to cure the intermittent fevers with which
-the troops were seized.
-
-I shall here mention another unusual remedy in intermitting fevers;
-and though I can bring only one instance in proof of its efficacy, yet
-this is so strong as to make it deserve farther trial. A man, on board
-of the Sandwich, had an obstinate intermittent which had resisted the
-bark, and was stopped by applying to the stomach a plaster, composed of
-gum plaster, epispastic plaster, and opium, in proportions which I do
-not now recollect.
-
-[113] Sir John Pringle on the Diseases of the Army.
-
-[114] This is elegantly expressed as follows, in Sir George Baker’s
-learned Dissertation on this disease:--“Primo neglectus tractatu
-asperior occurrebat: etenim corpus extenuatum atque confectum ut morbo
-fervido impar erat, ita ipsi impar curationi. Itaque optimum erat
-occurrere ipsis principiis atque auxilia mature præripere. In hoc enim
-corporis affectu aliquod certe in medicina opus est, haud multum in
-naturæ beneficio.”
-
-[115] In Dr. Griffith’s form of his medicine for the piles, six drachms
-of fresh-drawn linseed oil are joined with two drachms and a half of
-the vinous tincture of rhubarb, and given twice a day in a draught. I
-commonly used oil of almonds at the hospital. This may be considered
-as another instance of those useful combinations of medicines, which
-experience alone sometimes discovers. I have found it of use also in
-other internal hæmorrahages.
-
-[116] See Diseases of the Army, p. 273. 6th Edit.
-
-[117] Since coming to England, I have been informed by Dr. Garden,
-a learned and ingenious practitioner from South Carolina, that this
-medicine, in order to produce its proper effect, should be given in
-a very weak decoction; for that after having almost abandoned it in
-consequence of its failure when he gave it in strong decoctions, and
-in substance, he was again convinced of its efficacy by using it in a
-very weak decoction, a scruple being boiled in a pint of water to half
-a pint.
-
-[118] See page 345. A fact mentioned in Capt. Cooke’s Voyage to the
-North Pacific Ocean, may be also alledged in favour of this opinion.
-He remarks, that the Kamschadales, who were habituated to hard labour,
-were free from scurvy, while the Russians and Cossacks, who were in
-garrison in their country, and led indolent lives, were subject to it.
-
-[119] I was informed of this fact by Mr. Cairncross, an ingenious
-surgeon belonging to one of the battalions that served there during the
-siege.
-
-[120] I imagined that this was a new practice; but I find, since the
-first edition of this work was printed, that it has been recommended by
-Pere Labat in his voyage to the Antilles.
-
-[121] There is a symptom which takes place when men are beginning to
-recover from scurvy, (particularly when the cure is rapidly effected
-by the use of lemon and orange juice) upon which I have frequently
-reflected, but for which I have never been able to account. This
-consists in acute pains, which are felt in the breast and limbs,
-resembling rheumatic pains. I once knew the crew of a ship which was
-much affected with scurvy, and had about ninety men under cure by
-lemons and oranges, who were most of them affected with this symptom in
-one night, and made such a noise by crying out as to alarm the officers
-who were upon duty.
-
-[122] See the Medical Essays of Edinburgh. Sennertus, lib. iii. part i.
-sect. ii.--Haller Elem. Physiolog. lib. xix. sect. ii.
-
-[123] In the Princessa, 1781, and the Nonsuch, Prince George, and Royal
-Oak, in 1782.
-
-[124] Since this was first written, the melancholy tidings have
-arrived of another case to be added to this fatal list. It is that
-of the amiable and gallant Lord Robert Manners, who commanded the
-Resolution on the 12th of April, and having lost his leg, besides
-receiving a wound in his arm and breast, died of this untractable
-symptom on his passage to England; and though he shared a fate to be
-envied by every lover of true glory, his loss can never be enough
-deplored by his country and friends, being formed by his great virtues
-and accomplishments, joined to the lustre of his rank, to hold out an
-example of all that was good and great as a man and an officer.
-
-[125] See Kaau Boerhaave’s account of this epilepsy in a school at
-Harlaem, in a book, entitled Impetum faciens dictum Hippocrate per
-corpus consentiens (page 355.) A fact of the same kind is also related
-in a pamphlet, entitled Rapport des Commissaires chargés par le Roi de
-l’examen du Magnetisme Animal.
-
-[126] London Medical Observations and Inquiries, Vol. VI.
-
-[127] Medical Commentaries, Vol. III., and a Thesis printed at
-Edinburgh, 1784.
-
-[128] See experiments on a heated room. Philosophical Transactions,
-1775, Vol. LXV.
-
-[129] That species of locked jaw, called by authors the _Trismus
-Infantium_, to which children are liable the first week after birth, is
-probably owing to the contact of the external air upon the skin, which
-is accustomed in the womb to a moist and warm medium.
-
-[130] Aretæus Cappadox says, that tetanus in general is even more apt
-to occur in winter than in summer. De Cauf. & Sign. Morb. Acut. lib. i.
-cap. vi.
-
-[131] There are several valuable practical remarks on this complaint in
-some of the ancient authors, especially Aretæus. Their principal means
-of cure consisted in the application of warm oil to the whole surface
-of the body, particularly of the part affected. This author also
-recommends clysters of warm oil, occasionally combined with a medicine
-called _hiera_, which consisted of certain spices and gums, with some
-purgative, such as aloes or colocynth. Aretæus Cappad. de Curat. Morb.
-Acut. cap. vi. Celsus, lib. iv. cap. iii. Goræaus in vocabulum,ἱερα.
-
-[132] This is a fact which does not admit of doubt; but the manner in
-which the effect is here produced is a matter of conjecture. It is most
-probably owing to the compression and tremor of the air in consequence
-of its resistance to the motion of the ball. We can also conceive,
-that, with regard to an yielding part, such as the stomach or abdomen,
-a body flying with great velocity may even, for a moment, displace a
-portion of it by passing through the same space, without any other
-mechanical injury than contusion, in a manner similar to what happens
-to two balls in the act of collision in philosophical experiments made
-to illustrate the nature of elasticity; or the compressed air may
-even, in this case, act, as it were, like a cushion, preventing the
-sudden impulse and contact of the ball. This explanation furnishes
-a reason why the parts of the body above mentioned should be more
-liable to be affected by accidents of this kind than the head. Perhaps
-this difference may also, in part, arise from the principle laid down
-by Mr. Hunter, that the stomach is more essential to life, and more
-immediately the seat of it, than the head or any other member or organ
-of the body, and that an injury to this part is more immediately
-destructive of life than any other.
-
-[133] The honourable Captain Fitzroy.
-
-[134] Colonel Markham.
-
-[135] Animals are affected by these accidents as well as men. A cow
-in one of the ships was killed in one of the actions in April, by a
-double-headed shot passing close to the small of her back.
-
-[136] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ excerpta est.
-
-[137] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.
-
-[138] Vide pag. 408.
-
-[139] Vide pag. 409. Hæc formulæ ex Pharmacopœia Nosocomii Sti.Thomæ
-excerpta est. sed vice confectionis Damocratis hodie obsoletæ,
-adhibentur confectio aromatica & opium purificatum, ratione habitâ ad
-portionem fingulorum adeo ut parem edant effectum ac in vetere formulâ.
-
-[140] Vide pag. 456.
-
-[141] Ex auctoritate Cl. Huck Saunders.
-
-[142] Ex auctoritate Cl. Huck Saunders.
-
-[143] Ex auctoritate Cl. Lind.
-
-[144] Vide pag. 479.
-
-[145] Vide pag. 489.
-
-[146] Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo de
-morbis castrensibus.
-
-[147] Hæc formula ex Pharmacopœiâ Nosocomii Sti. Thomæ, excerpta est.
-
-[148] Vice olei ricini dare licet olei amygdalæ unciam unam cum
-tincturæ sennæ unciâ dimidiâ. Vide Pharm. Nosoc. Sti.Thomæ.
-
-[149] Hæc formula ex auctoritate Cl. Griffiths. In periculis a me ipso
-factis felicissimum successum ex hoc medicamento percepi.
-
-[150] Hoc medicamentum speciatim his hæmorrhagiis accommodatum quæ ex
-aliquo viscere læso vi externa exoriantur quales in nave sæpius quam
-alicubi accidere solent, ex præcipitiis & ex corpore colliso a molimine
-machinarum & tormentorum.--Prodest quoque in his casibus pulvis
-ipecacoanhæ compositus.
-
-[151] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.
-
-[152] Hæc est quam proxime formula a Cl. Mead legata Nosocomio Sti.
-Thomæ ubi olim munere medici functus est, & ibi ex eo tempore usque
-hodie feliciter in hydrope adhibita est.
-
-[153] Cl°. Huck Saunders qui dyspnœâ hydropicâ laboravit ipse, auxilio
-notabili erat hoc medicamentum. In talibus malis interdum summopere
-prodest decoctum digitalis purpureæ, ut medicus supra memoratus in suo
-casu compertus est.--Vid. Medical Transactions, Vol. III.
-
-[154] Vide Cl. Pringle in opere suo de morbis castrensibus.
-
-[155] Hujus doctrinæ auctor est Hippocrates, quæ restaurata est
-auctaque a Cl. Milman in opusculo suo de hydrope.
-
-[156] Hæc methodus medendi quæ æque efficax ac simplex est, primo
-excogitata fuit a Cl. Georgio Fordyce medico nosocomii Sti. Thomæ, ubi
-& ipse felicissimo cum successu eandem expertus sum, in muneribus meis
-ibi fungendis.
-
-[157] Vide opus Cl. Johannis Hunter de morbo venereo.
-
-[158] Vires opii in isto morbo primo innotuerunt ex experientiâ Cl.
-Nooth, dum præfuit nosocomiis militaribus in America, & pro optimo
-remedio a peritissimis medicis & chirurgis jam habetur.
-
-[159] Non hic intelligitur ptyalismum veram esse causam quâ efficitur
-medela morbi, sed præcipitur ut pro argumento sit hydrargyrum in vasa
-minima permeasse adeo ut effectum edat in subigendo morbo. Vide Opus
-Hunteri.
-
-
-[Transcriber's Note:
-
-Inconsistent spelling and hyphenation are as in the original.]
-
-
-
-
-
-
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-Project Gutenberg's Observations on the Diseases of Seamen, by Gilbert Blane
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-
-Title: Observations on the Diseases of Seamen
-
-Author: Gilbert Blane
-
-Release Date: September 8, 2016 [EBook #53007]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON DISEASES OF SEAMEN ***
-
-
-
-
-Produced by Wayne Hammond and The Online Distributed
-Proofreading Team at http://www.pgdp.net (This file was
-produced from images generously made available by The
-Internet Archive)
-
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-</pre>
-
-
-<p><span class="pagenum" id="Page_i">i</span></p>
-
-<div class="figcenter">
-<img id="coverpage" src="images/cover.jpg" alt="" />
-</div>
-
-<h1>
-<span class="x-large">OBSERVATIONS</span><br />
-
-<span class="medium">ON THE</span><br />
-
-<span class="x-large">DISEASES</span><br />
-
-<span class="medium">OF</span><br />
-
-SEAMEN.<br />
-
-<span class="medium">BY</span><br />
-
-<span class="large">GILBERT BLANE, M. D.<br />
-
-F. R. S. S. LOND. <small>AND</small> EDIN.</span><br />
-
-<span class="small table">PHYSICIAN EXTRAORDINARY TO THE PRINCE OF WALES,<br />
-PHYSICIAN TO THE DUKE OF CLARENCE,<br />
-AND TO ST. THOMAS’S HOSPITAL.</span><br />
-
-<span class="large">THE SECOND EDITION,</span><br />
-
-<span class="medium">WITH CORRECTIONS AND ADDITIONS.</span><br />
-
-<span class="medium">LONDON:</span><br />
-
-<span class="small table">Printed by <span class="smcap">Joseph Cooper</span>;<br />
-And sold by <span class="smcap">John Murray</span>, No. 32 Fleet Street;<br />
-<span class="smcap">J. Johnson</span>, St. Paul’s Church Yard;<br />
-And by <span class="smcap">William Creech</span>, in Edinburgh.<br />
-<br />
-M.DCC.LXXXIX.</span><br />
-</h1>
-<p><span class="pagenum" id="Page_ii">ii</span></p>
-
-<blockquote>
-
-<p>Nec Medici, nec Imperatores, nec Oratores, quamvis
-artis pr&aelig;cepta perceperint, quidquam magna laude
-dignum sine usu et excercitatione consequi possunt.</p>
-
-<p class="author">
-<span class="smcap">Cicero.</span><br />
-</p></blockquote>
-
-<p><span class="pagenum" id="Page_iii">iii</span></p>
-
-<h2 id="CONTENTS">CONTENTS.</h2>
-
-<table class="toc">
-  <tr>
-    <th colspan="2"><a href="#PART_I">PART I.</a></th>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_I_BOOK_I">BOOK I.</a></th>
-  </tr>
-  <tr>
-    <td colspan="2" class="x-small tdr">Page</td>
-  </tr>
-  <tr>
-    <td><a href="#PART_I_BOOK_I">Comprehending the Medical History of the Fleet, from March 1780, till August 1781</a></td>
-    <td class="tdrb">17</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_I_CHAP_I">CHAP. I.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_I_CHAP_I"><span class="smcap">Account</span> of the Health of the Fleet from March 1780, till July following</a></td>
-    <td class="tdrb"><i>ib.</i></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_I_CHAP_II">CHAP. II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_I_CHAP_II"><span class="smcap">Account</span> of the Health of the Fleet from August 1780, till December following</a></td>
-    <td class="tdrb">35<span class="pagenum" id="Page_iv">iv</span></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_I_CHAP_III">CHAP. III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_I_CHAP_III"><span class="smcap">Account</span> of the Health of the Fleet from January 1781, till July 1781, both Months included</a></td>
-    <td class="tdrb">46</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_I_BOOK_II">BOOK II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#PART_I_BOOK_II">Continuation of the Medical History of the Fleet, from August 1781, till the Conclusion of the War in April 1783</a></td>
-    <td class="tdrb">63</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_I">CHAP. I.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_I">Some <span class="smcap">Account</span> of the Interval between the Campaigns of 1781, and the Junction of the Reinforcement from England in April 1782</a></td>
-    <td class="tdrb"><i>ib.</i></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_II">CHAP. II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_II"><span class="smcap">Account</span> of the Health of the Fleet from the Junction of the Squadron from England, till the general Rendezvous at St. Lucia, in the beginning of April</a></td>
-    <td class="tdrb">75</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_III">CHAP. III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_III"><span class="smcap">State</span> of <span class="smcap">Health</span> of the Fleet in April 1782</a></td>
-    <td class="tdrb">98<span class="pagenum" id="Page_v">v</span></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_IV">CHAP. IV.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_IV"><span class="smcap">Account</span> of the Health of the Fleet while it lay at Jamaica, during May, June, and part of July, 1782</a></td>
-    <td class="tdrb">109</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_V">CHAP. V.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_V"><span class="smcap">Account</span> of the Health of the Fleet from its leaving Jamaica on the 17th of July 1782, till its Departure from New York on the 25th of October following</a></td>
-    <td class="tdrb">139</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_II_CHAP_VI">CHAP. VI.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_II_CHAP_VI"><span class="smcap">Account</span> of the Health of the Fleet from its Departure from New York till the Conclusion of the War</a></td>
-    <td class="tdrb">158</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#BOOK_III">BOOK III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#BOOK_III">Of the <span class="smcap">Numbers</span> and <span class="smcap">Mortality</span> of different <span class="smcap">Diseases</span> sent to Hospitals, with a general View of the whole Mortality during the War</a></td>
-    <td class="tdrb">185<span class="pagenum" id="Page_vi">vi</span></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_II">PART II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#PART_II">Of the <span class="smcap">Causes</span> of Sickness in Fleets, and the Means of <span class="smcap">Prevention</span></a></td>
-    <td class="tdrb">211</td>
-  </tr>
-  <tr>
-    <td><a href="#PART_II_INTRODUCTION">Introduction</a></td>
-    <td class="tdrb"><i>ib.</i></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_II_CHAP_I">CHAP. I.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#AIR">Of Air</a></td>
-    <td class="tdrb">225</td>
-  </tr>
-  <tr>
-    <td><a href="#CHAP_I_SECT_I">Sect. I. Of the noxious Effects of Land Air in particular Situations</a></td>
-    <td class="tdrb">227</td>
-  </tr>
-  <tr>
-    <td><a href="#CHAP_I_SECT_II">Sect. II. Of the Effects of foul Air from the Neglect of Cleanliness in Men’s Persons&mdash;<span class="smcap">Infection</span></a></td>
-    <td class="tdrb">237</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#MEANS_OF_PREVENTING_THE_INTRODUCTION_OF_INFECTION">1. Means of preventing the Introduction of Infection</a></td>
-    <td class="tdrb">240</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#MEANS_OF_PREVENTING_THE_PRODUCTION_OF_INFECTION">2. Means of preventing the Production of Infection</a></td>
-    <td class="tdrb">254</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#MEANS_OF_ERADICATING_INFECTION">3. Means of eradicating Infection</a></td>
-    <td class="tdrb">264</td>
-  </tr>
-  <tr>
-    <td><a href="#CHAP_I_SECT_III">Sect. III. Of the foul Air generated in a Ship</a></td>
-    <td class="tdrb">281</td>
-  </tr>
-  <tr>
-    <td><a href="#CHAP_I_SECT_IV">---- IV. Means of guarding against Infection and bad Air</a></td>
-    <td class="tdrb">293<span class="pagenum" id="Page_vii">vii</span></td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#CHAP_II">CHAP. II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_ALIMENT">Of Aliment</a></td>
-    <td class="tdrb">300</td>
-  </tr>
-  <tr>
-    <td><a href="#SECT_I_of_Solid_Food">Sect. I. Of solid Food</a></td>
-    <td class="tdrb"><i>ib.</i></td>
-  </tr>
-  <tr>
-    <td><a href="#SECT_II_of_Drink">---- II. Of Drink</a></td>
-    <td class="tdrb">319</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#OF_WATER">Of Water</a></td>
-    <td class="tdrb">324</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_II_CHAP_III">CHAP. III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_CLOTHING">Of Clothing</a></td>
-    <td class="tdrb">334</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_II_CHAP_IV">CHAP. IV.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_EXERCISE">Of Exercise</a></td>
-    <td class="tdrb">343</td>
-  </tr>
-  <tr>
-    <td><a href="#CONCLUSION"><span class="smcap">Conclusion</span></a></td>
-    <td class="tdrb">349</td>
-  </tr>
-  <tr>
-    <td><a href="#APPENDIX_TO_PART_II"><span class="smcap">Appendix</span> to <span class="smcap">Part II.</span></a></td>
-    <td class="tdrb">352</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#MEMORIAL_TO_THE_ADMIRALTY">Memorial to the Admiralty</a></td>
-    <td class="tdrb"><i>ib.</i></td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#SUPPLEMENT_TO_THE_MEMORIAL">Supplement to the Memorial</a></td>
-    <td class="tdrb">364</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_III">PART III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#DESCRIPTION_AND_TREATMENT"><span class="smcap">Description</span> and <span class="smcap">Treatment</span> of the Diseases most frequently occurring in Fleets in hot Climates</a></td>
-    <td class="tdrb">368</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_III_CHAP_I">CHAP. I.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_FEVERS">Of Fevers</a></td>
-    <td class="tdrb">370</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#OF_THE_INFECTIOUS_SHIP_FEVER">1. Of the infectious Ship Fever</a></td>
-    <td class="tdrb">371</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#OF_THE_BILIOUS_REMITTING_FEVER">2. Of the bilious Remitting Fever</a></td>
-    <td class="tdrb">415<span class="pagenum" id="Page_viii">viii</span></td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#OF_THE_YELLOW_FEVER">3. Of the Yellow Fever</a></td>
-    <td class="tdrb">425</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#INTERMITTENT_FEVERS">4. Of the Effects of some unusual Remedies in the Cure of obstinate Intermittent Fevers</a></td>
-    <td class="tdrb">456</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_III_CHAP_II">CHAP. II.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_FLUXES">Of Fluxes</a></td>
-    <td class="tdrb">466</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_III_CHAP_III">CHAP. III.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_SCURVY">Of Scurvy</a></td>
-    <td class="tdrb">499</td>
-  </tr>
-  <tr>
-    <th colspan="2"><a href="#PART_III_CHAP_IV">CHAP. IV.</a></th>
-  </tr>
-  <tr>
-    <td><a href="#OF_THE_WOUNDS_RECEIVED_IN_THE_ACTIONS_OF_APRIL_1782">Of the <span class="smcap">Wounds</span> received in the Actions of April 1782</a></td>
-    <td class="tdrb">519</td>
-  </tr>
-  <tr>
-    <td><a href="#APPENDIX_TO_PART_III"><span class="smcap">Appendix to Part III.</span></a></td>
-    <td class="tdrb">545</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#ASSORTMENT_OF_MEDICINES_TO_BE_CARRIED_TO_SEA">Assortment of Medicines to be carried to Sea</a></td>
-    <td class="tdrb">548</td>
-  </tr>
-  <tr>
-    <td class="i4"><a href="#FORMULAE_QUAEDAM">Formul&aelig; Medicamentorum</a></td>
-    <td class="tdrb">550<span class="pagenum" id="Page_1">1</span></td>
-  </tr>
-</table>
-
-<h2 id="DEDICATION">DEDICATION.<br />
-
-<span class="small">TO HIS</span><br />
-
-<span class="medium">ROYAL HIGHNESS</span><br />
-
-<span class="large"><span class="smcap">Prince</span> WILLIAM-HENRY.</span></h2>
-
-<p class="small">SIR,</p>
-
-<p>The following Work is the fruit
-of several years labour employed in
-the Public Service, chiefly under that
-great and successful Admiral, Lord
-Rodney, in a series of Naval Operations,
-which have been productive of
-<span class="pagenum" id="Page_2">2</span>
-events more glorious than any recorded
-in the Annals of Britain. As
-your Royal Highness was present during
-some part of the service which is
-the subject of these Observations, and
-as You have not only honoured the
-Sea Service by embracing it as a profession,
-and enrolling your illustrious
-Name among its officers, but in undergoing
-the dangers and fatigues of
-actual service, which is so necessary to
-attain that practical Skill which Your
-Royal Highness is well known to possess,
-I have, upon these grounds, presumed
-to lay this Work at Your feet.
-I should do this with greater satisfaction,
-<span class="pagenum" id="Page_3">3</span>
-were it more worthy of Your acceptance;
-but however inadequate my
-abilities may have been to the talk,
-it has been my sincere aim to produce
-a work of some utility to that only
-Bulwark of our Country, the British
-Navy, of which your Royal Highness
-is the Pride and the Hope.</p>
-
-<p>Your Royal Highness’s Permission
-to inscribe this work to You, and
-the personal Notice and Protection
-with which you have been pleased to
-honour me, I consider as the first
-Distinctions of my life, and of which
-I shall ever entertain a becoming
-<span class="pagenum" id="Page_4">4</span>
-sense, by cherishing those indelible
-sentiments of Respect, Gratitude, and
-Attachment, which are due to Your
-Royal Highness from</p>
-
-<div class="poem"><div class="stanza">
-<span class="i0">Your Royal Highness’s<br /></span>
-<span class="i2">Most faithful,<br /></span>
-<span class="i4">Most obedient, and<br /></span>
-<span class="i6">Most devoted Servant,<br /></span>
-<span class="i4">GILBERT BLANE.<br /></span>
-</div><div class="stanza">
-<span class="i0"><span class="smcap">London</span>,<br /></span>
-<span class="i0">May 1, 1785.<br /></span>
-</div></div>
-
-<p><span class="pagenum" id="Page_5">5</span></p>
-
-<h2 id="PREFACE">PREFACE.</h2>
-
-<p>Having been appointed by Lord Rodney
-Physician to the Fleet under his command,
-in the beginning of the year 1780, I determined
-to avail myself, to the utmost of my
-abilities, of the advantages which this field
-of observation afforded. This I was led to
-do, in order to satisfy my own mind as a
-matter of duty, as well as to find out, if
-possible, the means of bettering the condition
-of a class of men, who are the bulwark
-of the state, but whose lot is hardship
-and disease, above that of all others.
-<span class="pagenum" id="Page_6">6</span></p>
-
-<p>A fleet, consisting seldom of less than
-twenty ships of the line of battle, and
-sometimes exceeding forty, which I attended
-in the different scenes of active service in
-that distant and unhealthy region, for more
-than three years, has afforded me opportunities
-of making observations upon a large
-scale.</p>
-
-<p>My object has been prevention as much as
-cure; and as the former must more particularly
-depend on a knowledge of the external
-causes of disease, I have collected and arranged
-all the facts upon this subject that
-came within my reach, considering these as
-the only grounds from whence the remote
-causes of health and sickness could be deduced.</p>
-
-<p>When I entered upon my employment, the
-Commander in Chief gave an order, that
-every surgeon in the fleet should send me a
-<span class="pagenum" id="Page_7">7</span>
-monthly return, stating the degree of prevalence
-of different diseases, the mortality,
-and whatever else related to the health of
-the respective ships. This was done with
-a view to enable me to regulate the reception
-of men into hospitals, so that each ship
-might have a due proportion of relief, according
-to the degree of sickness on board,
-taking care at the same time that the hospitals
-should not be overcrowded; and also
-to acquaint the Commander in Chief, from
-time to time, of the state of sickness, or
-the predominance of particular diseases, in
-order to recommend such articles of diet,
-or other means, as might tend to cure them,
-or to check their progress. These returns
-have served also in this work as a method
-of collecting a multitude of well-established
-facts, tending to ascertain the causes and
-course of disease.
-<span class="pagenum" id="Page_8">8</span></p>
-
-<p>While the fleet was in port, I also superintended
-and visited daily the hospitals, of
-which there is one at almost every island on
-the station; and having kept an account of
-the different kinds of disease that were admitted,
-and of their mortality, I have in
-this way likewise been furnished with a
-number of facts that may throw light on
-the history of human maladies.</p>
-
-<p>Nevertheless, I do not boast of having
-made great discoveries; and every person of
-a correct judgement must be aware how difficult
-it is to ascertain truths, and to draw
-fair and solid inferences, on medical subjects.
-I have attempted little more than to
-amass, from my own observation, and by
-the assistance of the surgeons of the fleet, a
-number of well-established facts, and to arrange
-them in such a methodical manner, as
-to prove a groundwork for investigation;
-and I am persuaded that others, of more
-<span class="pagenum" id="Page_9">9</span>
-sagacity and enlarged knowledge than myself,
-may be able to deduce from them, observations
-that may have escaped me especially
-if these new, but imperfect, attempts
-should come to be compared with similar
-ones that may be made by other observers in
-other climates, and in other circumstances
-of service.</p>
-
-<p>I met with several obstacles in instituting
-inquiries, purely medical, to the extent I
-could have wished. There is, in the first
-place, from the nature of the subject, a
-great difficulty attending all practical inquiries
-in medicine; for, in order to ascertain
-truth, in a manner that is satisfactory to
-a mind habituated to chaste investigation,
-there must be a series of patient and attentive
-observations upon a great number of
-cases, and the different trials must be varied,
-weighed, and compared, in order to
-<span class="pagenum" id="Page_10">10</span>
-form a proper estimate of the real efficacy of
-different remedies and modes of treatment.</p>
-
-<p>But besides this difficulty belonging to
-the nature of the subject, there were others
-connected with the nature of the service;
-for the hospitals were at times so inadequate
-in point of size, and so ill provided
-with necessary articles and accommodations,
-particularly during the first part of my attendance,
-that my principal care was to remedy
-these defects by proper superintendence
-and representation.</p>
-
-<p>A due attention to air, diet, and cleanliness,
-is not only more essential than mere
-medical treatment, but the sick cannot be
-considered as fit subjects for evincing the
-powers of medicine till they are properly
-provided for in these respects. These inconveniences
-were owing, in a great measure,
-to the unusual extent of the service;
-<span class="pagenum" id="Page_11">11</span>
-for there was a much greater naval force in
-those seas, at this period, than was ever
-before known, and there was of course a
-proportional want of accommodation for
-the sick. Towards the end of the war
-these difficulties were much obviated, so
-that a fairer field of observation presented
-itself.</p>
-
-<p>Another obstacle to my practical inquiries
-was, that the fleets I belonged to seldom
-remained more than six weeks or two
-months at any one place, so that any series
-of observations that might have been instituted
-was interrupted, and I was in a great
-degree deprived of the fruits of them, by
-not seeing the event of cases under my
-management.</p>
-
-<p>The peace in the spring of the year 1783
-put an end to all my inquiries, and particularly
-prevented me from following out some
-<span class="pagenum" id="Page_12">12</span>
-practical researches. I have ventured, however,
-in one part of this work, to give the
-result of my experience in some diseases,
-more especially such as are peculiar to the
-climate and mode of life.</p>
-
-<p>Upon the whole, I have, in the following
-work, humbly attempted to follow what I
-conceive to be the only true method of cultivating
-any practical art, that is, to collect
-and compare a great number of facts. A
-few individual cases are not to be relied on
-as a foundation of general reasoning, the
-deductions from them being inconclusive
-and fallacious, and they are liable to be
-turned and glossed, according as the mind
-of the observer may he biassed by a favourite
-prepossession or hypothesis. It has been
-my study to exhibit a rigid transcript of
-truth and nature upon a large scale, and to
-take the average of numberless particular
-facts, to serve as a groundwork for observation;
-<span class="pagenum" id="Page_13">13</span>
-and I have endeavoured to analyse
-and collate these facts, by throwing the
-monthly returns that were made to me into
-the form of Tables, as the most certain
-and compendious way for finding their general
-result. If the materials are not sufficiently
-ample, or if the method should be
-found faulty and imperfect, let it be remembered,
-that I had no example to go by in
-this field of observation. It is to be regretted,
-that ages have passed without any
-attempts being made to transmit regular records
-of this kind to posterity. It would
-not only be extremely curious, as a piece
-of natural knowledge, but would conduce
-greatly to medical improvement and public
-utility, were we possessed of such information
-concerning the causes and nature of
-the diseases prevailing at sea, in various circumstances
-of weather, climate, and diet,
-in remote ages and countries, or even in
-our own age and country, as might enable
-<span class="pagenum" id="Page_14">14</span>
-us to compare them with present facts, and
-to ascertain more precisely the means of
-preventing and removing such diseases.</p>
-
-<p>The favourable reception which the first
-edition of this work has met with, renders
-it necessary to offer another to the Public;
-and though no new opportunities have occurred
-of making additional observations in
-the naval service I have endeavoured, during
-the last two years, from a pretty extensive
-experience in a large hospital, and from
-private practice, to add some new information
-on some practical points; and I hope
-this edition will be found throughout more
-full and correct than the former.</p>
-
-<p>The method I propose to follow in this
-work, is, First, to deliver the history of
-the different voyages and expeditions, so far
-as relates to health, giving an account of
-the prevalence and nature of the diseases
-<span class="pagenum" id="Page_15">15</span>
-and mortality on board of ships and in hospitals.</p>
-
-<p>Secondly, To deduce, from observations
-founded on these facts, and also from the
-former experience of others, the causes of
-sickness in fleets, and the means of prevention.</p>
-
-<p>Thirdly, To deliver some practical observations
-on the cure of the most common
-diseases incident to fleets, particularly in hot
-climates.
-<span class="pagenum" id="Page_16">16</span>
-<span class="pagenum" id="Page_17">17</span></p>
-
-<p class="ph1">OBSERVATIONS.<br />
-
-<span id="PART_I">PART I.</span></p>
-
-<h2 id ="PART_I_BOOK_I">BOOK I.</h2>
-
-<blockquote>
-
-<p>Comprehending the <span class="smcap">Medical History</span>
-of the <span class="smcap">Fleet</span>, from March, 1780, till
-August, 1781.</p></blockquote>
-
-<h2 id="BOOK_I_CHAP_I">CHAP. I.</h2>
-
-<blockquote>
-
-<p>Containing an Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span>
-from March, 1780, till July following.&mdash;&mdash;Five
-Ships of the Line arrive at Barbadoes from Europe in
-March&mdash;Join a large Squadron then on that Station&mdash;Their
-Health compared&mdash;Engagements with the
-Enemy in April and May producing Hardship and Exposure,
-but little Increase of Sickness&mdash;Method of
-collecting the Returns of the Surgeons&mdash;Influence of
-Situation upon Health in Harbours&mdash;Course of the
-Seasons, and Temperature of the West Indies&mdash;The
-Fleet reinforced in June and July with Ships from
-England and North America&mdash;Their Health.</p></blockquote>
-
-<p>During the war, which broke out
-with France in 1778, and with Spain in
-1779, the West Indies was the principal
-seat of naval operations, and much greater
-<span class="pagenum" id="Page_18">18</span>
-fleets were then employed in that quarter of
-the world than in any former period.</p>
-
-<p>Though there had been a great squadron
-on the Caribbee station during the greater
-part of 1779, no physician was appointed
-to it till the beginning of the next year,
-when I arrived there in that character with
-my friend and protector, Lord Rodney.</p>
-
-<p>There were then sixteen ships of the line
-on that station, most of which had been
-upwards of twelve months in the climate;
-and they were reinforced at this time by five
-more from England.</p>
-
-<p>The squadron which we found on the
-station was then extremely healthy, and in
-several of the ships there was not a man
-unfit for duty. We were told, however,
-that they had all been subject to sickness,
-particularly to the dysentery, soon after
-their arrival in that climate. Of the five
-with which the fleet was at this time reinforced,
-all but the Intrepid left England
-at Christmas, making part of the squadron
-<span class="pagenum" id="Page_19">19</span>
-which effected the first relief of Gibraltar,
-under the command of Lord Rodney, who
-continued his route to the West Indies, in
-order to take the command on the Windward
-station, where he arrived on the 16th
-of March. The Intrepid had arrived with
-a convoy the day before. These five ships
-were all pretty healthy on their passage, except
-the Sandwich and Terrible, in which
-a fever prevailed; but they had almost recovered
-from it before they arrived in the
-West Indies. A dysentery broke out in
-April in all the ships newly arrived, and it
-prevailed to the greatest degree in those
-which had been most affected with fevers
-in Europe, namely, in the Terrible and
-Intrepid. The Sandwich and Ajax were
-also affected, though in a less degree; but
-the Montagu, though this was her first
-voyage, and though she was just off the
-stocks, had been the most healthy of any
-of them from the time of leaving England,
-and continued so during all this campaign.
-I have not observed that new ships are more
-unhealthy than others, unless they are built
-of ill-seasoned timber; and they have this
-<span class="pagenum" id="Page_20">20</span>
-advantage, that there is no previous infection
-adhering to them. What may have
-contributed also to the superior health of
-the Montagu, was the precaution that was
-taken when this ship was first manned and
-fitted out, of stripping and washing the
-men that were brought from the guardship
-to complete the crew.</p>
-
-<p>The Intrepid, while in England, had been
-afflicted with fevers to a most uncommon
-degree; for, being one of the fleet in the
-Channel cruise the year before, almost the
-whole crew either died at sea, or were sent
-to the hospital upon arriving at Portsmouth.
-This ship, after refitting, was pretty healthy
-for a little time; but, probably from
-the operation of the old adhering infection,
-she became extremely sickly immediately
-after joining our fleet, and sent two hundred
-men to the hospital the first two months
-after arriving in the West Indies. Most of
-these were ill of the dysentery.</p>
-
-<p>The Pegasus frigate arrived with the ships
-from Gibraltar, and we have here an instance
-<span class="pagenum" id="Page_21">21</span>
-of the superior health commonly enjoyed
-by this class of ships over ships of
-the line; for when she was dispatched to
-England in the end of April, there had not
-been a man taken ill from the time of her
-arrival on the station.</p>
-
-<p>This season was a very active one in the
-operations of war; for, besides the general
-battle of the 17th of April, there were two
-partial actions in May; and, from the 15th
-of the former month till the 20th of the
-latter, our fleet was constantly in the face of
-the enemy’s, except for a few days that it
-was refitting at St. Lucia after the first battle.
-This was extremely harrassing to the
-men, not only from the incessant labour necessary
-in the evolutions of the fleet, but by
-their being constantly at quarters with the
-ships clear for action; for, in that situation,
-they had nothing to sleep upon but the bare
-decks, the hammocks and bedding being
-removed from between decks, where they
-might embarrass the men in fighting, and
-they become useful on the quarter deck, by
-serving to barricade the ship, which is done
-<span class="pagenum" id="Page_22">22</span>
-by placing them in ranges on the gunwale,
-to cover the men from the enemy’s grape
-and small shot. These hardships were productive
-of some sickness, though much less
-than might have been expected; for the
-weather is at all times warm, and it was at
-this time extremely moderate and dry. Besides
-we shall see in other instances as well
-as this, that, in the ardour inspired by the
-presence of an enemy, men are less exhausted
-by their exertions than on ordinary
-and less interesting occasions.</p>
-
-<p>Almost the whole of the sick and wounded,
-to the number of 750, were put on
-shore at Barbadoes, where all the fleet, except
-three ships<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">1</a>, arrived on the 22d of
-May.</p>
-
-<p>I now began to keep regular and methodical
-accounts of the sickness and mortality
-in the fleet, though in a manner more imperfect
-and less accurate than was afterwards
-<span class="pagenum" id="Page_23">23</span>
-adopted. I was embarked on board of the
-Sandwich, where the Commander in Chief
-had his flag, so that I was always present
-with the main body of the fleet, whether at
-sea or in port.</p>
-
-<p>A form of monthly returns<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">2</a> was adopted,
-which, as well as other points of method,
-was afterwards improved.
-<span class="pagenum" id="Page_24">24</span></p>
-
-<p>After collecting the returns for each month,
-I made abstracts of them in tables; in one
-column of which the complement of each
-ship is set down, in order to form calculations
-of the comparative prevalence and mortality
-of different diseases at different times. One
-of the abstracts is here inserted, (<a href="#TABLE_I">Table I</a>.)
-by way of specimen, and the proportional
-result of them for fourteen months is set
-down in another table, (<a href="#TABLE_II">Table II</a>.)
-<span class="pagenum" id="Page_25">25</span></p>
-
-<p>Though this last exhibits a tolerably just
-view, yet it may be remarked, as one imperfection,
-that there was no distinction made
-at this time in my returns between the
-killed and those who died of disease; so that
-in the month of May, which stands first,
-the proportion is too high; for there were
-sixty-four killed, and two hundred wounded,
-in the two actions of that month.
-<span class="pagenum" id="Page_26">26</span></p>
-
-<div class="table">
-<h3 id="TABLE_I">TABLE I.<br />
-<span class="medium">ABSTRACT of RETURNS,<br />
-1st June, 1781.</span></h3>
-
-<p>Transcriber’s keys:<br />
-<br />
-A Complement.<br />
-B Sick and Wounded on Board.<br />
-C Sent to the Hospital in the  course of last Month.<br />
-D Dead on Board in the course of last Month.</p>
-
-<table class="bbox">
-  <tr>
-    <th>SHIPS’ NAMES.</th>
-    <th>A</th>
-    <th>B</th>
-    <th>C</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">732</td>
-    <td class="tdr">28</td>
-    <td class="tdr">36</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Barfleur</td>
-    <td class="tdr">767</td>
-    <td class="tdr">133</td>
-    <td class="tdr">22</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Gibraltar</td>
-    <td class="tdr">650</td>
-    <td class="tdr">67</td>
-    <td class="tdr">88</td>
-    <td class="tdr">10</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">650</td>
-    <td class="tdr">7</td>
-    <td class="tdr">9</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">650</td>
-    <td class="tdr">45</td>
-    <td class="tdr">26</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">600</td>
-    <td class="tdr">31</td>
-    <td class="tdr">57</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">600</td>
-    <td class="tdr">62</td>
-    <td class="tdr">14</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">600</td>
-    <td class="tdr">85</td>
-    <td class="tdr">24</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">600 </td>
-    <td class="tdr">57</td>
-    <td class="tdr">38</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">600</td>
-    <td class="tdr">44</td>
-    <td class="tdr">134</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">600</td>
-    <td class="tdr">42</td>
-    <td class="tdr">35</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">600</td>
-    <td class="tdr">30</td>
-    <td class="tdr">23</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Invincible</td>
-    <td class="tdr">600</td>
-    <td class="tdr">50</td>
-    <td class="tdr">63</td>
-    <td class="tdr">9</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">600</td>
-    <td class="tdr">107</td>
-    <td class="tdr">54</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">550</td>
-    <td class="tdr">20</td>
-    <td class="tdr">10</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Princessa</td>
-    <td class="tdr">560</td>
-    <td class="tdr">88</td>
-    <td class="tdr">40</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Belliqueux</td>
-    <td class="tdr">500</td>
-    <td class="tdr">19</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Prince William</td>
-    <td class="tdr">500</td>
-    <td class="tdr">25</td>
-    <td class="tdr">14</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Panther</td>
-    <td class="tdr">420</td>
-    <td class="tdr">16</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">200</td>
-    <td class="tdr">5</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">200</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">200</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">11979</td>
-    <td class="tdr">977</td>
-    <td class="tdr">696</td>
-    <td class="tdr">64</td>
-  </tr>
-</table>
-</div>
-
-<p><span class="pagenum" id="Page_27">27</span></p>
-
-<p>The main body of the fleet lay at Barbadoes
-till the 6th of June, and the men had
-recruited extremely by their stay there; for
-vegetables, fruit, and other refreshments,
-can be procured at an easier rate, and in
-much greater plenty, at this island, than
-any other on the station.</p>
-
-<p>The fleet arrived at St. Lucia the next day
-after it sailed from Barbadoes, and remained
-there till the 18th of June. The whole
-of this month was showery at this island,
-though it is not accounted the common
-rainy season; for more rain falls here than
-at any of the other islands at that time in
-our possession, being the most mountainous,
-as well as the most woody and uncultivated,
-of them all. These rains produced some
-increase of sickness, but very little, when
-compared to what took place at the same
-time in the army on shore, and in the ships
-refitting at the Carenage. There died about
-this time from fifty to fifty-five men every
-week in an army of not quite two thousand
-men.
-<span class="pagenum" id="Page_28">28</span></p>
-
-<p>The difference in point of health between
-the Carenage (which, as the word implies,
-is the place where ships go to be hove down,
-or otherwise repaired) and Gros-Islet Bay,
-where the main body of the fleet lay, affords
-a striking proof of the effects of situation.
-The Carenage is a land-locked creek, with a
-marsh adjacent to it, whereas the other is a
-road open to the fine air of the sea, the only
-land sheltering it to windward being a small,
-dry island, consisting of one hill, of half a
-league in circumference, and some of the
-cliffs of the main island of St. Lucia.</p>
-
-<p>The increase of sickness here was farther
-prevented by the men having little labour
-to perform on shore, nor any haunts to encourage
-intemperance, a vice which the
-Admiral endeavoured still more effectually
-to prevent, by ordering all the rum stills in
-the neighbourhood to be destroyed.</p>
-
-<p>It may be proper here to introduce a general
-account of the seasons and temperature
-of the West Indies, as there will be
-frequent occasion hereafter to make allusions
-<span class="pagenum" id="Page_29">29</span>
-to them. With regard to the heat, though
-the range of the temperature is very small,
-in comparison of what it is in Europe, the
-variations follow the same seasons; for July
-and August are the hottest months, and December
-and January the coolest. This we
-would naturally expect, as our plantations
-lie all in the northern hemisphere, between
-the 10th and 20th degree of N. latitude,
-and therefore bear the same relation as Europe
-does to the sun’s annual course. The
-hurricanes happen in the same season in
-which the periodical rains chiefly fall, that
-is, in the months of August, September,
-and October, which are called the hurricane
-months, and this is also the most unhealthy
-season. The time of the year which is most
-apt to be rainy, next to this, is from the
-middle of May to the middle or end of
-June, but this is not invariable. The lowest
-I ever observed the thermometer was at 69&deg;;
-it stands very commonly at 72&deg; at sunrise,
-in the cool season, rising to 78&deg; or 79&deg; in the
-middle of the day. In the hot season, the
-common range is from 76&deg; to 83&deg;. It seldom
-exceeds this in the shade at sea; and
-<span class="pagenum" id="Page_30">30</span>
-the greatest height at which I ever observed
-it in the shade at land was 87&deg;. This is far
-short of the extremes of heat which they
-experience at certain seasons on the continent
-of North America, even very far north.
-In Pennsylvania and New York, the thermometer,
-I have been assured, rises frequently
-above 90&deg;. It does so commonly
-enough in the East Indies; but I believe it
-never was known to rise so high in the West
-Indies, so that the heat, comparatively speaking,
-may be called moderate and steady.</p>
-
-<p>The comparative mortality in June is
-small, owing to the fleet’s having been cleared
-of all the bad cases at Barbadoes before it
-sailed from thence. Though the proportion
-of sick in July is less, that of the mortality
-is greater, (see <a href="#TABLE_II">Table II</a>.) which seems to be
-owing to this circumstance, that the cases
-taken ill during the rainy weather of June
-did not terminate fatally till the succeeding
-month.</p>
-
-<p>In the course of this summer the fleet
-was reinforced by several ships of the line
-<span class="pagenum" id="Page_31">31</span>
-from England. The Triumph arrived in
-May, without any sick on board; but a flux
-prevailed a few weeks afterwards, without
-any evident cause, except the influence of
-the climate, and the exposure and fatigues
-during the operations of May. The disease,
-however, soon subsided, and the ship
-being kept in excellent order and discipline,
-continued healthy during all the remaining
-time in which she served with us.</p>
-
-<p>In June, the Russel, of 74 guns, arrived
-from North America, and the Shrewsbury,
-a ship of the same rate, from England.
-The former left England in 1778, but was
-obliged to put back by stress of weather and
-sickness, and upon arriving afterwards on the
-coast of America, was extremely afflicted
-both with fevers and the scurvy. These
-were removed to the hospital, and this ship
-had become free of all sickness before sailing
-for the West Indies, except that a few of the
-men were seized with fevers, and she remained
-healthy after arriving there, not suffering
-from any regular attack of sickness,
-such as affected the ships in general from
-<span class="pagenum" id="Page_32">32</span>
-Europe. The Shrewsbury left England
-healthy, but was soon attacked with a fever
-and flux, which continued to prevail till the
-end of the year.</p>
-
-<p>The fever in these two ships resembled
-rather the low ship fever of Europe than
-the bilious one peculiar to the climate.
-This last, indeed, seldom or never prevails
-to a great degree on board of a ship, unless
-it has been caught on the watering duty, or
-from some other exposure to the air of the
-land. I have, however, known a few instances
-of bilious fevers in men who never
-had been on shore from the time they left
-England; I have even known men of the
-same description attacked with intermittent
-fevers, which are supposed to depend still
-more on land air. This is perhaps owing
-either to the quantity of water in a great
-ship, part of which is always more or less
-putrid, or to the fresh-cut wood of the country
-taken on board for fuel, the steam of all
-which must resemble a good deal the effluvia
-of woods and marshes, which are supposed
-to give rise to intermittents.
-<span class="pagenum" id="Page_33">33</span></p>
-
-<p>In the beginning of July our fleet was
-reinforced with the Culloden, Egmont, and
-Centaur, all of 74 guns. In the end of the
-same month we were joined by the Alcide
-and Torbay, of the same rate, and also directly
-from England. The fleet was at this
-time at St. Christopher’s, having arrived
-there on the 22d of the month, with a large
-convoy from England, which had joined it
-at St. Lucia, under protection of the Thunderer
-and Berwick, two ships of the line,
-which being bound to Jamaica, I do not
-reckon as belonging to our fleet.
-<span class="pagenum" id="Page_34">34</span></p>
-
-<div class="table">
-<h3 id="TABLE_II">TABLE II.</h3>
-
-<blockquote>
-
-<p>Shewing the proportional Sickness and Mortality, in
-relation to the whole Numbers on board, for fourteen
-Months.</p></blockquote>
-
-<p class="table">
-<span class="trow">Transcriber’s keys:</span>
-<span class="trow">A Proportion of Sick and Wounded on board on the First of the Month.</span>
-<span class="trow">B Proportion of Sick and Wounded sent to the Hospital in the Course of the Month.</span>
-<span class="trow">C Proportion of Deaths on board in the Course of the Month.</span></p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">Months.</th>
-    <th>A</th>
-    <th>B</th>
-    <th>C</th>
-  </tr>
-  <tr>
-    <th>ONE IN</th>
-    <th>ONE IN</th>
-    <th>ONE IN</th>
-  </tr>
-  <tr>
-    <td>May, 1780</td>
-    <td class="tdr">18&frac12;</td>
-    <td class="tdr">20&frac12;</td>
-    <td class="tdr">87</td>
-  </tr>
-  <tr>
-    <td>June</td>
-    <td class="tdr">13</td>
-    <td class="tdr">68&frac12;</td>
-    <td class="tdr">418</td>
-  </tr>
-  <tr>
-    <td>July</td>
-    <td class="tdr">17&frac12;</td>
-    <td class="tdr">80</td>
-    <td class="tdr">163</td>
-  </tr>
-  <tr>
-    <td>August</td>
-    <td class="tdr">18</td>
-    <td class="tdr">227</td>
-    <td class="tdr">80</td>
-  </tr>
-  <tr>
-    <td>September</td>
-    <td class="tdr">9</td>
-    <td class="tdr">6</td>
-    <td class="tdr">188</td>
-  </tr>
-  <tr>
-    <td>October</td>
-    <td class="tdr">14</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>November</td>
-    <td class="tdr">33&frac12;</td>
-    <td class="tdr">192</td>
-    <td class="tdr">265</td>
-  </tr>
-  <tr>
-    <td>December</td>
-    <td class="tdr">16</td>
-    <td class="tdr">67</td>
-    <td class="tdr">185</td>
-  </tr>
-  <tr>
-    <td>January, 1781</td>
-    <td class="tdr">14</td>
-    <td class="tdr">60&frac12;</td>
-    <td class="tdr">316</td>
-  </tr>
-  <tr>
-    <td>February</td>
-    <td class="tdr">18</td>
-    <td class="tdr">413</td>
-    <td class="tdr">214</td>
-  </tr>
-  <tr>
-    <td>March</td>
-    <td class="tdr">15&frac12;</td>
-    <td class="tdr">30</td>
-    <td class="tdr">201</td>
-  </tr>
-  <tr>
-    <td>April</td>
-    <td class="tdr">11</td>
-    <td class="tdr">59</td>
-    <td class="tdr">169</td>
-  </tr>
-  <tr>
-    <td>May</td>
-    <td class="tdr">9&frac12;</td>
-    <td class="tdr">17</td>
-    <td class="tdr">188</td>
-  </tr>
-  <tr>
-    <td>June</td>
-    <td class="tdr">12</td>
-    <td class="tdr">40</td>
-    <td class="tdr">701</td>
-  </tr>
-  <tr>
-    <td>Mean Proportion</td>
-    <td class="tdr">15&frac12;</td>
-    <td class="tdr">93</td>
-    <td class="tdr">227</td>
-  </tr>
-</table>
-</div>
-<p><span class="pagenum" id="Page_35">35</span></p>
-
-<h2 id="BOOK_I_CHAP_II">CHAP. II.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from August,
-1780, till December following.&mdash;&mdash;The Fleet
-divided&mdash;The principal Squadron goes to North
-America&mdash;Fluctuation between Fevers and Fluxes&mdash;The
-Alcide and Torbay the most sickly Ships&mdash;Health
-mended by the Climate and Diet in North
-America&mdash;Hurricane in the West Indies&mdash;Sufferings
-in consequence of it&mdash;Fevers the chief Disease.</p></blockquote>
-
-<p>The hurricane months approaching, the
-season for active operations in the West
-Indies was now over. The whole force of
-the enemy, consisting of thirty-fix French
-and Spanish ships of the line, having gone
-to St. Domingo in the end of July, ten sail
-of the line were detached after them from
-our station, for the protection of Jamaica.
-The Admiral sailed for North America in
-August, with eleven ships of the line, leaving
-six for the protection of the islands.</p>
-
-<p>There was little alteration in the general
-state of the sick during the voyage to America,
-<span class="pagenum" id="Page_36">36</span>
-and indeed we found no diminution of
-the West-India heat, which at this season
-is at the greatest height, until we came to
-the 33&deg; of N. latitude.</p>
-
-<p>The only material alteration in point of
-health was in the Alcide and Torbay, which
-had arrived from England with a few men
-ill of fevers; but in the course of this
-voyage these two ships became as unhealthy
-as any that ever came under my observation.
-There was a greater number of sick on board
-of them than all the fleet besides, and it
-increased to such a degree, that upon their
-arrival at New York, which was in the
-middle of September, after a passage of three
-weeks, near one half of their men were unfit
-for duty. In the Alcide it was a fever that
-raged; in the Torbay it was a dysentery;
-and the unusual degree of sickness and mortality
-which appears in the Table for the
-month of September, was owing to the
-very sickly state of these two ships.</p>
-
-<div class="table">
-<h3 id="TABLE_III">TABLE III.</h3>
-
-<p>Shewing the Number of <span class="smcap">Fevers</span> and <span class="smcap">Fluxes</span> on board on the First of each Month, and the Number sent to the Hospital in the Course of the Month.</p>
-
-<p>Key:
-B On board.
-H Sent to the Hospital.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th>
-    <th colspan="4">MAY, 1780.</th>
-    <th colspan="4">JUNE.</th>
-    <th colspan="4">JULY.</th>
-  </tr>
-  <tr>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-  </tr>
-  <tr>
-    <td>Sandwich, 16th March</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">16</td>
-    <td class="tdr">19</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">5</td>
-    <td class="tdr">16</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Terrible, 16th March</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">40</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">86</td>
-    <td class="tdr">75</td>
-    <td class="tdr">3</td>
-    <td class="tdr">25</td>
-    <td class="tdr">60</td>
-    <td class="tdr">24</td>
-  </tr>
-  <tr>
-    <td>Triumph, 7th May</td>
-    <td />
-    <td class="tdr">0</td>
-    <td class="tdr"></td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">32</td>
-    <td class="tdr">17</td>
-  </tr>
-  <tr>
-    <td>Russell, 18th June</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td class="tdr">22</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury, 26th June</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide, 30th July</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Torbay, 30th July</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Monarch, 22d Nov.</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Alfred, 22d November</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th>
-    <th colspan="4">AUGUST.</th>
-    <th colspan="4">SEPTEMBER.</th>
-    <th colspan="4">OCTOBER.</th>
-  </tr>
-  <tr>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-  </tr>
-  <tr>
-    <td>Sandwich, 16th March</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">16</td>
-    <td class="tdr">4</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">5</td>
-    <td class="tdr">9</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible, 16th March</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">30</td>
-    <td class="tdr">13</td>
-    <td class="tdr">19</td>
-    <td class="tdr">12</td>
-    <td class="tdr">41</td>
-    <td class="tdr">9</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triumph, 7th May</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td colspan="4" class="tdc">continued healthy.</td>
-  </tr>
-  <tr>
-    <td>Russell, 18th June</td>
-    <td class="tdr">10</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td colspan="4" class="tdc">continued healthy.</td>
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Shrewsbury, 26th June</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td colspan="4" class="tdc">No return, the Ship being absent.</td>
-  </tr>
-  <tr>
-    <td>Alcide, 30th July</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">54</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">22</td>
-    <td class="tdr">20</td>
-    <td class="tdr">2</td>
-    <td class="tdr">59</td>
-    <td class="tdr">37</td>
-  </tr>
-  <tr>
-    <td>Torbay, 30th July</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">169</td>
-    <td class="tdr">143</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch, 22d Nov.</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Alfred, 22d November</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th>
-    <th colspan="4">NOVEMBER.</th>
-    <th colspan="4">DECEMBER.</th>
-    <th colspan="4">JANUARY, 1781.</th>
-  </tr>
-  <tr>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-    <th colspan="2">Fever.</th>
-    <th colspan="2">Flux.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-    <th>B</th>
-    <th>H</th>
-  </tr>
-  <tr>
-    <td>Sandwich, 16th March</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible, 16th March</td>
-    <td colspan="4" class="tdc">continued quite healthy.</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Triumph, 7th May</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Russell, 18th June</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Shrewsbury, 26th June</td>
-    <td colspan="4" class="tdc">No return, the Ship being absent.</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide, 30th July</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">23</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">5</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Torbay, 30th July</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">22</td>
-    <td class="tdr">30</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Monarch, 22d Nov.</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">12</td>
-    <td class="tdr">15</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Alfred, 22d November</td>
-    <td />
-    <td />
-    <td />
-    <td />
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">15</td>
-    <td class="tdr">16</td>
-    <td class="tdr">11</td>
-    <td class="tdr">8</td>
-  </tr>
-</table>
-</div>
-
-<p>We shall hereafter see reason for supposing
-that fever and dysentery proceed from the
-<span class="pagenum" id="Page_37">37</span>
-same cause; and as both these ships arrived
-from England in a similar state with regard
-to health, fevers would probably have been
-the prevailing disease in both; but a part of
-the 87th regiment, then serving as marines
-in the fleet, was put on board of the Torbay
-at St. Christopher’s, and some of them being
-ill of the dysentery, gave this turn to
-the disease which afterwards prevailed on
-board. I have formed a Table to shew the
-fluctuating state of these two diseases, and this
-was one of my first and most imperfect attempts
-towards a medical history of the
-fleet in a methodical way. (<a href="#TABLE_III">Table III</a>.)</p>
-
-<p>There was but little sickness in the rest
-of this squadron, except in the Terrible,
-where the dysentery prevailed a good deal.
-None of the ships of the line which we
-found in the West Indies, upon our arrival
-there, were now in company, except the
-Yarmouth, and this was the most healthy
-of all the ships that went to North America.</p>
-
-<p>The health of the fleet was very much recruited
-by its short stay in America; for the
-<span class="pagenum" id="Page_38">38</span>
-men were supplied with fresh meat and
-spruce beer, and they enjoyed the two finest
-months of the year in that temperate climate.
-The squadron left New York in the
-middle of November, and though dispersed
-by a violent storm, all the ships arrived safe
-in the West Indies before the middle of
-December.</p>
-
-<p>In October the fleet had attained such a
-degree of health, that though the calculation
-in the Table is made from five of the
-most sickly ships, no death happened in this
-month on board of any of them. In November
-the mortality was also inconsiderable,
-though the ships left in the West Indies are
-included in the calculation; which, had it
-been made upon those only that went to
-North America, the deaths would have been
-no more than one in seven hundred and
-eleven in this month, which is rather less
-than that of any other month in the Table.</p>
-
-<p>The amendment in health, in consequence
-of the change of climate, was most remarkable
-in the Terrible, which, by the
-<span class="pagenum" id="Page_39">39</span>
-time she left America, had entirely got rid
-of the violent dysentery that had prevailed
-for some time on board. This sudden change
-in the health of this ship was evidently
-owing to the great attention of the Captain
-to cleanliness and discipline, and no less to
-the assiduity and abilities of the Surgeon.
-The Alcide still continued sickly, though
-not so much so as the Torbay. The former
-had sailed on a cruise in October, and having
-met with very rough weather, the sick list
-was thereby increased. The dysentery now
-prevailed in that ship, as well as fevers, and
-those men chiefly were attacked with fevers
-who were ill of the scurvy, or recovering
-from it. This was not very common; and
-there were several other remarkable particulars
-with regard to the fevers in this ship;
-for her men were not only uncommonly
-subject to this disease, both in America and
-the West Indies, but to all the various forms
-of it; the low, infectious, ship fever of Europe,
-the bilious remitting, and the malignant
-yellow fever of hot climates. It would
-appear from this, as well as other instances,
-that a ship may assume, as it were, a particular
-<span class="pagenum" id="Page_40">40</span>
-constitution, or a tendency to some
-particular disease, for a length of time, and
-this depending on some lurking and adhering
-infection, or the manner in which she
-may have been victualled, watered, disciplined,
-or manned.</p>
-
-<p>The great benefit derived to the health of
-the fleet, from the change of climate, as
-well as other reasons, justified the Admiral
-in going to North America; and there was
-the more merit in this measure, as it was
-undertaken without precedent, and without
-instruction. Upon our return we found
-there was great good fortune in it, as well
-as wisdom; for there had happened on the
-10th of October a more violent hurricane
-than any in the memory of man, and the
-ravage it made both by sea and land is, perhaps,
-unparallelled in history. Several of
-the ships of the line were exposed to it; but
-though they suffered extremely, and were
-in the utmost danger, none were lost. Two
-of them happened to be at Antigua, which
-was out of the track of this hurricane, as
-it extended only from the 12th to the 15th
-<span class="pagenum" id="Page_41">41</span>
-degree of N. latitude; so that the only
-islands that suffered by it were Barbadoes,
-St. Lucia, St. Vincent, and Martinico.&mdash;Four
-frigates, and as many sloops of war,
-either foundered or were wrecked, and about
-one thousand seamen perished in them. One
-of the buildings of the hospital at Barbadoes
-was entirely demolished by the impetuosity
-of the sea, which, having risen to a great
-height, dashed a ship against it, and twenty-three
-seamen were buried in the ruins<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">3</a>.
-<span class="pagenum" id="Page_42">42</span></p>
-
-<p>The Montague suffered most on this occasion,
-and was also most subject to sickness
-and mortality, brought on in consequence
-of the great fatigue and hardships of the
-men in bringing her into port and refitting
-her; for the ship was almost torn to pieces
-both in the rigging and hull, and the bedding
-and other necessaries and conveniencies
-were entirely destroyed. The fever that
-prevailed on board at this time was of the
-most malignant kind known in this climate;
-<span class="pagenum" id="Page_43">43</span>
-and the worst cases arose in watering, and
-the other necessary duties on shore, from
-which the men would sometimes return
-frantic, and die in a few hours. There was
-a party of soldiers on board; and as they
-were not called upon to perform any duties
-<span class="pagenum" id="Page_44">44</span>
-on shore, they had but little sickness in companion
-of the sailors.</p>
-
-<p>The other ships having suffered less from
-the storm, were also less sickly, as it was
-not necessary for them to remain so long in
-the unhealthy Carenage to repair.</p>
-
-<p>The only disease that prevailed at this
-time, in these two ships, was fevers, there
-being few or no fluxes, though they had
-been so frequent in the former part of the
-year. Though fevers and fluxes depend on
-the same general causes, yet when these
-causes exist in a higher degree, it would appear
-that they are more apt to produce
-fevers. Thus the exhalations of the earth
-from marshes are more apt to produce fevers;
-and mere excesses of heat and cold,
-or moisture, are more apt to produce fluxes;
-just as in Europe a catarrh, which may be
-considered as a local febrile affection, as well
-as a dysentery, will be excited by exposure
-to cold or damp, without any specific bad
-quality in the air.
-<span class="pagenum" id="Page_45">45</span></p>
-
-<p>The Ajax and Montague are the only two
-ships of those left in the West Indies, which
-are included in the estimate of sickness and
-mortality in November and December, and
-they bear a very great proportion to the
-whole; for out of forty-four that died in
-fourteen ships of the line in November,
-twenty died in the Montague, and five in the
-Ajax; and out of forty-three, the whole
-number of deaths in December in twenty-one
-ships of the line, ten were of the
-Montague, and eleven of the Ajax.
-<span class="pagenum" id="Page_46">46</span></p>
-
-<h2 id="BOOK_I_CHAP_III">CHAP. III.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from January,
-1781, till July, 1781, both Months included.&mdash;&mdash;Arrival
-of seven Ships of the Line from England&mdash;Increase
-of Sickness in consequence of a Descent on
-St. Vincent’s&mdash;Long Cruise to windward of Martinico&mdash;Great
-Prevalence of Scurvy&mdash;Difference of
-Health in different Ships&mdash;New Ships not more unhealthy
-than others&mdash;Why Frigates are more healthy
-than Ships of the Line&mdash;Remarkable Cure of Scurvy
-in two Ships&mdash;Essence of Malt&mdash;Vegetables most
-antiscorbutic in their natural State&mdash;Advantage of
-supplying Refreshments on board of Ships in preference
-to Hospitals.</p></blockquote>
-
-<p>We are now come to that period in which
-our fleet was reinforced with seven ships of
-the line, which arrived at Barbadoes from
-England on the 5th of January, 1781,
-under the command of Lord Hood. This
-addition, with two which had arrived in
-November, made the force upon this station
-again amount to twenty-one ships of the
-line.</p>
-
-<h3 id="TABLE_IV">TABLE IV.<br />
-
-<span class="medium">Shewing the Number of each Disease on board on the First of each Month, the Numbers sent to the Hospital, and Dead, in the Course of the Month.</span></h3>
-
-<div class="table">
-<p>
-KEY:<br />
-B  On board.<br />
-H  Sent to the Hospital.<br />
-D  Dead.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th>
-    <th colspan="9">FEBRUARY, 1781.</th>
-  </tr>
-  <tr>
-    <th colspan="3">Fever.</th>
-    <th colspan="3">Flux.</th>
-    <th colspan="3">Scurvy.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th> B</th>
-    <th>H</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Barfleur</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Gibraltar</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">21</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">40</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Invincible</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">6</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Princessa</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Intrepid</td>
-    <td class="tdr">18</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">10</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Belliqueux</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Prince William</td>
-    <td class="tdr">21</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Panther</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">15</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">4</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">197</td>
-    <td class="tdr">2</td>
-    <td class="tdr">19</td>
-    <td class="tdr">158</td>
-    <td class="tdr">7</td>
-    <td class="tdr">21</td>
-    <td class="tdr">93</td>
-    <td class="tdr">19</td>
-    <td class="tdr">10</td>
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th>
-    <th colspan="9">MARCH.</th>
-  </tr>
-  <tr>
-    <th colspan="3">Fever.</th>
-    <th colspan="3">Flux.</th>
-    <th colspan="3">Scurvy.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th> B</th>
-    <th>H</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">8</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Barfleur</td>
-    <td class="tdr">28</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">35</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">27</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>* Gibraltar</td>
-    <td class="tdr">8</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">22</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">24</td>
-    <td class="tdr">18</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">50</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">5</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">3</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">56</td>
-    <td class="tdr">16</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">61</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">15</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Invincible</td>
-    <td class="tdr">6</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-  </tr>
-  <tr>
-    <td>* Princessa</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">102</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Intrepid</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Belliqueux</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">52</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Prince William</td>
-    <td class="tdr">23</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">47</td>
-    <td class="tdr">62</td>
-    <td class="tdr">5</td>
-    <td class="tdr">6</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Panther</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">3</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">174</td>
-    <td class="tdr">24</td>
-    <td class="tdr">16</td>
-    <td class="tdr">238</td>
-    <td class="tdr">67</td>
-    <td class="tdr">18</td>
-    <td class="tdr">202</td>
-    <td class="tdr">265</td>
-    <td class="tdr">27</td>
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th>
-    <th colspan="9">APRIL.</th>
-  </tr>
-  <tr>
-    <th colspan="3">Fever.</th>
-    <th colspan="3">Flux.</th>
-    <th colspan="3">Scurvy.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th> B</th>
-    <th>H</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">9</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Barfleur</td>
-    <td class="tdr">24</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">33</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Gibraltar</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">18</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">55</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">23</td>
-    <td class="tdr">27</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">26</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">116</td>
-    <td class="tdr">44</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">44</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">16</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Invincible</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">4</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">15</td>
-    <td class="tdr">4</td>
-    <td class="tdr">2</td>
-    <td class="tdr">30</td>
-    <td class="tdr">5</td>
-    <td class="tdr">10</td>
-  </tr>
-  <tr>
-    <td>* Princessa</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">40</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Intrepid</td>
-    <td class="tdr">9</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">13</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">1</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>* Belliqueux</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Prince William</td>
-    <td class="tdr">19</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">147</td>
-    <td class="tdr">40</td>
-    <td class="tdr">0</td>
-    <td class="tdr">16</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Panther</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">115</td>
-    <td class="tdr">5</td>
-    <td class="tdr">9</td>
-    <td class="tdr">317</td>
-    <td class="tdr">49</td>
-    <td class="tdr">9</td>
-    <td class="tdr">428</td>
-    <td class="tdr">115</td>
-    <td class="tdr">26</td>
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th>
-    <th colspan="9">MAY.</th>
-  </tr>
-  <tr>
-    <th colspan="3">Fever.</th>
-    <th colspan="3">Flux.</th>
-    <th colspan="3">Scurvy.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th> B</th>
-    <th>H</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">2</td>
-    <td class="tdr">2</td>
-    <td class="tdr">1</td>
-    <td class="tdr">10</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">18</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Barfleur</td>
-    <td class="tdr">12</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">16</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">54</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Gibraltar</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">30</td>
-    <td class="tdr">22</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">8</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">15</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">44</td>
-    <td class="tdr">31</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">2</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">57</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">10</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">15</td>
-    <td class="tdr">10</td>
-    <td class="tdr">1</td>
-    <td class="tdr">11</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">130</td>
-    <td class="tdr">25</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">132</td>
-    <td class="tdr">102</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">40</td>
-    <td class="tdr">35</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Invincible</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">6</td>
-    <td class="tdr">8</td>
-    <td class="tdr">4</td>
-    <td class="tdr">31</td>
-    <td class="tdr">54</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">15</td>
-    <td class="tdr">45</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">22</td>
-    <td class="tdr">6</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">4</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Princessa</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">30</td>
-    <td class="tdr">40</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Intrepid</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>* Belliqueux</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Prince William</td>
-    <td class="tdr">5</td>
-    <td class="tdr">5</td>
-    <td class="tdr">2</td>
-    <td class="tdr">53</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Panther</td>
-    <td class="tdr">3</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">76</td>
-    <td class="tdr">30</td>
-    <td class="tdr">12</td>
-    <td class="tdr">166</td>
-    <td class="tdr">39</td>
-    <td class="tdr">7</td>
-    <td class="tdr">641</td>
-    <td class="tdr">436</td>
-    <td class="tdr">22</td>
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th>
-    <th colspan="9">JUNE.</th>
-  </tr>
-  <tr>
-    <th colspan="3">Fever.</th>
-    <th colspan="3">Flux.</th>
-    <th colspan="3">Scurvy.</th>
-  </tr>
-  <tr>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th>B</th>
-    <th>H</th>
-    <th>D</th>
-    <th> B</th>
-    <th>H</th>
-    <th>D</th>
-  </tr>
-  <tr>
-    <td>Sandwich</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Barfleur</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">58</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Gibraltar</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">48</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triumph</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">15</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">16</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">4</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">36</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Terrible</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">14</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">26</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">19</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">14</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">4</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">26</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Invincible</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">22</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">84</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Shrewsbury</td>
-    <td class="tdr">3</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">4</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">20</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Princessa</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">40</td>
-    <td class="tdr">0</td>
-    <td class="tdr">70</td>
-    <td class="tdr">154</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Intrepid</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td>* Belliqueux</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Prince William</td>
-    <td class="tdr">4</td>
-    <td class="tdr">4</td>
-    <td class="tdr">2</td>
-    <td class="tdr">13</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-    <td class="tdr">8</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Panther</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Triton</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Hyena</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Cyclops</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">&sect;</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">101</td>
-    <td class="tdr">12</td>
-    <td class="tdr">6</td>
-    <td class="tdr">149</td>
-    <td class="tdr">57</td>
-    <td class="tdr">5</td>
-    <td class="tdr">480</td>
-    <td class="tdr">198</td>
-    <td class="tdr">4</td>
-  </tr>
-</table>
-
-<p>N. B. Where the Spaces are marked thus, &sect;, no Return was made.
-<span class="pagenum" id="Page_47">47</span></p>
-</div>
-
-<p>The whole fleet was tolerably healthy
-during this month, the season being dry and
-cool; there was, however, a small increase
-of sickness at this time, and it was owing
-to a descent made on St. Vincent’s in December.
-The soldiers, (of whom there was
-still a regiment on board of the fleet) the
-marines, and some of the seamen, had been
-on shore for one night only; but many of
-them having lain on the ground, some having
-been intoxicated, or having eaten to
-excess of sugar-cane and fruit, caught fevers
-and fluxes, which increased the proportion
-of diseases and deaths the following months,
-as appears by the Table.</p>
-
-<p>I have exhibited, in another Table, a view
-of the sickness and mortality of this fleet for
-the five succeeding months. (<a href="#TABLE_IV">Table IV</a>.)
-This account, as well as most of those that
-are to follow, is confined to three diseases,
-that may be called the sea epidemics. These
-are, fever, flux, and scurvy.</p>
-
-<p>The whole fleet met at Barbadoes on the
-13th of January, and no service was undertaken
-<span class="pagenum" id="Page_48">48</span>
-till the accounts of the Dutch war
-arrived on the 30th of that month. In consequence
-of this intelligence, the greater
-part of the ships of war went against St.
-Eustatius, which was taken on the 3d of
-February.</p>
-
-<p>Ten days after this a squadron of seventeen
-ships of the line was sent to cruise to
-windward of Martinico, with a view to intercept
-a French squadron which was then
-said to be on its passage from Europe. The
-cruise was there continued for six weeks;
-after which small divisions of the ships were
-sent to water and refit, by turns, at St.
-Lucia, and were relieved by the ships left
-for the protection of that island.</p>
-
-<p>Soon after this, the whole squadron came
-to leeward of Martinico; and though the
-former intelligence had proved false, the
-greater part of our fleet still kept the sea, in
-order to block up the enemy in Fort-Royal
-Bay. This they continued to do till the
-29th of April, when a French fleet of
-twenty-two ships of the line, from Europe,
-<span class="pagenum" id="Page_49">49</span>
-joined by four from Martinico, forced their
-way into their own port, pushing to leeward
-our fleet, consisting only of eighteen ships of
-the line; so that the greater part of them did
-not get into port till they came to an anchor
-at Barbadoes on the 23d of May.</p>
-
-<p>It was in this season of cruising, and
-keeping the sea, that the fleet contracted
-such a degree of scurvy as had never before
-been known in the West Indies. This disease
-is not so apt to arise in a hot climate as
-in a cold one; and the prevalence of it on
-this occasion was owing to the men having
-been for a great length of time upon sea
-victualling; for one part of the fleet had not
-had a fresh meal from the time of leaving
-America, that is, for six months; and that
-part of it which came last from England had
-been in the same circumstances for seven
-months; nor had any of them been in a
-place capable of supplying vegetable refreshments
-from the time they left Barbadoes in
-the end of January. But though no fresh
-meat or vegetables could be procured at St.
-Lucia or St. Eustatius, yet the scurvy did
-<span class="pagenum" id="Page_50">50</span>
-not make such progress in the ships that lay
-at anchor there, as in those that were at sea;
-and it appears that the time in which it
-prevailed most was, while the greatest number
-of ships was at sea, that is, in the month
-of March. It appears, indeed, by the Table,
-that there was a greater number ill of this
-complaint on the 1st of May than on the 1st
-of April; but it appears also, that more were
-sent to the hospital in March than in April,
-and very near half of the May list must
-have been taken ill in March<a id="FNanchor_4" href="#Footnote_4" class="fnanchor">4</a>. The difference
-of being in port and at sea consists
-chiefly, 1st, In there being plenty of water
-while in port, so that it can be used freely,
-not only to drink, but to wash the clothes;
-and we know that cleanliness tends greatly
-to ward off the scurvy. 2dly, Though no
-fresh meat nor vegetables could be procured
-at those ports, sugar, which may be considered
-as a very antiscorbutic article of diet,
-<span class="pagenum" id="Page_51">51</span>
-could always be procured at a very cheap
-rate, and the seamen, when in port, used to
-exchange their salt provisions for it. 3dly,
-There is at sea a dismal uniformity of life,
-favourable to indolence and sadness, and
-therefore tending to hasten the progress and
-aggravate the symptoms of the scurvy;
-whereas the change of scene and variety of
-objects, when in port, tend to cheer and recreate
-the mind, and thereby to avert this
-disease.</p>
-
-<p>The squadron that came from England
-under Lord Hood, suffered, upon the whole,
-much less from acute diseases, during the
-first months of their service in this climate,
-than the ships that arrived with Lord Rodney,
-which was probably owing, in part at
-least, to the former having arrived at the
-driest and coolest season of the year. The
-Barfleur, however, had a large proportion of
-all the three prevailing diseases; and large
-ships are in general more subject to them
-than those of a smaller rate. But of all the
-ships in the fleet, the Alfred had the greatest
-proportion of the three sea epidemics. The
-<span class="pagenum" id="Page_52">52</span>
-Prince William suffered more than any other
-ship in the fleet from the flux, and the
-Princessa from the scurvy. In some instances,
-reasons can be assigned for the prevalence
-of particular diseases in particular
-ships, such as accidental infection, or the
-manner in which they have been victualled,
-manned, or disciplined; but in many cases
-the cause is so subtile or obscure as to elude
-our inquiry.</p>
-
-<p>The most healthy of the new squadron,
-during this campaign, were the Belliqueux
-and Panther; the former was a new ship,
-and came from England with a very irregular
-and ill-disciplined crew. Soon after arriving
-in the climate, she was threatened with a
-dysentery, which, though it spread a good
-deal, did not prove severe nor mortal; but
-being left at St. Eustatius on this account,
-while the rest of the fleet was cruising, she
-soon became very healthy, and remained so.
-This is the second instance we have had
-occasion to remark of a new ship being
-healthy.
-<span class="pagenum" id="Page_53">53</span></p>
-
-<p>The Panther preserved her health by
-being on small separate cruises, and frequently
-in port, not being attached to the
-main squadron. The Sandwich was the
-only other ship not engaged in the long
-cruise.</p>
-
-<p>Of the ships lately from England, that
-were employed in this cruise, the Gibraltar
-seems to have been the least sickly. This
-ship left England healthy; but having received
-a draft of dirty men when upon the
-eve of sailing, a fever of the infectious kind
-broke out on the passage, so that she arrived
-in the West Indies in a sickly state. This
-fever disappeared very soon after; and it is
-proved by this, as well as other facts, that
-a warm climate, so far from tending to generate,
-or even to foster the infection of
-fever, tends rather to extinguish it. The
-Gibraltar had been put under excellent discipline
-by her former commander, while in
-the Channel service; and this being afterwards
-kept up, the men were always clean
-and regular. This was the Spanish Admiral’s
-ship, taken by the fleet under the
-<span class="pagenum" id="Page_54">54</span>
-command of Lord Rodney off Cape St.
-Vincent’s, in January 1780. She was then
-called the Phœnix, and was of a singular
-excellence both with respect to materials
-and construction. Whether the cedar, of
-which a great part of her timbers consisted,
-contributed to the healthiness, by its balsamic
-effluvia, I will not pretend to determine.</p>
-
-<p>The Invincible was also uncommonly
-healthy during this cruise, which may likewise
-be ascribed to good discipline, and to
-her having been more than three years in
-commission before sailing from England,
-whereby the men were brought into order,
-and accustomed to each other and to a sea
-life. This ship was almost singular in having
-no acute diseases for several months
-after arriving from Europe; but at length
-paid the tribute to the climate in May and
-June, as may be seen in the Table.</p>
-
-<p>From the account of the three frigates
-at the bottom of the list in the Table, it
-appears how much more healthy they are
-than ships of the line. The total complements
-<span class="pagenum" id="Page_55">55</span>
-of the three is exactly equal to that
-of one seventy-four-gun ship; but their
-whole sickness and mortality is less than
-that of any one ship of the line of that class,
-although the Triton was uncommonly sickly
-for a frigate.</p>
-
-<p>There seem to be several causes for the
-superior degree of health usually enjoyed
-by this smaller class of ships. There is less
-chance of mixtures of men in frigates, as
-their complement is smaller, and it is more
-easy for the captain and officers to keep an
-eye over a few men than a great number;
-for, in a great ship, there are generally men,
-who, concealing themselves in the most retired
-parts, no one takes cognizance of
-them, and they destroy themselves, and
-infect others, by their laziness and filth.
-In the next place, there is a greater proportion
-of volunteers and real seamen in frigates,
-and more landmen and pressed men
-in ships of the line, the former being more
-in request, on account of the greater chance
-of prize money. Lastly, a small ship is
-more easily ventilated, and the mass of foul
-<span class="pagenum" id="Page_56">56</span>
-air issuing from the hold, from the victuals,
-water, and other stores, as well as the effluvia
-exhaling from the men’s bodies, is less than
-in a large ship.</p>
-
-<p>Many other and more minute remarks
-might be made on different ships in this
-season of hard service; but to do this would
-be tedious, and the inspection of the Tables
-may suggest observations to the reader.
-There is a striking and instructive fact,
-however, with regard to two ships, which
-I cannot help relating. The Alcide and
-Invincible, both of seventy-four guns, in
-working to windward, after the action with
-the French fleet, on the 29th of April, anchored
-at Montserrat on the 11th of May,
-in order to water. They remained there
-only part of two days, and they procured
-no refreshment, except a few bushels of
-limes. The scurvy then prevailed to a great
-degree in both ships; but between this time
-and the 23d of May, when they came to an
-anchor at Barbadoes, sixty men, who had
-been confined with this disease, were discharged,
-as fit for duty, from the sick list of
-<span class="pagenum" id="Page_57">57</span>
-the Invincible, and a hundred and fourteen
-from that of the Alcide. These were the
-only two ships that had the advantage of the
-limes; and during these twelve remaining
-days of the voyage the scurvy continued to
-increase in all the other ships. Dr. Lind is
-the first author who gives a decided preference
-to lemons, limes, and oranges, over every
-other antiscorbutic; and the above-mentioned
-fact proves as demonstrably as possible the infinite
-advantage of this species of acid in
-scurvy.</p>
-
-<p>The fleet was supplied with essence of
-malt during all this campaign; and though
-it was, no doubt, of service, it was far from
-having that powerful and manifest effect
-that the acid fruits had, and certainly did
-by no means prevent the scurvy in all cases.
-I have strong testimonies, however, of its
-beneficial effects from the surgeons of several
-of the ships, particularly of the Gibraltar,
-Centaur, Torbay, and Alcide, in all of which
-it was found either to cure the scurvy in its
-first beginning, to retard its progress, or to
-<span class="pagenum" id="Page_58">58</span>
-mend the appearance of scorbutic ulcers, and
-dispose them to heal.</p>
-
-<p>I had conceived that melasses, being a
-vegetable sweet, must have been a very
-powerful antiscorbutic; but the greatest part
-of the last reinforcement of seven ships
-came from England furnished with this as
-an article of victualling, as a substitute for a
-certain proportion of oatmeal, which was
-withheld agreeably to a late very judicious
-order of the Admiralty. But though I am
-persuaded that this article of diet mitigated
-the disease, it was very far from preventing
-it; and the Princessa in particular, which
-suffered most from the scurvy, was well
-supplied with it.</p>
-
-<p>There is reason to think that it is not in
-the vegetable sweet alone that the antiscorbutic
-principle resides, but in this in conjunction
-with the natural mucilage, such as
-exists in the malt. I suspect likewise that
-the change which the essence undergoes in
-its preparation tends also to rob it of some
-of its original virtue. But the melasses are
-<span class="pagenum" id="Page_59">59</span>
-still farther altered by being deprived of the
-natural mucilage by means of quick lime,
-with which all sugar is clarified in the boilers.
-Dr. Hendy, of Barbadoes, to whom I have
-been obliged for several remarks, informed
-me, that the liquor, before it undergoes this
-operation, has been found by him to produce
-the most salutary effects in the scurvy; but
-as this cannot be had at sea, we had no opportunity
-of comparing it with other antiscorbutics.
-It is certain also that the medical
-effects of the native sweet juices are,
-in other respects, very different from what
-they are in their refined state; for manna,
-wort, and the native juice of the sugar cane,
-are purgative; whereas sugar itself is not at
-all so<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">5</a>. This affords a presumption, that they
-may be also different in their antiscorbutic
-quality; and there is reason to think, from
-<span class="pagenum" id="Page_60">60</span>
-experience, that the more natural the state in
-which any vegetable is, the greater is its
-antiscorbutic quality. Vegetables, in the
-form of sallads, are more powerful than
-when prepared by fire; and I know, for
-certain, that the rob of lemons and oranges
-is not to be compared to the fresh fruit.
-Raw potatoes have been used with advantage
-in the fleet, particularly by Mr. Smith, of
-the Triton, who made the scorbutic men eat
-them, sliced with vinegar, with great benefit.
-This accords also with what Dr.
-Mertans, of Vienna, has lately communicated
-to the Royal Society of London.</p>
-
-<p>When the fleet arrived at Barbadoes on
-the 23d of May, it was found that the number
-of sick on board amounted to sixteen hundred,
-and that there was not accommodation for
-more than two hundred at the hospital. As
-<span class="pagenum" id="Page_61">61</span>
-there was hardly any complaint but scurvy,
-the Admiral, at my representation, issued an
-order for serving the sick on board of their
-own ships with fruit and other vegetables
-and refreshments, such as milk and soft
-bread. This course of diet commenced in
-the beginning of June; and as the greater
-part of the fleet was near four weeks thereafter
-in port, they enjoyed the advantages of
-it during that time; and the very great diminution
-of sickness and mortality, which
-appears by the Tables in that month, sufficiently
-evinces the benefit derived from it.
-In less than four weeks the fleet, from being
-very sickly, became extremely healthy.</p>
-
-<p>It was remarked, that the men recovered
-faster on board than on shore; and it would
-appear that land air, merely as such, has no
-share in the cure of the scurvy, and that the
-benefit arises from the concomitant diet,
-cleanliness, and recreation. The expedient
-of curing men on board of their ships was
-here suggested by necessity; but it succeeded
-so well, that it was adopted afterwards in
-preference to an hospital, which is indeed a
-<span class="pagenum" id="Page_62">62</span>
-useful relief to a fleet where there are contagious,
-acute disorders; but with regard to
-scurvy, I am convinced, that on foreign stations,
-at least, where the accommodations of
-the sick are more indifferent than in England,
-many advantages would arise from supplying
-men with refreshments on board of their
-ships. It appears that only four men died of
-this disease in the whole fleet in the month
-of June, though there were so many ill of
-it; whereas it appears by the books of hospitals,
-that scorbutic men die there in a
-much greater proportion, and chiefly in consequence
-of other diseases, particularly the
-flux, which they catch by infection, or bring
-on by intemperance. It is farther in favour
-of this scheme, that great numbers of those
-sent on shore are lost by desertion. It is also
-a great saving to Government, the expence
-not being a fourth part of what it would
-cost at an hospital.</p>
-
-<p>The fleet left Barbadoes on the 10th and
-12th of July, and continued healthy till the
-greater part of it sailed for North America
-in the beginning of August.
-<span class="pagenum" id="Page_63">63</span></p>
-
-<h2 class="ph1" id="PART_I_BOOK_II">PART I.<br />
-
-<span id="BOOK_II" class="x-large">BOOK II.</span></h2>
-
-<blockquote>
-
-<p>Continuation of the <span class="smcap">Medical History</span> of
-the <span class="smcap">Fleet</span>, from August, 1781, till the
-Conclusion of the War in April, 1783.</p></blockquote>
-
-<h2 id="BOOK_II_CHAP_I">CHAP. I.</h2>
-
-<blockquote>
-
-<p>Some Account of the Interval between the Campaign
-of 1781 and the Junction of the Reinforcement from
-England in April, 1782.&mdash;&mdash;The main Body of
-the Fleet goes to North America&mdash;Lord Rodney goes
-to England, and returns to the West Indies with
-twelve Ships of the Line&mdash;Health of the Fleet in
-England&mdash;Sickness most prevalent in the Beginning
-of a War&mdash;A natural Tendency to Recovery in
-Ships and Individuals&mdash;Advantages of this Squadron
-in point of Victualling.</p></blockquote>
-
-<p>When the main body of the fleet went
-to America in August, Lord Rodney went to
-England for the recovery of his health.&mdash;Wishing
-<span class="pagenum" id="Page_64">64</span>
-to lay before the public boards several
-reforms that suggested themselves to
-me in the course of the late service, I accompanied
-the Admiral, purposing to return
-when the season for hostile operations should
-have brought back the fleet from the coast
-of America.</p>
-
-<p>Soon after arriving in England, I presented
-a memorial<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">6</a> to the Board of Admiralty,
-proposing such means for the preservation of
-the health of the fleet as had occurred to
-me during my past service.</p>
-
-<p>The Board of Admiralty considered this
-memorial with all the attention that could
-be expected in the general hurry of service,
-inseparable from a great and extensive war;
-and I am happy in being able to say, that,
-in consequence of my application, most of
-the particulars recommended have since been
-so far carried into effect as to produce a
-practical conviction of their utility.
-<span class="pagenum" id="Page_65">65</span></p>
-
-<p>Lord Rodney having recovered his health,
-hurried out to his station with all the force
-that could then be equipped, as the enemy
-were expected at the Caribbee Islands, with
-a superior force, after their successes against
-us in the autumn campaign in America.</p>
-
-<p>I had again the honour to accompany the
-Admiral. He first sailed from Portsmouth,
-with four ships of the line, on the 14th of
-December, and was to have been joined by
-two more that lay ready at Plymouth; but
-by the time we arrived off this harbour the
-wind became contrary, whereby we were
-detained there till the 14th of January,
-1782. During this time more ships were
-got ready, and six were added to the squadron;
-for the public anxiety at that time
-called forth every exertion to strengthen this
-reinforcement, upon which the fate of the
-whole West Indies was supposed to depend.</p>
-
-<p>This fleet cleared the Channel in the midst
-of a storm, and with the wind at the same
-time so scanty, that we barely weathered
-Ushant; but Lord Rodney’s perseverance
-<span class="pagenum" id="Page_66">66</span>
-and resolution, stimulated by the exigency
-of the occasion, banished all hesitation and
-timidity. The rough weather, and contrary
-winds, continued through the variable latitudes;
-but having met with fresh blowing
-trade winds, common at that season, we
-had the good fortune to get safe to Barbadoes
-with the whole squadron on the 19th of
-February.</p>
-
-<p>All the twelve ships<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">7</a> of this reinforcement
-had been on service for a considerable
-length of time since they had been last commissioned,
-except the Anson, a new ship,
-which had never before been at sea, and the
-Fame and Yarmouth, which had lately undergone
-a thorough repair, since which time
-they had been only for a few weeks at sea in
-the Channel before they were ordered on this
-expedition.</p>
-
-<p>The only ship that was sickly when we
-left England was the Fame, on board of
-<span class="pagenum" id="Page_67">67</span>
-which some pressed men, with the infection
-about them, had been received from the
-Conquestadore guardship; and the fever
-which broke out in Plymouth Sound, where
-I was first sent for to visit that ship, was
-probably owing to the infection which these
-men brought with them. The other ships
-were, upon the whole, healthy; for it appeared
-by the weekly accounts delivered to
-the Admiral, that the mortality, including
-even that of the Fame, for the four weeks
-before we sailed, had been only one in thirteen
-hundred, and that there had been about
-one in twenty-nine on the sick list.</p>
-
-<p>An opportunity offered on this occasion of
-comparing the health of ships of war in
-England with that in the West Indies.
-The health of the fleet in general at home
-was at this time about the proportion above
-mentioned; but it is to be remarked, that it
-was healthier then than in the former part of
-the war.</p>
-
-<p>Plymouth hospital, which is calculated
-for twelve hundred men, was not half full;
-<span class="pagenum" id="Page_68">68</span>
-and there were not at this time more than
-six hundred men at that of Haslar, which is
-calculated to contain two thousand; but the
-latter was generally full during the first two
-or three years of the war, from the great
-fleets that put into Portsmouth. At one
-time part of the sick were even obliged to
-be accommodated with tents in the neighbourhood
-of the hospital, for want of room.
-But towards the end of the year 1781 the
-infectious fever, which constitutes a great
-part of the sickness in the European seas,
-was almost extirpated, and in a cruise of
-five weeks in the north part of the Bay of
-Biscay, under Admiral Darby, in September
-and October of this year, only six men were
-buried in that time from twenty-eight ships
-of the line.</p>
-
-<p>This was chiefly owing, as I apprehend,
-to the length of time which the war had
-continued, in consequence of which the
-men of the respective ship’s companies had
-been accustomed to each other, and habituated
-to the mode of life peculiar to a man
-of war, regulating themselves according to
-<span class="pagenum" id="Page_69">69</span>
-certain rules of good order and cleanliness.
-The causes of the fever above mentioned,
-as shall be more fully illustrated hereafter,
-are chiefly connected with the circumstances
-occurring in the beginning of a war, when
-men of all descriptions are mixed, without
-proper precautions being taken to guard
-against the infection imported from jails or
-guardships. The sickness in the French
-fleet was still greater in the beginning of
-the war than in the British; and this has
-been the case in all the wars of this century.
-In the fleet commanded by the Comte d’Orvilliers,
-in 1779, the sickness was so great
-as to disable many of the ships from service,
-and great numbers of men were landed at
-Brest, with a fever so malignant as to infect
-the inhabitants of the town and country
-adjacent. I believe, besides, that the general
-health prevailing at this time in the fleet in
-England, was, in part, owing to the sour
-crout and melasses, which were now supplied
-more amply than had ever been done before.
-The entire exemption from scurvy in particular
-is to be ascribed to these improvements
-in diet.
-<span class="pagenum" id="Page_70">70</span></p>
-
-<p>There is a tendency in acute diseases to
-wear themselves out, both in individuals
-that labour under them, and when the infection
-is introduced into a community.
-Unless there was such a <i>vis medicatrix</i>, there
-could be no end to the fatality of these
-distempers; for the infectious matter would
-go on multiplying itself without end, and
-would necessarily destroy every person who
-might be actually attacked, and would infect
-every person who might be exposed to it.
-But animal nature is so constituted, that this
-poison, after exciting a certain set of motions
-in the body, loses its effect, and recovery
-takes place; and those who happen
-not to be infected at first, become in some
-measure callous to its impression, by being
-habitually exposed to it. There is, therefore,
-a natural proneness to recovery, as
-well with regard to that indisposition which
-takes place among a set of men living together,
-as with regard to a single individual
-who actually labours under the disease.
-Thus the most prevailing period of sickness
-is when men are new to their situation and
-<span class="pagenum" id="Page_71">71</span>
-to each other, so that time of itself may
-prove the means of prevention as well as
-of cure.</p>
-
-<p>This consideration, however, ought not to
-supersede any part of our attention with regard
-to the scurvy, which does not become
-spontaneously extinct like acute diseases.</p>
-
-<p>During the three first weeks of this passage
-from England to the West Indies, there
-was wet and boisterous weather, but it had
-very little effect in augmenting sickness;
-and though it not only subjected the men to
-fatigue, cold, and damp, but prevented the
-ships from opening their lower-deck ports
-till the 2d of February, between the 31st
-and 32d degree of latitude, thereby producing
-close air and moisture where the
-men sleep, yet, in the whole squadron, from
-its leaving England till this time, there were
-only seven deaths, four of which were in
-the Fame.</p>
-
-<p>The only sea epidemic that made its appearance
-was the infectious ship fever,
-<span class="pagenum" id="Page_72">72</span>
-which, in many cases, was attended with
-pleuritic, rheumatic, and other inflammatory
-symptoms, owing to the cold and wet, to
-which the men were exposed in the variable
-latitudes. The warm, dry, fresh breezes
-which we had during the remainder of the
-passage, were probably what prevented any
-bad consequences from the former hardships,
-for there died only four men from the above-mentioned
-date till we arrived at Barbadoes;
-and it appeared by the Admiral’s weekly
-account, that the proportion of the sick
-neither increased nor diminished from the
-time we got into a warm climate and fine
-weather till our arrival on the 19th of
-February.</p>
-
-<p>This squadron left England with several
-advantages in point of victualling, which no
-ships had before enjoyed. They were amply
-supplied with sour crout and melasses; they
-had all more or less wine, of an excellent
-quality; and the Formidable had an entire
-supply of it, in place of spirits, of which
-none was put on board. This slip had hitherto,
-<span class="pagenum" id="Page_73">73</span>
-and did for some months afterwards,
-enjoy an extraordinary, perhaps an unparallelled,
-degree of health. What farther contributed
-to the health of this ship was,
-that she had been long in commission, and
-most of the recruits with which the crew
-had been completed were men turned over
-from other ships. There was also extraordinary
-medical attention paid, particularly
-in watching the first beginnings of complaints.</p>
-
-<p>Upon the arrival of the squadron at Barbadoes,
-it was found, that, the two hostile
-fleets having returned from North America
-in the beginning of December, the campaign
-had opened with the siege of St.
-Christopher’s, which had been invested by
-twenty-eight ships of the line, and a considerable
-army. Our fleet, under Lord Hood,
-having attempted, with great enterprise and
-skill, but without success, to relieve it,
-Lord Rodney made haste to join them with
-the reinforcement he had brought from
-England. He remained at anchor at Barbadoes
-<span class="pagenum" id="Page_74">74</span>
-only one night, and in a few days
-came off Antigua, where he was informed
-of the surrender of St. Christopher’s; and
-here, on the 25th of February, he was
-joined by the rest of the fleet in their return
-to windward.
-<span class="pagenum" id="Page_75">75</span></p>
-
-<h2 id="BOOK_II_CHAP_II">CHAP. II.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from the Junction
-of the Squadron from England, till the general
-Rendezvous at St. Lucia in the Beginning of April.&mdash;&mdash;The
-Fleet found on the Station very healthy&mdash;Health
-of the Ships from the American Station&mdash;Health
-of the Ships from England compared with
-that of the Ships found on the Station&mdash;Small-pox
-prevalent&mdash;Instance of the remarkable Efficacy of
-Lemon Juice in curing the Scurvy&mdash;Additional Reinforcement
-from England&mdash;Watering Duty dangerous
-and unhealthy&mdash;The most healthy Ships those
-that had been longest in the Climate&mdash;List of the
-Numbers taken ill of each Complaint in March&mdash;Inflammation
-of the Liver not common in the West
-Indies.</p></blockquote>
-
-<p>The fleet which was found in the West
-Indies consisted of all the sixteen that went
-from thence to America in August, 1781,
-(except the Terrible, which had been lost)
-together with six ships of the line<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">8</a> from the
-<span class="pagenum" id="Page_76">76</span>
-American station, the St. Albans, which arrived
-from England in November, and the
-Russel, which had remained in the West
-Indies during the hurricane months. They
-were all extremely healthy, having only
-one man in twenty-eight on the sick list,
-and very few had been sent to hospitals.</p>
-
-<p>This fleet, after arriving from America,
-had lain at anchor for three weeks at Barbadoes,
-where it had the advantage of the
-vegetable refreshments which that island
-affords; but during three weeks that it lay
-at anchor, in the face of the enemy, at St.
-Christopher’s, the men were excluded from
-all communication with the shore, and had
-no vegetable food, except some yams, with
-which they were supplied from Antigua, in
-place of biscuit, of which there was at this
-time a scarcity. These ships had therefore
-been in no port for six weeks, except for a
-few days that they lay in the road of Antigua
-refitting, and putting the sick and
-wounded on shore.
-<span class="pagenum" id="Page_77">77</span></p>
-
-<p>The men had also been deprived of their
-natural rest, and exposed to the air during all
-the time that the fleet was at anchor before
-St. Christopher’s; for they had been twice
-attacked by the enemy in that situation,
-and were therefore under the necessity of
-keeping the ships constantly clear for action;
-yet no increase of sickness followed. This
-might partly be owing to the eagerness and
-alacrity of spirits naturally excited in such
-a situation, and also to the fleet not lying
-under the lee of any land, and having springs
-upon their cables, so that they had all the
-perflation and all the purity of air which
-ships enjoy when at sea. The fumigation
-which ships undergo in battle, has also
-been thought to contribute to their health.</p>
-
-<p>To whatever cause it was owing, the fleet
-we found in the West Indies was at this
-time healthier than that which had just come
-from England; and there was but little difference
-in the degree of health of the different
-ships that composed it. Of those which
-left the West Indies in August, and returned
-in December, the only one that could be
-<span class="pagenum" id="Page_78">78</span>
-said to have any epidemic disease was the
-Prince William, which had never got entirely
-free from the dysentery that was formerly
-mentioned as prevailing so much on
-board of this ship last year. The disease
-was kept up, by the ship never having been
-cleared of the men affected with it, and by
-the crew in general being ill provided with
-slops<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">9</a>, a circumstance that would render
-them more susceptible of whatever infection
-they might be exposed to.</p>
-
-<p>There were also some remains of the same
-disease in the Intrepid, the seeds of it having
-been more or less continued from the summer
-of 1780, at which time it prevailed to
-a most violent degree. The Alfred had a
-few of all the sea epidemics, and had been
-for a long time before more or less in the
-same situation, from a neglect of cleanliness,
-particularly of the men’s persons.</p>
-
-<p>The only ship in which there was any
-thing like an epidemic was the Canada,
-<span class="pagenum" id="Page_79">79</span>
-This ship, when at home, had for many
-months before she sailed been in unremitting
-service, and very little in port. On the passage
-from England to America, in August,
-1781, there broke out a severe dysentery,
-to which the scorbutic habit of the men,
-from being so long at sea, probably predisposed
-them. Though it had abated much
-in February, 1782, it was then by no means
-extinct, and continued till April. The
-Prince George had been in commission all
-the war, and was a model of discipline and
-cleanliness, and consequently of health. This
-continued till the passage from America,
-when, upon the first cold weather after leaving
-New York, there broke out a violent
-dysentery, of which sixteen men died. This
-is agreeable to what Dr. Lind observes, that
-the flux may be brought on by a sudden
-transition, either from cold to heat, or from
-heat to cold. All the men that were ill of
-this disease having been sent to the hospital
-at Barbadoes, and the usual attention to
-cleanliness having been kept up, the disease
-entirely vanished.
-<span class="pagenum" id="Page_80">80</span></p>
-
-<p>All the other ships of the American station
-had been more or less visited with sickness
-after they left England, except the Bedford.
-This was probably owing to this ship having
-been longer in commission than any of the
-others, that is, for four years, and all that
-time under the same commander. This last
-circumstance falls to the lot of few ships;
-but a great advantage attends it; for the
-mutual knowledge and attachment of the
-captain and ship’s company is naturally
-productive of regularity and good discipline,
-and thereby of health.</p>
-
-<p>The Royal Oak, Prudent, and America,
-which left England with the Bedford,
-though they had been afflicted with the
-scurvy and other complaints soon after arriving
-in America, had been quite healthy
-for some time before coming to the West
-Indies, and were so much so at this period,
-that, though there were a few sores and
-slight complaints on their sick lists, there
-was not a man confined with illness, so as
-properly to be called sick. The Royal Oak,
-having been the flag ship of Admiral Arbuthnot,
-<span class="pagenum" id="Page_81">81</span>
-was manned with choice seamen,
-which is a circumstance generally conducive
-to health; for these being accustomed to a
-sea life, are more provident, more handy
-and methodical in all that relates to diet,
-cloathing, and cleanliness. The scurvy,
-which infected her upon first arriving in
-America, was successfully treated on board
-by serving to those who were ill of it a
-mess, composed of soft bread, baked on
-purpose, and mixed with wine and essence
-of malt.</p>
-
-<p>The Prudent, though now quite healthy,
-had been sickly soon after being put into
-commission in Europe, and upon first arriving
-in America. She had been uncommonly
-sickly, when a new ship, upon her
-first voyage, which was to the East Indies,
-during the peace. This remarkable degree
-of sickness was probably owing to a particular
-experiment that was made in preparing
-the wood of which she was built. This
-experiment consisted in soaking the timber
-for a length of time in a strong pickle, in
-order to make it less corruptible. The only
-<span class="pagenum" id="Page_82">82</span>
-other ship on which the trial of this was
-made was the Intrepid; and it has been already
-mentioned that this was an extremely
-sickly ship. The effect of it upon the wood
-was to cause a constant moisture and mouldiness
-in the orlops and holds. In the Intrepid,
-the sickness was never conquered till
-a practice was followed of pumping and
-bailing her with great care, and putting a
-fire into the well for six hours every day,
-by which means the dampness, and the
-mildew produced by it, were removed and
-prevented, and the ship thereby rendered
-healthy.</p>
-
-<p>The two squadrons being united, and
-consisting of thirty-four ships of the line,
-proceeded to St. Lucia, where they arrived
-on the 1st of March.</p>
-
-<p>I received monthly returns as formerly,
-and the form of them was improved by
-adding a column for the numbers taken ill
-of the several diseases in the course of the
-month. The returns of February are not
-complete, there being none for the 1st of
-<span class="pagenum" id="Page_83">83</span>
-that month, as we had not then arrived;
-but as the returns of the 1st of March have
-relation to the preceding month, a judgement
-may be formed of the sickness and
-mortality of February from the following
-table:</p>
-
-<h3><span class="smcap">Extract</span> from the <span class="smcap">Returns</span> of the
-1st of March, 1782.</h3>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Put on the<br />Sick List<br />last Month.</th>
-    <th>Died last<br />Month.</th>
-    <th>Sent to the<br />Hospital<br />last Month.</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">53</td>
-    <td class="tdr">15</td>
-    <td class="tdr">9</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">263</td>
-    <td class="tdr">67</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">121</td>
-    <td class="tdr">2</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">618</td>
-    <td class="tdr">25</td>
-    <td class="tdr">59</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">1555</td>
-    <td class="tdr">109</td>
-    <td class="tdr">73</td>
-  </tr>
-</table>
-
-<p>This account is abstracted from the returns
-of twenty-nine ships of the line, and
-two frigates.
-<span class="pagenum" id="Page_84">84</span></p>
-
-<p>The diseases and deaths under the head of
-“Other Complaints,” is much more numerous
-in this month than usual, which is
-chiefly owing to the preceding actions with
-the enemy, and to the prevalence of the
-small pox. Of the deaths under this head,
-seventeen were in consequence of wounds,
-six from small pox, one from a mortification<a id="FNanchor_10" href="#Footnote_10" class="fnanchor">10</a>
-in the shoulder, and one from consumption.</p>
-
-<p>None of the epidemics affected one part
-of the squadron more than another, except
-that the ships last from England had a less
-proportion of the flux than the rest; and
-the few cases of this disease that were in
-these ships arose after their arrival in the
-climate. The Conqueror and Fame, which
-<span class="pagenum" id="Page_85">85</span>
-were the two most sickly ships, had no
-complaints but fevers.</p>
-
-<p>The fevers had now begun to take on
-some of the characteristic symptoms of the
-climate; the chief of which is a greater
-abundance of bile. In the Repulse, two
-men had the yellow colour of the skin,
-which is so peculiar to the fevers of this
-climate.</p>
-
-<p>The crew of the Anson caught an infectious
-fever from a guardship in England;
-and when the Proth&eacute;e sailed, there was a
-fever of the same kind on board; but from
-the change of climate, the symptoms became
-milder, and the disease disappeared
-in both these ships in the course of this
-month.</p>
-
-<p>The small pox prevailed more at this
-time in the fleet than I have ever known
-it to do either before or since, and that
-both in the squadron from England and in
-that from North America. There were six
-cases in the Formidable, all of which did
-<span class="pagenum" id="Page_86">86</span>
-well, though two were of the confluent
-kind.</p>
-
-<p>Though there needs hardly any additional
-proof of the extraordinary efficacy of lemon
-juice in curing the scurvy, yet it may be of
-service to impress so useful a truth on the
-mind by mentioning such striking proofs of
-it as occurred from time to time. The Arrogant
-spoke with a Portuguese vessel near
-Madeira, from which some of this fruit was
-procured, and the only scorbutic man on
-board happening to have some of the most
-desperate symptoms, such as putrid gums,
-contracted hams, the calves of the leg hard
-and livid, and frequent faintings, a fair opportunity
-offered for trying its virtues.
-The man was allowed two of them daily,
-and was perfectly well in sixteen days, during
-all which time the ship was at sea, so
-that it was impossible to ascribe the cure to
-any other cause.</p>
-
-<p>The fleet remained at St. Lucia from the
-1st till the 18th of March, completing the
-water, provisions and stores, landing the sick
-<span class="pagenum" id="Page_87">87</span>
-at the hospital, and also watching the motions
-of the enemy, who arrived about the
-same time at Martinico from the siege of
-St. Christopher’s. During this time we
-were reinforced with the Duke, of 90 guns,
-and the Warrior and Valiant, of 74 guns,
-from England. On the 18th the whole
-fleet, except the Invincible, which was detached
-with a convoy to Jamaica, sailed on
-a cruise to windward of Martinico, in quest
-of a French convoy expected from Europe;
-which having eluded us, and got into their
-own harbour, the whole fleet returned to
-St. Lucia on the 30th of March, excepting
-the Prudent, which was sent to Barbadoes.</p>
-
-<p>We found at St. Lucia the Magnificent,
-of 74, and the Agamemnon, of 64 guns,
-which were the last reinforcement of this
-campaign, making the British fleet on this
-station amount to forty ships of the line,
-a much greater force than was ever before
-employed on foreign service. They were
-all copper bottomed.
-<span class="pagenum" id="Page_88">88</span></p>
-
-<p>The weather continued fine all this month,
-yet there was some increase of sickness, owing
-chiefly to the hardship the men underwent
-in wooding and watering. In Choc
-Bay, where the fleet watered, there was at
-this time a higher surf than was ever remembered,
-which made the operation of
-watering (at all times noxious in this climate)
-uncommonly toilsome and dangerous.
-It was, indeed, next to impracticable; for
-many longboats were staved on the beach,
-by which several men had their limbs broken,
-and some lost their lives, by being
-crushed or drowned; but the necessity of
-the service admitted of no relaxation or delay.
-There was no increase of wind to account
-for this surf, so that it was owing
-either to something in the currents, or to
-some subterraneous cause; and there had
-been felt at Barbadoes and St. Lucia, about
-this time, a slight shock of an earthquake<a id="FNanchor_11" href="#Footnote_11" class="fnanchor">11</a>,
-<span class="pagenum" id="Page_89">89</span>
-to which many imputed this extraordinary
-surf. In other respects, there were fewer
-causes of sickness than usually occur to a
-fleet in port in this part of the world; for
-the air of the road is remarkably pure, and
-there were fewer temptations and opportunities
-of intemperance than at the other
-islands.</p>
-
-<p>The monthly returns of the surgeons
-were very full and complete; but as it
-would be tedious to insert at length those
-of every particular ship, and as the number
-of ships fluctuated in different months, I
-shall do no more hereafter than set down
-the general results from calculation, so as
-to shew the proportional prevalence of disease
-and mortality in each month.
-<span class="pagenum" id="Page_90">90</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Sickness
-and Mortality in March.</h3>
-
-<div class="table">
-
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the
-Course of this Month.<br />
-<br />
-B Proportion of those who died, in
-relation to the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">20</td>
-    <td class="tdr">64</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">35</td>
-    <td class="tdr">71</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">126</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">33</td>
-    <td class="tdr">108</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">9</td>
-    <td class="tdr">76</td>
-  </tr>
-</table>
-</div>
-
-<p>The first column is formed by dividing
-the whole number on board by the number
-<span class="pagenum" id="Page_91">91</span>
-taken ill. The second column is formed by
-first adding the number ill on board on the
-first of the month to the number taken ill
-during the month, subtracting from this
-sum the number sent to the hospital, and
-dividing the remainder by the number of
-deaths.</p>
-
-<p>The number on the sick list of twenty-eight
-ships of the line, and two frigates,
-on the first of this month, was eight hundred
-and forty-five; the number put on the
-lists in the course of the month was one
-thousand eight hundred and eighty-four;
-and the number sent to the hospital in the
-same time was three hundred and seventy-three;
-and there died on board thirty-one.
-<span class="pagenum" id="Page_92">92</span></p>
-
-<p>The total mortality this month, in relation
-to the whole number of men on board,
-was one in six hundred and seven.</p>
-
-<p>It almost always happens, that ships of
-war are more or less short of complement,
-and allowance is made for this in all the
-calculations; for having had an opportunity
-of inspecting the weekly accounts delivered
-to the Admiral, it was always in my
-power to be informed how many there were
-short of the legal complement of men in
-each ship.</p>
-
-<p>It appears, from comparing the Tables of
-this month with those of the preceding,
-that there had been a great increase of
-fevers and fluxes, particularly of the latter.
-The fevers prevailed chiefly in the ships
-lately from England, especially the Fame
-and Conqueror. In the Duke there were a
-great number ill of fevers; but this ship
-not having arrived from England till after
-the first of the month, is not included in
-the calculation. The fluxes were most prevalent
-in the ships we found on the station,
-<span class="pagenum" id="Page_93">93</span>
-particularly the Canada, Resolution, and
-Nymph frigate. The scurvy had increased
-very little, but prevailed most in the ships
-we found here. The only ships of the
-new squadron that had this disease to a
-considerable degree, were the Conqueror
-and Nonsuch. The former had indeed a
-good many ill of it; but the return having
-been made in an imperfect manner, this
-ship is not included in the calculation.</p>
-
-<p>But the ships that were by far the most
-healthy were those that had been the longest
-from England, the Ajax, Russel, Montague,
-Royal Oak, and Prudent. There had been
-formerly a great mortality in all these ships;
-and it would appear that this uncommon
-degree of health was owing, in some measure
-at least, to this circumstance, that the
-most weakly had been swept off by the
-different distempers to which they were exposed;
-so that only the more hardy and
-robust had survived.</p>
-
-<p>Under the head of “Other Complaints,”
-a much smaller number were put on the
-<span class="pagenum" id="Page_94">94</span>
-list, and still fewer died, in this than the
-preceding month. This difference is owing
-to the number that died of wounds last
-month.</p>
-
-<p>There died on board, in the course of
-this month, thirteen of fevers, seven of
-fluxes, and seven of other complaints, of
-whom five died of small pox, one of asthma,
-and one of wounds he received at St. Christopher’s.</p>
-
-<p>In order to show more fully and minutely
-what are the complaints incident to fleets
-in this climate, I shall set down a list of
-the numbers taken ill of the different diseases
-and accidents during this month, extracted
-from the returns of twenty-eight
-ships of the line, and two frigates.</p>
-
-<table>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">806</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">463</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">130</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">129</td>
-  </tr>
-  <tr>
-    <td>Small pox</td>
-    <td class="tdr">49</td>
-  </tr>
-  <tr>
-    <td>Pectoral complaints</td>
-    <td class="tdr">40</td>
-  </tr>
-  <tr>
-    <td>Venereal complaints</td>
-    <td class="tdr">32</td>
-  </tr>
-  <tr>
-    <td>Colds</td>
-    <td class="tdr">30<span class="pagenum" id="Page_95">95</span></td>
-  </tr>
-  <tr>
-    <td>Rheumatism</td>
-    <td class="tdr">18</td>
-  </tr>
-  <tr>
-    <td>Angina</td>
-    <td class="tdr">10</td>
-  </tr>
-  <tr>
-    <td>Gravel</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Dropsy</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Ophthalmia</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Leprosy</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Fistula in ano</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Hernia humoralis</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Abscess</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Fractures</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td style="max-width: 5em">Various slight accidents, as bruises, cuts, scalds, &amp;c.</td>
-    <td class="tdr">163</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">1884</td>
-  </tr>
-</table>
-
-<p>The number of ulcers bears here a smaller
-proportion to the whole than it does in general
-to the sum total of the sick list; for
-being the most tedious of all complaints,
-they consequently accumulate more than any
-other. Thus many of the cases now set
-down as slight accidents, will, in the ensuing
-month, be in the state of obstinate
-ulcers.</p>
-
-<p>Most of the diseases of one hot climate
-resemble those of another, so far as I know;
-but there is one disease which we hear of as
-being extremely prevalent all over the East
-Indies, which is hardly ever met with in
-the tropical regions of the West. This is
-the inflammation of the liver, of which I
-<span class="pagenum" id="Page_96">96</span>
-remember to have seen only one well-marked
-case, and it was that of a gentleman who
-had been in the East Indies, and had been
-subject to it there: nor do I recollect more
-than one, or at most two, cases of this sort
-out of several thousand cases of various diseases
-that were reported to me. This is
-either owing to the greater heat and dryness
-of the air in the East Indies, or some other
-peculiarity with which we are not acquainted<a id="FNanchor_12" href="#Footnote_12" class="fnanchor">12</a>.</p>
-
-<p>Every other inflammatory complaint exists
-more or less, though they are much rarer
-than in cold and temperate climates. The
-phthisis pulmonalis is not so common as in
-cold climates, but proves sooner fatal to
-<span class="pagenum" id="Page_97">97</span>
-most constitutions. There are certain pulmonic
-complaints, particularly those of the
-asthmatic kind, to which the climate of the
-West Indies is remarkably favourable; but
-those in which there are tubercles and ulceration
-seem to be hurried faster to a fatal
-termination. The climates, from the thirtieth
-to the fortieth degree of latitude, seem
-to be best suited to consumptive complaints.
-The rheumatisms that occur in hot climates
-are mostly of the chronic kind.
-<span class="pagenum" id="Page_98">98</span></p>
-
-<h2 id="BOOK_II_CHAP_III">CHAP. III.</h2>
-
-<blockquote>
-
-<p>State of Health of the Fleet in April 1782&mdash;&mdash;Battles
-on the 9th and 12th&mdash;The Fleet very healthy&mdash;from
-the Quality of Provisions&mdash;from the Effects of Victory&mdash;Advantages
-of close Action&mdash;What Diseases
-most prevalent&mdash;Extraordinary Degree of Health in
-the Formidable.</p></blockquote>
-
-<p>This month being interesting, on account
-of the memorable engagements that happened
-in it, the remarks shall, for this reason, be
-somewhat more full and particular.</p>
-
-<p>Three ships of the line having been sent to
-protect convoys to Jamaica, and one having
-been sent to protect a convoy to Barbadoes,
-there remained thirty-six at St. Lucia in the
-beginning of this month. By the end of the
-first week their damages were repaired, their
-water and provisions complete, and the sick in
-a great measure recovered.
-<span class="pagenum" id="Page_99">99</span></p>
-
-<p>An equal force of the enemy lay over
-against us at Martinico, the two powers of
-Britain and France being to make this distant
-quarter of the world the theatre for trying
-their strength, and deciding the sovereignty
-of the seas. In the view of this great event,
-our commander forwarded the necessary duties
-of the fleet with such zeal and diligence,
-and watched the motions of the enemy with
-such vigilance, that he overtook their grand
-squadron a few hours after they left their own
-port, and engaged them two several days,
-with a success, glorious and complete.</p>
-
-<p>Nothing had been wanting to equip this
-fleet for the great and decisive exertion it was
-to make. Every ship, except two, might be
-said to be healthy, most of them were complete
-in men, well appointed with officers,
-and well found in stores and provisions.&mdash;Conformable
-to this was the eagerness, the
-confidence, and resolution, which led them
-to success and victory.</p>
-
-<p>After this battle, the whole fleet, with the
-prizes, bore away for Jamaica, where part
-<span class="pagenum" id="Page_100">100</span>
-of it arrived on the last days of April, but the
-greater part of it kept the sea, till after the
-middle of May.</p>
-
-<p>As this month is more than usually interesting,
-the tables are given at full length,
-and a column is added for the wounded.</p>
-
-<p>The sum total, of the numbers of the men
-on board of the thirty-six ships that composed
-the line of battle on the 12th of April, was
-21,608, and the mortality during the month,
-exclusive of those who were killed or died of
-wounds, was one in 862.</p>
-
-<p>There was less sickness, and less death,
-from disease in this month, than any of the
-former twenty-three months, in which I
-kept records of the fleet, and less than in any
-subsequent month, till the fleet got to the
-coast of America.</p>
-
-<p>To account for this, it is to be observed,
-that the men had not been exposed to the
-noxious air of the shore in watering, as in
-the preceding month: they had received
-
-<span class="pagenum" id="Page_101">101</span>
-from England a fresh supply of provisions,
-among which was sour krout, melasses, and
-essence of malt, all in addition to the ordinary
-articles of victualling: many of the
-ships were supplied with wine, in place of
-rum, and as the weather was all along dry
-and fine, the men suffered the less from the
-exposure and want of sleep, which are the
-necessary consequences of keeping ships
-clear for battle for several days and nights
-together.</p>
-
-<h3 id="TABLE_V">TABLE V.<br />
-
-<span class="medium">ABSTRACT of the RETURNS for APRIL, 1782.</span></h3>
-
-<div class="table">
-<p>
-Transcriber's Keys:<br />
-F Sick on board on the 1st of the Month.<br />
-M Put on the List during the Month.<br />
-D Dead.<br />
-H Sent to the Hospital.<br />
-</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">SHIPS’ NAMES</th>
-    <th colspan="4">FEVER.</th>
-    <th colspan="4">FLUX.</th>
-  </tr>
-  <tr>
-    <th>F</th>
-    <th>M</th>
-    <th>D</th>
-    <th>H</th>
-    <th>F</th>
-    <th>M</th>
-    <th>D</th>
-    <th>H</th>
-  </tr>
-  <tr>
-    <td>* Formidable</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Barfleur</td>
-    <td class="tdr">6</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">5</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>Prince George</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">2</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">18</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Duke</td>
-    <td class="tdr">57</td>
-    <td class="tdr">78</td>
-    <td class="tdr">2</td>
-    <td class="tdr">32</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Namur</td>
-    <td class="tdr">5</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">11</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Royal Oak</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">11</td>
-    <td class="tdr">23</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">8</td>
-    <td class="tdr">46</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">6</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">2</td>
-    <td class="tdr">1</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>* Valiant</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">10</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">5</td>
-    <td class="tdr">21</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Warrior</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">12</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">10</td>
-    <td class="tdr">15</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Magnificent</td>
-    <td class="tdr">0</td>
-    <td class="tdr">21</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Bedford</td>
-    <td class="tdr">11</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">27</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Canada</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">24</td>
-    <td class="tdr">70</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">19</td>
-    <td class="tdr">25</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">21</td>
-    <td class="tdr">27</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Hercules</td>
-    <td class="tdr">2</td>
-    <td class="tdr">38</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">5</td>
-    <td class="tdr">18</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">3</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Fame</td>
-    <td class="tdr">36</td>
-    <td class="tdr">50</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">8</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">10</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Princessa</td>
-    <td class="tdr">1</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>* Conqueror</td>
-    <td class="tdr">30</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">1</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Arrogant</td>
-    <td class="tdr">2</td>
-    <td class="tdr">16</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">33</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Marlborough</td>
-    <td class="tdr">7</td>
-    <td class="tdr">19</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">21</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Yarmouth</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Belliqueux</td>
-    <td class="tdr">43</td>
-    <td class="tdr">118</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td>Prince William</td>
-    <td class="tdr">4</td>
-    <td class="tdr">27</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">24</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Repulse</td>
-    <td class="tdr">20</td>
-    <td class="tdr">40</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>St. Albans</td>
-    <td class="tdr">1</td>
-    <td class="tdr">22</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Agamemnon</td>
-    <td class="tdr">2</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Proth&eacute;e</td>
-    <td class="tdr">6</td>
-    <td class="tdr">13</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">49</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>America</td>
-    <td class="tdr">2</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Anson</td>
-    <td class="tdr">3</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">26</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Nonsuch</td>
-    <td class="tdr">6</td>
-    <td class="tdr">11</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">2</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">7</td>
-    <td class="tdr">16</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ramillies</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">26</td>
-    <td class="tdr">1</td>
-    <td class="tdr">4</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Nymph</td>
-    <td class="tdr">2</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">8</td>
-    <td class="tdr">9</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Flora</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">312</td>
-    <td class="tdr">743</td>
-    <td class="tdr">15</td>
-    <td class="tdr">65</td>
-    <td class="tdr">195</td>
-    <td class="tdr">516</td>
-    <td class="tdr">7</td>
-    <td class="tdr">19</td>
-  </tr>
-</table>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">SHIPS’ NAMES</th>
-    <th colspan="4">SCURVY.</th>
-    <th colspan="4">WOUNDS.</th>
-  </tr>
-  <tr>
-    <th>F</th>
-    <th>M</th>
-    <th>D</th>
-    <th>H</th>
-    <th>F</th>
-    <th>M</th>
-    <th>D</th>
-    <th>H</th>
-  </tr>
-  <tr>
-    <td>* Formidable</td>
-    <td class="tdr">0</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">37</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Barfleur</td>
-    <td class="tdr">6</td>
-    <td class="tdr">30</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">37</td>
-    <td class="tdr">8</td>
-    <td class="tdr">6</td>
-  </tr>
-  <tr>
-    <td>Prince George</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">14</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Duke</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">60</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Namur</td>
-    <td class="tdr">8</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Royal Oak</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">54</td>
-    <td class="tdr">5</td>
-    <td class="tdr">15</td>
-  </tr>
-  <tr>
-    <td>Alfred</td>
-    <td class="tdr">15</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">30</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Montagu</td>
-    <td class="tdr">2</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">25</td>
-    <td class="tdr">5</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Valiant</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">37</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Monarch</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">33</td>
-    <td class="tdr">2</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Warrior</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Centaur</td>
-    <td class="tdr">5</td>
-    <td class="tdr">15</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">14</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Magnificent</td>
-    <td class="tdr">7</td>
-    <td class="tdr">16</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">20</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Bedford</td>
-    <td class="tdr">1</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">17</td>
-    <td class="tdr">4</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ajax</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">30</td>
-    <td class="tdr">1</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Canada</td>
-    <td class="tdr">1</td>
-    <td class="tdr">8</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Resolution</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">19</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Hercules</td>
-    <td class="tdr">0</td>
-    <td class="tdr">12</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">18</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Russel</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">4</td>
-    <td class="tdr">29</td>
-    <td class="tdr">3</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Fame</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">12</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Torbay</td>
-    <td class="tdr">3</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">25</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Princessa</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">19</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Conqueror</td>
-    <td class="tdr">10</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">23</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Arrogant</td>
-    <td class="tdr">4</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">11</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Marlborough</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">16</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-  </tr>
-  <tr>
-    <td>* Yarmouth</td>
-    <td class="tdr">3</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">33</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Belliqueux</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">10</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Prince William</td>
-    <td class="tdr">5</td>
-    <td class="tdr">18</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Repulse</td>
-    <td class="tdr">3</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">9</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>St. Albans</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">7</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Agamemnon</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">23</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Proth&eacute;e</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">24</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>America</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">1</td>
-    <td class="tdr">27</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Anson</td>
-    <td class="tdr">1</td>
-    <td class="tdr">1</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">13</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>* Nonsuch</td>
-    <td class="tdr">18</td>
-    <td class="tdr">25</td>
-    <td class="tdr">0</td>
-    <td class="tdr">6</td>
-    <td class="tdr">0</td>
-    <td class="tdr">2</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Alcide</td>
-    <td class="tdr">7</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">15</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Ramillies</td>
-    <td class="tdr">&sect;</td>
-    <td class="tdr">3</td>
-    <td class="tdr">0</td>
-    <td class="tdr">3</td>
-    <td />
-    <td />
-    <td />
-    <td />
-  </tr>
-  <tr>
-    <td>Nymph</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Flora</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">103</td>
-    <td class="tdr">208</td>
-    <td class="tdr">2</td>
-    <td class="tdr">18</td>
-    <td class="tdr">8</td>
-    <td class="tdr">810</td>
-    <td class="tdr">60</td>
-    <td class="tdr">32</td>
-  </tr>
-</table>
-
-<p>N. B. The Ships marked thus, *, came from England in February and March, 1782.</p>
-
-<p>All the Ships named in the Table were in the Engagements in April, except the Ramillies and the two Frigates.</p>
-
-<p>In the Spaces marked thus, &sect;, no Return was made.</p>
-</div>
-
-<p>Might not this extraordinary degree of
-health have also been owing, in part, to the
-effects of success upon the spirits of the men?
-It is related<a id="FNanchor_13" href="#Footnote_13" class="fnanchor">13</a>, that, when the fleet under Admiral
-Matthews was off Toulon, in daily expectation
-for some time of engaging the combined
-fleet of France and Spain, there was a
-general stop put to the progress of disease,
-particularly of the scurvy, from the influence
-of that generous flow of spirits, with
-which the prospect of battle inspires British
-<span class="pagenum" id="Page_102">102</span>
-seamen. But if the mere expectation and
-ardour of a battle, without any happy event,
-could have such a sensible effect, what must
-have been the effect of the exultation of <small>VICTORY</small>,
-a victory in which the naval glory of
-our country was revived and retrieved, after
-a series of misfortunes and disgraces, which
-had well nigh extinguished the national pride
-in every department of service! The plain
-and honest, though unthinking seaman, is
-not less affected by this than the more enlightened
-lover of his country. Even the
-invalids at the hospital demonstrated their
-joy, upon hearing of this victory, by hoisting
-shreds of coloured cloth on their crutches.</p>
-
-<p>It would appear, that there is something
-in situations of exertion and danger, which
-infuses a sort of preternatural vigour. When
-the mind is interested and agitated by active
-and generous affections, the body forgets its
-wants and feelings, and is capable of a degree
-of labour and exertion, which it could
-not undergo in cold blood. The quantity
-of muscular action employed in fighting at a
-great gun for a few hours, is perhaps more
-<span class="pagenum" id="Page_103">103</span>
-that what is commonly employed in a week
-in the ordinary course of life, and though
-performed in the midst of heat and smoke,
-and generally with the want of food and
-drink, yet the powers of nature are not exhausted
-nor overstrained; even the smart of
-wounds is not felt; and the future health of
-those who survive unhurt by external violence
-is so far from being injured, that it is sometimes
-mended by this violent, but salutary agitation.</p>
-
-<p>The loss in action, and the number of mortal
-wounds, were not so great as might have
-been expected in a battle continued for a whole
-day. This advantage was owing to the superiority
-of our fire, as well as to the closeness of
-the fight, of which the Commander in Chief
-set the illustrious example, by penetrating
-the enemy’s line with his own ship; a bold
-and singular effort which first decided the event
-of the day. When ships in action are
-opposed to each other at a small distance, the
-velocity of cannon balls is so great, that in
-penetrating a ship’s side, few or no splinters
-are torn off; and by these more men are commonly
-killed and wounded, than by the ball
-<span class="pagenum" id="Page_104">104</span>
-itself. For the same reason, a close shot does
-less damage also to the ship itself, than a distant
-one; for a quick-flying ball makes an
-aperture less than its own diameter, whereas
-a spent one produces innumerable deadly splinters,
-at the same time shivering the object it
-strikes, and making wide and extensive rents
-in it. The proportion of the wounded to the
-killed, is also greater in distant, than in close
-fight, on account of the great number of
-small splinters; and we have an experimental
-proof of this, in comparing the action in
-Fort Royal Bay in April 1781, with this
-near Dominica in April 1782. In the former,
-the enemy having kept far to windward,
-and engaged at a great distance, the proportion
-of the wounded to the killed was
-considerably more than four to one<a id="FNanchor_14" href="#Footnote_14" class="fnanchor">14</a>; whereas
-in the latter, where the greater part of the
-battle was close, the proportion of the
-wounded to the killed, was little more than
-three to one<a id="FNanchor_15" href="#Footnote_15" class="fnanchor">15</a>.
-<span class="pagenum" id="Page_105">105</span></p>
-
-<p>Though it is a remark not belonging to a
-medical work, yet it may be observed, that
-the greatest advantage that arose to us from
-close action was, that the fire of the enemy was
-thereby silenced; for the advantages would be
-mutual and equal, on the supposition, that
-the French, in such a situation, were to keep
-the deck, and stand to their guns equally
-well with the British seamen.</p>
-
-<p>It appears, by examining the table, that the
-ships in which the fevers chiefly prevailed
-this month, were those that came last from
-England, and that those in which the fluxes
-prevailed most were chiefly of the squadron
-we found on the station, namely, the Canada,
-Resolution, and Prince William. The
-latter however recovered greatly in the course
-<span class="pagenum" id="Page_106">106</span>
-of this month. Some of the Ships that arrived
-last from England, namely, the Arrogant,
-Proth&eacute;e, and Anson, were also considerably
-afflicted with fluxes, but they were of an extremely
-mild kind; and the small number of
-deaths from this disease in comparison with
-those from fevers, is a proof of a former
-observation, that this is the safest form
-in which an acute disease can shew itself.
-This small degree of mortality was also owing
-to the judicious method of treating it which
-was in general practised throughout the fleet;
-and it is but justice to the medical gentlemen
-to say, that they shewed on this, as well as
-every other occasion, great skill and attention
-in the treatment of the sick and wounded.</p>
-
-<p>The sum total of fevers and fluxes that
-have been put on the list this month, is much
-the same as that of the preceding month;
-but the proportion of fluxes in April is much
-greater.</p>
-
-<p>The proportion of scurvy is somewhat increased;
-which is not to be wondered at,
-when it is considered, that though the fleet
-<span class="pagenum" id="Page_107">107</span>
-had not been so long at sea as is necessary to
-produce it, especially in this climate, yet the
-men having had no refreshments when last in
-port, may be considered as having been all
-that time at sea.</p>
-
-<p>The superior degree of health in this
-month will appear in a still stronger light,
-if we cast our eye on the column expressing
-the number sent to the hospital, the proportion
-of which is, comparatively, very
-small.</p>
-
-<p>The ships that had been the longest from
-England, were still among the most healthy.
-But of all the fleet, none was so free from
-sickness and mortality as the Formidable.
-No man belonging to this ship died of disease
-for the first four months after sailing from
-Plymouth, though there were at times
-900 men on board, and never less than the
-established complement, which is 750; and
-so few were taken sick in that time, that
-only thirteen were sent to hospitals, and
-their complaints were small-pox and ulcers.
-<span class="pagenum" id="Page_108">108</span></p>
-
-<p>This ship left England provided with every
-thing that could be supposed to conduce to
-the health of men, and may be considered
-as an experiment to prove what degree of
-health may be attained by proper management
-and attention. She was furnished not
-only with abundance of sour krout, melasses,
-and essence of malt, in common with the
-other ships; but what was peculiar to her,
-was an entire supply of excellent wine, in
-place of spirits, of which none was used
-during the period mentioned.
-<span class="pagenum" id="Page_109">109</span></p>
-
-<h2 id="BOOK_II_CHAP_IV">CHAP. IV.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> while it lay at
-Jamaica during May, June, and Part of July, 1782.&mdash;&mdash;French
-Prizes Causes of Sickness&mdash;Their
-Difference from the English in point of Cleanliness
-and Discipline&mdash;Bad Effects of Land Wind and
-Watering Duty&mdash;Situation of Port Royal&mdash;Season
-uncommonly dry and windy&mdash;Fluxes more prevalent
-at Sea than in Harbour&mdash;Comparison of the Sickness
-at this Time with that of the Army and with that of
-the Squadron under Admiral Vernon forty-one Years
-before&mdash;Effects of Contagion and foul Air&mdash;Officers
-more affected than the common Men.</p></blockquote>
-
-<p>All the squadron that was left to windward
-of Jamaica, consisting of twenty-four
-ships of the line, kept the sea during great
-part of May, the last division of it not
-having come to Port Royal till the 25th of
-that month.</p>
-
-<p>The whole fleet remained in harbour
-during the remainder of the month, and the
-<span class="pagenum" id="Page_110">110</span>
-whole of the next, except the Warrior,
-Proth&eacute;e, and Russell; the two former were
-sent on a cruise, in which the Warrior continued
-quite healthy, as she had been ever
-since her arrival from England; and in the
-Proth&eacute;e a great check was given to the
-fevers and fluxes which had begun to prevail
-at Port Royal. The Russell was sent
-to England with a convoy.
-<span class="pagenum" id="Page_111">111</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Prevalence
-of Sickness and Mortality in May.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill or wounded in the Course of the Month.<br />
-B Proportion of those that died in relation to the Numbers of Sick or wounded.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">26</td>
-    <td class="tdr">29</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">18</td>
-    <td class="tdr">63</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">57</td>
-    <td class="tdr">34</td>
-  </tr>
-  <tr>
-    <td>Wounds</td>
-    <td class="tdr">627</td>
-    <td class="tdr">60</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">44</td>
-    <td class="tdr">127</td>
-  </tr>
-  <tr>
-    <td>General Proportion, including wounded</td>
-    <td class="tdr">7&frac12;</td>
-    <td class="tdr">46</td>
-  </tr>
-  <tr>
-    <td>General Proportion, exclusive of Wounds</td>
-    <td class="tdr">8</td>
-    <td class="tdr">48</td>
-  </tr>
-</table>
-</div>
-<p><span class="pagenum" id="Page_112">112</span></p>
-
-<p>The whole number of sick on board on
-the first of this month, in thirty-six ships
-of the line and two frigates, upon which
-the preceding calculation is formed, was one
-thousand four hundred and eighteen. The
-whole number taken ill in the course of the
-month was two thousand eight hundred and
-twenty-eight; the number sent to the hospital
-was one hundred and seventy-three;
-and there died on board ninety-four.</p>
-
-<p>The proportion of those who died this
-month, in relation to the whole number on
-board, was one in two hundred and eighty-seven.</p>
-
-<p>There was a considerable increase of sickness
-and mortality this month in all the
-common diseases, and chiefly in that part of
-the squadron which was in port. There
-was less increase in the number of fevers
-than either of the other two epidemics;
-but such was their increased malignancy,
-that more died of them than of both the
-others. The number of fluxes was more
-than double of what it was the preceding
-<span class="pagenum" id="Page_113">113</span>
-month, and the mortality from them was
-also in a much greater proportion, as may
-be seen from the Tables.</p>
-
-<p>The fevers prevailed chiefly in port, and
-the fluxes at sea. A good many of the latter,
-indeed, arose in the Alcide, though
-constantly in port; but this seemed to be
-owing to contagion conveyed by some British
-soldiers, who were sent on board of
-this ship after being retaken in one of the
-French men of war, several of whom were
-ill of this disease. But there were few
-fluxes in those ships at Jamaica in which
-the most malignant fevers appeared. There
-were a few in those in which the fevers
-arose from the air of the marshes on the
-watering duty; but there were none on
-board of the French prizes, nor in those
-ships in which that sort of fever was
-which proceeded from a similar cause, that
-is, filth and animal effluvia. Upon the
-whole, in those ships in which the fever
-was most malignant, there the fewest fluxes
-were found.
-<span class="pagenum" id="Page_114">114</span></p>
-
-<p>Several circumstances contributed to the
-increase of sickness and mortality this
-month.</p>
-
-<p>1st. The infection, or rather the foul air,
-of the French prizes, in most of which a
-very bad fever broke out among the officers
-and men that were sent from the ships of
-our fleet to take charge of them.</p>
-
-<p>The discipline and internal œconomy of
-the French ships of war are greatly inferior to
-those of the British. Their decks are never
-washed, and there is a great defect in every
-point of cleanliness and order. The free
-course of the air is obstructed by lumber of
-every kind, and by bulkheads, which are
-not taken down even in the time of battle;
-and the gratings are covered night and day
-with tarpaulins, even in a hot climate.
-There are not even scuppers opened on the
-lower deck as outlets to the water and filth,
-which necessarily accumulate there, and for
-which the only vent is a pipe contrived on
-purpose, passing from that deck along the
-ship’s side into the hold, which becomes
-<span class="pagenum" id="Page_115">115</span>
-thereby a common sink, inconceivably putrid
-and offensive. And in addition to the
-ordinary causes of corruption, there was
-one peculiar to the occasion; for the blood,
-the mangled limbs, and even whole bodies
-of men, were cast into the orlop, or hold,
-and lay there putrifying for some time. The
-common sailors among the French have a
-superstitious aversion to the throwing of
-bodies overboard immediately after they are
-killed, the friends of the deceased wishing
-to reserve their remains, in order to perform
-a religious ceremony over them when the
-hurry and danger of the day shall be over.
-When, therefore, the ballast, or other contents
-of the holds of these ships, came to be
-stirred, and the putrid effluvia thereby let
-loose, there was then a visible increase of
-sickness. For the first three weeks after the
-capture, the stench proceeding from the
-numbers of wounded men contributed also
-to taint the air.</p>
-
-<p>The Ville de Paris was much more sickly
-than the other prizes, not only from her being
-larger, and thereby containing a greater
-<span class="pagenum" id="Page_116">116</span>
-mass of foul air, but by receiving the surviving
-part of the crew of the Santa Monica,
-one of our frigates, which had been cast
-away on the Virgin Islands, and whose men
-were so reduced by hardship and intemperance,
-that most of them were taken ill as
-soon as they came to breathe the unwholesome
-air of the French prize. To whatever
-cause it was owing, the fever was much more
-violent here than in the other prizes, and it
-generally carried men off on the third or
-fourth day; and what is remarkable, the
-officers were affected by it in a greater proportion
-than the common men. One lieutenant,
-and every warrant officer, except
-the boatswain, died of it. This was a proof
-that the sickliness was owing to the bad air,
-and not to the intemperance and irregularity
-so usual on board of prizes, which only
-the common men give into; and the probable
-cause of the officers being most affected
-is, that they were accustomed in common to
-a purer air, by living in the most clean and
-airy parts of the ship.
-<span class="pagenum" id="Page_117">117</span></p>
-
-<p>It is also remarkable, that the Ville de
-Paris was healthy when taken, and had been
-so ever since leaving France in March, 1781;
-nor had any other of the captured ships of
-the line been sickly for some time before,
-except the Ardent, when she arrived at Martinico
-four months before, at which time
-the greater part of the crew were sent to the
-hospital with fevers. This, as well as other
-facts of the same kind, tends to prove, that
-when men come to be much habituated to
-bad air, their health is not affected by it.</p>
-
-<p>The French ships were purified by washing
-and scraping, by fumigating daily with gunpowder
-and vinegar, and by the use of wind
-sails; but nothing seemed to contribute so
-much to sweeten the air in them as burning
-fires in the hold; for this tended both to make
-the putrid matter exhale, and to carry it off,
-by producing a perpetual change of air. Captain
-Curgenven, who at this time commanded
-the Ville de Paris, had great merit from his
-very assiduous and successful endeavours in so
-difficult a duty as the management and equipment
-of this great ship. In consequence of
-<span class="pagenum" id="Page_118">118</span>
-the judicious measures taken, and the men
-becoming more used to the bad air, the sickness
-ceased in the course of a few weeks.</p>
-
-<p>In the accounts given in the tables, the
-French prizes are not included, for the disorderly
-state in which they were at this time
-prevented my receiving regular returns: but
-having made inquiry concerning the mortality
-in the Ville de Paris, I found, that of
-a crew of three hundred and twelve men,
-there died ten in the month of May, and
-there were thirty sent to the hospital, whose
-cases were so unfavourable, that about one
-half died. The only diseases were fevers.
-The surgeon of the Ardent told me about
-the same time, that one third of the crew
-of that ship was ill of fevers.</p>
-
-<p>The second cause of the prevalence of
-sickness, while the fleet was at Jamaica,
-was, the watering duty, which was carried
-on at Rock-fort, about three leagues from
-Port Royal. It was the practice of many
-of the ships to leave the water casks on shore
-all night, with men to watch them; and as
-<span class="pagenum" id="Page_119">119</span>
-there is a land wind in the night, which
-blows over some ponds and marshes, there
-were hardly any of the men employed on
-that duty who were not seized with a fever
-of a very bad sort, of which a great many
-died. The ships that followed a different
-practice were somewhat longer in watering;
-but this was much more than compensated
-by their preserving the health and saving the
-lives of their men.</p>
-
-<p>The land wind which blows on the shore
-in the night time, is a circumstance in which
-Jamaica differs from the small islands to
-windward, over which the trade wind blows
-without any interruption: but though this
-land wind blows upon Port Royal from some
-marshes at a few miles distance, it does not
-seem to produce sickness, for it is a very healthy
-place, and several of the ships enjoyed
-as good health as in the best situations on
-the windward station. The bay which forms
-this harbour is bounded towards the sea by
-a peninsula of a singular form, being more
-than ten miles in length, and not a quarter
-of a mile broad at any part. Great part of
-<span class="pagenum" id="Page_120">120</span>
-it is swampy and overgrown with mangroves,
-and though of such small extent, we fancied
-that some of the ships that lay immediately
-to leeward of this part were more sickly than
-those that were close to the town of Port
-Royal, which stands at the very extremity of
-this long peninsula upon a dry, gravelly soil.</p>
-
-<p>The weather this month was uniformly
-dry in port; but at sea the air was moist
-and hazy. Between Jamaica and Hispaniola,
-where part of the squadron was left to cruise,
-dead calms prevailed; and this, joined to the
-moisture of the air, was probably what
-caused the flux to prevail chiefly in this part
-of the fleet. At Port Royal, on the contrary,
-there was a strong dry breeze, which
-set in every day about nine o’clock in the
-morning, and blew all day so fresh, that
-there was frequently danger in passing from
-one ship to another in boats. This is called,
-in the language of the country, the <i>fiery sea
-breeze</i>, an epithet which it seems to have
-got not from its absolute heat, but from the
-feverish feeling which it occasions by drying
-up the perspiration. It was remarked, that
-<span class="pagenum" id="Page_121">121</span>
-this breeze was stronger this season than had
-ever been remembered; and it sometimes
-even blew all night, preventing the land
-breeze from taking its usual course. This
-year was farther remarkable for the want of
-the rains that were wont to fall in the
-months of May and June. We shall have
-occasion to remark hereafter, that this was
-a very uncommon season also in Europe and
-America. The heat, by the thermometer,
-this month, on board of a ship at Port Royal,
-was, in general, when lowest in the night,
-at 77&deg;, and when highest in the day, in the
-shade, at 83&deg;.</p>
-
-<p>There was a considerable increase of scurvy
-in this month, compared with the former
-months of this campaign; but very inconsiderable,
-compared with what had occurred
-in cruises of the same length in former years.
-The last division of the fleet had been at sea
-seven weeks, all but one day, when it arrived
-at Port Royal; and though the scurvy had
-appeared in several of the ships, it did not
-prevail in any of them to a great degree,
-except in the Nonsuch. Out of fourteen
-<span class="pagenum" id="Page_122">122</span>
-deaths which happened in the whole fleet
-from this disease, in May, seven of them
-were in this ship, and several were sent from
-her to the hospital in the last and most desperate
-stage of it. But, upon the whole, the
-cases of the true sea scurvy in the fleet, in
-general, were few and slight, and a great
-many of those given in the reports under the
-head of scurvy, were cutaneous eruptions or
-ulcers, not properly to be classed with it.</p>
-
-<p>The cruise in the preceding year to windward
-of Martinico, may be compared with
-that in May of this year; for the fleet in
-both cases had been at sea about the same
-length of time. But the comparison is very
-greatly in favour of the latter, which is most
-probably to be imputed to the plentiful supply
-of melasses, wine, sour krout, and essence
-of malt. But no adequate reason that I
-could discover can be assigned for the prevalence
-of it in the Nonsuch to a degree so
-much more violent than in the other ships;
-and it was here farther remarkable, that it
-attacked every description of men indiscriminately;
-for I was assured by the officers
-<span class="pagenum" id="Page_123">123</span>
-and by the surgeon, that not only the helpless
-and dispirited landsman was affected, but
-old seamen, who had never before suffered
-from it on the longest cruises. I have been
-led by this, and some other facts, to suspect
-that there may be something contagious in
-this disease.</p>
-
-<h4>JUNE.</h4>
-
-<p>The greater part of the fleet remained at
-Jamaica during this month, refitting and
-watering. Twelve ships of the line were
-sent to sea on the 17th, under the command
-of Rear-admiral Drake, but not being able
-to get to windward on account of the fresh
-breezes that prevailed, they returned to Port
-Royal on the 28th. Such of these ships as
-were sickly, became more healthy while at
-sea; but some bad fevers arose, particularly
-in the Princessa; and it is a curious circumstance,
-that these fevers attacked only those
-men who had been on shore on the watering
-duty; from which it would appear, that
-something caught or imbibed, which is the
-cause of the fever, lies inactive for some
-<span class="pagenum" id="Page_124">124</span>
-time in the constitution, some of the men
-not having been affected for more than a
-week after they had been at sea.</p>
-
-<p>The weather continued dry and windy, as
-in the former month; but the heat was in
-general about two degrees higher, the thermometer
-varying from 79&deg; to 84&frac12;&deg;.</p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Sickness
-and Mortality in June.</h3>
-
-<div class="table">
-
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of this Month.<br />
-B Proportion of those who died, in relation to the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">11</td>
-    <td class="tdr">19</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">20</td>
-    <td class="tdr">83</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">47</td>
-    <td class="tdr">231</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">37</td>
-    <td class="tdr">97</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">6</td>
-    <td class="tdr">39</td>
-  </tr>
-</table>
-
-<p><span class="pagenum" id="Page_125">125</span></p>
-
-<p>The proportion of deaths in relation to the
-whole numbers on board, was one in one
-hundred and thirty-eight.</p>
-
-<p>There was only one in thirty of the sick
-sent to the hospital in the course of this
-month.</p>
-</div>
-
-<p>There was an increase both in the numbers
-and fatality of fevers. This increase
-was chiefly in that sort of fever which depends
-on the air and climate, the greater
-part of which was caught on the watering
-duty. There was a diminution of those
-fevers depending on infection, and the foul
-air of ships, which arose in the French
-prizes. The care that was taken in purifying
-these ships was very effectual; for only
-four died this month in the Ville de Paris,
-and fewer also were sent to the hospital than
-in May. The increase of the other kind of
-fever was chiefly owing to there being a
-greater number of ships in port, the crews
-of which were employed in watering, and
-partly, no doubt, to the increase of heat in
-the weather. The ships in which the fevers
-<span class="pagenum" id="Page_126">126</span>
-were most fatal were the Monarch, the
-Duke, the Torbay, and the Resolution.
-The sickness in the Duke was still in a
-great measure owing to the same infection
-that had hitherto prevailed; for this ship
-had never been cleared of the infectious
-fever, for want of room at the hospital.
-That which broke out in the Torbay was
-also of the low infectious kind, few of them
-having the symptoms of that which is peculiar
-to the climate, which prevailed in the
-other ships. This ship, though formerly
-very subject to infectious complaints, had
-been remarkably healthy for some time past;
-but it would appear that there was a large
-stock of latent infection, which shewed itself
-from time to time.</p>
-
-<p>Some ships, particularly the Montague
-and Royal Oak, had no increase of fevers
-or other complaints, though the one lay in
-port for seven, and the other for eleven
-weeks, and were more or less exposed to the
-causes of sickness which affected the rest of
-the fleet. This is a proof, among many
-others, that a particular combination of
-<span class="pagenum" id="Page_127">127</span>
-causes is necessary to produce a disease: no
-single one, however powerful, being sufficient,
-without the concurrence of others.
-What seemed to be wanting here was the
-predisposition requisite for the admission of
-disease into the constitution; for the ships
-that enjoyed this happy exemption were
-such as had long-established and well-regulated
-crews, accustomed to the service and
-climate.</p>
-
-<p>There had been this month a diminution
-both of the numbers and mortality of fluxes,
-which is agreeable to what was before remarked,
-that fevers were more apt than
-fluxes to prevail in the bad air of a harbour<a id="FNanchor_16" href="#Footnote_16" class="fnanchor">16</a>.
-It was also before remarked, that there were
-few or no fluxes in those ships in which the
-fever was most malignant; and now that the
-<span class="pagenum" id="Page_128">128</span>
-fever began to grow more mild in the French
-prizes, the flux began to appear. In the
-Barfleur, Duke, and Namur, both diseases
-seemed to prevail equally; but the fevers,
-though numerous, were more of the low
-nervous kind than bilious or malignant;
-and the fluxes chiefly attacked those who
-were recovering from fevers. We may farther
-remark, that these three men of war
-were three-decked ships, of 90 guns, the
-crews of which being more numerous, and
-composed of a more mixed set of men,
-were consequently subject to a greater chance
-of infection, and a greater variety of complaints.
-The Formidable still remained healthy
-to an extraordinary degree. Some fevers
-were indeed imported from the Ville de
-Paris by men that had been lent to that ship,
-and who were taken ill after their return.
-Of these, a few of the worst cases were sent
-<span class="pagenum" id="Page_129">129</span>
-to the hospital, and two died on board, who,
-with one that died the preceding month,
-make the whole mortality of this ship,
-since leaving England, amount only to the
-loss of three men.</p>
-
-<p>There has been little or no increase of
-scurvy this month; for though the numbers
-put on the list appear to be greater, the
-mortality is much less. It may indeed appear
-a matter of surprise that there should
-have been any scurvy at all, considering
-that the greater part of the fleet was at anchor
-all this month. But as this was the
-greatest fleet that had ever visited Jamaica,
-it was impossible to find fresh provisions for
-the whole; and the small supply they had
-did not amount to one fresh meal in a week.
-Port Royal is also remote from the cultivated
-part of the island, so that fruit and vegetables
-were both scarce and high priced,
-particularly this year, on account of the
-usual rains in May and June having failed.
-There was, however, an allowance of fresh
-provisions and vegetables made to the sick
-by public bounty; for as the hospital could
-<span class="pagenum" id="Page_130">130</span>
-contain but a small proportion of the sick
-and wounded, an order was given for the
-supply of fresh meat, fruit, and vegetables,
-to the sick, and five hundred pounds of Peruvian
-bark were also distributed as a public
-gratuity, besides sugar, coffee, and wine.</p>
-
-<p>With these aids, and the various good articles
-of victualling from England, the fleet
-was preserved uncommonly healthy for a
-West-India campaign: for though the mortality
-had increased considerably during our
-stay at Jamaica, yet the loss of men, upon
-the whole, was small, compared with that
-of other great fleets in this climate on former
-occasions. The greatest squadron, next
-to this, that had ever been on this station
-was that under Admiral Vernon in the year
-1741, at the same season. From this fleet
-upwards of eleven thousand men were sent
-to the hospital in the course of that and the
-preceding year, of whom there died one
-in seven, besides what died on board of
-their own ships and in two hospital ships<a id="FNanchor_17" href="#Footnote_17" class="fnanchor">17</a>.
-<span class="pagenum" id="Page_131">131</span>
-The disproportion of sickness in the two
-fleets will appear still greater, when it is
-considered that Admiral Vernon’s contained
-only fifteen thousand seamen and marines<a id="FNanchor_18" href="#Footnote_18" class="fnanchor">18</a>;
-whereas that under Lord Rodney contained
-twenty-two thousand. What added to the
-sickness of the former was the unfortunate
-expedition to Carthagena in April, 1741;
-to which probably it was owing that a much
-greater proportion of yellow fevers were
-landed from the fleet at that time than from
-ours, as appears by the papers left by Mr.
-Hume, who was then surgeon of the hospital.
-The hospital was then at a place called
-Greenwich, on the side of the bay opposite
-to Port Royal, and was very large; but it
-was found to be in a situation so extremely
-unhealthy, that it was soon after abandoned
-and demolished, and the hospital has since
-been at Port Royal.</p>
-
-<p>It appears by the tables, that a greater
-number was put on the list under the head of
-<span class="pagenum" id="Page_132">132</span>
-<i>other complaints</i> in this month than the last.
-This was owing to the great number of
-ulcers which I have remarked to keep pace
-with feverish as well as scorbutic complaints;
-for when the constitution of the air is favourable
-to disease, or the habit of body
-prone to it, wounds and sores are found
-then to be more difficult of cure. There
-were twelve deaths besides those occasioned
-by what have been called the three epidemics.
-Of these, five perished by drowning
-and other accidents, three died of ulcers,
-one of wounds received in action, one of
-<i>cholera morbus</i>, and one of an abscess.</p>
-
-<p>It has appeared that very few ships of
-this numerous fleet preserved their health
-while lying at anchor; and it would seem
-that short and frequent cruises are very conducive
-to health. It was eleven weeks from
-the time that the first of our fleet came to
-anchor at Jamaica till the main body of it
-sailed for America on the 17th of July.
-Great fleets are in time of war under the
-necessity of being at one time longer at sea,
-<span class="pagenum" id="Page_133">133</span>
-and at another time longer in port, than is
-consistent with the health of the men, the
-ships being obliged to act in concert and to
-co-operate with each other. This is one
-reason, among others, for ships of the line
-being more sickly than frigates. As ships
-of war must be guided by the unavoidable
-exigencies of service, it would be absurd to
-consider health only; but if this were to be
-the sole object of attention, a certain salutary
-medium could be pointed out in dividing
-the time between cruising and being in
-harbour; and it is proper that this should be
-known, that regard may be had to it, as far
-as may be consistent with the service. I
-would say, then, that in a cold climate men
-ought not to be more than six weeks at sea
-at one time, and need not be less than five
-weeks, and that a fourth part of their time
-spent in port would be sufficient to replenish
-their bodies with wholesome juices. In a
-warm climate men may be at sea a considerable
-time longer, without contracting scurvy,
-provided they have been under a course
-of fresh and vegetable diet when in port.
-<span class="pagenum" id="Page_134">134</span></p>
-
-<p>Though contagion is not so apt either to
-arise or to spread in this climate as in colder
-ones, there were several circumstances about
-this time tending to prove that it may
-exist in a hot climate. Those ships which
-had their men returned to them from the
-French prizes, in all of which fevers prevailed,
-had an increase of sickness not only
-in the men that were returned, but in the
-rest of the crew. There was another presumption
-of contagion, from the proportion
-of mortality among the surgeons and
-their mates, who were by their duty more
-exposed to the breath, effluvia, and contact
-of the sick. There died, during our stay
-at Jamaica, three of the former, and four
-of the latter, which is a greater proportion
-than what died of any other class of officers
-or men.</p>
-
-<p>It has been the opinion of some, that fevers
-do not arise from any putrid <i>effluvia</i>,
-except those of the living human body, or
-some specific infection generated by it while
-under the influence of disease. It has been
-<span class="pagenum" id="Page_135">135</span>
-alledged in proof of this, that the putrid
-air in some great cities is breathed without
-any bad effects; and a celebrated professor of
-anatomy<a id="FNanchor_19" href="#Footnote_19" class="fnanchor">19</a> used to observe, that those employed
-in dissecting dead bodies did not
-catch acute diseases more readily than other
-people. I believe this may be true, in a
-climate like Europe, where cold invigorates
-the body, and enables it to resist the effects
-of foul air; but I am persuaded it is otherwise
-in tropical climates. The external
-heat of the air induces great languor and
-relaxation, and we cannot breathe the same
-portion of air for the same length of time
-in a hot as in a cold climate, without great
-uneasiness. The want of coolness must,
-therefore, be compensated by a more frequent
-change of air, and by its greater purity:
-any foulness of the air is accordingly
-more felt in a hot climate; and, according
-to the modern theory, air, already loaded
-with putrid phlogistic vapour, will be less
-qualified to absorb the same sort of vapour
-<span class="pagenum" id="Page_136">136</span>
-from the blood in the lungs, in which, according
-to this theory, the use of respiration
-consists. Be this as it will, there is
-something in purity of air which invigorates
-the circulation, and refreshes the body; and
-the contrary state of it depresses and debilitates,
-particularly in a hot climate; and in
-this way foul air may induce disease, like
-any other debilitating cause, independent of
-infection, or any specific quality. There
-was no reason to suspect any such infection
-in the Ville de Paris; for there was no
-sickness on board of this ship when in possession
-of the enemy, and the sickness that
-prevailed after her being captured seemed to
-proceed from what may be called simple putrefaction.
-There was an instance of the
-same kind in one of our own ships of the
-line, in which a bad fever broke out in the
-beginning of July, which seemed to be owing
-to the foul air of a neglected hold; for
-there was a putrid stench proceeding from
-the pumps, which pervaded the whole ship.
-I perceived this very sensibly one day, when
-visiting some officers who were ill of fevers;
-<span class="pagenum" id="Page_137">137</span>
-and before I left the ship an alarm was given
-of two men being suffocated in what is called
-the <i>well</i>, which is the lowest accessible part
-of the hold. This fever was of a very malignant
-kind, and fell upon the officers more
-than the men; for six of them were seized
-with it, of whom three died on the third
-day after being taken ill.</p>
-
-<p>The fevers, which were of the greatest
-malignity at this time, affected the officers
-more than the common men. Only one
-captain died at Jamaica while the fleet was
-there, and it was of this fever. We lost
-five lieutenants, of whom four died of it;
-and this was the disease which carried off
-the three surgeons. But foul air was not
-the only cause that produced this fever
-among the officers, several of whom brought
-it on by hard drinking, or fatiguing themselves
-by riding or walking in the heat of
-the sun. It cannot be too much inculcated
-to those who visit tropical countries, that
-exercise in the sun, and intemperance, are
-most pernicious and fatal practices, and that
-<span class="pagenum" id="Page_138">138</span>
-it is in general by the one or the other
-that the better sort of people, particularly
-those newly arrived from Europe, shorten
-their lives.</p>
-
-<p>Before leaving Jamaica, I sent to England
-a Supplement to the Memorial given
-in, last year<a id="FNanchor_20" href="#Footnote_20" class="fnanchor">20</a>.
-<span class="pagenum" id="Page_139">139</span></p>
-
-<h2 id="BOOK_II_CHAP_V">CHAP. V.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span>, from its
-leaving Jamaica on the 17th of July, till its Departure
-from New York on the 25th of October.&mdash;&mdash;What
-Diseases most prevalent on the Passage
-to America&mdash;Rapid Increase of the Scurvy during
-the last Week of the Passage&mdash;Method of supplying
-the Sick at New York&mdash;The Fleet uncommonly
-healthy in October&mdash;State of the Weather and of
-Health in America in Summer and Autumn, 1782.</p></blockquote>
-
-<p>The season of the hurricanes approaching,
-and all the convoys destined for England
-this year being dispatched, the main
-body of the fleet, consisting of twenty-four
-ships of the line, left Port Royal on the
-17th of July, under the command of Admiral
-Pigot, in order to proceed to the coast
-of America. A great convoy for England
-had been sent off a few days before, protected
-by the Ville de Paris and six other
-ships of the line, which we overtook and
-<span class="pagenum" id="Page_140">140</span>
-passed at the west end of the island. When
-we arrived off the Havannah, a large squadron
-of the enemy was seen there in readiness
-to sail, which induced the Admiral to
-wait in sight of it for the convoy, which
-did not come up till ten days after. Owing
-to this delay, and our meeting with baffling
-winds on the rest of the passage, we did not
-arrive at New York till the 7th of September.
-We found there the Invincible and
-Warrior, which sailed after us, but arrived
-before us, by having taken the windward
-passage.
-<span class="pagenum" id="Page_141">141</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Prevalence
-of different Diseases, and their Mortality,
-in July, 1782.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">13&frac12;</td>
-    <td class="tdr">16</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">24</td>
-    <td class="tdr">49</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">91</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">20</td>
-    <td class="tdr">134</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">5&frac12;</td>
-    <td class="tdr">33</td>
-  </tr>
-</table>
-
-<p>The mortality this month, in relation to
-the whole numbers on board, was one in
-a hundred and thirty.</p>
-
-<p>There were only one in thirty-eight of
-the sick sent to the hospitals.
-<span class="pagenum" id="Page_142">142</span></p>
-</div>
-
-<p>The fevers arose chiefly during the first
-two weeks after leaving Jamaica, which
-renders it probable that the seeds of them
-were brought from thence. Had they been
-owing to the heat simply, they would
-have been as apt to arise in some subsequent
-part of the passage; for the tropical
-heats at this season of the year extend to
-the 30th degree of latitude, which we did
-not cross till the 22d of August, that is,
-near five weeks after leaving Jamaica. The
-only ships in which the fever could be imputed
-to infection or foul air were the Barfleur,
-Alcide, and the Aimable frigate. The
-first had received, as recruits, at Jamaica,
-men who had been confined for some time
-before in a French jail, and a fever of a
-bad kind spread on board of her soon after.
-The Aimable was a prize from the French;
-and the sickness was here so evidently owing
-to foul air, that, whenever the contents
-of the hold were stirred, so as to let
-loose the putrid effluvia, there was then an
-evident increase of sickness. The fever in
-the Alcide was of a peculiar slow kind, to
-be described hereafter, and seemed to be a
-<span class="pagenum" id="Page_143">143</span>
-continuation of the same infection which
-had so long existed in that ship.</p>
-
-<p>The Duke, which had hitherto been by
-far the most subject to fevers of any ship
-in the fleet, became more and more free
-from them even in the most early part of
-this passage, and might be said to be entirely
-so at the time she arrived in America.
-The fever had been so very prevalent in
-this ship since leaving England, that there
-was hardly a man who had escaped it.
-Could this have any effect in making them
-less liable to catch it a second time?</p>
-
-<p>In the course of this passage the dysenteries
-came to prevail over the fevers, as we
-have found to be commonly the case at sea.
-It appears by the former table, compared
-with the next, that the mortality in fevers
-was much the same, and that in the dysentery
-it was greater than while the fleet
-was at Jamaica. This does not argue, however,
-that the diseases were equally malignant,
-but was owing to the want of an hospital,
-and of those comforts of diet which
-<span class="pagenum" id="Page_144">144</span>
-the sick enjoyed on board while in harbour.
-This last was particularly felt in the dysenteries,
-in the cure of which more depends
-upon diet than in most other diseases. In
-all the calculations of mortality on board of
-ships, if any have been sent to the hospital,
-they are to be deducted from the number;
-and these make a greater difference in the
-mortality on board than their numbers simply
-would indicate; for only the worst
-cases, and those therefore who were most
-likely to die, used to be sent to the hospital.
-But as the fleet was at sea during the whole
-of this month, no allowance of this kind is
-to be made.
-<span class="pagenum" id="Page_145">145</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Sickness
-and Mortality in August.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">31</td>
-    <td class="tdr">17</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">46</td>
-    <td class="tdr">35</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">25</td>
-    <td class="tdr">66</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">27</td>
-    <td class="tdr">43</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">7&frac12;</td>
-    <td class="tdr">31</td>
-  </tr>
-</table>
-
-<p>The mortality this month, in relation to
-the whole numbers on board, was one in
-one hundred and sixty-nine.</p>
-</div>
-
-<p>The scurvy began to appear very soon
-upon this passage; for by the end of August,
-at which time the fleet had only been
-six weeks at sea, and that in a warm climate,
-<span class="pagenum" id="Page_146">146</span>
-and in dry weather, it had made considerable
-progress. It first appeared and
-prevailed most in the Prince George and
-Royal Oak, though they had been ten
-weeks at Jamaica. This was the first sickness
-with which the latter had been affected
-since arriving in the West Indies; and there
-was no perceivable peculiarity in either of
-them to account for their being subject to it
-more early, or more violently, than the rest
-of the fleet. If the disease is contagious,
-as has been suspected, there might be a few
-men on board of them, who, being uncommonly
-prone to the disease, would be soon
-affected, and communicate it, or at least
-hasten the symptoms in those who might be
-less predisposed to it. But this is only conjecture.
-Before the end of the voyage, the
-whole fleet was more or less afflicted with it,
-though it had been only seven weeks and
-three days at sea; but the men had received
-so few refreshments while in port, that their
-constitutions were prepared to fall into this
-disease. The Barfleur, Alfred, and Princessa,
-were most affected with it next to the two
-ships mentioned above.
-<span class="pagenum" id="Page_147">147</span></p>
-
-<p>The seventeen ships which arrived from
-England in February and March were much
-less affected with it than the rest of the
-fleet, which was, no doubt, owing to the
-wine, melasses, and sour krout, with which
-they were so amply supplied. Though these
-articles were all expended before leaving Jamaica,
-yet the good effects of them on the
-constitutions of the men were visible in the
-course of this passage.</p>
-
-<p>The America was the most free from it of
-all the ships of the old squadron; and this
-was owing to the great humanity and attention
-of the captain<a id="FNanchor_21" href="#Footnote_21" class="fnanchor">21</a>, who, as soon as any
-of the men were taken ill, allowed them
-wine and other refreshments from his private
-store. There was another proof in the Conqueror
-of the great importance of attending
-to this disease in its earliest stage. Mr.
-Lucas, the surgeon of this ship, by watching
-the first beginnings of it, by a proper
-regulation of diet, and the administration of
-the essence of malt and juice of limes, not
-<span class="pagenum" id="Page_148">148</span>
-only prevented the progress of the disease,
-but proved, that, with great attention, it
-may even be cured at sea. It is of the utmost
-consequence in this disease to put the men
-on the sick list on the very first appearance of
-the symptoms, so that they may early have
-the advantage of proper treatment and regimen.
-It is only at this period of it that the
-effects of essence of malt are sensible; but
-we have seen that the juice of certain fruits
-will cure it in more advanced stages.</p>
-
-<p>There is a very important remark suggested
-by comparing the two preceding tables
-with that which follows. It appears
-that in the month of September a much
-greater number was taken ill of scurvy, and
-also that there died of this disease a greater
-proportion than in the two preceding months.
-All the mischief from it in that month happened
-in the first week of it, during which as
-many died as in the whole month of August;
-for the fleet came to an anchor on the 7th of
-September at New York, where the worst
-cases were immediately sent to the hospital,
-and those that remained on board were supplied
-<span class="pagenum" id="Page_149">149</span>
-with every necessary refreshment. Had
-the fleet remained longer at sea, the mortality
-would probably have increased in the
-same progression; and this circumstance
-ought to be well considered in undertaking
-cruises.</p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Prevalence
-of Sickness and Mortality in September.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">49</td>
-    <td class="tdr">31</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">46</td>
-    <td class="tdr">68</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">15&frac12;</td>
-    <td class="tdr">39</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">68</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">62</td>
-    <td class="tdr">226</td>
-  </tr>
-  <tr>
-    <td>General Proportion,</td>
-    <td class="tdr">7</td>
-    <td class="tdr">58</td>
-  </tr>
-</table>
-<p><span class="pagenum" id="Page_150">150</span></p>
-
-<p>The proportion of deaths, in relation to
-the whole numbers on board, was one in
-three hundred and ninety-eight.</p>
-
-<p>About one third of all the sick were sent
-to the hospital.</p>
-</div>
-
-<p>As the proportion of ulcers was uncommonly
-great, I thought it worth while to
-make a calculation of it. The Barfleur had
-the greatest number; and this ship, for
-causes I cannot assign, was more afflicted
-with bad ulcers than any other in the fleet,
-for several months together.</p>
-
-<p>The fleet having arrived at New York in
-this unhealthy state, the first care was to
-make provision for the sick. There were
-somewhat more than fifteen hundred on the
-sick lists of all the ships, and the hospital
-could accommodate little more than six hundred.
-In order that it might not be overcrowded,
-and that each ship might have a
-just share of relief, I went round the fleet to
-ascertain the due proportion of those cases
-that were the most proper objects for being
-<span class="pagenum" id="Page_151">151</span>
-sent on shore. All the infectious and acute
-Complaints, and some of the worst scorbutics,
-were accordingly sent to the hospital.
-Those who were kept on board being chiefly
-such as were affected with the scurvy, were
-supplied with various refreshments in their
-respective ships, and seemed to recover as
-soon as if they had been sent on shore.
-They had indeed almost every advantage enjoyed
-by those at the hospital; for, besides
-fresh meat thrice a week, and spruce beer
-daily in common with the other seamen,
-each man on the sick list was supplied every
-week at the public expence with four pounds
-of apples and half a pound of sope. There
-were also thirty casks of limes taken in a
-prize, which were distributed among the
-scorbutic men, and proved of infinite use.
-Admiral Pigot’s great zeal for the good of
-the service, as well as his natural humanity,
-induced him to listen to whatever was proposed
-for the benefit of the men.</p>
-
-<p>The supply of sope was a thing entirely
-new in the service; but the good effect of
-all the other articles would most probably
-<span class="pagenum" id="Page_152">152</span>
-have been defeated, unless the men had been
-furnished with the means of cleanliness,
-which is the most essential requisite of health.
-The advantage of this method will appear by
-the returns of next month to have been very
-conspicuous; and it was on this occasion
-more than any other that I saw realised in
-every particular the plan proposed in the
-memorial to the Admiralty. It may be
-added, that the sick that were left on board
-were not even without the recreation of the
-shore enjoyed by those at the hospital; for
-most of the captains had the attention to
-send daily on shore, for amusement and exercise,
-such as were able to walk. Thus
-there were all the advantages of an hospital
-obtained at much less expence to Government,
-and without the risque of intemperance,
-desertion, or infection, which are the
-inconveniencies connected with an hospital.
-What farther contributed to health at this
-time was, a large quantity of excellent wine
-with which the fleet was supplied.
-<span class="pagenum" id="Page_153">153</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the proportional Sickness
-and Mortality in October.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">45</td>
-    <td class="tdr">250</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">61</td>
-    <td class="tdr">69</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">34</td>
-    <td class="tdr">197</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">181</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">127</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">12&frac12;</td>
-    <td class="tdr">196</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths in this month,
-in relation to the whole number on board,
-was only one in fourteen hundred and seventy-eight.</p>
-
-<p>About one in twenty-nine of the sick was
-sent to the hospital.
-<span class="pagenum" id="Page_154">154</span></p>
-</div>
-
-<p>There was, upon the whole, less sickness
-and mortality in this month than in any
-other during which I kept records of the
-fleet. This was, no doubt, owing in part
-to the climate, but was chiefly the effect of
-the extraordinary attention paid to the refreshments
-of the men. The fleet was here
-exactly in the same situation, and at the
-same season, two years before, but was not
-near so healthy.</p>
-
-<p>Nor were the advantages derived from the
-great plenty of refreshments, procured at
-this time at New York, merely temporary;
-for the men’s constitutions were so much
-improved by them, that the part of the
-fleet which remained under the command of
-Lord Hood was at sea for twelve weeks without
-being affected by the scurvy. This was
-chiefly to be ascribed to the previous refreshments;
-for we have seen, that, in a passage
-of seven weeks from Jamaica to New York,
-the fleet was greatly affected with the scurvy,
-in consequence of not having had the advantages
-of fresh meat and vegetables when
-last in port. The climate had, no doubt,
-<span class="pagenum" id="Page_155">155</span>
-also a share in keeping off the scurvy; for
-the greater part of the twelve weeks was
-taken up in a cruise off St. Domingo; and,
-I believe, it never was known that a fleet
-was so long at sea, in a cold climate, without
-being greatly affected with this disease.</p>
-
-<p>It appears, that though the proportion of
-fevers had increased somewhat this month
-over that of fluxes, yet the former were less
-fatal; and, I think, the true dysentery is
-more frequent in this climate, and more apt
-to prove fatal in its acute state, than in the
-West Indies. I have indeed preferred the
-term flux to that of dysentery, for this reason,
-that the symptoms in many cases did
-not rise so high as properly to constitute dysentery;
-and the disease proves fatal in the
-West Indies more frequently in the chronic
-than in the acute state. The fluxes were
-daily gaining ground when we left New
-York, and continued to prevail to a great
-degree in the Magnificent, which remained
-in that climate several weeks after us.
-<span class="pagenum" id="Page_156">156</span></p>
-
-<p>The climate and situation of the fleet had
-a greater effect in diminishing ulcers than
-any other complaints; for the proportion
-of them in this month is little more than
-one third of what it was in the last.</p>
-
-<p>The calculation for October was made upon
-thirteen ships of the line, which sailed from
-New York on the 25th of that month.</p>
-
-<p>The weather had then begun to grow
-cold; but few or none of the diseases peculiar
-to a cold climate had appeared. There
-occurred, while we were at New York,
-several cases of inflammation of the liver
-among the officers and men who came from
-the West Indies. It was remarked formerly,
-that this complaint hardly ever occurred
-in the West Indies; but it would
-appear that the residing there disposes to an
-inflammation of this organ upon changing
-to a colder climate.</p>
-
-<p>The preceding summer had been uncommonly cold,
-not only in North America,
-but in the whole temperate part of the
-<span class="pagenum" id="Page_157">157</span>
-northern hemisphere, so far as I could learn
-by inquiry. In consequence of this, the
-crops failed in Europe, America, and the
-northern parts of Asia. The same circumstance
-had a remarkable effect on the reigning
-diseases of the season at New York;
-for, instead of the bilious complaints common
-in the end of summer and in autumn,
-a slight fever of the inflammatory kind had
-prevailed. An epidemic catarrh had spread
-all over Europe, and some part of Asia, in
-the earlier part of the year; and perhaps
-this was connected with the peculiar state
-of the atmosphere about this time. It was
-before observed, that there was something
-unusual in the state of the weather at Jamaica
-while the fleet lay there; and it is
-possible that this might be owing to the
-same general cause.
-<span class="pagenum" id="Page_158">158</span></p>
-
-<h2 id="BOOK_II_CHAP_VI">CHAP. VI.</h2>
-
-<blockquote>
-
-<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from its Departure
-from New York till the Conclusion of the
-War.&mdash;&mdash;Passage to the West Indies&mdash;Account of
-the Ships there during our Absence&mdash;Arrival of a
-Squadron from England&mdash;Of these, two Ships only
-were healthy&mdash;Causes of this&mdash;Inflammatory Complaints
-in the Union&mdash;Probable Cause of these&mdash;Comparison
-of the two Squadrons&mdash;Increase of Sickness
-from Recruits brought from England&mdash;from
-French prisoners.</p></blockquote>
-
-<p>Thirteen ships of the line sailed
-from America for the West Indies on the
-25th of October, under the command of
-Admiral Pigot, and the other half of the
-fleet was left under Lord Hood, to watch
-the motions of the French squadron, which
-was then at Boston.</p>
-
-<p>The day on which we left the coast of
-America a storm came on, which lasted
-<span class="pagenum" id="Page_159">159</span>
-two days; but the rest of the passage being
-fair and moderate, we arrived at Barbadoes
-on the 20th of November, where
-the fleet continued for the remainder of the
-month.</p>
-
-<p>All the above-mentioned squadron, except
-two ships, is comprehended in the calculation
-of the following table, and also the
-Magnificent, Prudent, and Nonsuch. The
-two last had continued in the West Indies,
-during our absence.
-<span class="pagenum" id="Page_160">160</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in November.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">54</td>
-    <td class="tdr">25</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">78</td>
-    <td class="tdr">132</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">86</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">94</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">46</td>
-    <td class="tdr">103</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">15</td>
-    <td class="tdr">77</td>
-  </tr>
-</table>
-
-<p>About a sixth part of the whole sick were
-sent to the hospital this month, and one half
-of these were sent to the hospital at Halifax
-from the Magnificent.</p>
-
-<p>The proportion of deaths this month, in
-relation to the whole number on board, was
-one in eight hundred and eighty-seven.
-<span class="pagenum" id="Page_161">161</span></p>
-</div>
-
-<p>Fewer were taken ill this month than
-the preceding, but more in proportion died;
-which might partly be owing to the fleet
-having been more at sea, and partly to the
-change of climate.</p>
-
-<p>Fevers were now more numerous, and also
-more fatal than any other disease; and we
-see them follow the contrary proportion to
-fluxes in the progress to the southward, that
-they did in our progress to the northward.
-These fevers prevailed chiefly in the Formidable
-and Warrior. In the former it first
-appeared among some men that had been
-pressed at New York from a privateer, some
-of whom were seized a few days after our
-arrival at Barbadoes with the yellow fever,
-and they were the only instances of it at this
-time in the fleet.</p>
-
-<p>The scurvy continued to diminish, but
-the ulcers increased as we came into the
-torrid zone.</p>
-
-<p>Diseases in general were so slight and so
-few at this time, that the whole squadron
-<span class="pagenum" id="Page_162">162</span>
-from America sent only forty-eight men to
-the hospital at Barbadoes from its arrival to
-the end of the month.</p>
-
-<p>It may be proper here to give an account
-of some of the ships that remained on this
-station, while the main body of the fleet was
-in America.</p>
-
-<p>The Prudent, when she left us, was extremely
-healthy, and continued so till a flux
-broke out in July, which was communicated
-by some men from a cartel, who were
-ill of this disease. It spread among the ship’s
-company, and prevailed for three months.
-The only deaths during the seven months
-that this ship was separated from the fleet
-were, two from flux, and one from scurvy,
-and only twenty-five were sent to hospitals.
-This is a proof how much more healthy
-the windward station is than that of Jamaica.
-The scurvy arose at one time, in a
-cruise of five weeks, though there was no
-appearance of it at another time in a cruise
-of six weeks. The cause of this seems to
-be the difference of the weather at the two
-<span class="pagenum" id="Page_163">163</span>
-periods; for it was very wet in the former,
-and very dry in the latter. The time in
-which this ship was most exposed to sickness
-was while she was under repair at Antigua,
-a situation in which hardly any ship escapes
-a severe visitation of sickness; yet this ship
-was not at all affected by it, which seemed
-to be owing to the uncommon pains taken
-by the captain to prevent the men from
-labouring in the sun during the hot part of
-the day.</p>
-
-<p>The Nonsuch was five months separated
-from the fleet, during which time ten men
-died. Nine of these died of fevers, and one
-of the dysentery. She sailed from Jamaica
-for Barbadoes about the same time that the
-fleet sailed for North America, and was nine
-weeks on the passage. A fever was the
-prevailing disease, and the men probably
-inhaled the seeds of it at Jamaica, in common
-with most of the other ships’ companies
-that were there. The scurvy, which
-had formerly prevailed so much, appeared
-at this time; but it was in a very moderate
-degree, considering the length of the passage.
-<span class="pagenum" id="Page_164">164</span>
-None died of it, and few were so ill as to require
-being sent to the hospital. Had this
-ship gone into a colder climate, like the
-others, it would probably have prevailed
-to a greater degree. The whole number
-sent to the hospitals for various complaints,
-during the five months, was only thirteen.</p>
-
-<p>The Nymph frigate was the only other
-ship left in the West Indies which is included
-in the tables. There happened only
-two deaths in her from June to October,
-both months included. One of these was
-from scurvy, the other from asthma. She
-was in that time upon two cruises, each of
-which lasted eight weeks. During the first
-the weather was dry and fine, and during
-the other it was wet and sultry, with the
-same effect upon health as in the Prudent;
-for in the second cruise the scurvy prevailed
-to a considerable degree, but not at all during
-the first. This disease was prevented
-from becoming violent or fatal, on either
-occasion, by the great attention of Mr. Anderson,
-the surgeon. He found great benefit
-from the essence of malt, when given
-<span class="pagenum" id="Page_165">165</span>
-early in the complaint; and some limes having
-been taken in a prize, while this disease
-was at the worst, the scorbutic men
-were so much recovered by the use of them,
-that they were all able to return to duty before
-the ship arrived in port.
-<span class="pagenum" id="Page_166">166</span></p>
-
-<h4>DECEMBER.</h4>
-
-<p>The whole squadron remained at anchor
-at Barbadoes, and nothing worth notice occurred
-till the arrival of a reinforcement of
-eight ships of the line, under Sir Richard
-Hughes, on the 8th of December. This
-squadron had been detached by Lord Howe,
-after the relief of Gibraltar, and the action
-with the combined fleets on the 20th of
-October. It consisted of one ship of 90
-guns, one of 80, three of 74, and three of
-64. They sailed from England on the 9th
-of September, and from that time till their
-arrival at Barbadoes they had not been in
-port, except for ten days that they were at
-Madeira, where they were supplied with
-fresh meat, fruit, and vegetables, by which
-means the scurvy, which had begun to prevail
-to a considerable degree, was almost entirely
-eradicated, and the health of the men
-was surprisingly restored, for so short a time.</p>
-
-<p>When they joined us, however, there was
-a good deal of sickness on board of them all,
-<span class="pagenum" id="Page_167">167</span>
-except the Union and Ruby. The former
-had been more than three years in commission,
-and in that time had never been sickly,
-and had now all the advantages of a long-established
-and well-regulated ship’s company.
-All the rest had been newly commissioned
-and manned when they left England.
-The superior health of the Ruby was owing
-to her having been manned with the
-crews of other ships, some of which had
-just arrived from the West Indies; whereas
-the others had been manned chiefly by
-draughts of pressed men from guardships,
-or by raw volunteers, of whom a great
-many were raised in Ireland about this time.
-The Bellona and Berwick having been somewhat
-longer in commission than the rest,
-were less sickly.</p>
-
-<p>The following tables will shew the comparative
-state of health of the squadron formerly
-on the station with that which had
-newly arrived from England.
-<span class="pagenum" id="Page_168">168</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the old Squadron,
-in December.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">32</td>
-    <td class="tdr">80</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">94</td>
-    <td class="tdr">99</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">62</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">64</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">57</td>
-    <td class="tdr">71</td>
-  </tr>
-  <tr>
-    <td>General Proportion,</td>
-    <td class="tdr">11&frac12;</td>
-    <td class="tdr">124</td>
-  </tr>
-</table>
-
-<p>The proportion of the deaths this month
-to the whole number of men belonging to
-this part of the fleet, was one in eleven hundred
-and two. There were fifty-six sent to
-the hospital, which was one in eighteen of
-all the sick.
-<span class="pagenum" id="Page_169">169</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the new Squadron,
-in December.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">11</td>
-    <td class="tdr">55</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">86</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">107</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">191</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">56</td>
-    <td class="tdr">54</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">5</td>
-    <td class="tdr">64</td>
-  </tr>
-</table>
-
-<p>The proportion of the deaths this month
-to the whole number of men belonging to
-this part of the fleet, was one in four hundred
-and forty.
-<span class="pagenum" id="Page_170">170</span></p>
-</div>
-
-<p>There were one hundred and eighty-nine
-sent to the hospital; but the proportion to
-the whole number of sick cannot be ascertained,
-as we do not know how many were
-on the list on the first of the month.</p>
-
-<p>The increase of fevers in the old squadron
-was chiefly owing to their having spread in
-the Nonsuch; and they seemed to partake
-more of that kind which originates in jails
-and ships, than of that which is peculiar to
-the climate. The body of one of the men
-who died of this fever was inspected at the
-hospital, and there was found to be inflammation
-and even perforation of the intestines,
-without any previous symptom that
-could lead to expect such an appearance, a
-circumstance more likely to happen in the
-former sort of fever than the latter.</p>
-
-<p>The increase of scurvy was owing to the
-numbers that were taken ill of it in the
-Magnificent on the passage from Halifax,
-from whence she sailed in the beginning of
-this month, and joined the fleet at Barbadoes
-in the end of it. There was a great deal of
-<span class="pagenum" id="Page_171">171</span>
-sickness in this ship at Halifax, and on the
-passage, owing to the want of such clothing
-as was suitable to that severe climate. One
-of the principal complaints was an inflammatory
-sore throat.</p>
-
-<p>There was no change in the situation of
-the fleet, only that four ships of the line
-were sent on the 16th to cruise near Guadaloupe,
-and they continued at sea till the
-beginning of February.</p>
-
-<p>The new squadron was much afflicted
-with the jail fever, brought from England;
-and it was much more prevalent, as well as
-malignant, on board of the Suffolk than any
-of the rest. During the passage it prevailed
-most in the Princess Amelia, not less than
-twenty having died of it. It subsided in this
-ship before she arrived in the West Indies;
-but on board of the Suffolk it continued to
-rage for some months after.</p>
-
-<p>As the hospital at Barbadoes was too small
-to contain all the sick of this squadron, only
-the cases of greatest danger and the most infectious
-<span class="pagenum" id="Page_172">172</span>
-were sent on shore, and those that
-remained were provided with fresh vegetables
-and milk on board of their own ships, in the
-same manner as had been formerly practised
-with such success on similar occasions. This
-was continued for four weeks, during which
-time they all got into tolerable health, except
-the Suffolk.</p>
-
-<p>There appeared, by the returns of the
-new squadron, to be a greater number under
-the head of “Other Complaints,” which
-was owing to the number of pulmonic complaints,
-the consequence of the influenza
-which prevailed in Europe, at sea, as well
-as on shore, in the spring and beginning of
-the summer of this year.</p>
-
-<p>Though inflammatory complaints are rare
-in this climate, yet in a few of the ships
-there was some appearance of them; and I
-remarked that they occurred in those ships
-which were in other respects most healthy,
-and most free from infection. A good many
-of the men were seized with inflammatory
-sore throats in the Bellona a few days before
-<span class="pagenum" id="Page_173">173</span>
-she arrived at Barbadoes, and this was in
-other respects the most healthy ship next to
-the Union and Ruby. In the Union there
-was no violent acute complaint whatever,
-which was very singular among so great a
-body of men; but several rheumatisms,
-coughs, and catarrhs, arose in her this month,
-and there even occurred two pleurisies in the
-following month. The bowel complaints
-which occurred on board of this ship were
-also of an inflammatory nature. These distempers
-seemed to proceed from accidental
-exposure and irregularity; and is it not
-highly probable that these causes, instead of
-producing local inflammatory complaints,
-might have been the means of exciting bad
-fevers and fluxes, as in the other ships, had
-the men been equally predisposed to them,
-by living in foul air, or under the influence
-of infection?</p>
-
-<p>The following tables will shew the comparative
-state of health of the two squadrons
-in the three first months of next year.
-<span class="pagenum" id="Page_174">174</span></p>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the old Squadron in January,
-1783.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">67</td>
-    <td class="tdr">70</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">157</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">44</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">48</td>
-    <td class="tdr">117</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">12&frac12;</td>
-    <td class="tdr">214</td>
-  </tr>
-</table>
-
-<p>The mortality this month, in relation to
-the whole number on board, was one in
-twelve hundred and fifty-seven. About one
-fifteenth of all the sick were sent to the
-hospital.
-<span class="pagenum" id="Page_175">175</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the new Squadron in
-January, 1783.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">12</td>
-    <td class="tdr">48</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">29</td>
-    <td class="tdr">153</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">320</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">137</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">19</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">5&frac12;</td>
-    <td class="tdr">109</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths to the whole
-number on board was one in five hundred
-and forty. About one in thirty of all the
-sick were sent to the hospital.
-<span class="pagenum" id="Page_176">176</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the old Squadron in
-February.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">46</td>
-    <td class="tdr">69</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">159</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">63</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">100</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">51</td>
-    <td class="tdr">136</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">13&frac12;</td>
-    <td class="tdr">173</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths to the whole
-number on board was one in sixteen hundred
-and ninety-seven. One ninth of all the
-sick were sent to the hospital.
-<span class="pagenum" id="Page_177">177</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the new Squadron in
-February.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">30</td>
-    <td class="tdr">50</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">34</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">212</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">174</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">52</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">11</td>
-    <td class="tdr">185</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths to the whole
-number was one in twelve hundred and seventy-six.
-The proportion sent to the hospital
-was the same this month as in the other
-part of the squadron.
-<span class="pagenum" id="Page_178">178</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the old Squadron,
-in March.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">28</td>
-    <td class="tdr">12&frac12;</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">71</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">46</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">226</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">76</td>
-    <td class="tdr">44</td>
-  </tr>
-  <tr>
-    <td>General Proportion,</td>
-    <td class="tdr">11</td>
-    <td class="tdr">194</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths to the whole
-number was one in thirteen hundred and
-sixty-one. About one ninth of all the sick
-were sent to the hospital.
-<span class="pagenum" id="Page_179">179</span></p>
-</div>
-
-<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness
-and Mortality in the new Squadron,
-in March.</h3>
-
-<div class="table">
-<p>
-Transcriber’s Keys:<br />
-A Proportion of those taken ill in the Course of the Month.<br />
-B Proportion of Deaths, in relation to  the Numbers of the Sick.</p>
-
-<table class="bbox">
-  <tr>
-    <th rowspan="2">DISEASES.</th>
-    <th>A</th>
-    <th>B</th>
-  </tr>
-  <tr>
-    <th colspan="2">ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">44</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">49</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">123</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">183</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">38</td>
-    <td class="tdr">138</td>
-  </tr>
-  <tr>
-    <td>General Proportion</td>
-    <td class="tdr">12</td>
-    <td class="tdr">403</td>
-  </tr>
-</table>
-
-<p>The proportion of deaths to the whole
-number was one in four thousand and eighty-seven.
-About one in eleven of all the
-sick were sent to the hospital.
-<span class="pagenum" id="Page_180">180</span></p>
-</div>
-
-<p>The main body of the fleet remained at
-Barbadoes till the 12th of January, when
-they went to cruise to windward of Martinico,
-in order to intercept a French squadron
-expected from North America. This
-cruise lasted four weeks; and intelligence
-being received of the enemy’s having taken
-a different route, the whole fleet bore away
-for St. Lucia, where it came to an anchor
-on the 8th of February.</p>
-
-<p>In the course of the three months above
-mentioned, we see the two squadrons approaching
-to each other, in point of health,
-till they became pretty equal and similar;
-and the new squadron became even somewhat
-more healthy than the old.</p>
-
-<p>The increase of fevers in the old squadron
-was owing to two causes. One was the importation
-of new-raised recruits brought
-from England by some ships that arrived in
-the beginning of January. These were distributed
-to such ships as stood most in need
-of men; and being very dirty and ill cloathed,
-were likely to harbour infection. They
-<span class="pagenum" id="Page_181">181</span>
-were evidently the cause of sickness in the
-Warrior and Royal Oak; for these ships
-were before that time healthy, and the fever
-began with these strangers, and spread
-amongst the former crew. It is remarkable
-that the ships that brought them from England
-were not affected by them.</p>
-
-<p>It was caught in the Royal Oak from six
-men that came from England in the Anson,
-which men, though first put on board the
-Namur, communicated no fever there, having
-been kept separate from the rest of the
-men; but being sent to the Royal Oak,
-they were themselves first taken ill with a
-fever, which afterwards spread to about
-thirty of the other men. What was singular
-in this fever was, that the eyes and skin
-of all that were affected by it became yellow,
-though without any particular malignancy;
-for only two died on board, and one
-in the hospital. There was one whose skin
-was very yellow, yet his complaint was so
-slight as never to confine him to his bed.
-<span class="pagenum" id="Page_182">182</span></p>
-
-<p>The other cause of the increased proportion
-of fevers in the old squadron was, the
-great number of these complaints that arose
-in the Magnificent. This ship having been
-sent on a cruise about the middle of February,
-and the weather being rainy, squally,
-and uncommonly cold, for the climate,
-many fevers of the inflammatory kind appeared.
-During this cruise she made prize
-of a large French frigate, called the Concord,
-and the greater part of the prisoners
-being taken on board, the fever from that
-time assumed a different type, with new and
-uncommon symptoms; for, instead of being
-inflammatory and requiring bleeding, as before,
-it became more of a low, putrid kind,
-and was attended in most cases, if not in all,
-with a continual sweating; so that, instead
-of evacuations, the remedies that were found
-most effectual were the Peruvian bark, blisters,
-and opium. Thus we see fevers variously
-modified according to men’s constitutions,
-the state of the air, and the noxious
-<i>effluvia</i> of the strangers that intermix with
-them.
-<span class="pagenum" id="Page_183">183</span></p>
-
-<p>We find the proportion of fluxes increasing
-in the new squadron in January and
-February, as they had formerly done in most
-of the ships soon after their arrival from
-England. They were observed also to prevail
-principally in those ships that had formerly
-been most subject to fevers, and not
-to arise till the fever had subsided. They
-were found, for instance, to arise later in
-the Suffolk, where the fever was obstinate
-and malignant, than in the Princess Amelia,
-where the fever had been at one time general
-and fatal, but not so violent and lasting
-as in the other.</p>
-
-<p>The four ships that were sent to cruise
-near Guadaloupe continued at sea for seven
-weeks; and it was owing to the prevalence
-of scurvy in these and in the Magnificent
-that the proportion of that disease was
-greater at this time in the old than in the
-new squadron.</p>
-
-<p>The fleet remained at St. Lucia till the
-accounts of the peace arrived in the beginning
-of April. The service was then at an
-<span class="pagenum" id="Page_184">184</span>
-end, and I returned to England with the
-first division of the fleet, which sailed from
-St. Lucia on the 12th of April, under the
-command of Rear-admiral Sir Francis
-Drake, who was at this time in extremely
-bad health, and requested me to accompany
-him.
-<span class="pagenum" id="Page_185">185</span></p>
-
-<p class="ph1" id="PART_I_BOOK_III">PART I.<br />
-
-<span class="x-large" id="BOOK_III">BOOK III.</span><br />
-
-<span class="medium">Of the Numbers and Mortality of different
-Diseases sent to Hospitals.</span></p>
-
-<h2 id="BOOK_III_CHAP_I">CHAP. I.</h2>
-
-<blockquote>
-
-<p>Hospital at Gibraltar, 1780&mdash;at Barbadoes, 1780&mdash;Causes
-of Mortality from various Diseases&mdash;Accidents&mdash;the
-Hurricane&mdash;Wounds&mdash;Amputations&mdash;Scorches&mdash;Fluxes
-very apt to arise at the Hospital&mdash;Proportion
-that were received and died at Antigua&mdash;St.
-Christopher’s&mdash;St. Lucia, and at Barbadoes, 1782&mdash;at
-Jamaica, 1782&mdash;at New York, Autumn, 1780&mdash;1782&mdash;General
-View of the Admissions and Mortality
-at all the Hospitals during the War.</p></blockquote>
-
-<p>In order to judge of the loss sustained by
-disease, in the course of that service of which
-a relation has been attempted, the sick sent
-to the hospitals must be taken into account.
-I shall, therefore, give a short view of the
-different diseases admitted, and their mortality,
-at the several hospitals connected with
-the fleets in which I served. This will
-serve also to illustrate the different effects
-<span class="pagenum" id="Page_186">186</span>
-that different situations have upon the health
-and recovery of men<a id="FNanchor_22" href="#Footnote_22" class="fnanchor">22</a>.</p>
-
-<p>The fleet which effected the first relief of
-Gibraltar, under the command of Lord
-Rodney, consisting of twenty ships of the
-line, arrived there in the third week of January,
-1780, after a passage of three weeks
-and a few days from England, in which
-they had an action with the Spanish fleet,
-and obtained a victory over them, on the
-16th of that month. The whole fleet, except
-one ship, sailed from Gibraltar on the
-13th of February, and while it lay there,
-the diseases sent to the hospital, and their
-respective mortality, were as follows<a id="FNanchor_23" href="#Footnote_23" class="fnanchor">23</a>:
-<span class="pagenum" id="Page_187">187</span></p>
-
-<div class="table">
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">622</td>
-    <td class="tdr">65</td>
-    <td class="tdr">9&frac12;</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">17</td>
-    <td class="tdr">0</td>
-    <td class="tdr">0</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">13</td>
-    <td class="tdr">1</td>
-    <td class="tdr">13</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">20</td>
-    <td class="tdr">3</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>Wounds</td>
-    <td class="tdr">29</td>
-    <td class="tdr">9</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">12</td>
-    <td class="tdr">3</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">713</td>
-    <td class="tdr">79</td>
-    <td class="tdr">9</td>
-  </tr>
-</table>
-
-<p><a id="FNanchor_24" href="#Footnote_24" class="fnanchor">24</a>This comprehends not only the deaths
-in the time the fleet remained there, but all
-that happened afterwards. The mortality,
-<span class="pagenum" id="Page_188">188</span>
-from wounds and ulcers, is greater than
-might be expected in so fine a climate, and
-at the coolest season of the year; but as the
-place was then besieged, the sick and wounded
-could not be supplied with those refreshments
-that were necessary to the recovery of
-the men, and wounds and ulcers are complaints
-very apt to be affected by the quality
-of the diet.
-<span class="pagenum" id="Page_189">189</span></p>
-</div>
-
-<p>The following is an Account of the Men
-admitted at the Hospital at Barbadoes in
-the Campaign of 1780, that is, from the
-16th of March till the end of June:</p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">277</td>
-    <td class="tdr">43</td>
-    <td class="tdr">6&frac12;</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">70</td>
-    <td class="tdr">22</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">199</td>
-    <td class="tdr">47</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">92</td>
-    <td class="tdr">16</td>
-    <td class="tdr">5&frac12;</td>
-  </tr>
-  <tr>
-    <td>Wounds</td>
-    <td class="tdr">167</td>
-    <td class="tdr">61</td>
-    <td class="tdr">2&frac12;</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">129</td>
-    <td class="tdr">23</td>
-    <td class="tdr">5&frac12;</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">943</td>
-    <td class="tdr">212</td>
-    <td class="tdr">4&frac12;</td>
-  </tr>
-</table>
-
-<p>The fevers were chiefly from the five line-of-battle
-ships that came immediately from
-Europe in March. Upon their arrival they
-sent on shore one hundred and ninety-three
-<span class="pagenum" id="Page_190">190</span>
-men ill of fevers, only one with the flux,
-fifteen with the scurvy, and five with ulcers.</p>
-
-<p>When these ships returned to Barbadoes
-in May, along with the rest of the fleet,
-the greater part of the sick were then also
-on board of them. By that time the flux
-and scurvy had broke out. The former
-prevailed chiefly in the Terrible; the latter
-in the Intrepid. That part of the fleet
-which we found on the station sent on shore
-a very small proportion of all the classes of
-complaints, except wounds.</p>
-
-<p>Of the wounds, nineteen were amputations,
-of which there died nine, mostly of the
-locked jaw. There were forty-six scorched
-by gunpowder, of whom there died fourteen;
-so that, besides those who were killed
-outright, and those who died on board in
-consequence of accidents of this kind, before
-they could be sent to an hospital, about one
-fourth of all the wounds, and the same proportion
-of all the deaths from wounds, at
-the hospital, was owing to this cause. This
-circumstance ought to induce commanders
-<span class="pagenum" id="Page_191">191</span>
-to take every precaution to prevent such accidents.
-In the subsequent part of the war
-they were less frequent, in consequence of
-that greater caution, and more accurate method
-of working great guns, which were
-acquired by practice and experience<a id="FNanchor_25" href="#Footnote_25" class="fnanchor">25</a>.</p>
-
-<p>In the account of the mortality, I have
-included only such as died before the 1st of
-January, 1781; for if any were carried off
-after that time, it was most probably by
-some incidental complaint. There were sixty-five
-of them at that time remaining, and
-they were chiefly men disabled by lameness
-waiting for a passage to England as invalids.</p>
-
-<p>Out of the twenty-three that were killed
-by the fall of the house in the hurricane on
-the 10th of October, eight were of the number
-above accounted for; but these are not
-included in any of the classes of deaths.</p>
-
-<p>The mortality among the men admitted
-at this time was greater than what occurred
-<span class="pagenum" id="Page_192">192</span>
-afterwards in any of the hospitals that I attended,
-except that at Jamaica. The principal
-cause of this was, that as the fleet was
-so much greater than had ever been known
-here before, there was not suitable accommodation
-for such numbers as it was necessary
-to send on shore, and we had not then
-fallen on the method of supplying refreshments
-to the men on board of their ships.
-The circumstance by which the men suffered
-most was, the great crowding which
-the want of room made necessary. There is
-here no public building appropriated for an
-hospital; so that this, as well as every thing
-else, being found by contract, and the number
-of sick being so much greater than it
-was usual to provide for, the whole was at
-this time conducted in a manner not very
-regular.</p>
-
-<p>It appears that the greatest mortality in
-any class of disease was that of the fluxes,
-of which the greatest number sent to hospitals
-are such as have languished for some
-time under this disease, in which state it
-<span class="pagenum" id="Page_193">193</span>
-generally proves fatal in the West Indies, in
-consequence of incurable ulcers in the great
-intestines, to which the heat of the climate,
-as well as the scorbutic habit and sea diet, is
-particularly unfavourable. But the whole
-of the mischief arising from it does not appear
-in the table; for it was the most apt of
-any disease to supervene upon other complaints
-which were under cure at the hospital.
-It more particularly attacked those
-who were recovering from the scurvy, and
-was the cause of the greater number of
-deaths under this head in the table. It was
-found to be more contagious than fevers,
-either because the men’s constitutions were
-more predisposed to it, or, perhaps, because
-the infectious matter of it being more gross
-and less volatile, it is not so readily dissipated
-by the heat of the climate; for, either from
-this, or some other circumstance, infectious
-fevers are not so easily generated, nor so apt
-to spread, as in Europe. That these fluxes
-were owing to infection may be inferred
-from hence, that, when men ill of the
-scurvy were cured on board of the ships
-<span class="pagenum" id="Page_194">194</span>
-they belonged to, they were not liable to
-this disease, neither did they prevail at these
-hospitals afterwards, when great care was
-taken to separate infectious diseases from the
-others.</p>
-
-<p>The only regular hospital on this station
-is that at Antigua. This island being the
-seat of the royal dock yard, there is an established
-hospital in time of peace as well as
-war. It so happened, that great fleets never
-came here to put their sick and wounded on
-shore, as at Barbadoes; so that the greater
-number of those received into it were from
-single ships that came to careen. As there
-was, therefore, less necessity for crowding,
-and as the slighter cases could be admitted,
-there was a less proportion of deaths here
-than at most of the other hospitals.</p>
-
-<p>There were two other establishments for
-the reception of the sick and wounded on
-this station, but they were only temporary.
-These were at St. Lucia and St. Christopher’s,
-where the men being received in
-<span class="pagenum" id="Page_195">195</span>
-great numbers at a time from large fleets,
-and as there were accommodations only for
-the most urgent cases, the mortality approached
-more nearly to that of Barbadoes.
-There died at St. Christopher’s, in the years
-1780 and 1781, in the proportion of one in
-six, and at St. Lucia, in the same time, one
-in five and a half, or two in eleven. The
-air of the hospital at St. Lucia was remarkably
-pure, and this degree of mortality was
-owing to the sick having been accommodated
-in tents and huts. In the two last
-years of the war, when an hospital was
-built, and regularly established, the mortality
-was not much above one half of this.</p>
-
-<p>Some authors have endeavoured to form
-an estimate of the success of practice from
-the different rates of mortality; but this is
-extremely fallacious; for the fatality of diseases
-will depend on their violence, the proportion
-of deaths being very different in
-cases that are slight, from what it is in those
-that are dangerous. We shall take a view,
-however, of the hospital at Barbadoes at
-<span class="pagenum" id="Page_196">196</span>
-another period, in which there seemed little
-or no difference in the violence of the disease,
-and when the superior success seemed
-to be owing to the hospital’s not being so
-crowded, and to the better attendance and
-treatment of the sick. The following is a
-view of the diseases that were admitted in
-the last three months of the year 1782,
-the greater part of which were landed from
-the reinforcement of eight ships of the line
-that joined the fleet at Barbadoes in the beginning
-of December:
-<span class="pagenum" id="Page_197">197</span></p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th colspan="2">Proportion.</th>
-  </tr>
-  <tr>
-    <th />
-    <th />
-    <th />
-    <th>NEARLY</th>
-    <th>ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">224</td>
-    <td class="tdr">29</td>
-    <td class="tdr">8</td>
-    <td />
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">17</td>
-    <td class="tdr">6</td>
-    <td class="tdr">3</td>
-    <td />
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">50</td>
-    <td class="tdr">5</td>
-    <td />
-    <td class="tdr">10</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">25</td>
-    <td class="tdr">10</td>
-    <td />
-    <td class="tdr">2&frac12;</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">46</td>
-    <td class="tdr">8</td>
-    <td class="tdr">6</td>
-    <td />
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">362</td>
-    <td class="tdr">58</td>
-    <td class="tdr">6</td>
-    <td />
-  </tr>
-</table>
-
-<p>It happened on this, as on the former occasion,
-that none were sent on shore but
-such as were very ill, or had contagious
-complaints, the rest being provided with refreshments
-on board of their ships. There
-were no wounds at this time, but there was
-a greater proportion of fevers; so that the
-complaints, upon the whole, might be said
-to be about equally dangerous. The mortality
-now was, however, considerably less,
-and this is to be imputed to the more favourable
-situation of the hospital, which I
-<span class="pagenum" id="Page_198">198</span>
-did not allow to be overcrowded; and the
-men had all manner of justice done them in
-point of attendance and accommodation.</p>
-
-<p>I shall give another example of the same
-kind in the hospital at Jamaica, when our
-fleet went there after the battle of the 12th
-of April. All the men accounted for here
-were landed from the fleet under Lord Rodney
-in May, June, and July, 1782<a id="FNanchor_26" href="#Footnote_26" class="fnanchor">26</a>.</p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">224</td>
-    <td class="tdr">71</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">65</td>
-    <td class="tdr">23</td>
-    <td class="tdr">3</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">48</td>
-    <td class="tdr">10</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">92</td>
-    <td class="tdr">21</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Wounds</td>
-    <td class="tdr">70</td>
-    <td class="tdr">18</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">40</td>
-    <td class="tdr">18</td>
-    <td class="tdr">2</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">539</td>
-    <td class="tdr">161</td>
-    <td class="tdr">3&frac12;</td>
-  </tr>
-</table>
-<p><span class="pagenum" id="Page_199">199</span></p>
-
-<p>This uncommon degree of mortality was
-not owing to the bad air of the place, for
-Port Royal is naturally as healthy as most
-parts in that climate; nor was it owing to
-bad accommodations, or to neglect of any
-kind; but is imputable entirely to this circumstance,
-that the hospital being extremely
-<span class="pagenum" id="Page_200">200</span>
-small, those only were sent to it who were
-very ill. There were at this time upwards
-of forty ships of the line at Jamaica, and an
-hospital, containing only three hundred
-beds, could afford but a very inadequate
-relief. Some officers are unwilling that any
-man should die on board of their ships, for
-fear of dispiriting the others; and many
-were sent to the hospital, in the most desperate
-stage of sickness, that they might
-there die.</p>
-
-<p>There cannot be a stronger proof than
-this of the fallacy of judging of the success
-of practice by the proportion of the deaths;
-for the sick on this occasion were better accommodated,
-better provided for in every
-respect, and as regularly attended, as at any
-other period of my service in the West Indies,
-yet the mortality was greater than at
-any other time.</p>
-
-<p>Having given instances of the common
-rate of mortality in hospitals in Europe and
-the West Indies, I shall next give examples
-of the success we had in North America,
-<span class="pagenum" id="Page_201">201</span>
-when the fleet was there in the autumns of
-1780 and 1782.</p>
-
-<p class="hang"><span class="smcap">Account</span> of the Sick landed at New York
-from the West-India Fleet, consisting of
-eleven Ships of the Line, in Autumn,
-1780.</p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">34</td>
-    <td class="tdr">9</td>
-    <td class="tdr">4</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">229</td>
-    <td class="tdr">27</td>
-    <td class="tdr">9</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">433</td>
-    <td class="tdr">40</td>
-    <td class="tdr">11</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">47</td>
-    <td class="tdr">8</td>
-    <td class="tdr">6</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">82</td>
-    <td class="tdr">10</td>
-    <td class="tdr">8</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">825</td>
-    <td class="tdr">94</td>
-    <td class="tdr">9</td>
-  </tr>
-</table>
-<p><span class="pagenum" id="Page_202">202</span></p>
-
-<p class="hang"><span class="smcap">Account</span> of the Sick landed at New York
-from the West-India Fleet, consisting of
-twenty-six Ships of the Line, in Autumn,
-1782.</p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">104</td>
-    <td class="tdr">14</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">131</td>
-    <td class="tdr">14</td>
-    <td class="tdr">9</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">617</td>
-    <td class="tdr">30</td>
-    <td class="tdr">20</td>
-  </tr>
-  <tr>
-    <td>Ulcers</td>
-    <td class="tdr">74</td>
-    <td class="tdr">10</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">70</td>
-    <td class="tdr">4</td>
-    <td class="tdr">17</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">996</td>
-    <td class="tdr">72</td>
-    <td class="tdr">14</td>
-  </tr>
-</table>
-
-<p>The difference of mortality here, from
-what occurred in the West Indies, is partly
-imputable to climate, and partly to the
-smaller number of acute diseases. In the
-two accounts last stated, the difference in
-<span class="pagenum" id="Page_203">203</span>
-favour of the latter seemed chiefly to arise
-from the superior attention to the sick, and
-the better treatment of them. It was mentioned
-before, that in autumn, 1782, at
-New York, they were better supplied, both
-at hospitals and on board of their ships,
-with every thing that could be wished, and
-that on this occasion almost every scheme I
-had proposed was realised. The extraordinary
-success in the scurvy was owing to the
-great quantities of vegetables that were supplied;
-for several fields of cabbages had
-been planted in the neighbourhood of the
-hospital for the use of the sick. This was
-owing to the humane attention of Admiral
-Digby, who had also caused cows to be
-purchased to supply the hospital with milk.
-Cleanliness, and the separation of diseases,
-were also strictly attended to; and I am
-persuaded that many of the scorbutic men
-were saved by keeping them separated from
-the fevers and fluxes; for it has been observed,
-that men ill of the scurvy, or recovering
-from it, are very apt to be infected,
-particularly with the flux.
-<span class="pagenum" id="Page_204">204</span></p>
-
-<p>It appears, that the disease in which climate
-makes the greatest difference is the
-flux. It was observable, that though the
-dysentery at this time was more fatal on
-board of the ships at New York than in
-the West Indies, yet it was less so at
-the hospital. The cause of this seems to
-be, that the acute state of this disease, of
-which men die on board before there is
-time to remove them to an hospital, is more
-fatal in a cold climate; but when it becomes
-more protracted, which is the case
-with most of the cases sent to hospitals,
-they then do much better in a cold than in
-a hot climate.</p>
-
-<p>I shall here subjoin an account of the
-numbers that were admitted, and died, during
-the whole war, at the hospitals of the
-different parts at which the fleets I was
-connected with touched.
-<span class="pagenum" id="Page_205">205</span></p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th>
-  </tr>
-  <tr>
-    <td>At Gibraltar</td>
-    <td class="tdr">2131</td>
-    <td class="tdr">203</td>
-    <td class="tdr">10</td>
-  </tr>
-  <tr>
-    <td>Barbadoes</td>
-    <td class="tdr">4604</td>
-    <td class="tdr">861</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Antigua</td>
-    <td class="tdr">6099</td>
-    <td class="tdr">914</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>St. Lucia</td>
-    <td class="tdr">3363</td>
-    <td class="tdr">478</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td>St. Christopher’s</td>
-    <td class="tdr">853</td>
-    <td class="tdr">142</td>
-    <td class="tdr">6</td>
-  </tr>
-  <tr>
-    <td>Jamaica</td>
-    <td class="tdr">10088</td>
-    <td class="tdr">1672</td>
-    <td class="tdr">6</td>
-  </tr>
-  <tr>
-    <td>New York</td>
-    <td class="tdr">17880</td>
-    <td class="tdr">2179</td>
-    <td class="tdr">7&frac12;</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">45018</td>
-    <td class="tdr">6449</td>
-    <td class="tdr">7</td>
-  </tr>
-</table>
-
-<p>I have been able to calculate the numbers
-of deaths from disease in this great fleet,
-both on board and at hospitals, during the
-period of my own service, which was three
-years and three months, and they amounted
-to three thousand two hundred<a id="FNanchor_27" href="#Footnote_27" class="fnanchor">27</a> independent
-<span class="pagenum" id="Page_206">206</span>
-of those that were killed and died of
-wounds.</p>
-
-<p>There died of disease in the fleet I belonged
-to, from July, 1780, to July, 1781,
-about one man in eight, including both
-those who died on board and at hospitals<a id="FNanchor_28" href="#Footnote_28" class="fnanchor">28</a>.
-But the annual mortality in the West-India
-fleet, during the last year of the war, that
-is, from March, 1782, to March, 1783,
-was not quite one in twenty<a id="FNanchor_29" href="#Footnote_29" class="fnanchor">29</a>. This difference
-was partly owing to the general increase
-of health in fleets as a war advances,
-partly to some improvements in victualling,
-and partly to better accommodations as well
-as regulations in what related to the care of
-the sick.
-<span class="pagenum" id="Page_207">207</span></p>
-
-<p>Though the mortality in fleets in the
-West Indies is, upon the whole, greater than
-in Europe, yet it has so happened, that, in
-the late war, the fleet at home has, at particular
-periods, been considerably more sickly
-than that in the West Indies was at any one
-time. I was informed by Dr. Lind, that,
-when the grand fleet arrived at Portsmouth
-in November, 1779, a tenth part of all the
-men were sent to the hospital. It appears<a id="FNanchor_30" href="#Footnote_30" class="fnanchor">30</a>,
-<span class="pagenum" id="Page_208">208</span>
-that in the years 1780 and 1781, a period at
-which the fleet in the West Indies was most
-sickly, the medium of the numbers on the
-sick list was one in fifteen, and many of
-these were very slight complaints; whereas,
-in the fleet alluded to in England, the diseases
-were mostly fevers, and so ill as actually
-to be sent to the hospital. It appears
-likewise, that there was the greatest proportion
-of sick in our fleet when it was on the
-coast of America in September, 1780<a id="FNanchor_31" href="#Footnote_31" class="fnanchor">31</a>.
-This difference is owing to the greater prevalence
-of the ship fever, and of the scurvy,
-in a cold than in a hot climate.</p>
-
-<p>With regard to the mortality at hospitals,
-the comparison is greatly in favour of those
-in England. This is owing to the greater
-regularity, and the better accommodation
-and diet, which an hospital at home admits
-of, as well as to the difference of climate. It
-has also been mentioned, that, on most occasions,
-the hospitals I attended abroad were so
-limited as to contain only the worst cases, in
-consequence of which there would of course
-<span class="pagenum" id="Page_209">209</span>
-be a greater proportional mortality than in
-the great hospitals of England.</p>
-
-<p>The following is an account of the whole
-loss of lives from disease, and by the enemy<a id="FNanchor_32" href="#Footnote_32" class="fnanchor">32</a>,
-in three years and three months, in
-the fleets and hospitals with which I was
-connected:</p>
-
-<table>
-  <tr>
-    <td>Died of disease<a id="FNanchor_33" href="#Footnote_33" class="fnanchor">33</a></td>
-    <td class="tdr">3200</td>
-  </tr>
-  <tr>
-    <td>Killed in battle</td>
-    <td class="tdr">648</td>
-  </tr>
-  <tr>
-    <td>Died of wounds</td>
-    <td class="tdr">500</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total<a id="FNanchor_34" href="#Footnote_34" class="fnanchor">34</a></td>
-    <td class="bt tdr">4348</td>
-  </tr>
-</table>
-<p><span class="pagenum" id="Page_210">210</span></p>
-
-<p><span class="pagenum" id="Page_211">211</span></p>
-
-<p class="ph1" id="PART_II">PART II.<br />
-
-<span class="small smcap">of the</span><br />
-<span class="x-large">CAUSES of SICKNESS in FLEETS,</span><br />
-<span class="small">and the</span><br />
-<span class="large">MEANS of PREVENTION.</span></p>
-
-<h2 id="PART_II_INTRODUCTION">INTRODUCTION.</h2>
-
-<p>In the year 1780 I printed a small treatise
-for the use of the fleet, containing general
-rules for the prevention of sickness;
-and this part of the work is chiefly taken
-from it.</p>
-
-<p>My own opportunities of experience, as
-exhibited in the preceding Part, have been
-sufficiently extensive to suggest many observations
-on this subject; but as my object is
-utility, rather than the praise of originality,
-I shall not confine myself to these. Great
-<span class="pagenum" id="Page_212">212</span>
-part of what is to be advanced is taken from
-books<a id="FNanchor_35" href="#Footnote_35" class="fnanchor">35</a> and conversation, as well as my own
-experience, my design being to exhibit a
-concise view of all the discoveries on this
-subject that have come to my knowledge.
-I have assumed nothing, however, from
-mere report or testimony, having had opportunities,
-from my own observations, of
-verifying or disproving the assertions of
-others.</p>
-
-<p>More may be done towards the preservation
-of the health and lives of seamen than
-is commonly imagined; and it is a matter
-not only of humanity and duty, but of interest
-and policy.</p>
-
-<p>Towards the forming of a seaman a sort
-of education is necessary, consisting in an
-habitual practice in the exercise of his profession
-from an early period of life; so that
-<span class="pagenum" id="Page_213">213</span>
-if our stock of mariners should come to be
-exhausted or diminished, this would be a
-loss that could not be repaired by the most
-flourishing state of the public finances; for
-money would avail nothing to the public
-defence without a sufficient number of able
-and healthy men, which are the real resources
-of a state, and the true sinews of
-war.</p>
-
-<p>In this view, as well as from the peculiar
-dependence of Britain on her navy, this order
-of men is truly inestimable; and even
-considering men merely as a commodity, it
-could be made evident, in an œconomical and
-political view, independent of moral considerations,
-that the lives and health of men
-might be preserved at much less expence
-and trouble than what are necessary to repair
-the ravages of disease.
-<span class="pagenum" id="Page_214">214</span></p>
-
-<p>It would be endless to enumerate the accounts
-furnished by history of the losses and
-disappointments to the public service from
-the prevalence of disease in fleets. Sir
-Richard Hawkins, who lived in the beginning
-of the last century, mentions, that in
-twenty years he had known of ten thousand
-men who had perished by the scurvy.
-Commodore Anson, in the course of his
-voyage of circumnavigation, lost more than
-four fifths of his men chiefly by that disease.
-History supplies us with many instances
-of naval expeditions that have been
-entirely frustrated by the force of disease
-alone: that under Count Mansfeldt in 1624;
-that under the Duke of Buckingham the
-year after; that under Sir Francis Wheeler
-in 1693; that to Carthagena in 1741;
-that of the French under D’Anville in 1746;
-and that of the same nation to Louisbourg
-in 1757<a id="FNanchor_36" href="#Footnote_36" class="fnanchor">36</a>.
-<span class="pagenum" id="Page_215">215</span></p>
-
-<p>That the health of a ship’s company depends
-in a great measure upon means within
-our power, is strongly evinced by this, that
-different ships in the same situation of service
-enjoy very different degrees of health.
-Every one who has served in a great fleet
-must have remarked, that out of ships with
-the same complement of men, who have
-been the same length of time at sea, and
-have been victualled and watered in the same
-manner, some are extremely sickly, while
-others are free from disease. Is it not naturally
-to be inferred from hence, that the
-health of men at sea depends in a great
-measure upon circumstances within the
-<span class="pagenum" id="Page_216">216</span>
-power of officers, and, indeed, upon their
-exertions, much more than medical care<a id="FNanchor_37" href="#Footnote_37" class="fnanchor">37</a>?</p>
-
-<p>It has appeared in the preceding part of
-this work, that the diseases most prevalent
-among seamen are fevers, fluxes, and the
-scurvy. These are indeed some of the most
-fatal that can attack the human body; but
-there is a numerous tribe of complaints,
-which are also some of the most severe
-scourges of human nature, from which
-they are in a manner entirely exempt.&mdash;These
-are the diseases to which the indolent
-and luxurious are subject, and which so far
-embitter their life as to render their portion
-of worldly enjoyment nearly on a level with
-that of the poor and laborious. The diseases
-alluded to are chiefly the gout, stomach
-complaints, hypochondriac and other nervous
-<span class="pagenum" id="Page_217">217</span>
-disorders. In all countries it is the better
-sort of people that are most subject to
-these; for they are owing to the want of
-bodily exercise, to the great indulgence of
-the senses, and a greater keenness and delicacy
-in the passions and sentiments of the
-mind. Man being formed by nature for
-active life, it is necessary to his enjoying
-health that his muscular powers should be
-exercised, and that his senses should be habituated
-to a certain strength of impression.
-Animal and vegetable nature may be aptly
-enough compared to each other in this respect;
-for a tree or plant brought up in a
-greater degree of shelter and shade than what
-is suitable to its nature, will be puny and
-sickly; it will neither attain its natural
-growth nor strength of fibre, nor will it be
-able to bear the influence of the weather,
-nor the natural vicissitudes of heat and cold
-to which it may be exposed.</p>
-
-<p>It is to be remarked, however, that exercise
-and temperance may be carried to excess,
-and that in these there is a certain salutary
-medium; for when labour and abstinence
-<span class="pagenum" id="Page_218">218</span>
-
-amount to hardship, they are equally
-pernicious as indulgence and indolence.
-This is strongly exemplified in seamen; for,
-in consequence of what they undergo, they
-are in general short lived, and have their
-constitutions worn out ten years before the
-rest of the laborious part of mankind. A
-seaman, at the age of forty-five, if shewn to
-a person not accustomed to be among them,
-would be taken by his looks to be fifty-five,
-or even on the borders of sixty<a id="FNanchor_38" href="#Footnote_38" class="fnanchor">38</a>.</p>
-
-<p>The most common chronic complaints
-which a long course of fatigue, exposure to
-the weather, and other hardships, tend to
-bring on, are pulmonary consumptions,
-rheumatisms, and dropsies. It is also to be
-considered, that these complaints, particularly
-the last, are farther fomented by hard
-drinking, which is a common vice among
-<span class="pagenum" id="Page_219">219</span>
-this class of men, and they are led to indulge
-in it by the rigorous and irregular
-course of duty incident to their mode of life.</p>
-
-<p>With regard to gout, indigestion, hypochondriac
-complaints, and low spirits, there
-is something in hard labour of every kind
-that tends to avert them, and particularly in
-that rough mode of it peculiar to a sea life.
-There is also something in the harsh sensations
-from the objects which seamen are in
-use to see, hear, and handle, which so modifies
-their constitutions and hardens their
-nerves as to make them little liable to what
-may be called the diseases of excessive refinement,
-such as those above mentioned. I
-have, indeed, met with such diseases at
-naval hospitals; but I always remarked that
-they were in landsmen who had been pressed,
-and who had been bred to sedentary and indolent
-occupations.</p>
-
-<p>The diseases above enumerated, as well as
-most other chronic complaints, being the
-offspring of indolence and luxury, while
-fevers and feverish complaints fall equally
-<span class="pagenum" id="Page_220">220</span>
-on all ranks and descriptions of men, it
-was a saying of some of the ancients, that
-acute diseases were sent from heaven<a id="FNanchor_39" href="#Footnote_39" class="fnanchor">39</a>;
-whereas chronic diseases were of man’s own
-creation. But I shall endeavour in the
-course of this work to evince, that, with regard
-to seamen at least, acute diseases are as
-much artificial as any others, being the offspring
-of mismanagement and neglect; with
-this difference, that they are imputable not
-<span class="pagenum" id="Page_221">221</span>
-so much to the misconduct of the sufferers
-themselves, as of those under whose protection
-they are placed.</p>
-
-<p>If I were to add any other complaint to
-the three already mentioned, as most prevalent,
-and peculiar to a sea life, it would be
-those foul and incurable ulcers which are so
-apt to arise at sea, particularly in a hot climate.
-The slightest scratch, or the smallest
-pimple, more especially on the lower extremities,
-is apt to spread, and to become an
-incurable ulcer, so as to end in the loss of a
-limb. The nature of the diet, and the malignant
-influence of the climate, both conspire
-in producing them.</p>
-
-<p>The diseases most frequent and prevalent
-at sea have this advantage, that they are
-more the subjects of prevention than most
-others, because they depend upon remote
-causes that are assignable, and which increase
-and diminish according to certain circumstances,
-which are in a great measure within
-our power.
-<span class="pagenum" id="Page_222">222</span></p>
-
-<p>The prevention of diseases is an object
-as much deserving our attention as their
-cure; for the art of physic is at best but
-fallible, and sickness, under the best medical
-management, is productive of great inconvenience,
-and is attended with more or
-less mortality. The means of prevention
-are also more within our power than those
-of cure; for it is more in human art to remove
-contagion, to alter a man’s food and
-cloathing, to command what exercise he is
-to use and what air he is to breathe, than it
-is to produce any given change in the internal
-operations of the body. What we know
-concerning prevention is also more certain
-and satisfactory, in as much as it is easier to
-investigate the external causes that affect
-health than to develope the secret springs of
-the animal œconomy.</p>
-
-<p>This part of the work, therefore, is
-chiefly addressed to those who direct the
-navy either in a civil or military capacity;
-for the general health of ships depends so
-much upon the victualling and manning in
-<span class="pagenum" id="Page_223">223</span>
-the first instance, and, afterwards, on the
-degree of discipline and order which are
-kept up, that I am persuaded that a certain
-degree of attention on their part would
-almost entirely eradicate disease from our
-fleets.</p>
-
-<p>Several remarks in this part of the work
-will be found so obvious, that it might
-seem superfluous to mention them. But it
-has been my intention to omit nothing that
-I have heard of or observed as a matter of
-ascertained utility, and, I believe, the most
-experienced will find either something new,
-or what they had not before sufficiently attended
-to. Though the design of it is that
-of being extensively useful, yet my trouble
-would be compensated, should it prove the
-means of health and comfort to a single
-ship’s company; nay, I should not repent
-my labour, could I enjoy the conscious certainty
-of its being the means of saving the
-life of one brave and good man.</p>
-
-<p>The prevention of disease has relation
-only to the external causes that affect health,
-<span class="pagenum" id="Page_224">224</span>
-and I shall consider these under the four
-heads of</p>
-
-<p>
-I. AIR,<br />
-II. ALIMENT,<br />
-III. EXERCISE,<br />
-IV. CLOATHING.<br />
-</p>
-
-<p><span class="pagenum" id="Page_225">225</span></p>
-
-<h2 id="PART_II_CHAP_I">CHAP. I.<br />
-
-<span id="AIR" class="large">AIR.</span></h2>
-
-<p>Under this head I shall not only consider
-the natural state of the air of the atmosphere
-in point of heat and cold, moisture
-and dryness, purity and corruption,
-but also the different artificial impregnations
-of it from the holds or other parts of a
-ship, or from the persons of men who have
-been neglected in point of cleanliness.</p>
-
-<p>The common air of the atmosphere at sea
-is purer than on shore, which gives to a sea
-life a very great advantage over a life at
-land. This advantage is still greater in the
-tropical regions, where the land air, especially
-such as proceeds from woods and
-marshes, is so fatal, and where the heat is
-also considerably less at sea than on shore.
-But this superior purity of the air at sea is
-<span class="pagenum" id="Page_226">226</span>
-more than counterbalanced by the artificial
-means of propagating diseases on board of
-a ship. Since a sea life, however, has this
-great natural advantage to health, the causes
-of disease peculiar to it are chargeable rather
-to the mismanagement of men than to
-any thing unavoidable in nature; and we
-are from this encouraged to exert our endeavours
-in removing them.</p>
-
-<p>The effects of land air, however, are not
-to be neglected by those who are studious of
-preserving the health of a ship’s company,
-for seamen are exposed to it in various ways
-while they are in harbour; and this is what
-we shall first treat of.
-<span class="pagenum" id="Page_227">227</span></p>
-
-<h3 id="CHAP_I_SECT_I">SECT. I.<br />
-
-<span class="medium">Of the noxious Effects of <span class="smcap">Land Air</span> in
-particular Situations.</span></h3>
-
-<p>All the diseases incident to a fleet, except
-the scurvy, are more apt to arise in a
-harbour than at sea, and particularly the violent
-fevers peculiar to hot climates. There
-are generally woods and marshes adjacent to
-the anchoring places in the West Indies,
-and the men are exposed to the bad air proceeding
-from thence, either in consequence
-of the ship’s riding to leeward of them, or
-of people’s going on shore on the duties of
-wooding and watering. Instances of this,
-without number, might be adduced from the
-accounts of voyages to all the tropical countries.
-Our fatal expeditions to the Bastimentos,
-and to Carthagena, in former wars,
-are striking proofs of it; and we have seen
-the same effects, though in a much less degree,
-while the fleet was at Jamaica in 1782.
-<span class="pagenum" id="Page_228">228</span></p>
-
-<p>I have known a hundred yards in a road
-make a difference in the health of a ship at
-anchor, by her being under the lee of
-marshes in one situation, and not in the
-other<a id="FNanchor_40" href="#Footnote_40" class="fnanchor">40</a>. Where people at land are so situated,
-as not to be exposed to the air of woods
-and marshes, but only to the sea air, they
-are equally healthy as at sea. There was a
-remarkable instance of this on a small island,
-called Pidgeon Island, formerly described,
-where forty men were employed in making
-a battery, and they were there from June
-<span class="pagenum" id="Page_229">229</span>
-to December, which includes the most unhealthy
-time of the year, without a man
-dying, and with very little sickness among
-them, though they worked hard, lived on
-salt provisions, and had their habitations entirely
-destroyed by the hurricane. During
-this time near one half of the garrison of
-St. Lucia died, though in circumstances
-similar in every respect, except the air of
-the place, which blew from woods and
-marshes.
-<span class="pagenum" id="Page_230">230</span></p>
-
-<p>The duties of wooding and watering are
-so unwholesome, that negroes, if possible,
-should be hired to perform them. In general,
-however, the employing of seamen in
-filling water and cutting wood is unavoidable,
-but it should be so managed as not to
-allow them, on any account, to stay on shore
-all night; for, besides that the air is then
-more unwholesome, men, when asleep, are
-more susceptible of any harm, either from
-the cold or the impurity of air, than when
-awake and employed.</p>
-
-<p>As the service necessarily requires that men
-should be on shore more or less, however
-unwholesome the air may be, means are to
-be used to prevent its pernicious impressions
-on the body. Certain internal medicines,
-such as bitters, aromatics, and small quantities
-of spirituous liquors, tend to preserve
-the body from its bad effects. Of the bitters,
-Peruvian bark is, perhaps, the best;
-and there is a well-affected instance of its
-efficacy in the account given by Mr. Robertson
-of a voyage in the Rainbow to the
-coast of Africa; and by the same means
-<span class="pagenum" id="Page_231">231</span>
-Count Bonneval and his suite escaped sickness
-in the camps in Hungary, while half
-of the army were cut off by fevers. In
-consequence of Mr. Robertson’s representation
-of the effects of bark in curing and preventing
-the fevers of that climate, the ships
-of war fitted out for the coast of Guinea have
-been supplied with it gratuitously, and Government
-would find its account in extending
-this bounty to all the tropical stations.</p>
-
-<p>We have seen, in the former part of this
-work, that the fever produced by the impure
-air of marshes may not appear for many
-days after the noxious principle, whatever it
-is, has been imbibed; men having been
-sometimes seized with it more than a week
-after they had been at sea. It naturally occurs,
-therefore, that something may be done
-in the intermediate time to prevent the effects
-of this bad air; and nothing is more
-adviseable than to take some doses of Peruvian
-bark, after clearing the bowels by a
-purgative. Some facts, related in the first
-part of this work, show that an interval of
-ten days or a fortnight may elapse between
-<span class="pagenum" id="Page_232">232</span>
-the imbibing of the poison and its taking
-effect. And, in order to guard against the
-diseases of this climate in general, it would
-be more proper to take some large doses of
-bark once in either of these periods, than to
-make a constant practice of taking a little,
-as I have known some people do, by which
-they may also render their body in some
-measure insensible to its good effects. I
-knew a physician of some eminence in the
-West Indies, who always enjoyed uninterrupted
-health, and he imputed it to his taking
-from half an ounce to an ounce of
-bark every change and full of the moon, as
-he thought that fevers of the intermitting
-and remitting kind, were more apt to occur
-at these periods. Whether this idea be well
-founded or not, the practice is proper, upon
-the other principle that has been mentioned,
-and the phases of the moon will at least
-serve as an aid to the memory.</p>
-
-<p>The spices of the country, such as capsicum
-and ginger, for which nature has given
-the inhabitants of the torrid zone an appetite,
-have also been found powerful in fortifying
-<span class="pagenum" id="Page_233">233</span>
-the body against the influence of noxious
-air. Either these, or the bark, or similar
-substances, of a bitter and aromatic nature,
-given in a glass of spirits to men going
-upon unwholesome duty, have been found
-to have a powerful effect in preventing them
-from catching the fevers of the climate.
-The practice may be thought too troublesome
-in the hurry of service in a great fleet;
-and I in general avoid mentioning any thing
-but what is easily practicable, and highly
-important to the body of seamen at large;
-but such a precaution may be of service at
-least to officers, or to a ship’s company,
-when service is easy, or on a small scale.</p>
-
-<p>But besides the poisonous effluvia of woods
-and marshes, the sensible qualities of the air
-are also to be attended to. If I were required
-to fix on the circumstances most
-pernicious to Europeans, particularly those
-newly arrived in the West Indies, I would
-say, that they are too much bodily exercise
-in the sun, and sleeping in the open air; and
-the practices most hurtful next to these are,
-intemperance in drinking, and bad hours.
-<span class="pagenum" id="Page_234">234</span>
-The sickness and mortality among new
-comers may, in general, be imputed to some
-one of these causes. It is in favour of this
-opinion that women are not subject to the
-same violent fevers as the other sex, which
-is probably owing to their not giving into
-the above-mentioned irregularities.</p>
-
-<p>The last direction I shall mention with
-regard to the preservation of health in a
-harbour is, that the ship should be made to
-ride with a spring on the cable, that the
-side may be turned to the wind, whereby
-a free ventilation will be produced, and the
-foul air from the head, which is the most
-offensive part, will not be carried all over
-the decks, as it must be when the ship rides
-head to wind.</p>
-
-<p>Having little experience of my own with
-regard to diseases at sea in cold climates, I
-cannot recommend any particular precautions;
-but Dr. Lind thinks that garlick infused
-in spirits is one of the best preservatives
-against the bad effects of cold and wet.
-The French ships of war are furnished with
-<span class="pagenum" id="Page_235">235</span>
-great quantities of garlick as an article of
-victualling, and its effects seem to be very
-salutary. It would appear, that substances
-of this kind are very conducive to health in
-hot climates also. I was informed by Capt.
-Caldwell, that, when he commanded a sloop
-of war on the coast of Guinea, he was supplied
-with a large quantity of shalots by a
-Portuguese about the time he left the coast,
-and his men were remarkably healthy on the
-passage to the West Indies, while the other
-ships in company, who wanted this supply,
-were very sickly.</p>
-
-<p>But besides the obvious and sensible qualities
-of the air above mentioned, there are
-certain obscure properties which we do not
-understand, and which we find difficult to
-investigate; for there are diseases prevailing
-in certain places which seem to depend on
-some latent state of the air. Of this kind is
-the complaint of the liver, so common in
-the East Indies, yet almost entirely unknown
-in the West Indies; and in the West Indies
-there are certain diseases which prevail in
-one island and not in another; such as the
-<span class="pagenum" id="Page_236">236</span>
-<i>elephantiasis</i><a id="FNanchor_41" href="#Footnote_41" class="fnanchor">41</a> of Barbadoes, which is an affection
-of the lymphatics peculiar to that
-island. In the climates of Europe there are
-also certain obscure conditions of the air
-that favour one epidemic more than another,
-and in some years more than others<a id="FNanchor_42" href="#Footnote_42" class="fnanchor">42</a>. All
-this is very mysterious to us; and although
-we could detect these properties of the air,
-we probably could not prevent their bad effects,
-since man must every where breathe
-the air, whatever its qualities may be.
-<span class="pagenum" id="Page_237">237</span></p>
-
-<h3 id="CHAP_I_SECT_II">SECT. II.<br />
-
-<span class="medium">Of <span class="smcap">Foul Air</span> from the Neglect of Cleanliness
-in Men’s Persons&mdash;<span class="smcap">Infection</span>.</span></h3>
-
-<p>Nature has wisely so contrived our
-senses and instincts, that the neglect of
-cleanliness renders a person loathsome and
-offensive to himself and others, thereby
-guarding against those fatal diseases that
-arise from bodily filth. The noxious air we
-speak of is generated by men keeping the
-same clothes too long in contact with the
-body, while they are at the same time confined
-and crowded in small and ill-ventilated
-apartments. Such is the origin of the jail
-fever, otherwise called the ship and hospital
-fever; and it seems to be with reason that
-Dr. Cullen ascribes the low, nervous fever of
-Britain to a similar origin, being caused, as
-he thinks, by an infection of a milder kind,
-arising in the clothes and houses of the
-poor, who, from slovenliness or indigence,
-<span class="pagenum" id="Page_238">238</span>
-neglect to change their linen, and air their
-houses.</p>
-
-<p>Man is evidently more subject to disease
-than any other species of the animal creation,
-owing partly to the natural feebleness
-of his frame, but still more perhaps to the
-artificial modes of life which his reason
-leads him to adopt. There is no circumstance
-of this kind by which health is more
-affected than by clothing. Some of the
-most fatal and pestilential diseases are produced
-and communicated by it; for we see
-that the greater number of fevers, particularly
-those of the low and malignant sort,
-may be traced to the want of personal
-cleanliness.</p>
-
-<p>There are few subjects more mysterious
-and difficult of investigation than this of infection.
-The origin of specific contagions,
-such as the small pox and the venereal disease,
-seems to be almost beyond the reach
-of a conjecture; and why all the contagions
-we know, excepting that of the bite of a
-mad dog, should be confined to one species
-<span class="pagenum" id="Page_239">239</span>
-of animal, their effects not being communicable
-to any other, is equally unaccountable.
-Why is the body incapable of being affected
-more than once by certain morbid poisons;
-and whence comes the striking and curious
-differences of susceptibility to infection in
-different individuals at the same time, and
-of the same individual at different times?</p>
-
-<p>It would appear that the infection of
-fever, which we are chiefly to consider here,
-does not, like some of the diseases above
-mentioned, depend on the continued propagation
-of a certain poison, but that it may
-spontaneously arise from a concurrence of
-circumstances, producing a long stagnation
-of the effluvia of the body on the clothes,
-for want of clean linen, while people are
-excluded from the free air, as in jails, hospitals,
-or ships.</p>
-
-<p>In order, therefore, to preserve the crews
-of ships from such diseases, means should
-be taken not only to prevent the introduction
-of infection already existing, but to prevent
-the generation of it on board.
-<span class="pagenum" id="Page_240">240</span></p>
-
-<h3 id="MEANS_OF_PREVENTING_THE_INTRODUCTION_OF_INFECTION">1. Means of preventing the Introduction of
-Infection.</h3>
-
-<p>War being a state of violence and
-confusion, in which the hurry and emergency
-of service may be such as to render it
-impossible to put in practice all the rules
-which might be laid down concerning the
-preservation of health, yet it is necessary
-that those who direct the navy, either in a
-civil or military capacity, should be aware
-of the causes of sickness and mortality, in
-order to guard against them as far as is
-practicable. From an indolent acquiescence
-in this idea of the hardships and inconveniences
-of war being unavoidable, I have
-known neglect to arise in the conduct of officers
-with regard to those under their command,
-as if it was not the duty of a commander
-to employ his utmost attention to
-alleviate the misfortunes and mitigate the
-sufferings of his fellow creatures; and we
-have seen that much more of the calamities
-of war arise from disease than from the
-<span class="pagenum" id="Page_241">241</span>
-sword. The like excuse might be framed
-for the neglect of stores and arms, which,
-the hurry of service might equally expose
-to injury. We see, indeed, infinite pains
-taken to prevent cordage from rotting, and
-arms from rusting; but however precious
-these may be as the necessary resources of
-war, it will not be disputed that the lives of
-men are still more so; yet, though there is
-the additional inducement of humanity to
-watch over the health of men, I do not
-think that this, in general, is studied with
-a degree of attention equal to what is bestowed
-on some inanimate objects.</p>
-
-<p>Ships of war are exposed to infection
-chiefly by receiving such men as have been
-raised by pressing, who are frequently confined
-in guardships, under such circumstances
-of bad air and bodily filth as tend to
-generate the most virulent infection. The
-service also requires sometimes that men be
-received from jails, and they are either criminals
-delivered over by the civil jurisdiction
-of the country, or captives who have
-been restored by the enemy after a course of
-<span class="pagenum" id="Page_242">242</span>
-confinement in their prisons. It may happen
-too, as we have seen<a id="FNanchor_43" href="#Footnote_43" class="fnanchor">43</a>, that the enemy,
-who are made prisoners at sea, may have infection
-about them, and will communicate
-it the more readily that they are strangers.</p>
-
-<p>There are few fevers but what are infectious
-at some stage or other of the disease;
-but it is not necessary that fever should actually
-exist in order to create infection. In
-the most violent and pestilential fevers, such
-as have sometimes originated in the jails of
-England, the persons who communicated
-them were not affected with it themselves<a id="FNanchor_44" href="#Footnote_44" class="fnanchor">44</a>.
-Infection, like some other poisons, does not
-affect those who are accustomed to it, and
-therefore those who are in the habit of being
-exposed to it frequently escape its bad effects,
-especially if it is gradually applied, as must
-be the case with those about whose persons
-it is generated. For the like reason, physicians
-<span class="pagenum" id="Page_243">243</span>
-and nurses are less susceptible than
-others; and strangers, who are accustomed
-to a pure air, are the most susceptible of
-any. It is observed by Dr. Short, that contagious
-epidemics are more frequent and
-fatal in the country than in London, and
-this may probably be accounted for on the
-same principle; for every person in a great
-town is exposed to the breath and effluvia
-of others, and to a variety of putrid exhalations,
-which are unavoidable where multitudes
-inhabit together; but they are so used
-to them, that they are not affected by them;
-whereas in the country, where people are
-less accustomed to each other’s company,
-and less used to impure air in general, they
-are the more readily affected when infection
-is introduced among them. It may even
-admit of a doubt if any society of men,
-living together, are entirely free from morbid
-contagion. It certainly sometimes happens,
-that a ship, with a long-established
-crew, shall be very healthy; yet, if strangers
-are introduced among them, who are
-also healthy, sickness will be mutually produced.
-This principle in the human constitution,
-<span class="pagenum" id="Page_244">244</span>
-by which the presence of strangers
-affects it, is well illustrated by a fact<a id="FNanchor_45" href="#Footnote_45" class="fnanchor">45</a>,
-founded on the best testimony, that, in one
-of the small western islands of Scotland,
-which is so remote, that the inhabitants
-are frequently without any communication
-with strangers for several months together;
-they become so susceptible, in consequence
-of this long interruption of intercourse,
-that they are seized with a catarrh when
-strangers of any description come among
-them. It was said before, that cleanliness
-was founded on a natural aversion to what
-is unseemly and offensive in the persons of
-others; and there seems also to be implanted
-in human nature, for the same purpose,
-an instinctive horror at strangers, as is visible
-in young children and uncultivated people.
-In the early ages of Rome, one word
-signified both a stranger and an enemy<a id="FNanchor_46" href="#Footnote_46" class="fnanchor">46</a>.
-<span class="pagenum" id="Page_245">245</span></p>
-
-<p>These observations naturally suggest several
-useful and practical remarks. It would appear
-<span class="pagenum" id="Page_246">246</span>
-that the utmost attention is necessary
-not only to guard against the actual presence of
-<span class="pagenum" id="Page_247">247</span>
-of disease, but to be jealous of all new
-draughts of men, especially if they should
-<span class="pagenum" id="Page_248">248</span>
-come from guardships, jails, or tenders, and
-have been turned over from ships where
-<span class="pagenum" id="Page_249">249</span>
-disease is known to have prevailed; nay,
-that it is best to avoid mixtures of any kind.</p>
-
-<p>The infection of fevers seems different
-from most others in this, that it is very
-various in its degrees of virulence. There
-is reason to think that the poison of the
-small pox, and that of the venereal disease,
-are in their own nature invariable, and that
-the difference of these diseases, in point of
-malignancy, depends on the constitution and
-<span class="pagenum" id="Page_250">250</span>
-other circumstances of those affected; whereas
-that of fevers being of different degrees
-of activity, and being frequently obscure
-and latent, is, on that account, the more
-treacherous, and ought to be watched with
-the greater circumspection.</p>
-
-<p>The mode of manning the navy by pressing,
-I take it for granted, is unavoidable; at
-any rate, it would not become me to arraign
-a practice which has had the public sanction
-for ages. It is, however, one of the principal
-<span class="pagenum" id="Page_251">251</span>
-means both of generating and spreading
-the seeds of disease, in consequence of the
-indiscriminate seizure of men for the public
-service, and the confinement that is necessary
-to secure them. And as the exigences
-of the service make it necessary to admit
-persons of every description, there is no
-other remedy for this evil but to annihilate,
-if possible, the contagion that may thus be
-conveyed into ships of war. This is done
-by stripping and washing the new recruits
-who may be suspected of importing infection;
-also by cutting off their hair, clothing
-them with new clothes, and destroying
-the old, before they are allowed to mix with
-the ship’s company in which they are to
-enter.</p>
-
-<p>Those who have put these methods strictly
-in practice, have been sensible of their
-great utility; and the most exact attention
-is necessary, as a single infected man, or
-even any part of his clothing, may spread
-sickness through a whole ship’s company.
-When we reflect what havock an infectious
-fever sometimes makes in a ship, it will appear
-<span class="pagenum" id="Page_252">252</span>
-how very important this fort of attention
-is; and when the cause of the sickliness
-of particular ships is traced to its
-source, it will generally be found to have
-originated from taking on board infected
-men at Spithead, or wherever else the ship’s
-company may have been completed.</p>
-
-<p>After the first edition of this part of the
-work was printed, an excellent institution
-was established at Portsmouth for the prevention
-of infection. A ship was appointed
-for the reception of the recruits of the fleet
-to which they were carried, to be stripped,
-washed, and provided with new apparel,
-before they joined their respective ships.
-This had a visible good effect on the health
-of the fleet; and it was planned and executed
-by Sir Charles Middleton, Comptroller
-of the Navy, whole unwearied assiduity,
-as well as integrity and ability in that important
-post, claim the highest praise and
-gratitude from his country.</p>
-
-<p>It follows farther, from the preceding observations,
-that there is a sort of risque in
-<span class="pagenum" id="Page_253">253</span>
-mixing two different sorts of men, even
-when there is no actual disease or suspicion
-of infection; for, whether it is from dormant
-infection, or merely from the circumstance
-of change of air, such mixtures are
-known from experience to be sometimes
-productive of sickness. The late Admiral
-Boscawen was so sensible of this, that he
-avoided it, unless when some evident utility
-or necessity of service made it proper; and
-upon this principle he used to resist the solicitation
-of captains when they requested to
-carry men from one ship to another upon
-changing their commands.</p>
-
-<p>One probable reason, among others, for
-ships of the line being more sickly than frigates
-or smaller ships is, that in greater
-numbers there is a greater chance of men
-of various descriptions and modes of life
-being mixed together.
-<span class="pagenum" id="Page_254">254</span></p>
-
-<h3 id="MEANS_OF_PREVENTING_THE_PRODUCTION_OF_INFECTION">
-2. Means of preventing the Production of Infection.</h3>
-
-<p>The infection of fever is not always imported
-from without, but may be originally
-and spontaneously generated on board. The
-causes of this, as mentioned before, are want
-of personal cleanliness, and also confinement
-and crowding in close apartments.</p>
-
-<p>In order to promote cleanliness, care should
-be taken that every man, on his first entering
-into the service, be provided with a proper
-change of linen, and that a frequent
-muster and review be made, in order to inspect
-their persons, and to examine their
-stock of apparel. A true seaman is in general
-cleanly, but the greater part of men
-in a ship of war require a degree of compulsion
-to make them so; and such is the depravity
-of many, that it is common enough
-for them to dispose of their clothes for money
-to purchase spirituous liquors. A muster
-and review, therefore, wherein men
-<span class="pagenum" id="Page_255">255</span>
-should be obliged once in the week to present
-themselves clean before their officers,
-and to produce a certain necessary quantity
-of clean apparel, would conduce both to
-sobriety and cleanliness. The exertion of
-authority, and the infliction of punishment,
-is so far from being considered by the men
-as a hardship, that they expect it; and it is
-the duty of an officer, as it is of a parent to
-a child, to constrain those entrusted to his
-care to perform what is for their good. It
-is common also for men to lay up their
-clothes in a wet and unwashed state, which
-in time is productive of the most offensive
-and unwholesome vapours; and this can be
-prevented only by their chests and bags
-being frequently inspected by their superiors.</p>
-
-<p>It must be evident to any one who reflects
-on this subject, that a regulation of this
-kind is as necessary as any other part of
-duty; and it deserves to be made an article
-in the public instructions, instead of being
-left to the discretion of officers. This sort
-of discipline is particularly necessary in ships
-<span class="pagenum" id="Page_256">256</span>
-of the line, in which one cause of the greater
-unhealthiness is the difficulty of taking cognizance
-of so great a number; for, unless
-some regular method, as by muster, is established,
-there will be men who will escape
-notice, and skulk below, indulging in laziness
-and filth.</p>
-
-<p>The good sense and humanity of many
-captains in the late war, led them to adopt
-certain methodical regulations for the preservation
-of cleanliness and order. The only
-public sanction given to this sort of discipline,
-was that of Lord Howe, who gave
-it in orders to those under his command,
-that each ship’s company should be divided
-into as many divisions as there were lieutenants,
-and that these should be divided into
-squads, with a midshipman appointed to
-each; and that the officers should be respectively
-responsible for the good order and discipline
-of the men assigned to them.</p>
-
-<p>It is an excellent custom, and pretty general
-in the navy, to allow the men one day
-in the week for washing, when the weather
-<span class="pagenum" id="Page_257">257</span>
-and other circumstances will admit of it. It
-would be a farther improvement in the rules
-of the service to supply sope in the same
-manner as tobacco and slops are supplied,
-that is, to let the men have what quantity
-they want from the purser, who is allowed
-to charge it against their wages<a id="FNanchor_49" href="#Footnote_49" class="fnanchor">49</a>.</p>
-
-<p>Next to want of cleanliness, the circumstances
-most apt to give rise to infection are,
-close air and crowding. A certain length of
-time is necessary, in order that these should
-have this effect, and the longer they take
-<span class="pagenum" id="Page_258">258</span>
-place, the more certainly will infection be
-produced, and it will be the more virulent<a id="FNanchor_50" href="#Footnote_50" class="fnanchor">50</a>.
-<span class="pagenum" id="Page_259">259</span></p>
-
-<p>In order to admit air freely, the ports
-should be kept open whenever the weather
-will permit this to be done. The great objection
-to free ventilation is the danger of
-exposing men to the air in cold climates.
-But it fortunately happens, that fire, while
-it is the most effectual means of counteracting
-the cold air, is also the best means of
-promoting ventilation; for wherever there
-is fire, there is a constant change of air taking
-place by means of the draught to
-which it gives occasion. This cannot be
-done with safety and convenience in all parts
-<span class="pagenum" id="Page_260">260</span>
-of the ship; but frequent fires in the lower
-parts of a ship will prove extremely salutary
-by drying up the moisture, and producing a
-change of air, and also in a cold climate by
-the warmth it produces.</p>
-
-<p>The hammocks and bedding should also
-be aired by exposing them upon deck, especially
-after the ports have been long shut in
-consequence of bad weather. They cannot
-be thoroughly aired unless they are unlashed;
-and as this could not be conveniently done
-daily in men of war, it might be done from
-time to time by the different divisions in rotation<a id="FNanchor_51" href="#Footnote_51" class="fnanchor">51</a>.
-When the men come to sleep upon
-them after these operations, they experience
-the same agreeable sensations as from a
-change of linen; and this must conduce to
-health as well as pleasure, like all other natural
-and moderate gratifications. It may
-be farther remarked in favour of cleanliness,
-<span class="pagenum" id="Page_261">261</span>
-that it is not only directly conducive to
-health, but is naturally connected with habits
-of good order, sobriety, and other virtues.
-The most cleanly men are always the
-most decent and honest, and the most slovenly
-and dirty are the most vicious and irregular.</p>
-
-<p>A ship of war must have a much greater
-number of men on board than what are necessary
-to navigate her; for, besides the marines,
-a great many hands are necessary to
-man the great guns in time of action. For
-this reason, there is a greater risque of the
-inconveniences of overcrowding than in ships
-intended for commerce, and therefore much
-greater attention is necessary with regard to
-ventilation and cleanliness. There is a piece
-of management which tends also in some
-measure to obviate the necessity of crowding.
-This is to berth the watches alternately,
-by which it is meant, that one half
-of each watch should lie on different sides,
-whereby they do not sleep so close, and are
-not so much exposed to each other’s breath
-and to the heat and effluvia of each other’s
-<span class="pagenum" id="Page_262">262</span>
-bodies. This has the farther advantage of
-preserving the trim of the ship.</p>
-
-<p>What has been said of the ship and men
-in general, applies still more strongly to the
-sick, and the berth<a id="FNanchor_52" href="#Footnote_52" class="fnanchor">52</a> assigned to them; for
-there is nothing so apt to increase, and even
-generate, contagion, as a number of sick
-together, unless uncommon attention is
-paid to cleanliness and ventilation. This is
-so true, that, unless where the complaint is
-very catching, it is best not to separate the
-sick; for if they are a good set of men on
-board, those who are confined by sickness
-will be better nursed and tended by their
-messmates than in a sick berth. But if the
-state of infection renders separation necessary,
-the best part for the accommodation
-of the sick, in a ship of the line, is under
-the forecastle in a warm climate, and on the
-fore part of the main deck in a cold one.
-<span class="pagenum" id="Page_263">263</span>
-When they are under the forecastle, however,
-they ought to occupy only one side,
-as they would otherwise be disturbed by the
-men who must pass to and from the head,
-and the men in health would, in this case,
-be exposed also to contagion. As infection
-is most likely to arise among the sick, attention
-to cleanliness and air is doubly requisite
-where they lie; and it has a good effect to
-sprinkle hot vinegar and diffuse its steams
-among them once or twice a day.</p>
-
-<p>Thus we see that cleanliness and discipline
-are the indispensable and fundamental
-means of health, without which every other
-advantage and precaution is thrown away.
-Government never bestowed more attention
-and expence upon the victualling of the
-navy than during the late war; but it would
-be to little purpose to provide the most
-nourishing and antiscorbutic diet, the most
-wholesome and cordial wines, the most efficacious
-remedies, and the most skilful physicians
-and surgeons, if the men are not
-constrained to keep their persons sweet,
-their clothing and bedding clean, and their
-<span class="pagenum" id="Page_264">264</span>
-berths airy and dry. It is, therefore, upon
-officers more than any others that the health
-of the fleet depends; and I should be excused
-in the frequent mention I make of
-this, were it known how often I have been
-the witness of the fatal effects of the neglect
-of these rules.</p>
-
-<h3 id="MEANS_OF_ERADICATING_INFECTION">3. Means of eradicating Infection.</h3>
-
-<p>When, from a neglect of the means
-above mentioned, an infectious fever comes
-actually to prevail, and the infection, perhaps,
-adheres obstinately to the ship in spite
-of cleanliness, good air, and diet, and all the
-other means, which, if employed in due
-time, would have prevented it, then some
-measures are to be taken for eradicating this
-subtile poison.</p>
-
-<p>The first step towards this is, to prevent
-the disease from spreading, and this is done
-by separating the sick from the healthy,
-and cutting off all intercourse as much as
-possible. For this end, it is necessary to
-appropriate a particular berth to contagious
-<span class="pagenum" id="Page_265">265</span>
-complaints, and not only to prevent the
-idle visits of men in health, but to discover
-and separate the persons affected with
-such complaints as soon as possible, both
-to prevent them from being caught by
-others, and because recent complaints are
-most manageable and curable. Officers
-might be very useful in making an early
-discovery of complaints, by observing those
-who droop and look ill in the course of
-duty; for seamen think it unmanly to
-complain, and have an aversion to be put on
-the sick list. I have heard of a method
-practised in some ships, of keeping a book
-on the quarter deck for the officer to mark
-the names of such men as might look ill,
-or might be missed from duty upon calling
-the roll, in order to afford the surgeon a
-means of finding out those who should be
-the objects of his care.</p>
-
-<p>Those whose profession it is to superintend
-the health of the ship, would find it for
-their ease and interest, and should consider
-it as their duty, to walk over the different
-decks once a day, or every other day, in
-<span class="pagenum" id="Page_266">266</span>
-order to make an early discovery of those
-who may be taken ill. Though I have laid
-great stress on the duty of the commander,
-as the proper guardian of health, yet his
-assiduity will not avail unless the surgeon
-also does his part, by such acts of attention
-as I have mentioned, joined to skill in his
-profession.</p>
-
-<p>Surgeons are, perhaps, more regarded in
-our service than in that of other nations;
-but it would be for the public benefit if they
-were still more respected and encouraged.
-To men of liberal education and sentiments,
-as surgeons ought to be, and generally are,
-the most effectual inducements for them to
-do their duty are flattering attentions, and a
-certain degree of estimation in the eyes of
-their officers. Liberality of manners, on
-the part of superiors, is the most likely
-means of encouraging a conscientious performance
-of duty in this profession; for
-though strict and distant behaviour may operate
-upon the minds of those whose functions
-are merely mechanical, how can it infuse
-that tender attention to human sufferings,
-<span class="pagenum" id="Page_267">267</span>
-and that sense of duty, which may
-induce a man entrusted with the health and
-lives of his fellow creatures to act his part
-with propriety and effect?</p>
-
-<p>In order to prevent sickness from spreading,
-it is not sufficient to cut off all personal
-intercourse. The clothes of men are
-as dangerous a vehicle of infection as their
-persons; and it should be a strict and invariable
-rule in case of death from fever, flux,
-or small pox, to throw overboard with the
-body every article of clothing and bedding
-belonging to it.</p>
-
-<p>Upon the same principle, in case of recovery
-from any contagious disease, as it
-would be too great a waste to destroy the
-clothes and beds, they should be smoked,
-and then scrubbed or washed before the
-men join their messes and return to duty.
-This precaution is the more necessary, as
-infection in a ship is extremely apt to be
-communicated by bedding, from the custom
-of stowing the hammocks in the netting,
-by which they are brought in contact with
-<span class="pagenum" id="Page_268">268</span>
-each other. This, however, is an excellent
-custom, as it not only clears the ship below,
-and serves to form a barricade on the gunwale,
-but tends to air the bedding; and
-this salutary effect should not be prevented,
-except in case of rain, by the coverings,
-called hammock-cloths, by the use of which
-utility is evidently sacrificed to an excess of
-neatness.</p>
-
-<p>It sometimes happens that the number of
-sick in a ship is so great, that it is not possible
-to take proper and effectual measures on
-board for stopping the progress of disease.
-But when she can be cleared of the sick by
-sending them to an hospital, no pains should
-be spared to extirpate the remaining seeds of
-infection.</p>
-
-<p>For this purpose, let their clothing and
-bedding be sent along with them; let their
-hammocks, utensils, and whatever else they
-leave behind, be smoked, and either scrubbed
-or washed before they are used by other
-men, or mixed with the ship’s stores; let
-the decks, sides, and beams of their berths,
-<span class="pagenum" id="Page_269">269</span>
-be well washed, scraped, smoked, and dried
-by fire; then let them be sprinkled with
-hot vinegar, and, finally, white-washed all
-over with quick lime.</p>
-
-<p>Should any officer object to the trouble
-and inconvenience of all this, let him reflect
-for a moment how much more troublesome
-and inconvenient, as well as noisome
-and disagreeable, sickness itself proves
-to be; let him reflect that the efficiency of
-the ship, considered as a bulwark of defence,
-or an engine of annoyance, depends on the
-number of healthy hands, and that his own
-character is to depend on the exertions to be
-made by them in the day of battle, not to
-mention the attention due from him as a man
-to the sufferings of the objects themselves.</p>
-
-<p>But besides these recent infections, it
-sometimes happens that the seeds of disease
-adhere to the timbers of a ship for
-months and years together, and can be
-eradicated only by a thorough cleansing and
-fumigation. Sweeping, washing, scraping,
-and airing, are not sufficient entirely to
-<span class="pagenum" id="Page_270">270</span>
-remove the subtile infectious matter; but
-they will assist and will prepare it to be
-acted upon by heat and smoke, which are
-the only means to be depended upon. A
-complete fumigation can only be performed
-when the ship is in dock; and I shall here
-transcribe a method recommended by Dr.
-Lind.</p>
-
-<p>“It will be proper to remove every
-thing out of the ship, so that the hold
-may be swept, and, when the men have
-withdrawn, to light a number of charcoal
-fires in different parts, and to throw
-a handful or two of brimstone on each.
-The steam of these should be closely confined
-by shutting the ports and hatchways
-from morning till evening, no person
-in the mean time being allowed to
-go below, nor for some time after opening
-the ports and hatchways, that the
-steam may be dispersed.</p>
-
-<p>“In order to purify the men’s clothes,
-it would farther be proper to fumigate
-the hulk into which they are removed
-<span class="pagenum" id="Page_271">271</span>
-with tobacco once or twice a week while
-their ship is in dock, the men remaining
-below as long as they can bear it.</p>
-
-<p>“The clothes and hammocks of the men
-should be exposed in the hulk to the
-smoke of the tobacco, and those which
-are more particularly suspected may be
-hung up the ship, and exposed to the
-steam of the charcoal and brimstone.</p>
-
-<p>“The ship having been already fumigated
-with tobacco, it will be sufficient
-to use the fumigation of charcoal and
-brimstone above described for three days,
-and, after the last day’s fumigation, the
-inside of the ship should be well washed
-with boiling vinegar, and, before the men
-return on board, all the decks should be
-scraped and washed.”</p>
-
-<p>When a ship is at sea, these precautions
-cannot be taken so completely; but if infection
-is present, or is suspected, then
-cleansing and fumigating may be practised
-in a less degree. I have known a ship at
-<span class="pagenum" id="Page_272">272</span>
-sea fumigated with gunpowder kneaded with
-vinegar, so as to prevent it from exploding,
-and to make it burn slowly with a spattering
-flame. Flowers of sulphur<a id="FNanchor_53" href="#Footnote_53" class="fnanchor">53</a>, with
-<span class="pagenum" id="Page_273">273</span>
-about an eighth part of nitre, will answer
-still better. A quantity of these is placed
-in each interval of the guns between decks,
-every person being turned up, and the ports
-<span class="pagenum" id="Page_274">274</span>
-and hatches shut till they are consumed,
-and till the smoke has dispersed. It has also
-been recommended to burn resinous bodies,
-such as the woods of fir, spruce, and juniper,
-as the smoke of these is more salutary.
-Upon the same principle, the effluvium of
-tar is thought wholesome; and the cables
-that are coiled in the lower parts of a
-ship being soaked with tar, like most of the
-other ropes of a ship, probably conduce to
-the health of a place otherwise dank and
-unwholesome. Fumigation may also be
-performed by means of tar, either by throwing
-it on red-hot irons, or a wood fire,
-which may be carried about between decks
-in a pot or moveable grate, or over some
-cannon balls in a tub, or by immersing a
-red-hot loggerhead<a id="FNanchor_54" href="#Footnote_54" class="fnanchor">54</a> in a bucket of tar. If
-this is done in the place occupied by the
-sick, it will have a still better effect; and it
-will be of service to them to be removed for
-a short time under the half deck or forecastle
-till this or other means of purification
-<span class="pagenum" id="Page_275">275</span>
-are put in practice. In whatever manner
-fumigation is performed, it will be of service
-to spread out the clothes and bedding
-of the men, or to hang them upon lines,
-that they may be exposed to the heat and
-smoke.</p>
-
-<p>It will also be of great service to make
-the men expose their frowsy clothes to the
-sun and wind. If a strong infection is suspected,
-and it cannot be afforded to destroy
-the clothes, the best means of eradicating
-the poison is to hang them for a length of
-time over pots of burning brimstone in a
-large cask standing endways, with small
-apertures to admit air enough for the brimstone
-to burn.</p>
-
-<p>Fire in every shape is to be considered as
-the principal agent of purification, by its
-heat and the ventilation it occasions, perhaps,
-still more than its smoke. It has already
-been repeatedly inculcated, that the
-great enemies of infection are ventilation
-and heat. I have mentioned smoke and the
-effluvia of balsamic bodies, but these are not
-<span class="pagenum" id="Page_276">276</span>
-to be depended on; and it is the more necessary
-to mention this, as the attention bestowed
-on more trifling means may divert the
-mind from a proper regard to what is more
-essential. It is mentioned by the benevolent
-Mr Howard, that it is the custom in some parts
-abroad to scatter fresh branches of pine or
-spruce in the hospitals, in order to purify the
-air; but, trusting to this, they neglect the
-admission of fresh air, which is the only effectual
-method of sweetening the air.</p>
-
-<p>There is reason to think that the open
-air very soon dissipates and renders inert all
-infections of the volatile kind, and of course
-the warmer the air is the more readily it
-will have this effect. It is accordingly observed,
-that infection is much less apt to be
-generated about the persons of men, and that
-it adheres to them for a much less space of
-time in a hot climate than in a cold or temperate
-one. This is a remark, which, so far
-as I know, has not been made by any author;
-and, till observation suggested it to
-me, I fancied the reverse to be the truth.
-I have seen so many instances of filth and
-<span class="pagenum" id="Page_277">277</span>
-crowding in ships and hospitals in the West
-Indies, without contagion being produced,
-and which in Europe could hardly have
-failed to produce it, or to render it more
-malignant, that I am convinced there is
-something in tropical climates unfavourable
-to the production and continuance of infectious
-fevers<a id="FNanchor_55" href="#Footnote_55" class="fnanchor">55</a>. The ships which bring this
-fever from Europe in general get rid of it
-soon after arriving in a warm climate; and
-nothing but the highest degree of neglect
-can continue or revive it.</p>
-
-<p>The facts above mentioned brought into
-my mind what is related of the plague at
-Smyrna and other places, that it disappears
-at the hottest part of the year. It is also
-curious and important to remark, that the
-<span class="pagenum" id="Page_278">278</span>
-true pestilence never has been heard of between
-the tropics. It is not easy to assign
-the cause of this effect of heat upon infection,
-as every thing relating to this subject
-is very obscure. We can conceive it to be
-owing to the greater degree of airiness which
-the heat of the climate makes necessary, or
-to the use of fewer woollen clothes. There
-may be something in the state of the body,
-particularly in the pores of the skin, which
-disposes them less to imbibe or produce the
-poisonous effluvia, or, when imbibed, it
-may more readily be thrown out by perspiration
-with the other acrimony of the blood;
-or more probably, as has been hinted above,
-the virulent matter is of such a degree of volatility
-as to be readily dissipated in a certain
-degree of heat<a id="FNanchor_56" href="#Footnote_56" class="fnanchor">56</a>.
-<span class="pagenum" id="Page_279">279</span></p>
-
-<p>There is a fact, which, though seemingly
-of a contrary tendency, yet is in reality in
-proof of the same opinion. It is, that these
-same diseases disappear in circumstances of
-great cold. When England was last visited
-by the plague, it disappeared in winter; and
-the same is observed at Moscow and other
-places. In this case the infectious matter is
-rendered <i>inert</i>, but not <i>extinct</i>, and the return
-of heat sets it afloat in the atmosphere,
-so as to expose it to human respiration.
-Dr. Guthrie informs us, that infection is
-entangled and fixed by the cold of winter
-on the doors and walls of the houses of the
-Russian peasants, and that upon the return
-of the warm season it is set loose by the
-thaw, and then becoming active, produces
-diseases.</p>
-
-<p>With regard to the West Indies, the precautions
-that have been laid down are chiefly
-necessary when a ship newly arrives in the
-climate; for it is during the first three or
-four months that sickness is apt to prevail.
-<span class="pagenum" id="Page_280">280</span></p>
-
-<p>This does not depend upon any thing peculiar
-to the climate; for I have known
-ships arrive without being visited with any
-sickness. It seems to be owing, for the
-most part, to that flock of infection and
-disease imported from Europe exerting its
-effects, and when this has spent itself, the
-men remain in good health, unless exposed
-to the land air or other accidents; for the
-air at sea in those climates, as well as every
-where else, is extremely pure and wholesome,
-and there is no where that seamen are
-more healthy or comfortable.
-<span class="pagenum" id="Page_281">281</span></p>
-
-<h3 id="CHAP_I_SECT_III">SECT. III.<br />
-
-<span class="medium">Of the <span class="smcap">Foul Air</span> generated in a Ship.</span></h3>
-
-<p>I mean here to distinguish the unwholesome
-vapour produced by the contents of
-the ship from the infection produced by the
-effluvia of men’s persons, which was treated
-of in the last section.</p>
-
-<p>The means of preventing this foul air
-from being generated are, cleanliness, dryness,
-and ventilation.</p>
-
-<p>All parts of a ship may, if neglected, become
-dirty, and emit an offensive vapour;
-but the parts under water consisting of the
-orlop and hold, are more particularly so
-from the materials they contain, and from
-the want of free access to the fresh air; accordingly,
-there is always more or less
-stench in those parts, even in the best-regulated
-ships.
-<span class="pagenum" id="Page_282">282</span></p>
-
-<p>It was mentioned in the first part of this
-work, that an opinion was entertained by
-some that no foul air was productive of fevers
-but such as proceeds from the living
-human body. I alledged that this was
-otherwise, at least in hot climates; and
-some proofs of this opinion were adduced,
-particularly from the French prizes. Though
-the neglect of personal cleanliness is the
-principal source of disease, yet cleanliness of
-every kind, and purity of the air in every
-respect, is to be anxiously studied.</p>
-
-<p>With regard to general cleanliness, it is
-hardly necessary to mention sweeping, washing,
-and scrubbing of the decks; for the
-natural propensity of the English<a id="FNanchor_57" href="#Footnote_57" class="fnanchor">57</a> nation
-<span class="pagenum" id="Page_283">283</span>
-to neatness seldom allows any neglect of
-these. Lord Howe, to whose virtues as a
-man, and abilities as an officer, his country
-<span class="pagenum" id="Page_284">284</span>
-is so much indebted, gave it in general orders
-to wash the upper decks every day, the
-lower decks twice a week, and the orlop
-<span class="pagenum" id="Page_285">285</span>
-once a week at least. He also ordered that,
-every washing, smoking, mustering, and review
-of clothes, or any other means taken
-for the health of the ship, should be marked
-in the logbook, and the reason to be assigned
-there if omitted at the stated times.
-These rules are a good specimen of the order
-that ought to prevail in every branch of
-public duty; for it is well known to every
-experienced officer that it is a methodical
-proceeding of this kind which can alone
-render service either easy or effective.</p>
-
-<p>The loss of men’s lives from the foul air
-of the well is a common accident in ships,
-and I have been myself witness to several
-instances of it. Where there is the least
-suspicion of this, a candle should previously
-be let down, and if it should be extinguished,
-it may be concluded that the air is
-deadly. It becomes safe for men to breathe
-in it by leaving it open for some time, or,
-more expeditiously, by letting down fire in
-a pot or grate, which soon changes the air,
-by producing a draught of it upwards.
-<span class="pagenum" id="Page_286">286</span></p>
-
-<p>It is a very salutary practice to let down
-fires frequently into the well, both in order
-to purify the air and to dry the surrounding
-parts. It was formerly mentioned that this
-was daily done in the Intrepid, and the effect
-of it was to remove the wetness of the
-ballast and the mouldiness which had overspread
-the sides and beams; and having had
-the effect of sweetening and purifying the
-air, it seemed to be the principal circumstance
-that tended to make this ship extremely
-healthy from being the most sickly of all
-the fleet. This precaution, as well as every
-other point of cleanliness, is more necessary
-in large ships, because the mass of foul air,
-as well as the quantity of corrupting materials,
-is greater<a id="FNanchor_58" href="#Footnote_58" class="fnanchor">58</a>.
-<span class="pagenum" id="Page_287">287</span></p>
-
-<p>The following fact strongly evinces the
-good effect of fire and smoke:&mdash;When it
-was the custom for frigates to have their
-kitchens between decks, they were much
-more healthy than in the present construction,
-in which they have them under the
-forecastle, where the heat and smoke are
-dissipated without being diffused through the
-ship, and causing a draught of air upwards,
-as formerly. The men derived then also
-great benefit and comfort from having a
-large fire, round which they might assemble
-to warm and dry themselves in a sheltered
-place. I leave it to those who preside
-in the construction of the navy to determine
-how far it would be advisable to return
-to the old manner of construction.
-The French ships of the line have their
-kitchens and ovens between decks, and this
-must tend to counteract the effects of their
-want of cleanliness. The Dutch ships of
-the line have their kitchens on the orlop
-deck, which must be still more conducive
-to the general purity of the air.
-<span class="pagenum" id="Page_288">288</span></p>
-
-<p>Moisture is pernicious both in itself and
-as the instrument of putrefaction. All the
-complaints, called colds, are more owing to
-wet than cold; and moisture may be the
-means of producing, or at least of exciting
-dangerous fevers, when they would not
-otherwise appear. It besides contributes
-greatly to the production of scurvy. Ships
-built of ill-seasoned wood are found to be
-very unhealthy on account of the moisture
-contained in it. The moisture of timber
-arises not only from being used too soon
-after being felled, but also, as I am informed,
-from being stripped of its bark and
-outer surface when piled and exposed to the
-weather in dock yards. This method of
-smoothing and piling the wood is only a
-late practice; and the advantage in point
-of convenience and neatness seems to be
-more than overbalanced by the detriment it
-thereby receives.</p>
-
-<p>A wet hold diffuses moist vapour all over
-the ship; and it was a rule with some of
-those commanders whom I observed to be
-<span class="pagenum" id="Page_289">289</span>
-most successful in preserving the health of
-their men, not only to have daily fires in
-the well, but to bail out the water when
-the pumps could not exhaust it all, and never
-to allow it to collect to more than the
-depth of a few inches. It is, therefore,
-very doubtful whether it is a good practice
-to let in water, as is very commonly done
-in order to sweeten the hold, for the same
-sweetness will be preserved if it is kept
-strictly dry. If it should happen, indeed, that
-there should be a great deal of putrid matter
-in the lower parts of the ship, from previous
-neglect or unavoidable leakage, it may be adviseable
-to let in a quantity of water in
-order to loosen and wash off what is offensive,
-and then to pump it out.</p>
-
-<p>There is a circumstance in the first fitting
-out of a ship well worth attention, as highly
-conducive to the dryness and cleanness of
-the hold. I mean the choice of the ballast;
-for that which is called <i>shingle</i>, consisting all
-of pebbles, is far preferable to that which is
-sandy and earthy, as it does not so readily
-<span class="pagenum" id="Page_290">290</span>
-soak and retain the moisture and filth. Water
-or fluid of any kind readily subsides in it,
-and should any putrid matter be entangled
-in it, there will be less difficulty in washing
-it out.</p>
-
-<p>The decks should not be washed so often
-when the weather is moist as when it is
-fine, as it will be more difficult to dry them,
-and more harm may arise from the moisture
-than benefit from the cleanness. Washing
-should also be performed very early in the
-morning, even in the best weather, in order
-that there may be time for the decks to become
-dry in the course of the day. It is
-after a general washing that the moveable
-fires, formerly described, are most proper
-and useful.</p>
-
-<p>Every contrivance should be fallen upon
-to change the air in the orlop and hold.
-Ventilators and windsails<a id="FNanchor_59" href="#Footnote_59" class="fnanchor">59</a> are well adapted
-<span class="pagenum" id="Page_291">291</span>
-for this purpose, and should be used as frequently
-and for as long a time as possible.
-It has also a good effect in cooling the air in
-the lower parts of a ship in the West Indies,
-to lift the gratings of the hatches, raising
-them on their edges, and lashing them to
-the staunchions. It contributes likewise to
-cleanliness and coolness to keep the decks as
-clear as possible from<a id="FNanchor_60" href="#Footnote_60" class="fnanchor">60</a> chests and other lumber,
-which are in the way of sweeping and
-washing, and prevent also the free course
-of the air.</p>
-
-<p>Particular attention to ventilation is necessary
-in frigates, for almost all that part in
-which the men sleep is excluded from the
-air, and they are therefore very uncomfortable
-in the West Indies unless small scuttles
-are cut in the sides. But if this should be
-objected to as weakening or endangering the
-ship, there is a good contrivance for the same
-purpose, which I met with on board of the
-<span class="pagenum" id="Page_292">292</span>
-Nymphe frigate. It consists of a square
-wooden pipe, of about nine inches in the
-side coming from between decks, running
-along the side of the ship, and opening over
-the gunwale of the forecastle. There was
-one on each side.
-<span class="pagenum" id="Page_293">293</span></p>
-
-<h3 id="CHAP_I_SECT_IV">SECT. IV.<br />
-
-<span class="medium">Means of guarding against <span class="smcap">Infection</span> and
-<span class="smcap">Bad Air</span>.</span></h3>
-
-<p>Infection never prevails to such a degree,
-as to affect every person indiscriminately
-who is exposed to it. Even where the
-plague and small-pox prevail to the greatest
-degree, there are some persons who, though
-susceptible of these diseases, yet escape them.
-There are certain other infections of a weaker
-nature, as was before observed, and these
-will remain entirely inactive, till they find
-constitutions so disposed as to be fit subjects
-of their action. The seeds of disease may
-be compared to those of vegetables, which
-lye dormant, unless they happen to fall into
-a situation peculiarly adapted for exciting
-their activity. It is very difficult to account for
-this uncertainty in the operation of infection,
-but it is extremely providential, that under
-the most calamitous state of sickness, there
-<span class="pagenum" id="Page_294">294</span>
-are always some who are in health and who
-survive, for the necessary purposes of life.
-If this were not the case, it might happen
-that every person on board of a ship might
-perish from sickness in the course of a voyage,
-a circumstance which I believe has
-never been known to happen.</p>
-
-<p>There is an endless variety in the constitution
-of the human frame, both in mind and
-body, as well as in the features of the face.
-There are, perhaps, no two individuals in
-the world in whom the same effect precisely
-is produced by the same food, air, medicine,
-poison, or passions of the mind. The different
-effects of infection, therefore, upon different
-people, seem to depend, in many cases,
-on peculiarities of constitution too obscure
-to be explained; but there are also known
-circumstances which resist or encourage its
-effects.</p>
-
-<p>The great power of habit<a id="FNanchor_61" href="#Footnote_61" class="fnanchor">61</a> in taking off the
-effect of infection, has already been mentioned,
-<span class="pagenum" id="Page_295">295</span>
-and it would appear that novelty gives
-an increased energy and activity to all impressions,
-as well as those on the senses. If
-a person, therefore, escapes the first attack of
-infection, he will be more likely to continue
-exposed to it with safety in future.</p>
-
-<p>There are certain precautions necessary
-to be attended to by those who are unavoidably
-exposed to contagion, particularly
-in the first instance. Those who can afford
-a full diet, and a liberal use of wine, have
-been observed to resist infection better than
-those who use food and drink that is meagre
-and watery. It is also a good rule not to go
-among the sick, nor otherwise to expose
-one’s self to infectious air, with an empty
-stomach; for whether it is that the body is
-then more susceptible, or that the pores of
-the skin and lungs are in a more highly absorbing
-state, so as with greater readiness to
-inhale the poison of disease, it is certain that
-<span class="pagenum" id="Page_296">296</span>
-a person in that situation is more apt to catch
-harm from foul air of any kind. Whatever
-else weakens and exhausts the body, renders
-it also more susceptible of noxious impressions.
-Under the head of weakening powers, I comprehend
-not only what empties the body of
-its fluids, such as loss of blood, or a diarrhœa,
-but intoxication, fatigue, fasting, watching,
-and certain affections of the mind, such as
-care and grief.</p>
-
-<p>Cold and moisture may also be enumerated
-among the causes that invite the attack of
-infectious diseases. They are of themselves
-simply productive of catarrhs, rheumatisms,
-and the like disorders; but if an infection
-should be accidentally present when the body
-is exposed to them, then instead of these
-complaints, the disease peculiar to that infection
-will be produced<a id="FNanchor_62" href="#Footnote_62" class="fnanchor">62</a>. This was illustrated
-<span class="pagenum" id="Page_297">297</span>
-in the last reinforcement we had from
-England; for while bad fevers were breaking
-out in most of the other ships, the <a id="FNanchor_63" href="#Footnote_63" class="fnanchor">63</a>Union
-was affected with those complaints only
-which are simply the effects of cold and
-moisture. It would be more proper, perhaps,
-to say, <i>exposure to the air</i>, than to
-call it <i>cold</i>; for exposing the naked body to
-the open air, even in the warmest climate,
-is prejudicial to health. This holds at least
-with regard to Europeans who are accustomed
-to clothing, however the natives of hot
-climates who are naked, may expose themselves
-with impunity.</p>
-
-<p>It is of the greatest consequence to ascertain
-the extent of the influence of infection,
-for the means of avoiding and preventing it
-will very much depend upon this. It is
-now known, that infection extends itself to
-a very small distance. There are, indeed,
-some morbid poisons, such as that of the
-bite of a mad dog, and that of the venereal
-disease, which require actual contact to
-<span class="pagenum" id="Page_298">298</span>
-make them take effect. Others are more
-volatile, and seem to he inhaled by the
-breath, or absorbed by the skin, but these
-do not extend far. That of the plague<a id="FNanchor_64" href="#Footnote_64" class="fnanchor">64</a>
-does not reach above a few yards, and that
-of the small-pox and of fevers is probably
-equally limited. This discovery is very valuable,
-by ascertaining the limits of danger;
-for when a person imagines he runs the same
-risk when at a considerable distance from the
-seat of disease, as if he were in contact with
-the person affected, he will be apt to expose
-himself wantonly and unnecessarily to the
-infection.</p>
-
-<p>It seems to be owing to the ignorance of
-the extent of its influence, that the plague
-has in general been so fatal; for in consequence
-of the opinion that the whole surrounding
-atmosphere was affected, it was
-<span class="pagenum" id="Page_299">299</span>
-vainly attempted to purify it by large fires
-in the open air, or by <a id="FNanchor_65" href="#Footnote_65" class="fnanchor">65</a>firing off artillery, instead
-of trusting to the separation of the sick
-so as to avoid their near approach, and to
-the confinement of those in health to their
-own houses, which are all the precautions
-necessary to prevent its progress.
-<span class="pagenum" id="Page_300">300</span></p>
-
-<h2 id="CHAP_II">CHAP. II.</h2>
-
-<h3 id="OF_ALIMENT" class="large">Of <span class="smcap">Aliment</span>.</h3>
-
-<h3 id="SECT_I_of_Solid_Food">SECT. I. Of <span class="smcap">Solid Food</span>.</h3>
-
-<p>The most unnatural circumstance in a
-sea life is the food which men use, and the
-disease most peculiar to it is one which is
-owing chiefly to the nature of the aliment;
-for though other causes conspire in aggravating
-the scurvy, the depraved state of the
-<small>INGESTA</small> is the main and fundamental cause
-of it.</p>
-
-<p>It is this disease that is most fatal to seamen
-next to fevers. It was formerly as fatal,
-if not more so; but some modern improvements
-have rendered it less frequent
-and violent. The habitual use of salt provisions,
-besides producing evident symptoms
-of scurvy, begets such a state of the constitution,
-that, upon the least scratch being received,
-particularly on the lower extremities,
-a large and incurable ulcer ensues; and
-<span class="pagenum" id="Page_301">301</span>
-this circumstance, trifling as it appears, is
-the cause of losing an incredible number of
-men to the service, especially in the West
-Indies. The greater part of the food of a
-ship’s company is necessarily salted meat.
-Biscuit and pease, though of a vegetable
-nature, are hard of digestion; and though
-they qualify the animal food, they do not
-answer the purpose of fresh vegetables.
-Though officers have a supply of live stock
-even for the longest voyages, it would be
-impracticable to carry a quantity sufficient
-to preserve a whole crew from the scurvy.
-But certain articles have of late been introduced
-into use, of a durable and portable nature,
-which so qualify the salt provisions,
-that they can be used without inducing this
-disease. These are either such as are articles
-of common diet, viz. melasses and sour
-krout, or those which are intended only for
-the sick and recovering, such as portable
-soup and the preserved juice of lemons and
-oranges.</p>
-
-<p>It is one of the most ancient and real
-grievances in the service, that there has not
-<span class="pagenum" id="Page_302">302</span>
-been a sufficiently ample supply of nourishment
-and cordials for the weak and recovering.
-This complaint is made by <a id="FNanchor_66" href="#Footnote_66" class="fnanchor">66</a>Dr. Cockburn,
-who was physician to the fleet in the
-end of the last century; and it is a complaint
-that has not yet been entirely redressed, nor
-has the subject been considered with the attention
-it deserves. The only improvement in
-the sea victualling that I know of from that
-time till of late, has been the use of raisins
-for puddings, and the occasional use of vinegar,
-which is an article extremely salutary,
-and was looked upon as the great preservative
-of health in the Roman armies.</p>
-
-<p>After the force of disease has been subdued
-at sea, men are frequently lost by relapses,
-or pine away in dropsies and other
-chronic complaints, for want of being supported
-by some cordial and nourishing diet.
-It is mentioned in my memorial to the Admiralty,
-how insufficient the small quantity
-of surgeon’s necessaries are; and it is recommended
-that a large quantity of certain species
-<span class="pagenum" id="Page_303">303</span>
-of refreshment should be put in the
-purser’s charge, which, being substituted for
-the common sea victualling while men are
-ill or recovering, would cost Government
-little or nothing. Besides the articles already
-mentioned, it was recommended to
-set apart a quantity of the best wines, and
-to be provided with brown sugar, dried
-fruits, barley, rice, sago, and salep. To
-these might be added eggs, which, if greased
-and put in salt, may be preserved fresh for a
-great length of time. Carrots and other roots
-might also be preserved for the longest voyages
-by means of sugar; and green vegetables
-might in like manner be preserved by
-means of salt. But of all the articles, either
-of medicine or diet, for the cure of the
-scurvy, lemons and oranges<a id="FNanchor_67" href="#Footnote_67" class="fnanchor">67</a> are of much
-the greatest efficacy. They are real specifics
-in that disease, if any thing deserves that
-name. This was first ascertained and set in
-a clear light by Dr. Lind. Upon what
-principle their superior efficacy depends, and
-<span class="pagenum" id="Page_304">304</span>
-in what manner they produce their effect, I
-am at a loss to determine, never having been
-able to satisfy my mind with any theory
-concerning the nature and cure of this disease,
-nor hardly indeed of any other. An
-ingenious treatise has been published on this
-subject by Dr. Milman, to which I refer the
-reader, meaning to confine myself in this
-work chiefly to what is practical.</p>
-
-<p>Every person who has beheld with attention
-and feeling the tedious and languishing
-series of suffering which the sick and recovering
-endure for want of the means of supporting
-and recruiting their strength and
-spirits, must wish that those who preside
-in the civil department of the navy would
-seriously consider this subject, and complete
-the reform that has already been begun.</p>
-
-<p>With regard to the victualling of men in
-health, a most commendable attention has
-been paid to the improvement of it. The
-ordinary articles of victualling have not only
-been of excellent quality, but some new articles
-have been added, from which the
-<span class="pagenum" id="Page_305">305</span>
-greatest benefit has been derived. The
-chief of these are sour krout and melasses.
-The latter was first brought into use by
-Captain Ferguson in the beginning of the
-late war. He ordered it to be served with
-rice to the men who were affected, or threatened
-with the scurvy, in the ship under his
-command. The benefit experienced from it
-in this and other instances was so great,
-that during the last two years of the war it
-was made a regular article of sea victualling,
-and substituted in place of a certain proportion
-of oatmeal<a id="FNanchor_68" href="#Footnote_68" class="fnanchor">68</a>.
-<span class="pagenum" id="Page_306">306</span></p>
-
-<p>As bread is one of the principal articles
-of diet, the utmost care should be taken in
-preserving it, and great advantage would
-arise from stowing it in casks that are water
-<span class="pagenum" id="Page_307">307</span>
-tight, instead of keeping it in bags, or letting
-it lie loose in the bread room. Captain
-Cook, by this method, and by giving it a
-cast in the oven in the course of the voyage,
-preserved his biscuit found in every respect
-for more than three years. But the greatest
-improvement in this article of diet would be
-to have, in the form of flour, a greater proportion
-of what is now allowed in bread.
-The flour might be made into puddings,
-and seems, in this form, to be more nutritious
-and antiscorbutic than biscuit which
-has undergone a strong force of fire. This
-sort of mess would be still more proper and
-agreeable now that melasses is a stated article
-of diet. Flour, by being well pressed
-and rammed, will keep as long as biscuit,
-and it can be stowed in one fifth part of the
-space; it will, therefore, cost much less in
-freight than the same quantity of it in that
-form, and it may be baked abroad if necessary<a id="FNanchor_69" href="#Footnote_69" class="fnanchor">69</a>.
-Malt, by being well rammed, may
-also be preserved for a great length of time.
-<span class="pagenum" id="Page_308">308</span></p>
-
-<p>Of all the former articles of sea victualling,
-there was none more abused than oatmeal.
-The quantity allowed to each man
-was twice as much as he could consume,
-and the overplus went to the purser’s profits,
-or was wasted by being given to the hogs,
-or even wantonly thrown overboard. Melasses
-have, with great advantage, been substituted
-for part of it, in the proportion of
-<span class="pagenum" id="Page_309">309</span>
-eleven pounds for two gallons of oatmeal.
-The first trial of melasses was in the<a id="FNanchor_70" href="#Footnote_70" class="fnanchor">70</a> Foudroyant,
-and it answered so well, that, in a
-cruise under Admiral Geary in 1780, this
-was the only ship free from the scurvy, and
-out of two thousand four hundred men that
-were landed at the hospital with this disease,
-there were none from this ship. It
-appears to be so similar in its nature and effects
-to essence of malt, that it seems hardly
-worth while for Government to be at the
-expence of providing the latter.</p>
-
-<p>A certain proportion of barley has also of
-late been substituted for part of the oatmeal,
-which being more light and palatable, makes
-a pleasing variety, particularly to the sick
-and recovering. Captain Cook carried wheat
-with him, and found it to answer equally
-well. Might not potatoes also be a proper
-and salutary substitute, as they will keep a
-<span class="pagenum" id="Page_310">310</span>
-considerable length of time in a warm climate,
-and they have been successfully employed
-in their raw state for the cure of
-scurvy? It would not be right, however, to
-abolish oatmeal entirely; for there is a certain
-preparation of it which is an antiscorbutic
-of equal efficacy with any whatever, except
-the juice of lemons and oranges. This
-is flummery, or sowins, which is prepared by
-letting oatmeal and water stand together till
-they grow acidulous, and then boiling them
-into a jelly. I know of some well-attested
-instances of the crews of ships being saved
-from the scurvy by this alone.</p>
-
-<p>Butter is a good article of victualling in
-so far as it renders that part of the diet
-which consists of grain and vegetables more
-palatable, and thereby induces men to eat
-more. But as it is extremely corruptible in
-a warm climate, hardly any being used by
-the seamen but what is more or less rancid,
-it should never be sent to a tropical station.
-Greater quantities of it are condemned than
-of any other article of victualling, and it is
-therefore the most expensive to Government.
-<span class="pagenum" id="Page_311">311</span>
-There are certain articles that are the natural
-produce of the West-India islands, which
-may be substituted for it with the greatest
-advantage. These are sugar and cocoa<a id="FNanchor_71" href="#Footnote_71" class="fnanchor">71</a>,
-which, during the last year of the war, were
-served in place of butter with great success,
-and this proved an alteration in diet not
-only salutary, but agreeable to the seamen,
-whose inclinations are always to be consulted
-in such changes<a id="FNanchor_72" href="#Footnote_72" class="fnanchor">72</a>.
-<span class="pagenum" id="Page_312">312</span></p>
-
-<p>When a ship is in port, encouragement
-should be given to the sale of roots, greens,
-fruits, and sugar. The men have a good
-custom of exchanging part of their bread,
-beef, and pork, for what they can get from
-the shore; but as they in general prefer spirituous
-liquors to the above-mentioned articles,
-the greatest care and vigilance should
-be used to preclude men from such opportunities
-of injuring themselves<a id="FNanchor_73" href="#Footnote_73" class="fnanchor">73</a>. Every
-ship should be furnished with a seine, and
-other implements for fishing, when in harbour.
-<span class="pagenum" id="Page_313">313</span></p>
-
-<p>When captures are made, in which there
-are such articles as sugar, wine, rice, or
-fruits, it would be much better in many
-cases to allow the immediate use of them at
-sea, where the men may be disposed to
-scurvy or other diseases, than to wait for
-the conversion of them into money.</p>
-
-<p>Though it has been my object to introduce
-as many articles of diet as possible, independent
-of salt provisions, it does not follow
-that these are in themselves unwholesome.
-They are pernicious by being made
-almost the sole and exclusive article; but if
-used in moderate quantity, they are even in
-some respects well adapted for the food of
-<span class="pagenum" id="Page_314">314</span>
-seamen. The nature of their life gives them
-a strong digestion: in their duties they not
-only employ violent exercise, but use more
-muscles and a greater variety of postures
-and motions than men of any other profession.
-To such constitutions may not food
-of a refractory nature and hard of digestion
-have even an advantage over what is more
-delicate and digestible?</p>
-
-<p>It does not appear that it is the salt quality
-of the provisions used at sea that makes
-them productive of scurvy, but the want of
-their native juices and of the nutritious
-principle. A small quantity of salt is necessary
-to make all food palatable and wholesome,
-in so much that it is reckoned one of
-the necessaries of life. All animals have a
-craving for sea salt, and nature has kindly
-made it the most abundant and universal of
-all saline bodies. Food, without this seasoning,
-not only comes to be loathed, but
-the want of it renders the animal weak and
-flabby. As it not only assists digestion,
-but invigorates all the bodily functions by
-<span class="pagenum" id="Page_315">315</span>
-stimulating and bracing the fibres, it is in
-some cases a valuable medicine. It is remarkable
-that men are very apt to tire of a
-long continuance of fresh provisions<a id="FNanchor_74" href="#Footnote_74" class="fnanchor">74</a>, but
-never of what is salt; and even under the
-scurvy the latter will be relished, and sometimes
-preferred to most other kinds of food.
-It has been a practice with some to make
-the scorbutic men drink sea water; but
-though it is not attended with any manifest
-benefit, I never heard that it aggravated the
-disease.</p>
-
-<p>I was told by the gentlemen of the army
-at New York in 1780, that the soldiers in
-cantonments were not near so subject to
-agues as the people of the country; and the
-only difference in their mode of life was, that
-the former had in their allowance a certain,
-proportion of salt provisions.
-<span class="pagenum" id="Page_316">316</span></p>
-
-<p>In an unhealthy country I should think a
-free use of salt, as well as spice<a id="FNanchor_75" href="#Footnote_75" class="fnanchor">75</a>, would be
-salutary; and when ships are in port it would
-perhaps be better to allow a certain proportion
-of salt provisions, because it would not
-only be wholesome and agreeable, but the
-men’s constitutions would probably be more
-reconciled to an entire salt diet when necessary:
-but I would except from this the
-crews of such ships as have newly arrived
-from a long cruise or voyage, in which it
-may be necessary to alter the constitution as
-quickly as possible by a diet entirely fresh.</p>
-
-<p>Nothing that I have collected from my
-own observation, or that of others, has been
-<span class="pagenum" id="Page_317">317</span>
-neglected under this head, except one particular
-caution with regard to the preparation
-of the victuals. The large utensils employed
-to boil the provisions are made of
-copper, and it sometimes happens from neglect
-that these are allowed to contract a rust,
-which is one of the most active poisons we
-know. The neglect consists chiefly in allowing
-any thing acid, or what is liable to
-become acid, such as gruel or burgoo, to remain
-for a length of time without being
-washed out; for when victuals have been
-prepared in the boilers thus uncleaned, they
-produce the most violent effects, even to the
-loss of life, as once happened in a ship belonging
-to our fleet<a id="FNanchor_76" href="#Footnote_76" class="fnanchor">76</a>.
-<span class="pagenum" id="Page_318">318</span>
-<span class="pagenum" id="Page_319">319</span></p>
-
-<h3 id="SECT_II_of_Drink">SECT. II. Of <span class="smcap">Drink</span>.</h3>
-
-<p>As the solid part of sea diet is very dry
-and hard, and as the salt it contains is apt
-to excite thirst, a freer use of liquids than
-at land is necessary, particularly in a hot
-climate.</p>
-
-<p>It has been the custom, as far back as we
-know, to allow seamen the use of some sort
-of fermented liquor. We need hardly inquire
-if this is salutary or not; for it would
-be impossible at any rate to withhold it,
-since it is an article of luxury, and a gratification
-which the men would claim as their
-right. There is a great propensity in seamen
-to intoxicating liquors, which is probably
-owing to the hardships they undergo,
-and to the variety and irregularity of a sea
-life. But there is reason to think that all
-sorts of fermented liquors, except distilled
-spirits, are conducive to health at sea.
-<span class="pagenum" id="Page_320">320</span></p>
-
-<p>There is no doubt that malt liquor is extremely
-wholesome and antiscorbutic. The
-common quantity of small beer allowed
-daily is so liberal, that few men make use of
-their whole allowance; and there is no objection
-to the constant use of it, except that
-it is apt to spoil in the course of a few weeks,
-and that upon foreign stations the stock can
-seldom be renewed. One of the greatest
-improvements that could be made in the
-victualling of the navy would be the introduction
-of porter<a id="FNanchor_77" href="#Footnote_77" class="fnanchor">77</a>, which can be preserved
-in any climate for any length of time that
-may be necessary.</p>
-
-<p>Spruce beer seems to possess similar and
-equal virtues with malt liquor and it has
-<span class="pagenum" id="Page_321">321</span>
-this advantage, that the materials of it can
-at all times be carried about and used occasionally.
-It agrees with malt liquor in being
-a fermented vegetable sweet, the principal
-ingredient of it being melasses. The other
-ingredient, from which it takes its name,
-being a balsamic substance, seems to be more
-medicinal and antiscorbutic than hops, and
-is therefore, perhaps, preferable to malt liquor.
-There have been sufficient proofs of
-its virtues in single ships; and all the men
-of war that go to America and the West
-Indies might be conveniently supplied with
-it. Admiral Pigot provided a sufficient
-quantity for the whole fleet; but the peace
-coming on prevented the trial of it.</p>
-
-<p>The most salutary kind of drink next to
-malt liquor, and spruce beer, is wine. The
-<span class="pagenum" id="Page_322">322</span>
-benefit which the fleet derived from it at different
-times, and the advantage it has over
-spirits has been often taken notice of in
-the former part of this work. It seems to
-be owing to this that the French fleet sometimes
-enjoys superior health to ours, and is
-less subject to the scurvy<a id="FNanchor_78" href="#Footnote_78" class="fnanchor">78</a>. Wine is also
-preferable to every other medicine in that
-low fever with which ships are so much infested;
-and there is no cordial equal to good
-wine in recruiting men who are recovering.</p>
-
-<p>Spirits differ from wine in this respect,
-that they are a mere chemical liquor, incapable
-of assimilation with our fluids, having
-lost in distillation the native vegetable
-principle in which the whole of its nutritious
-quality and great part of its medical
-virtue resides.
-<span class="pagenum" id="Page_323">323</span></p>
-
-<p>The abuse of spirituous liquors is extremely
-pernicious every where, both as an
-interruption to duty, and as it is injurious to
-health. It is particularly so in the West
-Indies, both because the rum is of a bad
-and unwholesome quality, and because this
-species of debauchery is more hurtful in a
-hot than in a cold climate.</p>
-
-<p>It is with reason that the new rum is accused
-of being more unwholesome than
-what is old; for, being long kept, it not
-only becomes weaker and more mellow by
-part of the spirit exhaling, but time is allowed
-for the evaporation of a certain nauseous
-empyreumatic principle which comes
-over in the distillation, and which is very
-offensive to the stomach; therefore, though
-this is the produce of the West-India islands,
-yet what is supplied there is inferior to that
-which is brought from England.</p>
-
-<p>It was originally the custom to serve seamen
-with their allowance of spirits undiluted.
-The method now in use, of adding
-water to it, was first introduced by Admiral
-<span class="pagenum" id="Page_324">324</span>
-Vernon in the year 1740, and got the name
-of <i>grog</i>. This was a great improvement;
-for the quantity of half a pint, which is
-the daily legal allowance to each man, will
-intoxicate most people to a considerable degree,
-if taken at once in a pure state.</p>
-
-<p>The superiority of wine over spirits in
-any shape was so conspicuous, that towards
-the end of the war the fleets in the West
-Indies and North America were supplied
-with nothing but wine, and with a success
-sufficient to encourage the continuance of
-the same practice in future.</p>
-
-<h4 id="OF_WATER">Of <span class="smcap">Water</span>.</h4>
-
-<p>As water is a necessary of life, and as the
-health and comfort of men at sea depend
-upon its quality, it deserves particular attention.</p>
-
-<p>Spring water is to be preferred to running
-or stagnated water; for, unless it is taken
-at the source, or near it, it is apt to be
-<span class="pagenum" id="Page_325">325</span>
-impregnated with decayed vegetable and
-animal substances, such as leaves, grass,
-wood, and dead insects. This inconvenience
-is greatest in a hot climate, where every
-thing teems with life, and where the materials
-of putrefaction are both more abundant
-and more prone to corruption. This is the
-most pernicious kind of impurity; for the
-mineral impregnations common in springs
-are seldom, in any degree, unwholesome, and
-do not tend, like the other, to make the water
-corrupt. At many of the West-India
-watering places the water is found stagnated
-just above high-water mark; and care should
-be taken to go higher up to take it where it
-is running.</p>
-
-<p>The purest water is apt to spoil by producing
-a putrid glare upon the inner surface
-of the cask which contains it. There is a
-great difference in this respect between a
-new cask, especially if made of moist wood,
-and that cask which has been hardened and
-seasoned by age and use. Several contrivances
-have been proposed for preparing the
-vessels that hold the water; but none have
-<span class="pagenum" id="Page_326">326</span>
-been found by experience so effectual as letting
-them stand for some time full of sea
-water; and it is a great advantage of this
-method, that it is so easily practicable.</p>
-
-<p>It is in few places we meet with water
-such as that of Bristol, which, in clean vessels,
-may be kept for any length of time.
-We may consider all water kept in wooden
-vessels as more or less liable to putrefaction;
-but there is a substance, which is neither
-rare nor costly, that effectually preserves it
-sweet. This is <i>quick lime</i>, with which every
-ship should be provided, in order to put a
-pint of it into each butt when it is filled.
-It has the advantage of not being injurious
-to health; but, on the contrary, is rather
-friendly to the bowels, tending to prevent
-and check fluxes. In the year 1779 several
-ships of the line arrived in the West Indies
-from England, and they were all afflicted
-with the flux, except the Stirling Castle,
-which was the only ship in which quick
-lime was put into the water. Nor does it
-spoil the water for any culinary purpose.
-Its action in preventing putrefaction consists,
-<span class="pagenum" id="Page_327">327</span>
-in part at least, in destroying vegetable
-and animal life. An addition of putrescent
-matter is produced in water by the generation
-of small insects; and the glare that
-collects on the sides of casks, and also what
-collects on the surface of the water, is a
-species of vegetation of the order called by
-naturalists <i>alg&aelig;</i><a id="FNanchor_79" href="#Footnote_79" class="fnanchor">79</a>. Quick lime is a poison
-to this species of vegetable life as well as to
-insects: but upon whatever principle it depends,
-the property of it in preserving water
-sweet is so well ascertained, that it is inexcusable
-ever to neglect the use of it.</p>
-
-<p>Quick lime is equally efficacious for this
-purpose, whether slacked or unslacked; and
-though the latter form is more convenient
-for stowage, by having less weight and
-bulk, yet the other is to be preferred for the
-sake of safety; for if water should by chance
-reach the unslacked lime, a great degree of
-heat is thereby produced, which has been
-known to give occasion to the most formidable
-accidents.
-<span class="pagenum" id="Page_328">328</span></p>
-
-<p>The only other objection I know of to
-the use of quick lime is, that it converts
-the water into a lime water, rendering it
-thereby disagreeable to the palate and stomach:
-but the quantity necessary to preserve
-it makes but a very weak lime water;
-for part of the lime is precipitated by the
-mephitic air, or the aerial acid, as it is
-otherwise called, of which there is some
-contained in the water. The accidental exposure
-to the atmosphere, which also abounds
-with this sort of air, tends farther to lessen
-the acrimony of the quick lime<a id="FNanchor_80" href="#Footnote_80" class="fnanchor">80</a>.</p>
-
-<p>There are other substances which have
-been found useful in correcting bad water.
-Alum and cream of tartar, as antiseptic bodies,
-have been employed for this purpose.
-<span class="pagenum" id="Page_329">329</span>
-Vinegar and the vegetable acid juices and
-fruits, such as tamarinds, may be used occasionally
-to take off the putrid offensive
-taste which may have arisen in case the use
-of quick lime has been neglected. In the
-fleet under Sir Charles Saunders, the water
-of the river St. Lawrence having been found
-to produce fluxes, this quality was removed
-by throwing four pounds of burnt biscuit
-into each cask before it was used. But there
-is nothing so effectual, and subject to so few
-inconveniences, as quick lime.</p>
-
-<p>The next method to be mentioned of purifying
-water is filtration, which not only
-separates the gross impurities, but removes
-the putrid smell and taste. It is performed
-with a dripping stone, which is a convenient
-<span class="pagenum" id="Page_330">330</span>
-contrivance for officers, but cannot furnish
-a supply for a whole ship’s company.</p>
-
-<p>When the water of wells or brooks is
-found loaded with mud, the following expeditious
-method of filtration, described by
-Dr. Lind, has been practised with success:&mdash;Let
-a quantity of clean sand or gravel be
-put into a barrel placed on one end, without
-the head, so as to fill one half or more of
-it, and let another barrel, with both ends
-knocked out, of a much smaller size, (or
-let it be an open cylinder of any kind) be
-placed erect in the middle of it, and almost
-filled with sand or gravel. If the impure
-water be poured into the small barrel or
-cylinder, it will rise up through the sand
-of both barrels, and appear pure above the
-sand of the large one in the interval between
-it and the small one.</p>
-
-<p>But when water is offensive in consequence
-of being long kept, the most effectual and
-expeditious method of sweetening it is by
-exposing it to the air in as divided a state as
-possible. Boiling will not expel the putrid
-<span class="pagenum" id="Page_331">331</span>
-effluvia contained in water; but such is the
-attraction of air for this offensive matter,
-that the water need only be thoroughly exposed
-to it to be rendered quite sweet. This
-is best done by a machine invented by Mr.
-Osbridge, a lieutenant of the navy. It consists
-of a hand pump, which is inserted in a
-scuttle made at the top of a cask, and by
-means of it the water, being raised a few
-feet, falls through several sheets of tin
-pierced like cullenders, and placed horizontally
-in a half cylinder of the same metal.
-The purpose of it is to reduce the water
-into numberless drops, which being exposed
-in this form to the open air, is deprived of
-its offensive quality. The same method will
-serve to separate the superfluous quick lime
-in the water. It is a machine very deservedly
-in common use, and the working of it is
-a moderate and salutary exercise to men in
-fair weather.</p>
-
-<p>The following contrivance will be found
-to afford a sufficient supply of sweet water
-to particular messes, and may be considered
-as an artificial and more expeditious sort of
-<span class="pagenum" id="Page_332">332</span>
-dripping stone.&mdash;Let the narrow mouth of
-a large funnel be filled with a bit of sponge,
-over which let there be a layer of clean gravel
-or sand covered with a piece of flannel,
-and over the whole another layer of sand.
-Muddy or offensive water being poured upon
-this, runs or drops out clear; and care must
-be taken to change the sand, sponge, &amp;c.
-frequently, as they will become loaded with
-the impurities of the water<a id="FNanchor_81" href="#Footnote_81" class="fnanchor">81</a>.</p>
-
-<p>There should be in every ship an apparatus
-for distilling water in case of distress.
-This consists merely of a head and worm
-adapted to the common boiler, and distillation
-may go on while the victuals are boiling.
-More than eight gallons of excellent
-fresh water may be drawn off in an hour
-from the copper of the smallest ship of
-war<a id="FNanchor_82" href="#Footnote_82" class="fnanchor">82</a>. I refer for a more particular account
-<span class="pagenum" id="Page_333">333</span>
-of all this to the works of Dr. Lind, who
-was the original inventor and recommender
-of this method.</p>
-
-<p>This invention seems to have escaped
-others so long, from the idea that the <i>desideratum</i>
-in freshening sea water was some
-substance to be added to it while under distillation.
-No such substance is necessary,
-and, the more simple the mode of distillation,
-the fresher the water will prove.</p>
-
-<p>Rain water at sea is always pure and
-wholesome, and may be saved occasionally
-by means of a sail or awning.
-<span class="pagenum" id="Page_334">334</span></p>
-
-<h2 id="PART_II_CHAP_III">CHAP. III.</h2>
-
-<h3 id="OF_CLOTHING">Of <span class="smcap">Clothing</span>.</h3>
-
-<p>Nature has made man so defenceless,
-that even the rudest nations, in the hottest
-climates, in general, adopt some sort of covering
-to guard themselves from the weather.
-We may affirm, that clothing is the
-most artificial circumstance in the life of
-man; and there is none, of which the
-errors subject him to more inconvenience
-and hardship. Insensible perspiration is performed
-by the pores of the skin, and being
-one of the most important functions of the
-body, the suppression of it seems to be one
-of the principal causes, or at least one of
-the most frequent attendants on feverish and
-inflammatory complaints; and one of the
-most common causes of this suppression is
-the application of cold to the skin.</p>
-
-<p>In order to keep up perspiration, it is necessary
-that the orifices of the pores of the
-<span class="pagenum" id="Page_335">335</span>
-skin should be bathed, as it were, in the vapour
-already secreted from them; and clothing
-seems to act in confining this, as well
-as in preventing the escape of the natural
-heat and the access of the external air.
-Though the air should not be cold, it will
-check perspiration by carrying off this vapour
-and drying the skin. In the warmest
-climates exposure of the skin to the external
-air is unsafe; for it not only produces a
-feverish and uneasy sensation at the time,
-but occasions the most dangerous internal
-disorders. In consequence of the great sensibility
-and sympathy of the body, and from
-the pores of the skin being open in a warm
-climate, exposure is in some respects even
-more dangerous than in a cold one. Nothing
-is more apt to bring on the locked
-jaw and tetanus than sleeping in the open
-air; and it was observed in Jamaica, that
-when it was the custom to wear cotton and
-linen clothes, the dry belly-ache was much
-more common than now that it is the custom
-to wear woollen cloth.
-<span class="pagenum" id="Page_336">336</span></p>
-
-<p>We know besides, that the pores of the
-skin can absorb not only the moisture that
-floats in the atmosphere, but a variety of
-foreign bodies, whether noxious or medicinal,
-which may be applied to their orifices;
-and as the air is in certain places loaded
-with noxious matter, may not clothing be
-considered as a filter, as it were, to separate
-the impurities of the air before it comes in
-contact with the surface of the body?</p>
-
-<p>It is therefore every where of the utmost
-consequence that sufficient and suitable clothing
-should be provided.</p>
-
-<p>It would certainly be for the benefit of
-the service that an uniform should be established
-for the common men as well as for
-the officers. This would oblige them at all
-times to have in their possession a quantity
-of decent apparel, subject to the inspection
-of their superiors. It would also be less easy
-to dispose of their clothes for money without
-detection, and desertion would also
-thereby be rendered more difficult.
-<span class="pagenum" id="Page_337">337</span></p>
-
-<p>It is of great consequence that the purser
-should lay in a sufficient stock of clothing
-and bedding suited to the climate for which
-the ship is destined, in order that there may
-be a sufficient supply after having been on a
-distant station for a certain length of time.
-I have known men suffer the greatest inconvenience
-and hardship, and infectious diseases
-kept up, from the neglect of this.</p>
-
-<p>The greatest evil connected with clothing
-is the infection generated by wearing it too
-long without shifting; for to this cause we
-have attributed the jail, hospital, or ship fever.
-The great importance of cleanliness appeared
-when we were treating of infection, from
-whence we may judge of what consequence
-it is that men should be provided with a
-shift of linen, as that part of the clothing
-which is in contact with the skin is most
-likely to harbour infection<a id="FNanchor_83" href="#Footnote_83" class="fnanchor">83</a>.
-<span class="pagenum" id="Page_338">338</span></p>
-
-<p>As clothing is not the gift of nature, being
-left to man’s own reason, it is subject to
-caprice, and thereby productive of inconvenience
-and disease. The necessity of it depends
-very much upon habit, like every
-thing else relating to the human body, and
-therefore sudden and unseasonable changes
-of apparel are very unsafe to health. It is
-also found that a partial exposure of the
-body is more pernicious than a general exposure.
-If I were writing for the more delicate
-part of the world, I should illustrate
-this by the danger of exposing the feet alone
-to cold or wet. It is seldom that seamen
-are susceptible to so great a degree, for their
-hardy and exposed life steels them against
-<span class="pagenum" id="Page_339">339</span>
-such impressions. But there is another circumstance
-which renders it of the utmost
-consequence to defend the feet against external
-injury. It frequently happens, that, without
-any visible symptoms of scurvy, the constitutions
-of seamen are such, that, upon the
-least scratch being received on the feet or
-legs, a large spreading incurable ulcer arises;
-which sometimes ends in the loss of a limb;
-but at any rate disables them from duty till
-a cure can be effected by the use of a fresh
-and vegetable diet, or a change of climate.
-Next to acute diseases and scurvy, this is the
-most destructive complaint incident to a sea
-life, particularly in a hot climate; and I
-have known great numbers of good men
-thereby lost to the service. It is, therefore,
-of the utmost consequence that men should
-not only be supplied with shoes, but be
-obliged to wear them, which is found to
-require a degree of compulsion; for in the
-West Indies it is observed that seamen always
-wish to go barefooted.</p>
-
-<p>Since the first edition of this work was
-published, I have been favoured with several
-<span class="pagenum" id="Page_340">340</span>
-valuable remarks on this subject, by Captain
-Caldwell, an officer of great humanity and
-experience. Among other remarks, he observes,
-that the different articles of clothing
-supplied to sailors are, in general, too slight,
-and of too small a size, which renders them
-expensive and inconvenient to large men.
-The trowsers, he observes, should be much
-thicker, and larger, as the least shower goes
-through them; and, in a cold climate,
-those made of <i>fear-nought</i><a id="FNanchor_84" href="#Footnote_84" class="fnanchor">84</a>, which do not
-cost more than the others, should also be
-allowed. What a situation are men in
-when topsails are reefing in the winter
-season while it rains, when cold and wet,
-with their trowsers sticking to them, (which
-would not be the case if they were of
-flannel) and it is not practicable that they
-should have change of clothing for every
-time they are obliged to be wet? Thick,
-double-milled caps are much wanted in bad
-weather to cover the head and ears. Dutch
-caps do not keep out the weather, and will
-not stay on the head. It is commonly remarked
-<span class="pagenum" id="Page_341">341</span>
-that the men who wear the thickest
-linen shirts are the most healthy.</p>
-
-<p>Men, upon first entering into the service,
-are allowed the advance of two months
-wages, in order to provide necessaries: but
-this, inadequate as it is for a long voyage,
-is not extended to pressed men. It is also
-argued against making large stoppages in
-seamen’s wages; that, by diminishing what
-they have to receive when paid off, a discouragement
-is thereby given to the service.
-But as we see men deserting from men of
-war when several years wages are due to
-them, the most reasonable and effectual encouragement
-seems to be to render their
-lives as comfortable and healthy as possible.</p>
-
-<p>But why might not most of the articles
-mentioned be supplied gratuitously? In favour
-of which Captain Caldwell makes use
-of an argument frequently inculcated in
-this work, viz. that so much advantage
-would accrue to Government by preserving
-the health and lives of men, and so much
-would be saved in hospitals, as would much
-<span class="pagenum" id="Page_342">342</span>
-more than reimburse the extraordinary expence<a id="FNanchor_85" href="#Footnote_85" class="fnanchor">85</a>.
-<span class="pagenum" id="Page_343">343</span></p>
-
-<h2 id="PART_II_CHAP_IV">CHAP. IV.</h2>
-
-<h3 id="OF_EXERCISE">Of <span class="smcap">Exercise</span>.</h3>
-
-<p>It commonly happens in a ship of war
-that a great proportion of the hands is
-landsmen; for, besides the men required to
-navigate the ship, a great number is necessary
-to fight the guns, as well as for other
-duties, and their health may be affected by
-the want of exercise.</p>
-
-<p>It has been observed before, that one use
-of frequent reviews and musters in a numerous
-crew is, to call forth men that would
-otherwise be overlooked, to oblige them to
-come into the open air, to keep themselves
-clean, and to prevent them from indulging
-in filth and laziness. It is observed, that
-seamen are in general less subject to scurvy
-than marines and landsmen, which seems to
-be owing to the greater activity of their life
-and alacrity of their minds.
-<span class="pagenum" id="Page_344">344</span></p>
-
-<p>There is an essay on the causes of the pestilence,
-by an anonymous author, published
-at Edinburgh in 1759, in which this disease
-is said to be entirely the offspring of idleness,
-and he illustrates this by its being more apt to
-arise in besieged towns than any other situation;
-and he alledges that a false alarm of
-the plague will actually produce it by throwing
-people idle, as was the case, he affirms,
-when the plague was last at Messina.</p>
-
-<p>There are always numbers who have been
-pressed into the service, to whom a sea life
-is new, and who are therefore prone to indolence,
-low spirits, and self-neglect. Men
-of this description are by far the most apt to
-fall into the scurvy; and next to the quality
-of the food, there is nothing contributes
-more to promote the scurvy than such a disposition.
-It is indeed both a cause and a
-symptom of this disease, and therefore idleness
-and <i>skulking</i> should be rigidly discouraged,
-unless the complaint is so far advanced
-as to render it cruel and even impossible
-to force men to take exercise.
-<span class="pagenum" id="Page_345">345</span></p>
-
-<p>The Conqueror, of 74 guns, one of our
-squadron in the last year of the war, was
-an instance of a ship in which only the
-prime seamen were attacked with the scurvy,
-and this is to be accounted for upon the
-same principle, for it proceeded from their
-having been exempted from the duty of
-pumping, in which the inferior classes of
-men were constantly employed, owing to
-the leaky state of the ship.</p>
-
-<p>As low spirits and indolence have such an
-unfavourable effect upon health, it would be
-wise, as well as benevolent, to promote whatever
-produces jollity, contentment, and good
-humour, so far as is consistent with sobriety
-and regularity. There are certain rough
-sports which are now almost in disuse; and
-whoever would revive and encourage them,
-would perform a useful office to the service.</p>
-
-<p>A sea life frequently demands violent
-temporary exertions, from the uncertainty
-of the weather, and other incidents; so that
-men are more exposed to extreme fatigue
-<span class="pagenum" id="Page_346">346</span>
-and sudden calls of duty in this than in any
-other situation of life. Nothing tends more
-to shorten life than excessive bodily labour
-and watching; and it is for this reason that
-seamen in general are short lived, and that
-their countenance and general appearance
-make them appear older than they really
-are by several years. This is remarkably
-the case when a seaman comes to be upwards
-of forty and it has been mentioned
-before, that a person not acquainted with
-this circumstance will make a mistake of
-ten years in guessing at the age of a seaman
-from his looks.</p>
-
-<p>Fatigue being therefore frequently the
-means of bringing on disease and breaking
-the constitution, as much tenderness is due
-to men as is consistent with the necessary
-duties of service. This is a circumstance
-in which young officers are apt to forget
-themselves; and they should take care how
-they <i>call all hands</i> wantonly, and oblige men
-to make exertions beyond their strength,
-especially as this will be submitted to more
-<span class="pagenum" id="Page_347">347</span>
-readily by sailors than any other set of men,
-from the generous alacrity of their nature.</p>
-
-<p>It would be well if it could be rendered
-convenient at all times, except in cases of
-danger or emergency, to put the men at
-three watches instead of watch and watch.
-By the former arrangement they have eight
-hours sleep and rest; by the latter only four
-hours are allowed, which is not sufficient
-for refreshment, nor is there time for them
-to get dry, in case they have been exposed
-to wet.</p>
-
-<p>It would be a good rule to have as few
-men as possible out of bed in the night-time,
-unless where active service renders it
-necessary; for, if unoccupied, they lie about
-the decks, fall asleep, and catch cold. In
-such situations, might not all the topmen
-but one remain on the forecastle, where they
-might take exercise, which they could not
-do aloft? I am indebted for this remark to
-the Rev. Mr. Ramsay, who joins to a great
-knowledge of the sea service a warm and
-disinterested zeal for its prosperity, and has
-<span class="pagenum" id="Page_348">348</span>
-been so good in several other instances as to
-communicate to me the results of his experience
-and observation.</p>
-
-<p>The good effects resulting from the indulgent
-treatment of men are, that it encourages
-them to enter into the service, and to
-do their duty with cheerfulness and resolution.
-There is something more daunting
-to the mind of man to see his companions
-suffering under oppression and languishing
-in disease, or perishing miserably from sores
-or sickness, than in the terrors of fire and
-sword, which, as we have seen, make the
-least part of the calamities of war. The
-good treatment of seamen, in so far as it
-regards their health, is by no means incompatible
-with strict discipline. Indeed strictness
-and even severity is necessary with seamen;
-for it is observed with regard to men
-who are used to arbitrary government, that
-they cannot bear indulgence and relaxation.
-But the steady enforcement of discipline and
-regularity is so far from being akin to cruelty,
-that it tends to prevent both sickness
-and the commission of crimes, consequently
-<span class="pagenum" id="Page_349">349</span>
-rendering the infliction of punishment less
-frequent and necessary. The chief excellence
-in the character of an officer seems to
-consist in uniting strict discipline with indulgence
-and humanity.</p>
-
-<h3 id="CONCLUSION">CONCLUSION.</h3>
-
-<p>The subject of the preceding remarks
-has been the prevention of diseases and it
-has appeared that the means of this are not
-so much in the province of the medical profession
-as of those who are entrusted with
-the direction of the navy in a civil or military
-capacity; and that with regard to cure
-and recovery also, a great deal depends upon
-them, by their having it in their power to
-make a suitable provision of proper diet and
-cordials. The great importance of the subject
-will plead my excuse for again calling to
-mind, that such attentions are not only dictated
-by humanity, but would be the greatest
-wisdom in an œconomical and national light,
-<span class="pagenum" id="Page_350">350</span>
-considering how expensive it is to <i>replace</i>
-men and to support invalids, not to mention
-that it is upon the health and lives of men
-that every public exertion essentially depends,
-and upon which may depend not only
-the character of officers, but the national
-character in the day of battle.</p>
-
-<p>It must be confessed, that though there is
-still room for improvement, the navy is now
-on a better footing with regard to the health
-and comfort of seamen than it appears to
-have been in former times. The victuals
-were in general in the late war of excellent
-quality; the civil branch has shewn in many
-instances a readiness to adopt the means and
-to furnish the articles that were recommended
-for the health of the men<a id="FNanchor_86" href="#Footnote_86" class="fnanchor">86</a>; and most
-of the commanders whom I have the honour
-to know are humane, attentive, and
-intelligent.</p>
-
-<p>To conclude; there is no situation of life
-in which there is room for more virtues,
-<span class="pagenum" id="Page_351">351</span>
-more conduct and address, than that of a
-sea officer. The men are thrown upon his
-humanity and attention in more views than
-one: they are subject to a more arbitrary
-exertion of power than the constitution of
-the date authorities in civil life, Englishmen
-giving up into his hands, from considerations
-of public expediency, that which they
-hold most dear, and of which they are most
-jealous, their <small>LIBERTY</small>. It is the character
-of seamen to be thoughtless and neglectful
-of their own interest and welfare, requiring
-to be tended like children; but from their
-bravery, utility, and other good qualities,
-they seem entitled to a degree of <i>parental</i>
-tenderness and attention from the state they
-protect and the officers they obey.
-<span class="pagenum" id="Page_352">352</span></p>
-
-<h3 id="APPENDIX_TO_PART_II">APPENDIX <small>TO</small> PART II.</h3>
-
-<blockquote>
-
-<p>In order to exhibit a concise view of the
-most material observations contained in
-this part of the Work, a Memorial, delivered
-to the Board of Admiralty in
-October, 1781, is here subjoined.</p></blockquote>
-
-<h4 id="MEMORIAL_TO_THE_ADMIRALTY">MEMORIAL,</h4>
-
-<blockquote>
-
-<p>Proposing Means for preventing the Sickness
-and Mortality prevailing among His Majesty’s
-Seamen in the West Indies.</p></blockquote>
-
-<p>I have for the two last years attended a
-squadron, consisting seldom of less than
-twenty ships of the line, in quality of physician
-to the fleet at Barbadoes and the Leeward
-Islands. I received, by the order of
-the Commander in Chief, a monthly return
-from the surgeon of each ship, setting forth
-the diseases, deaths, and other circumstances
-of the respective ships companies.
-<span class="pagenum" id="Page_353">353</span>
-I also superintended the hospital of the place
-where the fleet happened to lie when in port.
-These advantages have afforded me an intimate
-knowledge of the nature and causes of
-the sickness and mortality among the seamen,
-both on board of their ships and in
-hospitals.</p>
-
-<p>It appears by my returns, that there died
-in the course of the twelve months preceding
-July last, on board of ships, seven hundred
-and fifteen seamen and marines, of
-whom only fifty-nine died in battle and of
-wounds. There died in the same time in
-hospitals eight hundred and sixty-two: so
-that out of twelve thousand one hundred and
-nine men, which is the sum total of the complement
-of twenty ships of the line, there
-have perished in one year one thousand five
-hundred and seventy-seven, that is nearly
-every seventh man.</p>
-
-<p>There were also sent to England in the
-same year, three hundred and fifty men,
-disabled by lameness and chronic complaints,
-<span class="pagenum" id="Page_354">354</span>
-the greater part of whom will be for ever
-lost to the service.</p>
-
-<p>The degree of sickness is very different at
-different times; but it appears by the returns,
-that, at a medium, there has been
-one man in fifteen on the sick list.</p>
-
-<p>Having employed all the attention of
-which I was capable to find out the causes
-of this sickness and mortality, in order, if
-possible, to point out the means of prevention,
-I flatter myself with being able to
-assign the most general causes, and to propose
-some effectual remedies.</p>
-
-<p>When it is considered that sickness is almost
-entirely confined to ships of two and
-three decks, and that some of these are as
-healthy as frigates and merchant ships,
-though in the same circumstances of service
-with others that are extremely sickly, we
-are led from hence to infer, that sickness is
-not in its own nature unavoidable, and we
-are encouraged to hope, that the attainment
-<span class="pagenum" id="Page_355">355</span>
-of general health is within the compass of
-human management.</p>
-
-<p>I humbly and earnestly solicit attention
-to some of the most material observations
-and conclusions which have occurred in the
-course of a service, which, though short,
-has been extensive; and whatever is here
-proposed has this recommendation, that it is
-easily practicable, and is no addition to the
-public charges.</p>
-
-<p>First, I hardly ever knew a ship’s company
-become sickly which was well regulated
-in point of cleanliness and dryness. It
-is the custom in some ships to divide the
-crew into squads or divisions under the inspection
-of respective officers, who make a
-weekly review of their persons and clothing,
-and are answerable for the cleanliness and
-regularity of their several allotments. This
-ought to be an indispensable duty in ships of
-two or three decks; and when it has been
-practised, and at the same time ventilation,
-cleanliness, and dryness below and between
-decks, have been attended to, I have never
-<span class="pagenum" id="Page_356">356</span>
-known seamen more unhealthy than other
-men. The neglect of such attentions is a
-never-failing cause of sickness.</p>
-
-<p>I would, therefore, with all becoming deference,
-suggest, that such a regulation, instead
-of being left to the discretion of officers,
-should be made a part of the public
-instructions. From some commanders, who
-already practise these rules, the advantage
-of them comes to be known; and would
-not a public sanction not only render them
-general and permanent, but facilitate the
-duty of the officer, by making such a regulation
-appear a matter of legal necessity,
-instead of his own arbitrary act?</p>
-
-<p>Secondly, Scurvy is one of the principal
-diseases with which seamen are afflicted, and
-this may be infallibly prevented, or cured,
-by vegetables and fruit, particularly oranges,
-lemons, or limes. These might be supplied
-by employing one or more small vessels to
-collect them at different islands, and such an
-expedient would prevent much sickness, and
-save many lives. I am well convinced that
-<span class="pagenum" id="Page_357">357</span>
-more men would be saved by such a purveyance
-of fruit and vegetables, than could be
-raised by double the expence and trouble employed
-on the imprest service; so that policy,
-as well as humanity, concur in recommending
-it. Every fifty oranges or lemons might
-be considered as a hand to the fleet, inasmuch
-as the health, and perhaps the life, of a man
-would thereby be saved.</p>
-
-<p>Thirdly, The use of wine, in place of
-rum, has been found extremely conducive
-to health. In the course of my observation
-I have met with the most unquestionable
-proofs of the benefit that would arise from
-this substitution. It is a farther reason for
-such a change, that good rum is seldom or
-never supplied in the West Indies.</p>
-
-<p>Fourthly, The necessaries provided for the
-sick by the present establishment are not at
-all adequate, especially on a distant station,
-where the supply is not regular, and the
-quantity at best is such as can contribute but
-little to their comfort and recovery. An
-ample provision might be made for the sick,
-<span class="pagenum" id="Page_358">358</span>
-without any additional expence, in the following
-manner:</p>
-
-<p>It is a rule in the service, that though
-men are sick, their ordinary allowance of
-salt meat and other victuals is nevertheless
-served out, and is either used by the other
-seamen, who stand in no need of it, or is
-wasted. Now, if the pursers were instructed
-to provide themselves with certain species
-of necessaries, such as Madeira wine,
-sugar, rice, and dried fruits, to serve to the
-sick, in place of rum, and the common provisions
-of the ship, such a regulation would
-be productive of the very best effects, in recovering
-the health, and preserving the lives
-of those men who have the misfortune to be
-taken ill in a situation necessarily destitute
-of most of the comforts that can alleviate
-their sufferings. I cannot help here applauding
-a late regulation, by which melasses are
-substituted for part of the oatmeal; for the
-quantity of the latter heretofore legally allowed
-was so much greater than what was
-necessary, that one half of it has commonly
-been wasted.
-<span class="pagenum" id="Page_359">359</span></p>
-
-<p>It is to be observed, in general, with regard
-to the West Indies, that ships on service
-are to be considered, in a great measure,
-in the light of ships constantly at sea; for,
-excepting the island of Barbadoes, there is
-no other port in which fresh meat and vegetables
-can be procured in any quantity, and
-therefore sour krout, melasses, and such
-other articles of antiscorbutic diet as can be
-supplied on board, are absolutely necessary.
-Fleets could hardly exist here, were it not
-that a warm climate is naturally more unfavourable
-to the scurvy than a cold one.</p>
-
-<p>Fifthly, Though the health of a ship’s
-company depends chiefly on diet, and that
-discipline and order which is the business of
-officers, yet much depends also on the medical
-art, particularly in the West Indies;
-and as surgeons frequently cannot do justice
-to the men without wronging themselves,
-in a country where the price of every thing
-is exorbitant, and medicines often unsound,
-Government would find its account in supplying
-gratuitously some of the most costly
-<span class="pagenum" id="Page_360">360</span>
-articles, particularly Peruvian bark in a fresh
-state, from time to time, from England.</p>
-
-<p>Sixthly, It is now the general custom to
-send every sick person on shore to an hospital,
-where there is frequently worse air and
-worse accommodation than on board, from
-overcrowding the apartments. Contagious
-diseases, though not so common as in Europe,
-are here often mixed with those that
-are not so, whereby numbers are infected and
-carried off; and, besides this, the land air is
-infinitely more unwholesome in the West
-Indies than the air at sea or in a road. The
-scurvy is perhaps not at all contagious, nor
-is it very difficult of cure; but a number of
-cases of it terminate fatally from the flux or
-fever, caught either by contagion in hospitals,
-by the noxious influence of land vapours,
-or by intemperance. I beg leave, therefore,
-humbly to suggest, that as few sick
-as possible of any disease, but what is contagious,
-be sent to hospitals, and that some
-method be established for the supply of vegetables
-and other refreshments to the sick
-on board of their ships.
-<span class="pagenum" id="Page_361">361</span></p>
-
-<p>Seventhly, Crowding, filth, and the mixture
-of diseases, are the great causes of mortality
-in hospitals. There should be a space
-of five hundred cubic feet allowed for each
-man; and in general the sick had better remain
-on board than be crowded beyond that
-degree; or relief should be provided to the
-hospital by an hospital ship, which, for reasons
-already given, is preferable to any accommodation
-on shore; and such an institution
-would be more particularly proper for
-the reception of convalescent men.</p>
-
-<p>I would beg leave, therefore, earnestly
-to recommend that cleanliness, the separation
-of diseases, and a competent space, be
-regularly enjoined and strictly enforced in
-hospitals; and in order to make this more
-practicable in the great scale of service now
-going on, I would farther propose that hospital
-ships be established for the reception of
-the sick or recovering. I know from extensive
-experience and close observation, that
-these circumstances are more essential than
-even medicine and diet.
-<span class="pagenum" id="Page_362">362</span></p>
-
-<p>These are a few remarks extracted from a
-series of observations, and derived from
-great opportunities of experience. Many
-other remarks would suggest themselves; but
-I purposely confine myself to what is highly
-important, and easily practicable, with little
-or no addition to the public expence.
-Some of the improvements recommended
-are indeed an immediate, and all of them
-will be an eventual, saving to the public.</p>
-
-<p>The alterations that have been proposed
-are,</p>
-
-<p>1st, The establishment of a certain method
-and discipline, in order to secure regularity
-and cleanliness among the men, and
-to render the ships clean and dry.</p>
-
-<p>2dly, The supply of fruit and other vegetables
-for the cure of the scurvy.</p>
-
-<p>3dly, The substitution of wine<a id="FNanchor_87" href="#Footnote_87" class="fnanchor">87</a> for rum.
-<span class="pagenum" id="Page_363">363</span></p>
-
-<p>4thly, The provision of an adequate quantity
-of necessaries for the sick.</p>
-
-<p>5thly, The gratuitous supply of certain
-medicines.</p>
-
-<p>6thly, The curing of certain diseases on
-board instead of sending them to hospitals;
-and,</p>
-
-<p>Lastly, The preventing of filth, crowding,
-and the mixture of diseases in hospitals,
-by proper regulations, and by establishing
-hospital ships.</p>
-
-<p>I beg leave again to call to mind, that
-1518 deaths from disease, besides 350 invalids,
-in 12,109 men, in the course of one
-year, is an alarming waste of British seamen,
-being a number that would man three of
-His Majesty’s ships of the line; and what I
-advance is from a real conviction that a due
-attention to the above-mentioned propositions
-would save more than two thirds of
-the seamen that would otherwise die in that
-climate. It was to set this in a proper light
-<span class="pagenum" id="Page_364">364</span>
-that I requested leave to quit my duty during
-the absence of the greater part of the squadron
-in the hurricane months; and should
-any thing I propose meet with public approbation,
-and be carried into effect, I should
-esteem it a recompence far above any other
-gratification I can derive from the service.</p>
-
-<p>
-<span class="smcap">London</span>,<br />
-October 13, 1781.<br />
-<br />
-To the Right Hon. the Lords Commissioners<br />
-of the Admiralty.<br />
-</p>
-
-<hr class="tb" />
-
-<p>Next year the following Supplement to
-the preceding Memorial was sent to the
-Board of Admiralty:</p>
-
-<h4 id="SUPPLEMENT_TO_THE_MEMORIAL"><span class="smcap">Supplement</span> to the <span class="smcap">Memorial</span> delivered
-last Year to the Board of Admiralty.</h4>
-
-<p>Since my return to my duty on this
-station, additional experience has afforded
-me farther practical confirmation of the
-utility of the former proposals.
-<span class="pagenum" id="Page_365">365</span></p>
-
-<p>The great squadron employed on this station
-has, by the attention of the Commissioners
-of Victualling, and also of the Commander
-in Chief, been supplied with most of the
-articles recommended, in such quantities as
-to prove their efficacy; and indeed the small
-degree of mortality in comparison of former
-times, is a sufficient demonstration of this.</p>
-
-<p>I beg leave to give an instance in the Formidable
-of the great and salutary effects of
-the proposed improvements. This ship left
-England, furnished not only with sour krout
-and melasses, in common with most others
-in the squadron, but what was peculiar to
-herself was, an entire supply of good wine
-in place of spirits; and an experiment has
-been made in this instance, under my own
-eye, to ascertain what degree of health it
-was possible to attain in a great ship in this
-climate. With the above advantages, together
-with good discipline and medical care,
-no man<a id="FNanchor_88" href="#Footnote_88" class="fnanchor">88</a> died of disease from December,
-<span class="pagenum" id="Page_366">366</span>
-1781, to May, 1782, and only thirteen
-were sent to hospitals, whose complaints
-were small pox and ulcers. In the months
-of May and June last, when at Jamaica,
-there died of disease in this ship, three men,
-and seventeen were sent to the hospital,
-most of whom had contracted their sickness
-on board of French prizes.</p>
-
-<p>In the rest of the fleet the health was in
-proportion to the wine and other refreshments,
-and the cleanliness, good order, and
-discipline observed.</p>
-
-<p>In the squadron I attended the last five
-months, which seldom consisted, during the
-last three months of that time, of less than
-forty ships of the line, there have died of
-disease about 350 men, and about 1000 have
-been sent to hospitals; a degree of sickness
-and mortality which, though not greater
-than what frequently prevails in Europe, I
-am persuaded would have been still less,
-<span class="pagenum" id="Page_367">367</span>
-had the improvements proposed been complied
-with in a manner more extensive and
-complete, and had the general rules of discipline
-and cleanliness been kept up with
-due and equal strictness throughout the fleet.</p>
-
-<p>This last article, which, being the most
-important, I have placed first in the preceding
-memorial, it is only in the power of
-supreme authority to enforce; and my additional
-experience and observation have so far
-confirmed me in the opinion of the utility
-of this, as well as the other articles, that I
-hope to be again pardoned for repeating my
-humble and earnest solicitations that these
-regulations may be farther extended and enforced.</p>
-
-<p>
-<span class="smcap">Formidable</span>,<br />
-At Port Royal, Jamaica,<br />
-July 16, 1782.<br />
-</p>
-
-<p><span class="pagenum" id="Page_368">368</span></p>
-
-<p class="ph1" id="PART_III">PART III.</p>
-
-<h3 id="DESCRIPTION_AND_TREATMENT">DESCRIPTION AND TREATMENT<br />
-
-<span class="x-small">OF THE</span><br />
-
-<span class="x-large">DISEASES</span><br />
-
-<span class="x-small">MOST COMMONLY OCCURRING IN</span><br />
-
-<span class="large">FLEETS IN HOT CLIMATES.</span></h3>
-
-<p>It was mentioned in the Introduction to
-this work, that though my opportunities of
-experience were extensive, several obstacles
-had prevented me from making observations
-so accurately as could have been wished.
-These were chiefly the bad accommodation
-of the sick at some of the hospitals, and
-the shortness of our stay at any one place,
-which seldom exceeded six weeks or two
-months, and prevented me from completing
-such observations as I have happened to be
-engaged in. But having practised among
-great numbers, observations necessarily arose
-<span class="pagenum" id="Page_369">369</span>
-from the comparison of so many cases; and
-amidst the variety of situations connected
-with the emergencies and hardships of war,
-nature is seen in certain portions and under
-certain trials which are not met with in
-common life. I shall therefore describe the
-diseases such as they occurred, and shall add
-such remarks on practice as I could ascertain.</p>
-
-<p>The following observations shall be confined
-chiefly to what I have called the sea
-epidemics, viz. Fevers, Fluxes, and the
-Scurvy.
-<span class="pagenum" id="Page_370">370</span></p>
-
-<h2 id="PART_III_CHAP_I">CHAP. I.</h2>
-
-<h3 id="OF_FEVERS">Of <span class="smcap">Fevers</span>.</h3>
-
-<p>Though it is impossible to refer every
-particular case of fever to a distinct class, on
-account of the mixed and anomalous symptoms
-that arise, yet there are certain distinguishing
-features which afford sufficient
-ground for dividing them into different
-kinds, and such a division will at least serve
-to facilitate description, and to afford room
-for laying down the outlines of practice.</p>
-
-<p>The fevers which occurred most frequently
-on board of ships, and at naval hospitals
-belonging to the fleet in which I was employed,
-were the infectious ship fever,
-(which is the same with the jail and hospital
-fever) the bilious remitting fever, and
-the malignant yellow fever.
-<span class="pagenum" id="Page_371">371</span></p>
-
-<h4 id="OF_THE_INFECTIOUS_SHIP_FEVER">1. Of the infectious <span class="smcap">Ship Fever</span>.</h4>
-
-<p>This does not occur so frequently in hot
-as in cold climates, both because it is the
-disease of ships newly fitted out, which they
-seldom are in the West Indies, and because
-there is something in the warmth of a climate
-which prevents the production of contagion,
-as has been formerly remarked. But
-as great fleets arrived from time to time in
-the West Indies from Europe, with numbers
-of men labouring under this fever,
-there were sufficient opportunities of making
-observations upon it.</p>
-
-<p>It has been so well described by Sir John
-Pringle, Dr. Lind, and other writers, that
-it is unnecessary to enter into a minute detail
-of all its different appearances in its
-several stages; and I shall content myself
-with recounting some of the most distinguishing
-symptoms, and with marking the
-peculiarities that arose from the influence of
-the climate.
-<span class="pagenum" id="Page_372">372</span></p>
-
-<p>This fever is extremely various in its
-symptoms and in its degree of malignity
-and fatality. We are told in some of the
-histories of the jail distemper, that, upon
-its first attack, few escaped that were seized
-with it; but that afterwards it grew more
-mild; and it has been already observed, that
-the contagious poison of fever differs from
-that of small pox and other specific infections,
-by varying in its degrees of virulence.</p>
-
-<p>There are, however, certain characteristic
-symptoms pretty constant in this fever in all
-its forms.</p>
-
-<p>One of the most remarkable of these is a
-greater degree of muscular debility than what
-takes place in other fevers, and it deserves to
-be mentioned first, as being one of the most
-constant. It is also a tolerably true index of
-the degree of malignity, the danger being
-in proportion to this symptom. In the more
-advanced stages of the fever, a tremor of the
-hands, and of the tongue when put out, is
-a constant symptom, and seems to be connected
-with this weak state of the muscular
-<span class="pagenum" id="Page_373">373</span>
-fibres. I have seen, however, extreme debility
-without tremor in cases too of the
-greatest danger, and it was observable in
-these that there was little or no delirium.</p>
-
-<p>Another striking character of this fever is
-the delirium of a particular kind which usually
-attends it. Sensation and reason are here
-in a state uncommonly depraved; and it is
-in this sort of fever oftener than any other
-that we find a total deprivation of them in
-the symptom called <i>coma</i>. The delirium is
-seldom of a wild, ungovernable kind, such
-as occurs in inflammatory continued fevers,
-in the violent paroxysms of intermitting and
-remitting fevers, or in inflammations of
-the brain. It is, however, connected with
-great suffering; and this consists in anguish
-rather than pain, shewing itself by outward
-tremor, agitation, and what is called the
-<i>floccorum collectio</i>; also by sighing, mumbling,
-and moaning, symptoms always indicating
-danger.</p>
-
-<p>Delirium is a symptom, to the nature and
-appearances of which I have been particularly
-<span class="pagenum" id="Page_374">374</span>
-attentive, in consequence of a painful
-and diligent attendance upon some cases in
-which I was particularly interested from
-friendship and affection, and in which this
-was a remarkable symptom. It seems chiefly
-to consist in a false reference of our sensations,
-whether external or internal; and
-this is in no sort of fever more evident
-than in this. When any painful impression, for instance,
-is made by an external
-body, the patient, if in a state of delirium,
-does not refer it justly to the part affected;
-but the general agitation and incoherence of
-sentiments will be aggravated for the time.
-I have known a degree of heat applied to
-the extremities sufficient to blister them,
-yet the part did not shrink, though the raving
-and general uneasiness were increased.
-In like manner, with regard to internal sensations,
-when an irritation is excited to expel
-the urine or <i>feces</i>, the mind does not recognize
-it as such, but from a sense of uneasiness,
-probably mistaken for something else,
-an effort is made to relieve nature, which
-is done without a proper consciousness, and
-certain symptoms are produced which are
-<span class="pagenum" id="Page_375">375</span>
-well-known marks of danger in this fever.
-In watching those who have been under the
-influence of delirium, I have observed it increase
-when any particular want of nature
-urged, and this would continue for some
-time, the patient being incapable of procuring
-himself immediate relief on account of
-the false reference of sensation that has been
-mentioned; but he would become calm after
-voiding the urine or <i>feces</i>, or after receiving
-something to drink, according to the
-particular want that was present at the time.
-So great is the disorder in the common
-course of sensation in this fever, that a person
-ill of it has been even unconscious of inflammations
-of vital parts, which, in the natural
-state of the nerves, would have excited
-the most acute pain, and would have been
-distinctly referred to the part affected, but
-were not discovered nor suspected till inspection
-after death<a id="FNanchor_89" href="#Footnote_89" class="fnanchor">89</a>. I remember one case in
-<span class="pagenum" id="Page_376">376</span>
-which there were found large erosions, and
-even holes in the intestines, without any
-preceding complaint that could have led to
-suspect such an appearance. It would appear
-that the motions excited in the brain
-and nerves in such cases, instead of producing
-the sensations naturally belonging to
-them, serve to excite disagreeable emotions
-of a different kind, in which delirium consists.
-It seems to be from the same depraved
-state of sensation, that when a phthisical
-person is seized with this sort of fever, his
-cough is for the time suspended. I have
-seen the same circumstance occur in a maniacal
-case. From a like cause it sometimes
-happens in dangerous cases of fever, that
-in the height of delirium the <i>epiglottis</i> loses
-its natural irritability, so that liquids in the
-act of swallowing are apt to get into the
-<span class="pagenum" id="Page_377">377</span>
-windpipe, so as to excite coughing and
-threaten suffocation, as I have observed in
-some cases that came under my care.</p>
-
-<p>All these different forms of delirium are
-signs of a body extremely disordered in its
-functions, and forbode great danger.</p>
-
-<p>The next symptom I shall mention as
-most characteristic of this sort of fever is,
-the spots known by the name of <i>petechi&aelig;</i>
-and <i>vibices</i>, which, though far from being
-constant, are, perhaps, more peculiar to it
-than any other symptom. They occur only
-in the latter stages of the disease, and in
-cases of considerable danger. The common
-opinion concerning their cause is, that the
-blood is in such a dissolved state, that the
-red part of it is effused into the cellular
-membrane. The appearance in such bodies
-as I have inspected, seems to favour this
-opinion; for there was hardly any coagulation
-of the blood in the great vessels, and
-instead of those firm substances, called <i>polypi</i>,
-in the heart, there were only soft grumous
-bodies, which were so tender in their
-<span class="pagenum" id="Page_378">378</span>
-consistence, that, upon being handled, they,
-as it were, dissolved. Since the improved
-method of treating these fevers has been
-generally adopted, this symptom seldom
-occurs; for in most cases it may be called
-an artificial symptom, chiefly arising from
-close apartments and the heat of bed clothes.</p>
-
-<p>It may be considered as a peculiarity of
-this fever, that it is more indefinite in its
-crisis than most others. In continued fevers
-of the inflammatory kind, there are frequent
-attempts at remission, there are certain periodical
-exacerbations, and there is generally
-a distinct crisis marked by a freedom of the
-secretions and turbid urine: but in the fever
-of which we are treating, though the patient
-is generally somewhat worse towards
-the evening and during the night, its course
-is more equable, and the transition from
-sickness to health is insensible and gradual,
-being seldom marked with any perceptible
-crisis.</p>
-
-<p>The symptom next to be taken notice of,
-though a minute one, is very constant and
-<span class="pagenum" id="Page_379">379</span>
-characteristic in this sort of fever. It is a
-peculiar heat in the skin, communicated to
-the hand of another person. It is usual to
-grasp the wrist of the patient after feeling
-his pulse, in order to examine the state of
-the skin in point of heat and moisture; and
-in doing this a glow of heat is impressed on
-the palm of the hand, which lasts for some
-hours, if one should neglect so long to wash
-the hands. I have never met with this
-symptom in any of the sporadic fevers of
-England, though I am informed it sometimes
-occurs in these.</p>
-
-<p>The fever we are treating of differs also
-from the sporadic nervous fever of England,
-and from most others of the continued
-kind, in being attended with a more copious
-secretion of bile, which, when thrown up,
-is generally green, or, as it is otherwise
-called, of a porraceous colour. This symptom
-takes place in all climates; but is more
-remarkable in a hot climate, as might be
-expected.
-<span class="pagenum" id="Page_380">380</span></p>
-
-<p>These are the chief characteristic symptoms
-of this fever. I shall next point out
-such modifications of it as occurred in the
-West Indies from the influence of climate.</p>
-
-<p>In the first place, when this fever prevailed
-on board of any ship that arrived from a
-northern climate, it was soon after succeeded
-by, or, as it were, converted into, a dysentery;
-for those ships that arrived either
-from England or North America with the
-greatest stock of feverish infection, were the
-most subject to fluxes, after being two or
-three months in the West Indies. This
-was formerly made use of as an argument,
-to prove that the dysentery proceeds from
-the same cause with fever, taking a different
-determination, from circumstances of
-climate and constitution.</p>
-
-<p>Secondly, It sometimes happens that men,
-under the influence of this infection, are
-more apt than others to be affected with
-symptoms peculiar to the climate upon their
-first arrival. A very striking instance of this
-has been mentioned in the case of men that
-<span class="pagenum" id="Page_381">381</span>
-were pressed into the Formidable at New
-York, some of whom had the common ship
-fever on the passage; others, upon our arrival
-at Barbadoes, were seized with the yellow
-fever, and were the only men in the
-fleet who had it at that time. There was
-another instance in the recruits brought
-from England by the Anson, who were
-seized with a fever on board of the Royal
-Oak; and in this fever the skin and eyes
-were yellow, though without any symptoms
-of malignancy<a id="FNanchor_90" href="#Footnote_90" class="fnanchor">90</a>.</p>
-
-<p>Thirdly, It happened in some ships<a id="FNanchor_91" href="#Footnote_91" class="fnanchor">91</a>
-that the infection was kept up for several
-months after arriving in the climate, from a
-neglect of cleanliness, or the want of an opportunity
-of removing those who were infected
-to an hospital. It did not in these
-take a dysenteric turn, as in most of the
-other ships, but differed from the ship fever
-of colder climates, as above described, in
-some particulars, which I shall here enumerate.
-<span class="pagenum" id="Page_382">382</span>
-All the symptoms were milder:
-it was more protracted, and less dangerous.
-In the beginning there was but little difference,
-only the symptoms were less violent;
-but in the succeeding period of the disease
-the pulse deviated very little from the natural
-standard, and the skin felt cold and clammy.
-The tongue was white; and this did not
-seem so much owing to any fur covering it,
-as to its being itself of a pale, lifeless colour,
-as well as the face, and it appeared larger in
-size than natural. The teeth were clogged
-with a white fur. Those affected with this
-fever were subject to faintings, and had a
-constant uncomfortable languor and listlessness.
-Most of them had a deep-seated pain
-in the occiput, and an oppression at the
-stomach, but without any inclination to
-vomit. The unfavourable symptoms were
-<i>coma</i>, <i>delirium</i> and a yellowness of the skin.
-I never remember to have seen <i>petechi&aelig;</i> in
-any of them. The favourable symptoms
-were a warm moisture, or a miliary eruption
-on the skin, and a gentle <i>diarrhœa</i>,
-which, however, if neglected, was in danger
-of degenerating into an incurable flux.
-<span class="pagenum" id="Page_383">383</span>
-A great number were seized with this fever
-in the Alcide, in July, 1783, and what is
-remarkable, most of them had the tape
-worm, as I was informed by Mr. Telford,
-the surgeon of that ship, who frequently
-obliged me with valuable remarks; and he
-observed also, that it was evidently infectious,
-and that the skin communicated the
-same disagreeable feeling to the hand as was
-mentioned above.</p>
-
-<p>Though the inflammatory fever does not
-often occur in hot climates, yet, as it is of
-great consequence to distinguish it in all
-cases from the infectious fever of which we
-are treating, it may not be improper, nor
-uninstructive, here to point out the most
-remarkable differences. There is more resemblance
-in their symptoms, especially towards
-the beginning, than might at first be
-supposed; and as it is very material to avoid
-error with regard to the practice, which, in
-these two sorts of fevers, ought to be very
-different, and even opposite, I have taken
-particular pains to discriminate them.
-<span class="pagenum" id="Page_384">384</span></p>
-
-<p>The continued inflammatory fever is very
-uncommon in the West Indies; but in the
-form in which I have met with it in North
-America and England, there are cases in
-which the blood is sizy during the whole
-course of the disease, even without local
-affection, though, in general, there is more
-or less rheumatism, or pulmonic inflammation.
-The symptoms which chiefly distinguish
-such cases from the fever before described
-are, a greater degree of muscular
-strength, a more violent delirium, pale
-urine, a more parched tongue and skin,
-greater heat and thirst, and a pulse more
-frequent and strong, with a particular sharpness.
-There is another symptom sometimes
-occurring, which I consider as strongly characteristic
-of a fever of an inflammatory nature.
-This is a watery diarrhœa, without
-<i>f&aelig;ces</i> and without gripes, the stools consisting
-chiefly of the drink as it was taken in.
-There seems here to be a suspension of the
-power of absorption as well as secretion in
-the bowels, in consequence of a general
-spasm on the extreme vessels; for there
-is hardly even bile or mucus in the stools.
-<span class="pagenum" id="Page_385">385</span>
-There is also a particular appearance of the
-mouth connected with this type of fever,
-which is better learned by the eye than by
-description. It consists chiefly in a want
-of moisture on the lips, and a dryness and
-shining appearance of the teeth. With
-these symptoms, it will be found that the
-patient will bear the lancet in very advanced
-stages of the disease. These fevers seldom
-occur but in a sporadic way, unless when
-there is some peculiarity of season, as at
-New York in autumn, 1782. They are
-also more frequent among the better than
-the lower sort of people.</p>
-
-<p>By comparing these symptoms with those
-of the infectious fever above described, there
-will appear an obvious difference in their nature,
-and evident reasons for varying their
-treatment.
-<span class="pagenum" id="Page_386">386</span></p>
-
-<h4><span class="smcap">Treatment</span> of the <span class="smcap">Ship Fever</span>.</h4>
-
-<p>When the body is thrown into disorder
-by an attack of fever, the first step to be
-taken is to clear the stomach and bowels of
-their crude and acrid contents, consisting
-either of the food imperfectly digested, or
-the depraved natural secretions. So great
-is the disturbance produced by such offending
-matter, that, when nature is freed from
-this embarrassment, the functions of the
-body are frequently by this alone restored to
-their proper exercise, and a remission produced.
-It seems probable also, that this
-evacuation proves salutary not only by removing
-the morbid stimulus, but by preventing
-the absorption of corrupted or ill-concocted
-juices into the mass of blood,
-which would tend still farther to derange
-the functions of life. But perhaps the circumstance
-that first suggested the utility of
-evacuating the stomach, as the first step in
-the cure of fevers, was the nausea so common
-<span class="pagenum" id="Page_387">387</span>
-in the beginning of them, which may
-be considered as a natural indication of this
-practice. It farther appears rational, that,
-as acute diseases generally come on suddenly,
-and find the body in a state of repletion
-from the recent <i>ingesta</i>, the most obvious
-means of relief should be to free the bowels,
-and particularly the stomach, from what is
-foreign and oppressive to it. It seems also
-probable, that the <i>nausea</i> and the act of vomiting
-have a salutary effect independent of
-evacuation; for I have seen relief produced
-from these when nothing was evacuated.
-Such, indeed, is the great and universal influence
-and sympathy of the stomach, that
-the operation of vomiting affects every fibre
-of the body, and has been known to resolve
-tumours in the most distant parts. An early
-administration of an emetic is therefore the
-first step to be taken in the treatment of
-this as well as most other fevers.</p>
-
-<p>If it is given in small divided doses, it will
-most probably evacuate the bowels downwards;
-and the most convenient form for
-this purpose is a solution of emetic tartar. If
-<span class="pagenum" id="Page_388">388</span>
-it should not have this effect, some brisk
-purgative medicine should be given soon after
-the operation of it.</p>
-
-<p>I mention these evacuations before blood
-letting; for though this ought to be first in
-those cases in which it is proper, it is here
-seldom necessary, and we may pronounce it
-to be a remedy very ill adapted to this sort
-of fever, particularly in a hot climate. It
-sometimes happens, however, that there is
-violent head-ach, pain of the back and limbs,
-with a throbbing pulse; and these symptoms
-may in the very beginning not only
-justify, but require the losing some blood
-before the administration of the emetic or
-purgative.</p>
-
-<p>The next means of relief I shall mention,
-and also the most probable means of cutting
-short the disease, is to excite universal
-sweat. This being an imitation of nature,
-is founded on reason as well as experience;
-for it is by sweating that the fit of an intermittent
-is relieved and terminated; and continued
-fevers in general, if not always, begin
-<span class="pagenum" id="Page_389">389</span>
-with a fit of the same kind. A dry skin,
-accompanied with heat, is one of the most
-constant as well as troublesome and uneasy
-symptoms in all fevers; and it would appear
-from the peculiar heat of the skin in this
-sort of fever, that there is either a more
-than common acrimony of the matter of
-perspiration, or something peculiar in the
-mode of circulation on the surface of the
-body. Sweating does not seem to operate
-entirely by the evacuation of acrimony, for
-no relief is procured by it if it is partial;
-and it is evident from a number of facts
-that the state of the brain and <i>viscera</i> depends
-on that of the external surface of the
-body; for a free state of the pores of the
-skin, provided it is general, tends more than
-any other circumstance to relieve internal
-pain, and also to take off delirium. The
-good effect of sweating seems, therefore,
-chiefly to depend on a general relaxed state
-of the small vessels on the surface of the
-body; and it ought to be effected, if possible,
-by gentle, soothing means, and not by
-such regimen and medicines as heat the body
-and accelerate the circulation. This intention
-<span class="pagenum" id="Page_390">390</span>
-is best answered in the beginning by moderate
-doses of antimonial medicines, and
-either James’s powder or tartar emetic may
-be employed. The first is a more certain
-sudorific, being less apt than the other to
-run off by the bowels; and its effect will
-be still more certain, if accompanied with a
-mild opiate, rendered diaphoretic by <i>Spiritus
-Mindereri</i>, which will both prevent the antimonial
-from acting roughly, and will determine
-its operation to the skin. A sweat
-kept up by these means, together with plentiful
-warm dilution, from twelve to twenty-four
-hours, is the most probable means
-of bringing about a complete remission of
-the fever; and in this case a fresh accession
-is to be prevented by the immediate administration
-of the bark.</p>
-
-<p>These are the means proper for stopping
-the fever in the beginning, or tending to
-render its future progress more safe; and
-though, with this view, free evacuations
-have been recommended, yet, if the fever
-should go on, great caution is necessary in
-this respect in the future treatment, debility
-<span class="pagenum" id="Page_391">391</span>
-being the symptom chiefly to be guarded
-against. Purgatives may, indeed, be occasionally
-necessary, in consequence of accumulations
-of bile taking place; but, in general,
-the evacuations by stool should not
-be more frequent than in health; and some
-of the cases which were most unmanageable
-and fatal, were those in which there was a
-spontaneous <i>diarrhœa</i>. With regard to blood
-letting, it is always hurtful after the first
-two days, unless some inflammatory affection
-of a vital part should arise.</p>
-
-<p>The natural evacuation, which may with
-most safety and advantage be solicited and
-encouraged in this disease, is, that by perspiration;
-and it is observable, that in those
-cases for which nature does most, there is a
-universal warm sweat, which has generally
-a very offensive smell, and seems to be a salutary
-effort of the constitution to cure the
-disease. Where this takes place, little medical
-assistance is necessary, except to keep
-it up chiefly by warm dilution; and there
-is no circumstance in which the judgement
-of a physician is shewn more than in discerning
-<span class="pagenum" id="Page_392">392</span>
-those cases in which his chief business
-is to look on, where nature, being
-equal to the task, ought not to be disturbed
-by the active and officious interposition of
-art. We should not, however, aim at producing
-a profuse sweat, except with a view
-to effect a remission immediately after the
-first evacuations. In the course of the disease,
-it is only necessary to keep up a gentle
-moisture or softness of the skin.</p>
-
-<p>The head being particularly affected in
-this sort of fever, the patient is extremely
-restless and delirious, especially at night;
-and there is a medicine which has a most
-pleasing effect in procuring both rest and
-perspiration. This is a combination of an
-opiate with an antimonial medicine, which
-was administered in the evening with great
-success; and the sudorific effect is rendered
-more certain by the addition of some saline
-neutral, especially <i>Spiritus Mindereri</i><a id="FNanchor_92" href="#Footnote_92" class="fnanchor">92</a>. I
-<span class="pagenum" id="Page_393">393</span>
-tried pure opiates in the early stage of this,
-fever, but found them not to answer;
-though in the low<a id="FNanchor_93" href="#Footnote_93" class="fnanchor">93</a> fevers of England, and
-<span class="pagenum" id="Page_394">394</span>
-in the advanced stages and convalescent state
-of this fever, they are extremely safe and
-useful. Pure laudanum is also given by Dr.
-Lind, at Haslar, with great success in the
-height of the disease; but in the West Indies
-there is a greater tendency to acrid excretions,
-and the effect of pure opium in
-causing a retention of these, seems to be
-the cause of its disagreeing in that climate
-in the first stage of this fever.</p>
-
-<p>It may here be observed, that the addition
-of a little neutral salt alone will sometimes
-so qualify the operation of opium, as
-to prevent its bad effects, such as the increase
-of febrile heat and delirium, and the
-stupor and head-ach which, when given
-alone, it frequently induces the following
-day. I have generally employed nitre with
-this intention; but this does not seem so
-well adapted to this disease as some other
-neutral salts, as it tends too much to lower
-the powers of life.</p>
-
-<p>But with a view to perspiration, the <i>Spiritus
-Mindereri</i> is the most effectual neutral
-<span class="pagenum" id="Page_395">395</span>
-medicine when conjoined with an opiate,
-and there is not, perhaps, a more safe and
-pleasing diaphoretic known than a combination
-of it with syrup of poppies<a id="FNanchor_94" href="#Footnote_94" class="fnanchor">94</a>. There
-is some neutral salt in Dover’s powder, and
-this has more effect than could be expected
-from so small a quantity of an inert medicine;
-for I know from trials of my own,
-as well as those of others, that ipecacuanha
-and opium given together, in the proportions
-prescribed in that powder, will not
-have the same effect as when joined with the
-neutral salt. This is an instance of those
-useful combinations of medicines which can
-be discovered only by experience, but which
-every physician ought gladly to adopt in
-practice upon good testimony and fair trial,
-though he may not be able to account for
-their effects, nor to explain their mode of
-operation.
-<span class="pagenum" id="Page_396">396</span></p>
-
-<p>There is nothing more important than
-plentiful warm dilution; and the infusion of
-sauge, or any such light aromatic, is rather
-more proper than farinaceous decoctions, or
-any compositions in which there is wine or
-spirits. Success in this, as well as other
-diseases, depends on attention to nursing as
-much as upon medicine; for what would it
-avail here to administer medicines for promoting
-perspiration, unless they were assisted
-with fluids to allay thirst, to dilute the
-acrimony in the first passages and in the
-vessels, and to furnish the materials of free
-perspiration?</p>
-
-<p>But however desirable it may be to procure
-sweat, this is not to be attempted by close
-rooms and bed clothes, nor by hot medicines,
-such as volatile salts, serpentary, spirituous
-tinctures, or aromatics. These, according
-to the testimony of Sydenham, tend
-to increase the heat and delirium, and to
-produce <i>petechi&aelig;</i>, miliary eruptions, or local
-inflammations. In the intervals of the anodyne
-diaphoretic above described, <i>Spiritus
-Mindereri</i> and small doses of camphor, with
-<span class="pagenum" id="Page_397">397</span>
-proper dilution, may be safely employed to
-procure a soft skin.</p>
-
-<p>The only other means I shall mention
-with this view is, the application of warm
-moisture to the surface of the body, which
-may be done by soaking the feet and hands
-in warm water, or by fomenting the feet
-and legs with stupes<a id="FNanchor_95" href="#Footnote_95" class="fnanchor">95</a>. These operations
-have the effect of bringing on a general relaxation
-on the skin, thereby taking off febrile
-agitation and delirium, and inducing
-sleep. I sometimes, with seeming benefit,
-ordered cataplasms to be applied to the feet,
-merely of the emollient kind, without mustard
-or any other acrid substance, being intended
-to relax, and not to stimulate.</p>
-
-<p>In the use of pediluvia and fomentations,
-there is a difference worth attending to between
-the practice in this fever, and that in
-the inflammatory fever before described, for
-they are as hurtful in the latter as they are
-<span class="pagenum" id="Page_398">398</span>
-beneficial in the former. I have observed,
-in general, that they have a bad effect in all
-cases where there is sizy blood, particularly
-where the breast is affected.</p>
-
-<p>Delirium is one of the most constant and
-alarming symptoms in this disease, and the
-removing of it depends much upon the attendants
-as well as the physician. It has
-been said before, that it depended on a false
-apprehension of the impressions or natural
-sensations. When a person, for example,
-labours under delirium, and is affected with
-thirst, the minds is either so agitated with
-other objects, that this sensation is overlooked,
-or, instead of producing a craving
-for drink, it excites some other disagreeable
-emotion in consequence of the disordered
-state of <i>sensorium</i>. This last seems to
-be probable from the cessation of delirium,
-which will take place upon any natural want
-being satisfied; I have seen a temporary
-stop put to the patients raving by making
-him drink, or upon his discharging his
-urine or <i>feces</i>; for he is then unconscious
-of thirst and other natural wants, is therefore
-<span class="pagenum" id="Page_399">399</span>
-ignorant of the means of satisfying
-them; and when he does so, he fancies he is
-about something else which is the subject
-of his delirious thoughts. This observation
-leads to a material practical purpose; for it
-follows from it, that unremitting attention
-should be given to the patient’s feelings and
-all his possible wants, as those natural notices
-and instinctive cravings which occur in
-health are now wanting, in consequence of
-the depraved state of sensation.</p>
-
-<p>Most of the remarks that have hitherto
-been made apply to the earlier stages of the
-disease. The principal remedies applicable
-in the more advanced stages are, blisters,
-Peruvian bark, opium, and wine.</p>
-
-<p>I have found what Dr. Lind says concerning
-the efficacy of blisters confirmed by my
-own experience, especially in those fevers in
-which there was great delirium, <i>coma</i>, and
-head-ach; but I have not experience enough
-to say whether they were as useful in the
-beginning of the disease in the West Indies
-as he found them to be in England.
-<span class="pagenum" id="Page_400">400</span></p>
-
-<p>The men that were brought from the
-ships to the hospitals were affected with the
-disease in various stages; but as we had in
-general a very inaccurate history of the several
-cases, the method of treatment upon
-their first admission was pretty nearly the
-same in all; and it consisted, in the first
-place, in washing their face, hands, feet,
-and legs, with warm water and vinegar,
-from which they derived the greatest comfort,
-being commonly very dirty. There
-ought to be a <a id="FNanchor_96" href="#Footnote_96" class="fnanchor">96</a>warm bath at every naval hospital
-kept in constant readiness; for there
-are so few conveniences on board of a ship
-for preserving bodily cleanliness among the
-sick, that the surface of the body becomes
-loaded with filth, so that the operation of
-<span class="pagenum" id="Page_401">401</span>
-the warm bath could not fail to be highly
-comfortable and salutary as the first step to
-their cure when brought on shore. We had
-generally very indistinct information about
-the state of their bowels, as well as other
-circumstances, on account of their delirium;
-but it was at any rate useful, or at least
-safe, to give them a clyster. They were
-enjoined plentiful dilution; and if they
-were low, some wine and water was allowed.
-In the evening, the anodyne diaphoretic
-medicine was administered, and a
-blister applied to some part of the body. In
-consequence of this method, we seldom failed
-to find the patients better next morning;
-and it was tried in such numbers, that the
-efficacy of it was sufficiently ascertained. It
-happened in some cases, that these means
-were omitted, and a comparison of these
-with the others served to ascertain the true
-efficacy of the medicines; the stationary
-state of the symptoms, when the disease
-was thus left to itself, sufficiently proving
-the propriety of the treatment above described.
-<span class="pagenum" id="Page_402">402</span></p>
-
-<p>It is an important question to what circumstances
-of this fever the Peruvian bark
-is adapted. An early and indiscriminate use
-of it is recommended in some late publications,
-upon the authority of which I tried
-it without regard to the stages or symptoms,
-and without any prejudice either for or
-against the practice; but I found that this
-powerful remedy was in danger of doing
-much harm, unless great attention was paid
-to circumstances, in order to ascertain the
-proper seasons for giving it. The symptoms
-that forbid the use of bark are chiefly
-foul bowels, hard pulse, sizy blood, great
-delirium, dry tongue, a hot and dry skin,
-and inflammatory affections of the viscera.
-It was found extremely pernicious in an
-early stage of the disease previous to evacuations;
-and the object of practice at this time
-should be to relieve the habit by means of
-these, in order to produce a general relaxation
-of the secretions, and to render the skin
-cool and soft, thereby paving the way for
-the bark.
-<span class="pagenum" id="Page_403">403</span></p>
-
-<p>It is not necessary, however, especially in
-the advanced stages of the disease in this
-climate, to wait for an absolute remission,
-in order to administer the bark. In a cold
-or temperate climate it will seldom be found
-advisable to give it in any period of this
-fever; but in a hot climate it is sometimes
-admissible where there are symptoms
-of general debility, such as a small pulse
-and muscular weakness, even though the
-frequency of the pulse, delirium, and a dry
-skin and tongue, should indicate some degree
-of fever. It may be remarked, by the
-bye, that a dry tongue is a fallacious symptom,
-for it may happen in consequence of
-the patient’s breathing through the mouth
-instead of the nose, without any fault in the
-secretions of the <i>fauces</i>. The symptom
-which forbids the use of the bark more absolutely
-than any other is an inflammatory
-or dysenteric state of the bowels, in which
-cases it seems to be invariably pernicious.</p>
-
-<p>Where it happens that we are extremely
-anxious to throw in the bark, as we usually
-are in the West Indies, where fevers are
-<span class="pagenum" id="Page_404">404</span>
-very rapid and dangerous, and yet the
-symptoms seem hardly to admit its use, it
-was very commonly tried either in conjunction
-with some antimonial medicine or neutral
-salt, or these were given alternately
-with it, in order to soften and qualify its
-effects by preventing it from heating or
-otherwise aggravating the symptoms. Antimonial
-wine or <i>Spiritus Mindereri</i> were conveniently
-employed with this intention.</p>
-
-<p>With regard to the quantity of bark to be
-given, it may be proper in doubtful cases of
-this kind to begin with small doses, in order
-to feel how far it agrees or not; but in general
-it may be laid down as a rule with regard
-to this medicine, that, where it is
-really proper, and the medicine to be depended
-on, it is to be given in as large doses
-and as frequently as the stomach will easily
-bear it.</p>
-
-<p>The next remedy mentioned was opium.
-It is a medicine more admissible and useful
-in this than any other kind of fever. The
-same cautions nearly apply in the administration
-<span class="pagenum" id="Page_405">405</span>
-of it as have been given with regard
-to the Peruvian bark. The caution with
-regard to foul bowels is particularly necessary
-in a hot climate, where an over secretion
-of bile is so apt to take place. When,
-the Boreas frigate arrived from England in
-March, 1783, there was a very bad fever of
-the infectious kind on board, some cases of
-which being sent to the hospital at St. Lucia,
-were treated unsuccessfully with bark
-and opium, which I had been induced to
-try upon the authority of the authors above
-alluded to. I attributed this want of success
-to the neglect of previous evacuation;
-for, upon inspecting the bodies, the intestines
-were found full of bilious <i>feces</i>. I profited
-from this, and was more successful in the
-other cases. It were to be wished that physicians
-could oftener bring themselves to confess
-their errors in practice, and their writings
-would be more instructive; for it is of
-consequence to know what we are to avoid
-as well as what we are to follow.</p>
-
-<p>It has been mentioned that the best effects
-arise from the conjunction of an antimonial
-<span class="pagenum" id="Page_406">406</span>
-with an opiate; but, in this sort of fever,
-antimonials, and even most of the neutral
-salts, are hurtful after the first stage, and
-opiates may after this be given alone or
-combined with camphor. With regard to
-the precise period of leaving off antimonials,
-it must be left to discretion, and the constitution
-of the patient is the best guide.
-There is so great a difference in patients in
-this respect, that all practical precepts should
-be qualified by a due discrimination of constitutions.
-Absolute and dogmatical rules
-are so far from applying in the practice of
-physic, that there are some cases of the
-same disease that require a treatment even
-opposite to what is in general most adviseable.
-This may be very aptly illustrated
-by the small pox, of which there are cases
-that ought to be treated very differently from
-the general method laid down by Sydenham,
-and in which cordial medicines are highly
-proper and necessary. This difference in
-diseases themselves seems to be one great
-cause of the difference of opinion among
-physicians on practical points, each party
-finding some countenance in experience for
-<span class="pagenum" id="Page_407">407</span>
-their general doctrine, do not make allowance
-for the varieties that exist in nature;
-so that, in one sense, both may be said to be
-in the right. If the patient is not very
-much sunk, and if there are bilious symptoms,
-or an obstinate dryness in the skin, a
-few grains of James’s powder may be given
-with advantage even in an advanced period
-of the disease. If a hot and dry skin should
-at this period be the only troublesome symptom,
-it will be more safely and effectually
-removed by camphor combined with something
-opiate and the <i>Spiritus Mindereri</i>, which
-is the only neutral now admissible, than by
-antimonials, which, at this time, would be
-in danger either of ruffling the patient by
-their operation on his stomach and bowels,
-or of weakening him too much either in
-this way, or by exciting profuse sweats.
-Evacuant medicines of every kind being
-then improper, clysters are the only laxatives
-to be employed in case the state of the
-bowels require them.</p>
-
-<p>Having mentioned camphor, it may be
-proper here to remark, that it is a medicine
-<span class="pagenum" id="Page_408">408</span>
-of which I have found it extremely difficult
-to ascertain the virtues and effects; and in
-consequence of this ambiguity, I believe
-there are few articles of the materia medica
-more abused in practice. In all inflammatory
-affections, and in the beginning of all
-fevers where there is much heat and thirst,
-I think I have observed it to aggravate the
-symptoms. It seems in no case to be more
-proper than at certain periods of this fever,
-and especially when there happens to be
-spasmodic pains of the stomach, or tremors
-and cramps in the extremities.</p>
-
-<p>In this advanced stage of the fever, in
-which the most common symptoms are weakness,
-restlessness, tremors, and low delirium,
-no medicine was found so much to be trusted
-to as opium, which here acts as a cordial as
-well as an anodyne and antispasmodic. It
-may be given, in the camphorated julep, in
-the form of tincture, from five to ten drops
-every six or eight hours, or some of the officinal
-compounds, such as the theriaca or
-mithridate, may be employed with advantage.
-I have thought also, that, at this period,
-<span class="pagenum" id="Page_409">409</span>
-castor conjoined with opium seemed to
-improve its virtue. This was first suggested
-to me by Mr. Crudie, an ingenious German
-surgeon, whom I employed as an assistant at
-the hospital at St. Lucia; and since I have
-been physician to St. Thomas’s hospital, I
-have found the most pleasing effects, in similar
-cases, from a composition used there,
-the principal ingredients of which are opium
-and castor<a id="FNanchor_97" href="#Footnote_97" class="fnanchor">97</a>.</p>
-
-<p>In this state of the fever I have also used
-with advantage the decoction of Peruvian
-bark and serpentary, as recommended by
-Sir John Pringle; and when the skin is cold
-and the circulation is very languid, as is
-sometimes the case, volatile salts and powder
-of serpentary may very properly be employed.
-<span class="pagenum" id="Page_410">410</span></p>
-
-<p>But in the advanced state, and in the
-worst forms of this disease, there is perhaps
-no medicine superior to wine. This was
-given either pure, or diluted with water for
-common drink, and sometimes to the quantity
-of a quart in twenty-four hours. In
-delicate people, such as we meet with in
-private practice, the quantity ought to be
-less.</p>
-
-<p>There is this caution necessary with regard
-to the use of wine, that when the fever
-is gone off, and only extreme debility remains,
-the free use of it is not safe nor proper;
-for, in a weak and exhausted state, a
-person is more apt to be <a id="FNanchor_98" href="#Footnote_98" class="fnanchor">98</a>heated and intoxicated
-by any fermented liquor, than in
-health, or even in the preternatural and disturbed
-<span class="pagenum" id="Page_411">411</span>
-state of actual disease, such as occurs
-in this fever.</p>
-
-<p>After the disease is removed, a long state
-of weakness is apt to succeed, especially in
-a warm climate. The most proper remedies,
-then, are bitters, such as decoctions of Peruvian
-bark, infusions of quassia bark, gentian,
-or camomile flowers. These answer
-better than the bark in substance, which is
-now apt to nauseate and load the stomach,
-and the patient is apt to take an aversion to
-this and whatever else he took in a state of
-sickness. The best strengthening medicines
-are such as comfort the stomach and create
-appetite; and we may mention Huxham’s
-tincture of bark, in small doses, and a moderate
-use of wine, as the most proper for
-these purposes. Where colliquative sweats
-take place, elixir of vitriol is serviceable,
-<span class="pagenum" id="Page_412">412</span>
-and with this intention I have joined it,
-with evident advantage, to the evening anodyne,
-which, without such a corrector, tends
-rather to aggravate this symptom. I have
-known assafœtida prove a useful stimulus to
-the stomach at this time, and it may even
-be used while the fever subsists, especially
-where the secretions of the fauces are scanty.
-This medicine is recommended by Sir John
-Pringle in the same circumstances. But I
-consider the prudent use of opiates, particularly
-at bedtime, as the most effectual cordial
-and strengthening medicine in this convalescent
-state.</p>
-
-<p>But with regard to the management of
-the sick at this time, as much depends on
-diet as medicine. Nothing has been said
-concerning this in the acute state of fever,
-because no nourishment is then necessary.
-In that state there is a loathing of all food,
-and the powers of digestion and assimilation
-seem to be then suspended, so that alimentary
-substances become not only an useless
-load, but offensive and hurtful by turning
-acid or putrid. It is likewise evident from
-<span class="pagenum" id="Page_413">413</span>
-fact, as well as reason, that nature, in this
-situation, does not require sustenance; for
-we frequently see people labouring under
-fevers who do well and recover, though
-they have been entirely without nourishment
-for a length of time in which the like abstinence
-in a state of health would have
-proved fatal. The friends and attendants
-of the sick, from a prejudice not unnatural,
-but not considering the difference between
-health and that state of derangement which
-takes place in fever, are for ever wishing to
-supply the patient with nourishment, and
-every physician meets with trouble in counteracting
-this officiousness. Nevertheless,
-when the fever draws out to a considerable
-length, and the principal symptom is that
-state of weakness which, in low fevers, runs
-insensibly into that of convalescence, then
-it is necessary to pay the utmost attention
-to nourishment, and nothing tends more to
-insure and hasten recovery than the assiduous
-administration of light and nourishing
-food, the same cautions being observed which
-have just been mentioned with regard to
-cordials. One of the greatest hardships of
-<span class="pagenum" id="Page_414">414</span>
-a sea life is the want of those articles of diet
-that are suitable to a recovering state, and
-many lives are lost from this circumstance,
-after the force of the disease has been subdued<a id="FNanchor_99" href="#Footnote_99" class="fnanchor">99</a>.</p>
-
-<p>With regard to the peculiar form, before
-described<a id="FNanchor_100" href="#Footnote_100" class="fnanchor">100</a>, which this fever assumes a few
-months after ships have been in a hot climate,
-we found camphor, volatile salts, and serpentary,
-the best remedies. As there was a
-remarkable coldness of the skin, I was induced
-in one case to try the hot bath, and
-with good effect, from which it seems probable
-that a short stay in a bath, of a heat
-from 96&deg; to 100&deg;, so as to have its warming
-and stimulating, without its relaxing
-effects, would answer well in fevers of this
-kind.
-<span class="pagenum" id="Page_415">415</span></p>
-
-<h4 id="OF_THE_BILIOUS_REMITTING_FEVER">2. Of the <span class="smcap">Bilious Remitting Fever</span>.</h4>
-
-<p>This is peculiar to tropical climates,
-and arises in the same situations in which
-intermitting fevers arise in temperate and
-cold climates. It seldom arises at sea, unless
-where there has been previous exposure
-on shore, of which some examples have
-been mentioned in the first part of the work.
-It may generally be traced to the air of
-woods or marshes; and in our fleet hardly
-any men were attacked with it but those
-who were employed in the duties of wooding
-and watering.</p>
-
-<p>The most distinguishing symptom is a copious
-secretion of bile which attends it. Its
-course, in general, is shorter than that of
-the fever before described; and though the
-symptoms are more violent, they are not so
-equal and steady, owing to the tendency
-there is to remission. The symptoms are
-particularly violent at the beginning, in so
-<span class="pagenum" id="Page_416">416</span>
-much that some of the men, after being exposed
-upon duty to the heat of the sun and
-the air of marshes and woods, would become
-frantic, being seized almost instantaneously
-with <i>delirium</i> resembling madness.
-This fever, when it arises merely from the
-effluvia of woods and marshes, has a natural
-tendency to remit; nay, some fevers at St.
-Lucia, proceeding from this cause, were of
-the pure intermitting form from the beginning.
-But in many of those that arose at
-Jamaica little or no remission was to be perceived;
-and it was distinguished from the
-ship fever by the bilious vomits and stools,
-more violent delirium, and head-ach, and
-by being attended with less debility. The
-greater tendency to the continued form at
-this time was probably owing to this circumstance,
-that the men who were exposed
-to the land air in wooding and watering,
-were then exposed also to such causes as
-naturally produce continued fevers, such as
-infection, the foul air of the French prizes,
-intemperance, and hard labour. There was
-in some cases a yellowness of the eye, and
-even of the whole skin, but without the
-<span class="pagenum" id="Page_417">417</span>
-other symptoms that characterise the yellow
-fever, properly so called.</p>
-
-<p>In cases that proved fatal, the symptoms,
-for some time before death, resembled very
-much those of the fever before described at
-the same stage. There was either <i>coma</i> or
-constant delirium, great seeming anguish,
-the mouth and tongue very dry, or with
-only a little ropy slime, a black crust on the
-teeth, picking of the clothes, and involuntary
-stools.</p>
-
-<h4><span class="smcap">Treatment of the Bilious Remitting
-Fever.</span></h4>
-
-<p>The measures proper to be taken in the
-beginning of all fevers are pretty nearly
-the same. There is little difference in
-the first treatment of this from that of the
-ship fever, except that blood letting is here
-more frequently proper, and that a more
-free evacuation of the bowels is necessary
-on account of the more copious secretion of
-bile.
-<span class="pagenum" id="Page_418">418</span></p>
-
-<p>In full and athletic habits the disease very
-commonly begins with pains in the limbs,
-back, and head, with a strong throbbing
-pulse; in which case it is proper first of all
-to let blood at the arm. This is also highly
-proper and necessary in those cases mentioned
-above, in which the patient becomes suddenly
-frantic. But though the cases requiring
-blood-letting are more frequent in this
-sort of fever than that already treated of,
-yet great caution and nice discernment are
-necessary with regard to it, in all cases, in a
-hot climate. As fevers in such a climate
-run their course faster, the symptoms succeeding
-each other in a more close and hurried
-manner, greater expedition, as well as
-discernment, are required in timing the different
-remedies than what are necessary in a
-cold climate. Blood letting unseasonably
-and injudiciously employed either endangers
-life, or has a very remarkable effect in protracting
-recovery, by the irrecoverable weakness
-it induces.</p>
-
-<p>With regard to the evacuation by the
-bowels, it has already been mentioned in
-<span class="pagenum" id="Page_419">419</span>
-another part of the work, when on the subject
-of prevention, that, before the fever
-comes on, there is a languor and general
-feeling of indisposition, and that then an
-emetic and a purgative, followed by some
-doses of the bark, were the most likely
-means of preventing the attack of the disease.
-If the fever has properly begun, which
-is announced by a <i>rigor</i> taking place, then
-no time is to be lost in procuring evacuation;
-and, after blood letting, if the symptoms
-should require it, the best medicine is tartar
-emetic, which, if given in small divided
-doses, at short intervals, will most probably
-evacuate the whole intestines by vomiting
-and purging, and may even prove sudorific.
-But it will nevertheless be proper to administer
-a purgative medicine soon after; and
-what we found to operate with most ease,
-expedition, and effect, was, a solution of
-purging salts and manna, either in an infusion
-of sena, or in common water, or barley
-water, with some tincture of sena added
-to it.
-<span class="pagenum" id="Page_420">420</span></p>
-
-<p>The next step towards procuring a remission
-is, to open the pores of the skin,
-which is best done by small doses of James’s
-powder or emetic tartar, assisted by the common
-saline draughts, which will be given
-with most advantage in the act of effervescence,
-or by <i>Spiritus Mindereri,</i> together
-with plentiful warm dilution. I once, by
-way of comparison, tried the two antimonial
-preparations above mentioned in a number
-of men ill of this fever, who were sent
-to the hospital at one time, giving emetic
-tartar to one half, and James’s powder to
-the other, and their effects were so similar,
-that I could perceive no reason for preferring
-the one to the other. Antimonial medicines
-seem better adapted to this than any
-other sort of fever, and may be more freely
-given in it.</p>
-
-<p>These are the most likely means of bringing
-about a remission; and if this is effected,
-nothing remains to be done but to throw in
-as much Peruvian bark as the stomach will
-bear.
-<span class="pagenum" id="Page_421">421</span></p>
-
-<p>But whether from a fresh accumulation
-of bile, or some other circumstance, it may
-happen that the fever is kept up; and in
-this case there is commonly a sense of weight
-or uneasiness about the <i>hypochondria</i>, which
-seems to indicate that the redundant bile is
-in the gall bladder or ducts of the liver. In
-this case a repetition of evacuants is necessary,
-and calomel will be found to answer
-remarkably well as a purgative, its stimulus
-being so extensive as to loosen and bring
-away bile when the saline purgatives, such
-as that above mentioned, had failed of having
-that effect. I have known these to
-pass through the intestines without relieving
-the uneasy sensation about the stomach as
-calomel is found to do; and it will be still
-more effectual for this purpose, if given alone
-in a dose, from five to ten grains, and followed
-some hours afterwards by some other
-purgative. After this, antimonial medicines
-are again to be had recourse to; and these,
-as well as purgative and neutral medicines,
-are safe and useful in a more advanced stage
-of this fever than they are in the ship fever;
-for the strength is not so apt to sink, and
-<span class="pagenum" id="Page_422">422</span>
-the state of the bowels requires them more.
-Antimonials, however, are to be used sparingly
-and cautiously as the fever advances;
-for I have known them, when given only a
-few days after the first attack, to have the
-effect, in some constitutions, of making the
-stomach swell, and of producing a general
-sense of heat and uneasiness.</p>
-
-<p>After the evacuations of the bowels, the
-anodyne diaphoretic may be very seasonably
-given in the manner formerly mentioned;
-for it will not only tend to sooth and procure
-sleep after the commotion that has been
-excited, but by its gentle sudorific effect will
-assist in completing the remission.</p>
-
-<p>The principal point of management in
-the fevers of this climate is, to throw in
-the Peruvian bark in proper season. I formerly
-took occasion to differ from the opinion
-of those who alledge that little or no
-discrimination is necessary with regard to
-the circumstances in which bark is proper
-in continued fevers. I made fair and unprejudiced
-trials of this, but always found that
-<span class="pagenum" id="Page_423">423</span>
-some sort of remission, especially towards
-the beginning of the disease, was necessary,
-in order to make the use of this medicine
-safe and proper. The greatest vigilance is
-indeed required that the administration of it
-be not omitted when it is at all adviseable,
-as the course of fevers is very quick and
-critical in this climate. I have watched
-many nights with some friends in whose
-health I was particularly interested, to catch
-the hour when it might be allowable to give
-it; and where the propriety of it was somewhat
-ambiguous, it was usual to qualify it
-either by conjoining some antimonial or neutral
-salt with the first doses, or by giving
-them alternately with it, as has been formerly
-mentioned.</p>
-
-<p>Under the use of these means, the favourable
-symptoms are, a warm moist skin, a
-strong steady pulse, with the pulsations under
-a hundred in a minute, a natural countenance,
-and being free from delirium. But
-if the fever should not yield during the first
-week, but takes an unfavourable turn, the
-pulse then becomes more small and frequent,
-<span class="pagenum" id="Page_424">424</span>
-there is a general agitation, the tongue is
-tremulous when put out, there is great thirst
-and delirium, with a dry and hot skin. In
-these circumstances, besides the continuation
-of the antimonials in smaller doses,
-with the anodyne diaphoretic, and the occasional
-use of purgatives, blisters now become
-proper; and we found also camphor combined
-with nitre an excellent medicine at
-this period of the disease.</p>
-
-<p>Should the patient survive to the end of
-the second week, the treatment then comes
-to resemble more and more that of the infectious
-fever already described. Bark may
-be given, though there should be no proper
-remission, and cordials and opiates may be
-more freely used. Attention to the state of
-the bowels will still be necessary, since repeated
-accumulations of bile are apt to occur
-even in the most advanced stage, and
-gentle emetics of ipecacuana, as well as
-laxatives, may be necessary. For the same
-reason also, greater caution is requisite in
-the use of pure opiates than in the infectious
-ship fever before treated of. In order to
-<span class="pagenum" id="Page_425">425</span>
-keep the bowels soluble, it was a very usual
-practice, and found very useful, to conjoin
-a few grains of rhubarb with each dose of
-the bark.</p>
-
-<h4 id="OF_THE_YELLOW_FEVER">3. Of the <span class="smcap">Yellow Fever</span>.</h4>
-
-<p>The fever last treated of may be said to
-be peculiar to a hot climate; but the hot
-seasons of temperate climates produce something
-resembling it. That now to be described
-never occurs, so far as I know, except
-under the influence of tropical heats.
-Such a fever is indeed known without the
-tropics; for it is very common in Carolina
-in the hot season; but there the heat is
-even greater than that of the West Indies.
-In order to produce it, there must be, for
-some length of time, a heat seldom falling
-below seventy-five degrees on Fahrenheit’s
-thermometer.</p>
-
-<p>Though it differs from the fever last described,
-both in its causes and symptoms, it
-is not meant to say that it is so distinct as to
-<span class="pagenum" id="Page_426">426</span>
-form a separate species of disease, like the
-measles and small pox. Unless the characters
-of fevers are strongly marked, it is difficult,
-and even impossible, to refer them to
-any particular species; and the different concurrence
-of causes and constitutions is so
-various, that great numbers of ambiguous
-cases occur.</p>
-
-<p>With regard to the cause of the yellow
-fever, it differs from the bilious remittent
-in this, that the air of woods and marshes
-is not necessary to produce it; for it most
-commonly arose from intemperance or too
-much exercise in the heat of the sun. It
-was observable, however, that it was more
-apt to arise when, besides these causes, men
-were exposed to unwholesome air, particularly
-the foul air of ships, whether from infectious
-effluvia, or proceeding merely from
-the putrefaction that takes place in neglected
-holds.</p>
-
-<p>It is also remarkable with regard to it,
-that it is confined almost entirely to those
-who are newly come from a cold or temperate
-<span class="pagenum" id="Page_427">427</span>
-climate. The same remark is made by
-the French, who therefore call it <i>fievre de
-matelot</i><a id="FNanchor_101" href="#Footnote_101" class="fnanchor">101</a>, considering it as peculiarly incident
-to those who have newly arrived from a long
-voyage. It would appear also, from what
-has been formerly mentioned<a id="FNanchor_102" href="#Footnote_102" class="fnanchor">102</a> that those
-men, who have been exposed to that sort of
-infection that prevails in ships in cold climates
-are more particularly the subjects of
-the yellow fever when they arrive in a hot
-climate. It is farther in proof of the same
-opinion, that there are medical gentlemen,
-natives of the West Indies, who have hardly
-ever seen it, their practice lying at a distance
-from any sea-port town where strangers
-usually arrive. Of these strangers, those
-who are young, fat, and plethoric, are most
-apt to be attacked; and more of our officers
-in proportion were seized with it than common
-men.</p>
-
-<p>It has been said, that it never attacks either
-the female sex or blacks. This is in
-<span class="pagenum" id="Page_428">428</span>
-general, though not absolutely, true; for I
-knew a black woman, who acted as nurse to
-some men ill of this fever at Barbadoes,
-who died with every symptom of it.</p>
-
-<p>This fever assumes various forms, according
-to the peculiar constitutions of different
-men, and other circumstances; but in the
-following description I shall enumerate the
-most common appearances:&mdash;In general it
-begins with short alternate chills and flushes
-of heat, seldom with those rigors which
-constitute the regular cold fit, and with
-which most other fevers begin. These are
-immediately succeeded by violent head-ach,
-pain in the back, universal debility, sickness,
-and anguish at the stomach. There is
-commonly, in the beginning, a good deal of
-bile on the stomach, which is thrown off
-by vomiting, either natural or excited by
-an emetic. Those men who were taken ill
-of this fever in the Alcide, in the end of
-the year 1781, had a sore throat in the beginning;
-but this is not a common symptom.
-<span class="pagenum" id="Page_429">429</span></p>
-
-<p>In the course of this disease there is by
-no means a free secretion of bile, and least
-of all in those cases that are most violent,
-and prove the soonest fatal. In cases that
-are more protracted, and less desperate, there
-are frequent accumulations of it, as appears
-by the vomits and stools<a id="FNanchor_103" href="#Footnote_103" class="fnanchor">103</a>.
-<span class="pagenum" id="Page_430">430</span></p>
-
-<p>The eye in a few hours takes a yellow
-tinge, which soon after extends more or less
-<span class="pagenum" id="Page_431">431</span>
-over the face and whole skin. This is a
-symptom so striking and constant, that it
-<span class="pagenum" id="Page_432">432</span>
-gives name to the disease, though it is not
-absolutely either peculiar or essential to it.
-<span class="pagenum" id="Page_433">433</span>
-There is something contagious in this symptom,
-which seems somewhat singular, and
-difficult to be accounted for. It was observed
-<span class="pagenum" id="Page_434">434</span>
-in the Royal Oak and Alcide to extend
-to men who were but slightly indisposed;
-and at the hospital it spread to men
-<span class="pagenum" id="Page_435">435</span>
-in the adjoining beds, without imparting
-any malignity to their diseases.</p>
-
-<p>There is something very peculiar in the
-countenances of those who are seized with
-it, discernible from the beginning by those
-who are accustomed to see it. This appearance
-consists in a yellow or dingy flushing
-or fullness of the face and neck, particularly
-<span class="pagenum" id="Page_436">436</span>
-about the parotid glands, where the
-yellow colour of the skin is commonly first
-perceived. There is also in the eye and
-muscles of the countenance a remarkable
-expression of dejection and distress.</p>
-
-<p>One of the most constant and distinguishing
-symptoms of this fever is an obstinate,
-unremitting, and painful <i>pervigilium</i>, which
-is the more tormenting, as the patient is
-extremely desirous of sleep. It is seldom
-that even a <i>delirium</i> comes to his relief to
-make him forget himself for a moment;
-but he continues broad awake, night and
-day, with his reason and senses sound, in a
-state of the most uneasy agitation.</p>
-
-<p>But the most distinguishing symptom, and
-that which is expressive of the greatest danger,
-is, an unconquerable irritability in the
-stomach, which can be brought to bear nothing.
-An almost incessant retching takes
-place, which commonly, on the third day,
-ends in what is called the <i>black vomit</i>, the
-most hopeless of all the symptoms attending
-it. When this is examined, the colour is
-<span class="pagenum" id="Page_437">437</span>
-found to be owing to small dark flakes, resembling
-the grounds of coffee, and seems
-to be blood which had oozed from the surface
-of the stomach, a little altered. Indeed
-pure blood is sometimes thrown up, and we
-know that the red globules enter the smaller
-order of vessels, and issue by them; for
-bleeding at the nose is a common symptom
-about this time; and some relate that it also
-escapes by the ears and pores of the skin,
-which I never saw, but can readily believe
-it. At the same time, the stools grow
-black, and the urine is frequently of a very
-dark colour, which seem to be owing to
-the same cause. I never remember to have
-seen any one recover after these symptoms
-came on.</p>
-
-<p>There seems to be a general <i>error loci</i> of
-the more tenacious and globular parts of the
-blood into the smaller order of vessels, to
-which the yellow colour is in a great measure
-owing; and when any part of the skin
-is ever so little pressed upon, a damask red
-colour remains for some time, the small
-vessels readily admitting the red globules.
-<span class="pagenum" id="Page_438">438</span>
-It is certain that a yellow colour of the skin
-may be produced by such an <i>error loci</i>, without
-any suspicion of the presence of bile.
-We have an illustration of this in the ecchymosis
-which follows upon an external
-contusion. In this case the red part of the
-blood is mechanically forced either into the
-smaller order of vessels, or into the cellular
-membrane, which occasions a livid appearance,
-and in the course of the recovery the
-same parts become yellow, probably in consequence
-of some of the gluten of the blood
-assuming this colour after the red parts have
-been removed by absorption or otherwise.</p>
-
-<p>In the worst form of this disease there is
-all along an uncommonly distressing sensation
-of universal anguish, particularly about
-the stomach, where there is a sense of
-burning heat, which, as the miserable sufferers
-themselves express it, becomes unspeakable
-torture.</p>
-
-<p>A sense of weight at the breast, deep and
-frequent sighing, and a great failure of muscular
-<span class="pagenum" id="Page_439">439</span>
-strength, are dangerous symptoms in
-all stages of the disease.</p>
-
-<p>Upon the first attack the skin is extremely
-hot and dry, and the pulse hard and frequent;
-but the external heat soon becomes
-very little different from the usual standard
-of health, and the skin feels soft and moist.
-There sometimes happens an eruption of
-small pustules, with white heads, on the
-trunk of the body, which is a favourable
-sign; and I have seen a head-ach disappear
-upon this breaking out. The pulse does not
-serve as an index of danger; for, after the
-hurry of the first attack, it becomes very
-moderate in point of frequency, varying
-from eighty to a hundred pulsations in a minute,
-and is natural in point of regularity
-and strength.</p>
-
-<p>In these circumstances this fever differs
-from that which was last described; and it
-also differs from it in being attended with
-little delirium. I have seen cases in which
-the senses were not affected from beginning
-to end; and I never observed that violent
-<span class="pagenum" id="Page_440">440</span>
-and incessant delirium which attends other
-dangerous fevers.</p>
-
-<p>The state of the <i>fauces</i> is also different
-from that of most other fevers, for there
-is no excessive thirst. The tongue is somewhat
-white and foul; but I do not remember
-ever to have seen it black and dry.</p>
-
-<p>A want of action in the bowels, and an
-insensibility to purgative medicines, indicate
-great danger; and, next to the black slimy
-stools, one of the most unfavourable symptoms
-is, when the <i>feces</i> are like white clay,
-as I have seen in some cases that ran out to
-the length of a week before they proved fatal.
-When the black vomit and stools occur,
-death commonly happens on the third
-or fourth day. A bilious diarrhœa spontaneously
-coming on, is a very favourable symptom.</p>
-
-<p>In more unpromising cases the urine is
-scanty, and in the last stage of life it becomes
-of a very dark colour, as was mentioned
-before. A plentiful secretion of urine
-<span class="pagenum" id="Page_441">441</span>
-is a very favourable circumstance, and seems
-to be one of nature’s methods of curing the
-disease; for such cases are observed to terminate
-well. I remember one case in particular
-in which several quarts were made
-daily for several days together, and it was of
-a very dark saffron colour, but looked green
-where the surface was in contact with the
-side of the pot. I inspissated a small quantity
-of it, and found a large residuum,
-which was very deliquescent, and seemed
-to be all saline. In a hot climate the urine
-does not shew that separation and deposition
-which denote the crisis of fevers in cold climates,
-and this is perhaps owing to there
-being less mucilage and more alkali in the
-former, on account of the more putrescent
-state of the fluids. Upon adding a little
-vinegar to the urine in the case above mentioned,
-it became turbid like the critical
-urine of the fevers of Europe.</p>
-
-<p>At the approach of death, cold clammy
-sweats come on; the pulse continues regular
-and of a certain degree of strength, but
-grows gradually slower. I have counted it
-<span class="pagenum" id="Page_442">442</span>
-at forty pulsations in a minute. The patient
-is frequently sensible to the last moment;
-nor does the countenance sink into what is
-called the <i>Hippocratic</i> appearance. In other
-cases I have seen, at this time, <i>coma</i>, and
-not infrequently convulsions. Broad livid
-spots sometimes also appear on the skin.
-Extreme muscular debility, a great difficulty
-of deglutition, and a dimness of the
-eye-sight, are likewise common symptoms
-in the last scene.</p>
-
-<p>The different stages which lead to dissolution
-following each other thus rapidly, there
-is not that gradual failure of the powers of
-nature that usually give warning of approaching
-death; but the springs of life run
-down, as it were, at once, the wretched
-sufferer expires, and is happily delivered
-from the most extreme misery of which
-human nature is capable.</p>
-
-<p>Such is the general train of symptoms in
-this fever, taken entirely from my own observation;
-but great varieties occur both in
-the symptoms and duration, so great indeed,
-<span class="pagenum" id="Page_443">443</span>
-that it is hardly recognisable for the same
-disease. I shall give specimens of such anomalous
-cases in two that occurred at Port
-Royal, on board of the Canada, in July,
-1782.</p>
-
-<p>A lieutenant of that ship had been subject,
-for four days, to fits of retching, without
-any bilious discharge or pain in the stomach;
-and, except a white tongue, he had no
-symptom of fever in that time, nor any
-thing to prevent him from doing his duty.
-On the fourth day, when I first saw him,
-he began to complain of a fixed pain in the
-pit of the stomach, which was not very
-violent, and about the same time a yellowness
-began to appear on the white of the
-eye. He took a laxative medicine, which
-had the desired effect, and some volatile spirits,
-with some drops of thebaic tincture in
-simple mint water, for the pain in his stomach.
-He had a good night. Next day
-the complaint of the stomach was better;
-but there was great muscular debility. He
-had several natural stools; and as there seemed
-little indication but debility, he took nothing
-<span class="pagenum" id="Page_444">444</span>
-that day except an infusion of some
-bitters and aromatics in wine. As he did
-not want for appetite, he eat some broth
-and chicken; and nothing to give any alarm
-happened this day, except a short qualm,
-in which he was faint, with a sense of cold,
-feeling to himself, as he said, as if he
-should have expired. In the afternoon he
-began to have black-coloured stools, which
-was the first symptom that clearly betrayed
-the nature of the disease. He was then ordered
-as much Peruvian bark as he could
-take with red wine, and these his stomach
-bore. Decoction of bark was also given
-him in clysters. He had a strong voice,
-and was quite sensible, but grew weaker
-and weaker with frequent returns of the
-qualms, and he expired that evening before
-ten o’clock.</p>
-
-<p>I have not the least hesitation in ranking
-this case with the fevers last described,
-though so many of the usual symptoms were
-wanting. This gentleman, though of a
-lively, active disposition, was of a slender
-make, and of a dingy, doughy complection,
-<span class="pagenum" id="Page_445">445</span>
-and his case gave me the idea of a disease attacking
-a constitution which, not having
-powers to struggle with it, is overwhelmed
-without making resistance<a id="FNanchor_105" href="#Footnote_105" class="fnanchor">105</a>. In those robust,
-plethoric habits, which are most commonly
-attacked, there is a sufficient degree
-of strength to excite the violent symptoms
-before enumerated.</p>
-
-<p>A few days after this gentleman’s death,
-another officer of the same ship was taken ill
-with the same sort of fever, and it was also
-attended with several unusual symptoms.
-Neither his skin nor eyes were yellow; the
-skin was hot and dry throughout the disease,
-and during the three first days there
-<span class="pagenum" id="Page_446">446</span>
-was a diarrhœa, which was neither bilious,
-putrid, nor mucous, but consisted in watery
-stools. There were no gripes, nor any
-local pains whatever; but I never remember
-to have seen more suffering from that
-general anguish, particularly about the stomach,
-which attends this sort of fever. On
-the third night he began to vomit and purge
-blood, which soon terminated in that dark-coloured
-discharge which is a symptom so
-characteristic and fatal in this disease. He
-continued sensible till within eight hours of
-his death, which happened on the fourth
-night. The pulse was full and pretty
-strong during the whole course of the disease;
-but there was all along great debility
-and frequent sighing, symptoms that ought
-always to create alarm.</p>
-
-<h4><span class="smcap">Treatment of the Yellow Fever.</span></h4>
-
-<p>I feel this as the most painful and
-discouraging part of this work, the yellow
-fever being one of the most fatal diseases to
-<span class="pagenum" id="Page_447">447</span>
-which the human body is subject, and in
-which human art is the most unavailing.</p>
-
-<p>It seems hardly to admit of a doubt that
-there are particular instances of disease, in
-their own nature, <i>determinedly fatal</i>, that is,
-in which the animal functions are from the
-beginning so deranged, that there are no
-possible means in nature capable of controlling
-that series of morbid motions which
-lead to dissolution. Of this kind appear to
-be the greatest number of cases of the
-plague, many of the malignant small pox,
-and some of fevers, particularly of that kind
-now under consideration. It is extremely
-difficult to ascertain such cases from observation;
-and it may be said that the opinion
-of the existence of them is favourable to
-ignorance and indolence. But, on the other
-hand, it may be questioned if more harm is
-not likely to arise in medicine by being too
-sanguine and officious, than by a diffidence
-of art and trusting to the powers of unassisted
-nature? Were we thoroughly acquainted
-with the animal œconomy, we should perceive
-<i>&agrave; priori</i> in what instances the seeds of
-<span class="pagenum" id="Page_448">448</span>
-disease would either operate so as necessarily
-to terminate in death, or when they were
-within the command of art. But we can
-derive little or no information from this
-source, on account of our great ignorance
-of the secret operations of the living body;
-so that the only grounds of judging are our
-observation and experience concerning the
-usual event of disease, and the effects of remedies.
-Though these are circumstances
-attended with great uncertainty and ambiguity,
-yet I believe it will be admitted as
-the opinion of the most chaste and experienced
-observers, that there do really exist
-diseases whose course cannot be diverted by
-any means that can be employed. This
-opinion, I have said, is, in one view, extremely
-discouraging; yet, to the mind of
-a feeling and conscientious practitioner, who
-must often find his best endeavours baffled
-in many diseases as well as this, and who
-might be apt to look back and accuse himself
-of some fault or omission, it affords
-this satisfaction to his reflections, that the
-want of success may have been owing to
-<span class="pagenum" id="Page_449">449</span>
-something in the nature of the disease, and
-not to his want of skill and attention.</p>
-
-<p>But though the fatality of this disease is
-discouraging, let us not despond, but rather
-redouble our diligence in observing what assistance
-and relief nature may admit of.</p>
-
-<p>It is proper in this as in every other fever
-of this climate, to begin the cure by cleansing
-the first passages. This does not produce
-the same relief as in the common bilious
-fever, probably because there is a less
-free secretion of bile, and therefore less oppression
-from the collection of it.</p>
-
-<p>With regard to blood-letting, the most
-that can be said in its favour is, that if
-there should be a hard throbbing pulse, with
-violent pain in the head and back, it is <i>safe</i>
-in the first twelve hours. This limitation
-is necessary, at least with regard to common
-seamen, who do not bear evacuations so well
-as officers and others, who are used to a better
-diet, and to whom the loss of blood has,
-in some cases, been found useful in the
-<span class="pagenum" id="Page_450">450</span>
-early stage of this fever. It is, however, in
-all cases extremely dangerous, except in the
-circumstances mentioned above. The blood
-is said to shew a buff in the beginning of the
-disease, but in the second stage, it is mentioned
-by a French author<a id="FNanchor_106" href="#Footnote_106" class="fnanchor">106</a>, that it hardly
-coagulates or separates. But even the appearance
-of a buff, without considering other
-circumstances, does not always argue the
-propriety of blood-letting<a id="FNanchor_107" href="#Footnote_107" class="fnanchor">107</a>.</p>
-
-<p>The great object in the cure of this fever
-is, to bring the stomach to bear the bark.
-<span class="pagenum" id="Page_451">451</span>
-There are here wanting most of the circumstances
-that in the other cases forbid the
-use of it; for there is no preternatural
-quantity of bile in the stomach and intestines,
-nor is there a hot and dry skin, nor
-violent delirium. The only obstacle to its
-administration is the great irritability of the
-stomach, which is the most fatal symptom
-of the disease; and the principal part of the
-management of the patient consists in the
-prevention or removal of this. The stomach
-is to be treated with the utmost tenderness
-and attention. One gentle emetic
-at the beginning is all that is allowable;
-and as fresh collections of bile are less apt to
-occur, the repetition of it is less necessary.</p>
-
-<p>It is best to abstain altogether from antimonial
-medicines, and to render every thing,
-whether food, drink, or medicine, as grateful
-as possible. The liquid most apt to stay
-upon the stomach is the juice of the acid
-fruits of the climate, such as<a id="FNanchor_108" href="#Footnote_108" class="fnanchor">108</a> oranges and
-<span class="pagenum" id="Page_452">452</span>
-lemons. It happens frequently, however,
-that acids come to be loathed extremely, so
-as to nauseate the stomach and to encourage
-retching. In this case I have found a composition
-of wine and water with lemon juice
-and nutmeg, sweetened with sugar, and given
-warm, to be a very grateful and salutary
-drink. The patient sometimes prefers the
-decoction of farinaceous substances to every
-other liquid; and in one case in particular,
-which did well, the patient was led by taste
-to prefer warm water gruel to every thing
-else, and the great quantity he drank seemed
-to have a considerable share in his recovery,
-by keeping up a warm moist skin and producing
-a great flow of urine.</p>
-
-<p>In order to check vomiting, the saline
-draught, in the act of effervescence, has been
-employed with evident advantage; but in
-most cases this symptom is so obstinate as
-to discourage all attempts to remove it. I
-have known magnesia in mint water have a
-visible effect in soothing the stomach, particularly
-when given immediately after some
-acid beverage.
-<span class="pagenum" id="Page_453">453</span></p>
-
-<p>I was informed by Dr. Young, physician
-to the army, that he found an infusion of
-cham&aelig;mile flowers one of the best medicines
-in this vomiting; and a surgeon of one of
-the line-of-battle ships informed me, that he
-also found advantage from it in alleviating
-this symptom. The French author above
-mentioned affirms, that milk, boiled with
-some flour or bread, given in the quantity
-of a spoonful at a time, and frequently repeated,
-had more effect than any thing he
-tried in stopping the vomiting in this fever.
-I have seen this symptom relieved by fomenting
-the stomach with stupes wrung
-from the decoction of bark, and sprinkled
-with camphorated spirits and tincture of
-bark<a id="FNanchor_109" href="#Footnote_109" class="fnanchor">109</a>.</p>
-
-<p>But nothing I have ever seen tried had so
-great an effect in removing this irritability
-<span class="pagenum" id="Page_454">454</span>
-of stomach as a blister applied to it externally;
-and it is a remedy which, so
-far as I know, has not been hitherto recommended.
-In other fevers, when the
-head was not particularly affected, I preferred
-this part for the application of a blister,
-for it is in some respects more convenient
-than between the shoulders, and the
-stomach is the part more affected perhaps
-than any other in all fevers. But in this
-fever I was led to apply it to this part, both
-from its being affected in an uncommon degree,
-and from observing, upon inspecting
-the bodies of those who died, that the only
-morbid appearance that could be discovered
-was an inflammatory suffusion on the inner
-membranes of the stomach.</p>
-
-<p>I have employed opiates both externally
-and internally to allay this symptom, but
-without the effect that might have been expected
-from so powerful a sedative.</p>
-
-<p>As the stomach will seldom, even in the
-most favourable cases, bear such a quantity
-of bark as to subdue the disease, it must be
-<span class="pagenum" id="Page_455">455</span>
-exhibited in every other way that can be
-thought of, such as by clyster and by external
-fomentation, both of which I have
-employed with good effect. I used to order
-a pint of decoction of bark to be injected
-every three or four hours, and the fomentation
-to be employed nearly as often. I have
-heard of the decoction of bark being used as
-a warm bath with success; but I cannot
-decide concerning this practice from my
-own experience.</p>
-
-<p>I have no other internal remedy to recommend;
-for whatever power of retention the
-stomach may have should be employed in
-taking bark. If it should become tolerably
-retentive, camphor will be found of service;
-and if given in the evening with an
-opiate, perspiration and sleep will probably
-be procured, by which the patient will be
-greatly relieved.</p>
-
-<p>Blisters to the thighs and legs seemed to
-coincide with the general intention of cure,
-and they appeared to be of advantage in the
-cases in which they were tried.
-<span class="pagenum" id="Page_456">456</span></p>
-
-<h4 id="INTERMITTENT_FEVERS">4. Of the Effects of Flowers of Zinc and
-White Vitriol in the Cure of obstinate
-<span class="smcap">Intermittent Fevers</span>.</h4>
-
-<p>It frequently happens in the West Indies
-that intermittent fevers are so obstinate
-as to resist the common means of cure by
-the Peruvian bark; so that these complaints
-become extremely distressing to the medical
-practitioner as well as to the patient. Indeed
-this was a difficulty that occurred so
-often, that I was sometimes tempted to
-think, either that the great reputation of
-this medicine is not so well founded as is
-commonly believed, or that the bark generally
-in use in these times is not of so good
-a quality as that employed by the physicians
-who first established its character.</p>
-
-<p>But, in the first place, the experience upon
-which its reputation was first built was in a
-temperate climate, where very few agues
-are found to resist it when properly administered.
-In the next place, there is reason to
-<span class="pagenum" id="Page_457">457</span>
-believe that, in fact, the medicine itself now
-commonly in use is not equally powerful
-with what was first employed; and a species
-of it, called the Red Peruvian Bark,
-has lately been discovered, or rather, perhaps,
-revived, which is certainly of a superior
-quality, and has been found to cure intermittents
-in which the common sort had
-failed<a id="FNanchor_110" href="#Footnote_110" class="fnanchor">110</a>.</p>
-
-<p>However this may be, it is an undoubted
-fact that obstinate agues are much more frequent
-in the West Indies than in Europe;
-and something to supply the insufficiency of
-the bark seemed to be a <i>desideratum</i>.</p>
-
-<p>I was informed by Dr. Hendy, of Barbadoes,
-that he had found the flowers of zinc
-to answer in cases of intermittent fever, in
-<span class="pagenum" id="Page_458">458</span>
-which even the bark and every other remedy
-and mode of treatment had failed. It was
-found very successful in the like cases, both
-in my own trials at the hospitals, and by
-the surgeons of the men of war to whom I
-recommended the use of it. In order to
-judge what may be expected from it, I shall
-give a specimen of its success in some cases,
-at the hospital at St. Lucia, of which I kept
-an accurate account, in the months of February
-and March, 1783.</p>
-
-<p>About the time the fleet arrived there,
-six cases of intermittent fevers were sent to
-the hospital from different ships. One was
-of six weeks continuance, and had been
-some times of the tertian, sometimes of the
-quartan type. Two were quartans; one of
-which was of two months, the other of
-eight months duration. Two were regular
-tertians; of which one had only had two
-fits, but was a relapse after a week’s exemption
-from an attack of several weeks. The
-other was of three months continuance, attended
-with an eruption on the hands and
-<span class="pagenum" id="Page_459">459</span>
-arms. The sixth case was a quotidian of
-three weeks, attended with a cough of the
-same standing, and joined with sea scurvy.</p>
-
-<p>In all of them the bark had been given
-at some period or other; and the flowers of
-zinc were now tried in all, except the last.
-In three out of the five this medicine had
-the most visible good effects. In one the
-disease was so speedily removed, that there
-was only one fit after the first day of taking
-this medicine, and the other two had recovered
-perfectly after it had been used for seven
-days.</p>
-
-<p>In these cases there can be little or no
-ambiguity with regard to the real efficacy of
-the medicine, as the disease had lasted from
-two to six months, and there was no other
-circumstance of change in the situation or
-treatment of the patients that could account
-for their recovery.</p>
-
-<p>Of the two cases in which it failed, one
-was the tertian of three months, attended
-<span class="pagenum" id="Page_460">460</span>
-with the eruption; the other was the relapsed
-tertian of three days.</p>
-
-<p>With regard to the dose, I began with
-giving it in the quantity of two grains
-thrice a day, which, in some, produced the
-desired effect, and without the least sensible
-operation on the stomach or bowels. If
-this dose did not stop the fits after a few
-days trial, it was increased to three grains,
-which, in some, would produce a little sickness.
-I found that four grains ruffled the
-stomach a good deal; but if the patient is
-gradually habituated to it, even more than
-this may be given without inconvenience.</p>
-
-<p>In those cases in which it was successful
-it was not found necessary to give more
-than two grains at a dose, except in one of
-them, in which three were given the day
-before the fit ceased. In the two unsuccessful
-cases the medicine had a fair trial for a
-fortnight; but one of them getting no better,
-and the other seeming to get worse, it
-was left off.
-<span class="pagenum" id="Page_461">461</span></p>
-
-<p>The cases to which this medicine is
-adapted are those that have extremely distinct
-remissions, with no symptoms of bile
-nor any local affection. When agues come
-to be long protracted, they are frequently
-what may be called nervous; that is, consisting
-of certain morbid motions that seem
-to be induced by habit, after the original
-cause is removed, and with a tolerable enjoyment
-of appetite, sleep, and all the functions
-of life, during the intermission.</p>
-
-<p>The two cases in which the zinc failed
-recovered by the use of the bark. This
-had been unsuccessfully tried before, and its
-good effects now might either depend on its
-having been left off for some time, whereby
-the body recovered its sensibility to its virtues,
-or it might be in consequence of administering
-it in ardent spirits with a few
-grains of capsicum and ginger, additions
-which I found to improve its effects in other
-cases, and is a mode of giving it well suited
-to this climate.
-<span class="pagenum" id="Page_462">462</span></p>
-
-<p>The zinc was not tried in the sixth case,
-on account of the local affection and the remission
-being short and imperfect.</p>
-
-<p>The white vitriol, being a salt of zinc,
-might be supposed to possess the same virtues;
-and it would appear to do so from
-some facts<a id="FNanchor_111" href="#Footnote_111" class="fnanchor">111</a> that were reported to me in the
-West Indies, and also from some trials made
-by me at St. Thomas’s hospital since I came
-to England.
-<span class="pagenum" id="Page_463">463</span></p>
-
-<p>Though this is a medicine of very considerable
-powers, I do not mean to put it in
-competition with the bark, by proposing it
-as a substitute for it, or by representing it
-as superior to it in all circumstances; but
-only to propose it as a valuable subsidiary in
-particular cases. The account I have given
-is faithfully extracted from a diary of my
-practice; and were I to say more in its favour
-than the future experience of others
-may warrant, I should do more harm than
-service to its reputation. Many good medicines
-have had their characters hurt by being
-over-rated by the first proposers of them,
-who are naturally sanguine and partial, without,
-perhaps, intending to deceive. But
-when others find that their virtues do not
-come up to what has been asserted, they are
-apt to run into the other extreme, and explode
-<span class="pagenum" id="Page_464">464</span>
-them altogether; so that what was
-given out as good for every thing, is now
-found to be good for nothing<a id="FNanchor_112" href="#Footnote_112" class="fnanchor">112</a>.
-<span class="pagenum" id="Page_465">465</span>
-<span class="pagenum" id="Page_466">466</span></p>
-
-<h2 id="PART_III_CHAP_II">CHAP. II.</h2>
-
-<h3 id="OF_FLUXES" class="medium">Of <span class="smcap">Fluxes</span>.</h3>
-
-<p>These seem to arise in the same circumstances,
-and to be owing to the same
-general causes, as fevers. They may, in
-some sense, be considered as fevers, attended
-with peculiar symptoms in consequence of a
-determination to the bowels, just as fevers
-in cold climates are sometimes attended with
-rheumatism and catarrh. We have seen, in
-the first part of this work, that the dysentery
-arose chiefly in those ships which had
-been subject to fevers.</p>
-
-<p>This determination to the bowels is owing
-to a variety of causes, but is chiefly connected
-with external heat; for it is most common
-in hot climates, and towards the end
-of summer or in the autumns of cold climates,
-owing probably to a greater acrimony
-of the secretions of the intestines, and
-<span class="pagenum" id="Page_467">467</span>
-particularly of the bile. Dysenteries arise
-in camps also at the same seasons, and in the
-same circumstances as bilious fevers<a id="FNanchor_113" href="#Footnote_113" class="fnanchor">113</a>.</p>
-
-<p>Besides climate and season, the other circumstances
-determining to the one disease
-more than the other are, 1. A difference in
-the constitutions of different men; for in
-the same ship it sometimes happens that
-both diseases prevail equally, though all the
-men are using the same diet and breathing
-the same air. 2. The nature of the occasional
-cause. A dysentery, for instance, is
-more likely to arise from an irregularity in
-eating or drinking; a fever from being exposed
-to the weather, particularly marsh effluvia.
-3. The particular species of infection
-that may happen to be introduced.
-Suppose, for example, that a ship’s company
-is predisposed to acute distempers, and one
-man or more ill of the dysentery should be
-brought on board, this will become the prevailing
-disease, as happened in the Torbay
-in August, 1780. If the like number of
-<span class="pagenum" id="Page_468">468</span>
-fevers should be introduced, then fevers will
-be the prevailing disease.</p>
-
-<p>These two diseases may therefore be considered
-as <i>vicarious</i>, the one substituting itself
-for the other according to particular accidents,
-and both proceeding from the same
-general causes; and this is no new idea of
-mine, but seems to have been Dr. Sydenham’s,
-when he calls the dysentery a <i>febris
-introversa</i>. It may be farther added, that
-dysentery is the latest form in which this
-cause, which is common to both, can exert
-itself; for it is a disease more within the
-reach of art; and some of the most dangerous
-symptoms attending fevers, particularly
-<i>delirium</i>, seldom occur in dysentery.
-When it proves fatal, it is in consequence
-of violent local affection, and that in general
-after it has taken a chronic form. When
-an incipient fever turns into a dysentery, all
-the symptoms, and particularly the head-ach,
-delirium, and <i>coma</i>, if there should be
-any, are immediately relieved. And the
-most favourable cases of the yellow fever are
-those in which a bilious diarrhœa comes on,
-<span class="pagenum" id="Page_469">469</span>
-while the most fatal are those in which the
-bowels are so torpid as to be insensible to
-any stimulus either from their own contents
-or from medicine.</p>
-
-<p>I shall not enter into a minute description
-of this disease in all its stages, as this has
-been so ably executed by Sir John Pringle,
-Sir George Baker, and other authors, but
-shall only give a sketch of some of the most
-remarkable symptoms, particularly such as
-are peculiar to the climate and manner of
-life, so as to explain the varieties that may
-be necessary in the mode of treatment.</p>
-
-<p>The fluxes that arose in the fleet were
-either what may be called the acute idiopathic
-dysenteries, or a dysenteric state of the
-bowels from neglected diarrhœas, which was
-most apt to occur in the convalescent state
-of fevers, or in men labouring under the
-scurvy. The body is more susceptible of
-infection in a state of weakness from these
-or any other causes; and in hot climates
-the dysentery seems to be more infectious
-than fevers; for at hospitals it was so frequently
-<span class="pagenum" id="Page_470">470</span>
-communicated to men who were ill
-of other complaints, that it was in these
-the principal cause of mortality. For this
-reason, I was at more pains with regard to
-this disease than any other, in keeping those
-who were ill of it in a separate ward.</p>
-
-<p>I have met with some violent and untractable
-cases which proved fatal in the acute
-state; but, in general, this disease draws out
-to a chronic form in this climate, and does
-not prove mortal for many weeks. The
-usual cause of death appears, from the inspection
-of the bodies, to be an ulceration of
-the great intestines, particularly of the descending
-colon and the rectum. This part
-of the intestinal tube is most affected from
-its being the receptacle of all the acrid secretions
-from the rest of the canal; and it
-is naturally more subject to congestions of
-the fluids and incurable ulcers, as appears
-from the rectum being so liable to the h&aelig;morrhoids
-and the <i>fistula</i>. This ulceration
-of the great intestines is so common, that,
-out of eight cases which I inspected after
-death, seven had this appearance. The case
-<span class="pagenum" id="Page_471">471</span>
-in which there was none was not so much
-a case of dysentery as of inflamed bowels,
-brought on by the man having drank to
-excess of spirits while he was recovering
-from a dysentery. The acute <i>tormina</i> which
-always occur in the first days of the disease
-seem owing to an inflammation, which terminates
-in ulcers; and these being constantly
-irritated by the sharp humours, produce the
-<i>tenesmus</i>, which is the symptom most essential
-to dysentery in the after part of the disease.
-Any diarrhœa may in this manner
-become dysenteric. During the acute griping
-at the beginning, the stools are loose
-and copious; but as soon as the tenesmus
-takes place, they are scanty, which is most
-probably owing to the spasmodic strictures
-in the great intestines, in consequence of
-irritation upon their excoriated surface. The
-inflammatory state is more lasting and violent
-in a cold than a hot climate, the gripings
-are more severe, and the danger is
-also greater in this stage of it.</p>
-
-<p>The state which the great intestines fall
-into in old dysenteries seems to have something
-<span class="pagenum" id="Page_472">472</span>
-in it peculiar to itself: the several
-coats become thick and spongy; their texture
-is obliterated and destroyed; and they
-become of a black or very dark purple colour.
-This, however, cannot be called mortification;
-for the fibres of the gut do not
-lose their tenacity, nor is there that putrid
-and dissolved state in which gangrene consists;
-but it advances in time to such an extreme
-state of disease as to be entirely incapable
-of recovering its natural appearance
-and functions, and proves therefore the cause
-of death.</p>
-
-<p>The greater frequency and obstinacy of
-these chronic fluxes in hot than in cold climates
-seems to be owing to the same weakening
-of the powers of life which make
-recovery in general so tedious, and particularly
-that of wounds and ulcers. The
-greater quantity of acrid bile will also tend
-to keep up the ulceration. Dysenteries have
-this disadvantage, that the Peruvian bark,
-which is the most powerful restorative in
-other complaints of this climate, is here
-found to be inadmissible on account of the
-<span class="pagenum" id="Page_473">473</span>
-heat, thirst, and other febrile symptoms,
-which it seldom fails to induce in all stages
-of this disease.</p>
-
-<h4><span class="smcap">Treatment</span> of <span class="smcap">Fluxes</span>.</h4>
-
-<p>There are few diseases in which a
-prudent employment of art is more useful,
-or in which early means of relief are more
-requisite than in this<a id="FNanchor_114" href="#Footnote_114" class="fnanchor">114</a>.</p>
-
-<p>Where the dysentery is the original disease,
-and when the patient is robust and
-plethoric, with acute pain and a strong
-pulse, blood-letting may be practised with
-advantage in the beginning of the complaint.
-But there is no part of the practice
-<span class="pagenum" id="Page_474">474</span>
-in this disease in which the climate and
-manner of life makes a greater difference
-than in this; for in a temperate climate it
-frequently happens that repeated blood-letting
-is necessary; but in a hot climate, where
-the fibres are relaxed, and in the constitutions
-of seamen, whom we seldom or never
-find plethoric, the inflammatory symptoms
-requiring this evacuation do not run so high,
-nor continue so long.</p>
-
-<p>It is in all cases of the utmost consequence
-to administer as early as possible a brisk saline
-purgative. An ounce and a half or two
-ounces of purging salts may be dissolved in
-a quart of barley water or water gruel, and
-given warm in cupfuls, at small intervals,
-till a free and copious evacuation is produced.
-If there should be much fever, or
-sickness at stomach, two grains of emetic
-tartar will be a great improvement of this
-medicine; and there will be this farther
-advantage from its use, that if the stomach
-should be loaded with bile, in which state
-it is more irritable, an evacuation upwards
-<span class="pagenum" id="Page_475">475</span>
-will also be excited to the great relief of the
-patient.</p>
-
-<p>This early and seasonable measure will,
-in many cases, put a stop to the disease,
-especially if the patient is thrown into a
-sweat immediately after the bowels have
-been thus thoroughly evacuated. It is of
-great service in this disease to promote free
-perspiration, and even a plentiful sweat,
-which may be effected with great advantage
-by giving, at bed time, a medicine composed
-of opium, ipecacuana, and a little
-neutral salt, accompanying it with plentiful
-warm dilution. Nothing tends more to relieve
-griping and tenesmus than a general,
-warm moisture on the skin. The ipecacuana,
-which is an ingredient in this medicine, is
-one of the best anti-dysenteric remedies we
-know; the opium procures rest; and this,
-joined to the sudorific effect of the whole,
-not only gives a temporary relief, but tends
-to carry off the disease. It is most properly
-given in the evening; for there would be
-this inconvenience in constantly encouraging
-a sweat, that if the tenesmus should return,
-<span class="pagenum" id="Page_476">476</span>
-it would either be checked by the patient
-getting frequently out of bed, or there would
-be danger of his catching cold. I am well
-aware that we cannot be too cautious with
-regard to the use of opium in the beginning
-of this disease; but it is admissible more
-early in a hot climate than a cold one, as
-the inflammatory symptoms are less violent
-and can be sooner subdued; besides, it becomes
-an entirely different medicine when
-conjoined with the other ingredients that
-have been mentioned.</p>
-
-<p>The best medicine in the day time we
-found to be small doses of ipecacuana alone
-twice or thrice a day; and if there should
-be fresh collections of bile, small doses of
-the saline purgative will be necessary. Ipecacuana
-in this intention, may be given in
-the dose of two grains in athletic constitutions,
-such as those of seamen; but in the
-more delicate constitutions, such as are commonly
-met with in private practice, one
-grain is a sufficient dose. I have found
-manna and tamarinds a good addition to this
-medicine in the earlier stages of the disease,
-<span class="pagenum" id="Page_477">477</span>
-where there was much bile; but in a more
-advanced stage of it they are apt to produce
-gripings and flatulence.</p>
-
-<p>The marks of a redundance of bile are, a
-sickness at stomach, a sense of scalding at
-the anus when the stools are passing, and
-the yellow or green colour of the stools
-themselves. It is apt also to excite symptoms
-of fever, such as a foul tongue, a hot
-and dry skin, with thirst. When collections
-of it are suspected in this disease, it is best
-to evacuate it by vomiting, for it is thereby
-prevented from irritating the bowels, and
-from arriving at the inflamed parts with,
-perhaps, increased acrimony, acquired in
-passing through the whole length of the
-intestines.</p>
-
-<p>Some gentlemen of the fleet informed me
-that they found oil of almonds a useful addition
-to the purgative. Others as well as
-myself made a practical comparison of the saline
-purgative with that composed of rhubarb
-and calomel, as recommended by Sir John
-Pringle, and we gave the preference to the
-<span class="pagenum" id="Page_478">478</span>
-former, as more easy, speedy, and effectual in
-its operation, especially in the first stage. Cases
-may occur, however, in which the other may
-be more advisable; for where there is a sense
-of weight about the stomach, which most
-probably arises from the biliary organs being
-clogged with bile, and where emetics
-have failed to remove it, or the weakness of
-the patient may render them improper, then
-calomel has the best effect: for it was formerly
-observed, that it tends to loosen the
-secretions, and to stimulate the more distant
-excretories, such as the biliary ducts.</p>
-
-<p>It is very important to caution young
-practitioners concerning the employment of
-opium in all stages of this disease, but especially
-in the beginning; for though it is an
-excellent remedy when seasonably and judiciously
-employed, it is very liable to abuse,
-particularly in the hands of the inexperienced,
-who may be tempted to give it improperly
-from an anxiety to relieve; but as
-more harm may arise from an unseasonable
-administration of it than could be compensated
-by the best-timed use of it, it is best
-<span class="pagenum" id="Page_479">479</span>
-to err on the side of caution and omission.
-The principal caution to be observed with
-regard to this remedy is, to premise suitable
-evacuation, such as blood-letting, if necessary,
-but more especially purging. It is
-always pernicious to give it in its pure state
-during the <i>tormina</i>, so common in the first
-days. By these I mean the abdominal gripings,
-which denote inflammation, and are
-entirely different from the <i>tenesmus</i>, which
-is a more constant and characteristic symptom
-of the disease, and seems to arise from
-irritation and spasms of the rectum and
-colon.</p>
-
-<p>It was in this disease that I first observed
-the good effects of a small quantity of neutral
-salt in taking off the inconveniencies
-attending opium, such as the feverish heat
-and confusion of the head, which it is apt
-to produce in many constitutions; and as
-the administration of the anodyne coincided
-with the evening dose of ipecacuana, I was
-led to adopt a form similar to that of Dover’s
-powder, but with only half the quantity
-of opium; or, it was given in a liquid
-<span class="pagenum" id="Page_480">480</span>
-form, by combining twenty drops of thebaic
-tincture and a drachm of ipecacuana
-wine, with nitre from five to ten grains, in
-any simple vehicle in form of a draught.
-There is a very observable difference, in
-some cases, between opium given in a liquid
-and in a solid form; and the former is much
-more certain in its effect when the intention
-is to procure speedy and effectual ease.</p>
-
-<p>I have observed great benefit from the use
-of external remedies in dysentery, and these
-have, perhaps, been too much neglected by
-authors and practitioners. The warm bath
-is of great service, especially where the
-gripes and tenesmus are severe, and where
-the fever has been taken off by previous
-evacuation. Fomentations or warm applications
-of any kind to the abdomen give
-temporary relief; and it will be found of
-advantage to keep those parts, at all times,
-well defended from the cold air. Blisters to
-the abdomen were also found of use, and
-likewise acrid liniments, composed of oil,
-volatile spirits, and tincture of cantharides.
-Where the stomach has been much affected,
-<span class="pagenum" id="Page_481">481</span>
-I have perceived relief from fomenting it
-with stupes, upon which thebaic tincture
-and camphorated spirits were sprinkled, as
-recommended by Dr. Lind. I was once affected
-with a bad dysentery in the West Indies,
-and I thought myself much relieved
-by the warm bath and a blister. Strangury
-is not an uncommon symptom in this disease,
-independent of cantharides, and the
-most sensible and effectual relief is derived
-from fomentations to the pubis and perin&aelig;um,
-as I also experienced in my own case.</p>
-
-<p>What has been hitherto said regards
-chiefly the acute dysentery; but the most
-frequent and troublesome complaint that
-occurred at the hospital, was the same disease
-in what may be called its chronic state.</p>
-
-<p>There is a considerable variety of symptoms
-in all the stages of this disease, but
-particularly in the more advanced or chronic
-state, so that a corresponding variety is
-necessary in the modes of treatment, and
-there are few diseases in which there is more
-room for exercising the judgement.
-<span class="pagenum" id="Page_482">482</span></p>
-
-<p>In all stages of it an accurate discernment
-is necessary with regard to the use of opiates,
-and great part of the practice here consists in
-timing these well. They are least admissible
-in the beginning, where evacuation is the
-principal object; but as the disease advances
-they become more and more allowable and
-useful. The principal cautions necessary
-in their administration are, 1. To premise
-sufficient evacuation, so that the intestines
-may not be loaded with bile, <i>scybala</i>, or
-any other irritating matter at the time of
-giving the opiate. 2. To obviate the effects
-which an anodyne has of causing a
-retention of the contents of the intestines.
-This may be done, either by giving something
-purgative along with it, or after it
-has produced its quieting effect. The former
-method seems preferable; for as soon as the
-effect of the opiate is over, the purgative
-is ready to act; and in this way it is so far
-favourable to the operation of the purgative
-that large feculent stools will be discharged:
-whereas, had the purgative been given alone,
-it would have been more apt to produce
-<span class="pagenum" id="Page_483">483</span>
-scanty griping stools, attended with tenesmus.
-Rhubarb answers well in such cases,
-and may be given in a dose from twelve to
-twenty grains, according to the age and
-constitution. 3. To prevent feverish heat
-and delirium. This was proposed to be done
-in the first stage of the disease, by combining
-it with ipecacuana and a little neutral
-salt. With the same intention, it may now
-be joined with a few grains of Dr. James’s
-powder, or <i>vitrum ceratum antimonii</i>, in which
-form it would not be so strongly sudorific,
-an effect not so much required in the chronic
-as in the acute state.</p>
-
-<p>The principal causes that keep up the
-flux, and render it so obstinate, are, 1. A
-too great secretion of bile, either continual
-or frequently recurring. 2. Ulcers in the
-great intestines. 3. A lienteric state of the
-bowels. 4. A retention of <i>scybala</i>.</p>
-
-<p>The first cause is much less frequent than
-might be expected by those who fancy that
-every disease of this climate proceeds from
-<span class="pagenum" id="Page_484">484</span>
-bile. When there does occur a redundancy
-of bile, there is more occasion for the employment
-of evacuant medicines, and more
-need of caution in that of opiates. A medicine
-that will dispose the liver, or the circulating
-system in general, to form less bile, is a <i>desideratum</i>
-in physic; but, in case of an excessive
-flow of it, emetics and mercurial purgatives,
-as has been already mentioned, are
-the best means of evacuating it; and care
-should be taken that it be discharged before
-it accumulates too much, or becomes acrid
-by too long retention.</p>
-
-<p>In order to obviate that irritation in which
-tenesmus consists, some benefit was found
-from the injection of emollient and anodyne
-clysters, to wash off and dilute the acrimony,
-and to sooth and heal the parts. A
-strong infusion or decoction of linseed or
-starch may first be given to the quantity of
-near a pint, to be evacuated after a short retention,
-and then a few ounces of the same,
-with thirty or forty drops of laudanum, to
-be retained for a length of time, in order to
-procure rest. Instead of this last, I have
-<span class="pagenum" id="Page_485">485</span>
-known a small quantity of warm milk, with
-syrup of poppies, used with advantage in
-private practice.</p>
-
-<p>I was at first tempted to think that a very
-frequent injection of such clysters would be
-very useful, by washing and healing the colon
-and rectum, and preventing farther exulceration.
-But besides the objection arising
-from the tenderness of the parts, which, in
-some cases, renders the operation itself painful,
-I found that if they were given oftener
-than once a day, they rather increased the
-uneasiness, and made the patient feel languid
-and exhausted; so true it is that no
-practical rule can be established from reason
-alone without being brought to the test of
-experience. The rectum seems to have a
-peculiar sensibility, and a remarkable consent
-with the whole system; for a stool will
-induce syncope, or even death, in a state of
-great debility. Clysters may be pernicious,
-even though they produce no evacuation of
-<i>feces</i>; and Sydenham has remarked, with respect
-to other diseases, that their unseasonable
-or too frequent use greatly debilitates
-<span class="pagenum" id="Page_486">486</span>
-and disturbs the patient. When not abused,
-however, they are of the most eminent service
-in this and other complaints.</p>
-
-<p>Certain medicines, which have been called
-<i>sheathing</i>, have been recommended to be taken
-by the mouth. Of this kind are mucilage,
-oil, and wax. I have made trial of
-mucilage, such as starch, without any sensible
-effect, probably because it loses its qualities
-by the powers of digestion before it
-reaches the part upon which it is intended
-to act. With regard to oil, I have hardly
-enough of experience of my own to decide;
-but some of the surgeons of the fleet informed
-me that they found advantage from
-combining it with the purgatives. I was
-discouraged from using it by finding that it
-was apt, in the West Indies, to become rancid
-on the stomach, and, for this reason, I
-seldom, in any case, employed the castor
-oil, which, though produced in that climate,
-seems to answer better as a medicine
-in Europe. But since my return to England
-I have used, with great benefit, at St.
-Thomas’s hospital, a medicine, composed of
-<span class="pagenum" id="Page_487">487</span>
-tincture of rhubarb and oil, in old dysenteries,
-attended with discharges of blood. I
-took the hint of this from finding it of
-great service in deep-seated piles, as recommended
-by Dr. Griffith<a id="FNanchor_115" href="#Footnote_115" class="fnanchor">115</a>. It is necessary
-to combine something purgative with the
-oil, otherwise it might be altered by digestion,
-or absorbed, or might become rancid
-by too long retention in the first passages.
-Wax is a body not changeable by digestion,
-and seems therefore well suited for the purpose
-of sheathing the bowels; and I have
-found advantage from the preparation of it
-recommended by Sir John Pringle<a id="FNanchor_116" href="#Footnote_116" class="fnanchor">116</a>, on
-the authority of Dr. Huck. I have also
-seen some advantage in old fluxes, in St.
-<span class="pagenum" id="Page_488">488</span>
-Thomas’s hospital, from the use of spermaceti,
-given with an equal quantity of
-conserve of roses and half as much absorbent
-powder, agreeably to a form in use at
-that hospital.</p>
-
-<p>The climate has a great influence in preventing
-these ulcers from healing, upon the
-same principle that it prevents the cure of
-external sores and wounds, so that there are
-cases that admit of no cure but from a
-change of climate. I have seen in some
-cases of old dysentery, small, round, ill-conditioned
-ulcers break out on the surface
-of the body, which seemed to proceed from
-the same general habit that produced those
-of the intestines. There was something
-peculiar in the appearance of those external
-sores, being like small round pits, as if a
-part of the skin had been removed by caustic,
-and with little or no discharge. In a
-case of this kind, which proved fatal, I
-found the whole surface of the great intestines
-beset with small ulcers, not unlike
-those on the skin.
-<span class="pagenum" id="Page_489">489</span></p>
-
-<p>Since the first edition of this work was
-published, I have met with a pamphlet,
-written by Dr. Houlston, of Liverpool, in
-which the friction of mercurial ointment
-on the abdomen is recommended as a cure
-for old fluxes; and I have tried this practice
-in some very obstinate cases in St. Thomas’s
-hospital with evident success. In these
-cases it is probable the disease is kept up by
-a vitiated state of some of the various secretions
-belonging to the intestinal canal, which
-the mercurial alternative tends to correct.</p>
-
-<p>The next cause that was mentioned of the
-long continuation of fluxes, was a lienteric
-state of the bowels. This consists in a great
-irritability of the whole alimentary canal,
-whereby all the <i>ingesta</i> are transmitted so
-fast, that there is no time for assimilation.
-Liquid aliment, such as broth, is particularly
-subject to this inconvenience. There
-are few cases of long-protracted fluxes in
-the West Indies, without this symptom in
-some degree.
-<span class="pagenum" id="Page_490">490</span></p>
-
-<p>The remedies that are here found of most
-service are such as counteract irritability or
-relaxation. It is in cases where this is the
-prevalent symptom that opium may be most
-freely used. Frequent and small doses of
-the compound officinals, such as theriaca,
-pulvis e bolo compositus, or diascordium,
-have been found of service. Though the
-relaxation would seem here to indicate the
-Peruvian bark, yet I have hardly ever known
-it employed in any form in this or any other
-stage of the disease, without being hurtful.
-But there are other bitters not only safe but
-useful in restoring the tone of the bowels;
-of this kind are simaruba, quassia, and chamomile
-flowers. The first has been reckoned
-a specific in this sort of flux; but
-though its powers are undeniable, it will be
-found frequently to fail<a id="FNanchor_117" href="#Footnote_117" class="fnanchor">117</a>. I have also used,
-with advantage, a tincture of gentian and
-cinnamon in Port wine. Something aromatic
-<span class="pagenum" id="Page_491">491</span>
-has a good effect when added to the
-bitter, being adapted to prevent or obviate
-flatulence, which is a common and troublesome
-symptom in this complaint.</p>
-
-<p>That class of remedies which may be
-called pure astringents, might seem at first
-sight well calculated for cases of this kind.
-Of this sort are the <i>terra Japonica</i> and <i>extractum
-campechense</i>; but though I have seen
-evident benefit from this last, there are few
-cases in which such medicines are found by
-experience to be of material service. Where
-the cause consists in simple relaxation, they
-will effect a cure; but it more frequently
-happens that the disease is kept up by a vitiated
-state of the secretions, or a depraved
-action of the bowels.</p>
-
-<p>The absorbent earths are a more useful
-<span class="pagenum" id="Page_492">492</span>
-remedy in this form of the disease. They
-have, perhaps, a restringent effect independent
-of their power of absorbing acid. It
-is certain, however, that great part of their
-use consists in the destruction of acid, which
-is very apt to be generated in that depraved
-state of digestion which takes place in advanced
-fluxes, particularly in this lienteric
-state of the bowels. In the early and acute
-state the vegetable purgatives, such as cream
-of tartar, tamarinds, and manna, are proper;
-but in this advanced stage they are hurtful
-by the acidity and flatulence which they
-produce, and both the food and medicines
-should be so calculated as to avert and correct
-those inconveniencies. There is something
-in vegetable acids extremely unfriendly
-to a weak state of the bowels in general,
-tending to bring on spasmodic gripings, and
-preventing a healthy digestion and assimilation,
-as we know in the case of heartburn,
-and of those who make use of vinegar to
-check corpulency, by preventing the formation
-of blood. Vegetable acids, however,
-are admissible where there is a redundancy
-of bile, or where the excrements are
-<span class="pagenum" id="Page_493">493</span>
-putrid; and Dr. Zimmerman recommends
-tamarinds as a useful medicine in what he
-calls the putrid dysentery.</p>
-
-<p>Lime water has been recommended in old
-flaxes, and I tried it in several cases; but,
-except in one, I could not perceive any benefit
-from it.</p>
-
-<p>Absorbents may very properly be combined
-in prescription with some of the compound-officinal
-opiates, and a medicine will
-thereby be formed, which will have at once
-the advantage of an anodyne, a bitter, an
-astringent, a carminative, and absorbent.
-As these earths have little or no taste, they
-may also be added, with propriety, to the
-common drink, as in the form of the chalk
-julep, or <i>decoctum album</i>. It may be thought
-that here and elsewhere I have not been so
-particular as I ought to be concerning the
-forms and doses of medicines; but circumstances,
-such as age, constitution, and symptoms,
-make these, in a great measure, discretionary;
-and any one who is sufficiently
-conversant with physic to be entrusted with
-<span class="pagenum" id="Page_494">494</span>
-the charge of the sick, will have sufficient
-judgement to vary his practice accordingly.
-It has, therefore been my object rather to
-give the general principles of treatment than
-the particular forms of medicines.</p>
-
-<p>A proper regulation of diet, as well as medicine,
-is of the utmost consequence in this
-disease. A free indulgence of animal food
-is pernicious, particularly in the first stage
-of it. In the chronic state, a moderate use
-of it is allowable, and in the lienteric state
-it answers better in a solid form than that of
-broth, which is apt to gripe and to run
-quickly through the bowels. The best general
-articles of diet are farinaceous bodies;
-and these are greatly improved by being
-toasted brown before they are used. It was
-observed, in a former part of this work, that
-the flux was supposed to have been prevented,
-in the fleet commanded by Sir Charles
-Saunders, by throwing burnt biscuit into
-the water used by the crews of the ships.
-It is a good practice to put a well-burnt
-toast into all that the patient drinks, and
-toasted bread, or panada made of toasted
-<span class="pagenum" id="Page_495">495</span>
-bread or biscuit, is one of the best articles
-of diet. Brackish water ought to be avoided,
-as it ruffles the bowels when in so delicate
-a state. Fermented liquors are improper,
-except when the disease is advanced, and
-where weakness and relaxation are the prevailing
-symptoms. Malt liquor will hardly
-ever agree, on account of its acidity and flatulence.
-Of wines, Port is to be preferred
-as the most strengthening; Madeira as the
-least subject to acidity; and, for the common
-men, no drink of the fermented kind
-is safer than a moderate quantity of spirits
-diluted with water.</p>
-
-<p>Warm clothing is of the utmost consequence
-in this disease, and external warmth
-of the abdomen tends greatly to sooth the
-bowels. I have seen good effects from a
-warm gum plaster constantly worn on that
-part. Though cold is in general hurtful
-and unsafe, I have nevertheless known the
-sailors, who, by their habits of life, are commonly
-heedless, bathe in the sea when labouring
-under what they call the white flux,
-without any bad effects.
-<span class="pagenum" id="Page_496">496</span></p>
-
-<p>It sometimes happens that this disease
-baffles every effort both of medicine and
-diet, so that a change of climate becomes
-the only resource.</p>
-
-<p>The last cause of habitual flux that was
-mentioned was the retention of <i>scybala</i>,
-which keep up the irritation and tenesmus.
-It is very natural to neglect purgative medicines
-when there seems already to be too
-great a discharge by the bowels; but there
-is this inconvenience from omitting them
-for a length of time, that those hard lumps
-of feces, called <i>scybala</i>, are apt to collect in
-the c&aelig;cum and cells of the colon, as I have
-seen upon inspecting the dead bodies; and
-the fibres of the intestines being weakened,
-their natural strength is not sufficient to expel
-them without being stimulated by a purgative.
-It is therefore necessary to give some
-evacuant medicine from time to time, even
-though there should be no griping nor any
-marks of acrimony in the intestines. Rhubarb
-is allowed to be one of the best medicines
-for this purpose; and I have also
-known a combination of salts and sena have
-<span class="pagenum" id="Page_497">497</span>
-a good effect after a long neglect of purgative
-medicines. It is probable, from the
-durable effects produced, that these do not
-operate merely by the expulsion of <i>scybala</i>;
-and we can conceive that they may be of
-service by the removal of certain depraved
-fluid secretions, or that they may stimulate
-the vessels to a more healthy action and a
-more natural secretion. Be this as it will,
-experience teaches that in all fluxes it is of
-advantage to interpose from time to time
-some purgative medicine.</p>
-
-<p>From the preceding view of the variety of
-causes which tend to keep up this disease, it
-will appear that great judgement and discrimination
-are necessary in varying the practice
-according to circumstances; and there is
-no disease in which there is room for more
-attention and nicety in adapting the different
-remedies to the different symptoms. We
-can hereby also account for the various characters
-that different remedies have had,
-some having been extolled by one practitioner
-while they have been pronounced insignificant
-by another; for no one remedy will
-<span class="pagenum" id="Page_498">498</span>
-suit all the various cases of this disease. As
-it is of the greatest consequence to distinguish
-these cases, I have been more particular
-and diffuse on this article than any other;
-and having laboured under this complaint
-myself, I was naturally led to take a greater
-interest in its treatment, and had also thereby
-a better opportunity of making observations
-on it.
-<span class="pagenum" id="Page_499">499</span></p>
-
-<h2 id="PART_III_CHAP_III">CHAP. III.</h2>
-
-<h3 id="OF_SCURVY">Of the <span class="smcap">Scurvy</span>.</h3>
-
-<p>I shall not be so minute either in the
-description or treatment of the scurvy, as of
-the preceding diseases. A detail of this kind
-would lead to unnecessary prolixity and repetition;
-for the prevention and cure of it
-consisting in diet rather than medicine, have
-been fully handled in the former parts of
-this work; and the subject, in the descriptive
-as well as the practical part, has, in a
-manner, been exhausted by Dr. Lind. With
-regard to the theoretical part, I refer the
-reader to the ingenious treatise lately published
-by Dr. Milman.</p>
-
-<p>It has appeared that the principal source
-of scurvy is a vitiated or scanty diet, and
-that it is very much promoted by cold,
-moisture, filth, sloth, and dejection of mind.
-Hard labour has been assigned by some as a
-cause; but this is not conformable to my
-<span class="pagenum" id="Page_500">500</span>
-observation in general, and what has been
-related to have happened in the Conqueror<a id="FNanchor_118" href="#Footnote_118" class="fnanchor">118</a>,
-more particularly led me to be of a contrary
-opinion.</p>
-
-<p>The principal differences of the symptoms
-of the scurvy in hot and cold climates, so far
-as I have observed, are, that in the former
-the livid hardness on the extremities is an
-earlier symptom, and in the latter the gums
-are sooner affected, and the difficulty of
-breathing is a more frequent and more uneasy
-symptom. This difficulty of breathing
-is one of the most fatal symptoms, and is
-most frequent in those cases in which
-there are the fewest external marks of the
-disease, and is probably that form of the
-complaint which attacks a vital part by a
-sort of translation from the extremities.
-<span class="pagenum" id="Page_501">501</span></p>
-
-<p>There is a remarkable symptom sometimes
-attendant on this disease which has escaped
-authors, and is mentioned in Mr. Telford’s
-Report, page 23. This is the <i>nyctalopia</i>,
-or weakness of the eye-sight, which was
-also common in the garrison of Gibraltar<a id="FNanchor_119" href="#Footnote_119" class="fnanchor">119</a>,
-among those who were affected with the
-scurvy, a disease that prevailed much during
-the late siege of that place.</p>
-
-<p>With regard to the cure, enough has been
-said in the preceding parts of this work to
-prove that fresh vegetables are the most effectual
-antiscorbutics. I shall here mention
-a fact farther in proof of this, which has not
-before been taken notice of. When the
-fleet arrived at Barbadoes in May, 1781,
-part of the soldiers, who served as marines,
-were affected with the scurvy, and being sent
-to the army hospital, where, at that time,
-no fresh animal food was allowed, they recovered
-much faster by being confined to vegetable
-<span class="pagenum" id="Page_502">502</span>
-articles, than the seamen who were
-fed upon fresh animal food without any fresh
-vegetables.</p>
-
-<p>It has farther appeared, that there is something
-in a particular class of fruit of the
-lemon and orange kind, which far surpasses
-every other remedy, whether dietetic or medicinal.
-Numberless instances have occurred,
-in the preceding part of this work, of
-men having recovered at sea from using the
-juice of this fruit alone, even under all the
-inconveniences of a sea diet. When the
-juice is intended to be kept for a length of
-time, it should be expressed and bottled, a
-small quantity of spirits being added to preserve
-it for if fire is used in preparing it,
-as in the form of a rob, I know for certain
-that its virtues will be thereby very much
-impaired. It is very difficult to say upon
-what principle these fruits act, for no sensible
-effects are produced by them except a
-small increase of some of the secretions.</p>
-
-<p>It ought to be mentioned here as a fact of
-great consequence, though very little known,
-<span class="pagenum" id="Page_503">503</span>
-and never, I believe, published before, that
-the juice of limes and lemons is the best detergent
-of any external application that has
-yet been tried in scorbutic ulcers. Nothing
-was found so effectual in preventing these
-from spreading, and in disposing them to
-heal, as an emollient poultice with<a id="FNanchor_120" href="#Footnote_120" class="fnanchor">120</a> lemon
-or lime juice sprinkled on its surface; or it
-was applied by soaking in it the lint with
-which the sore was dressed, and also as a
-lotion, in which case it was used diluted
-with two or three times its quantity of water;
-for if used pure, it was found too irritating,
-and was apt to bring on a fungous
-disposition. This precaution is particularly
-necessary with regard to limes, the juice of
-which is a much more concentrated acid
-than that of lemons. Mr. Lucas, surgeon
-of the Conqueror, favoured me with several
-valuable remarks in proof of this practice.
-A poultice was always found a good application
-<span class="pagenum" id="Page_504">504</span>
-in these cases, by its power of absorbing
-the acrimonious discharge, which would
-otherwise irritate the neighbouring parts.
-I have been informed by a navy surgeon,
-who served in the former war, that he has
-known the most obstinate ulcers cured by
-applying a paste of oatmeal and water, the
-surface of which was sprinkled with Goulard’s
-preparation of lead.</p>
-
-<p>The fleet was furnished with essence of
-malt; but its powers were so inconsiderable,
-that some of the surgeons denied that it had
-any. In trials, however, that were made in
-an early state of the disease, it was found to
-have a sensible effect in checking and removing
-it. It was also found of evident use
-in the bad ulcers so apt to arise in scorbutic
-habits, and in this intention was superior to
-the Peruvian bark as an internal alterative.
-Indeed, in those ulcers that were truly scorbutic,
-the bark was found to be of very little
-use; and, next to what has been already
-mentioned, joined to the advantages of diet,
-opium was found of the greatest service in
-<span class="pagenum" id="Page_505">505</span>
-disposing these, as well as all other ill-conditioned
-sores of hot climates, to heal.</p>
-
-<p>I have mentioned the scorbutic habit as
-distinguished from the scurvy, but there
-seems to be no difference except in degree;
-for a person may be laid to labour under the
-disease before it betrays itself by any obvious
-symptom, and it must have gathered a certain
-degree of force before visible symptoms
-are produced. The chief mark of this latent
-and incipient stage of the disease is that
-incurable state of ulcers that has been mentioned,
-whether they appear spontaneously
-or in consequence of slight accidents. There
-is another mark of this scorbutic habit which
-is not mentioned in any description of the
-disease I have ever seen. It is a soft, indolent
-tumour which arises under the skin on
-a part which has received a small blow, or
-contusion, so slight as not to break the skin.
-It most commonly appears about the elbow
-or fore-arm, and generally disappears without
-any inconvenience, what it contains being
-absorbed. A surgeon, who opened one
-of them, (a practice, however, not to be
-<span class="pagenum" id="Page_506">506</span>
-approved of) informed me that it consisted
-of fluid blood. We may also reckon a languor,
-or sense of weight, as one of those
-marks of scurvy which occur before the
-more obvious symptoms appear.</p>
-
-<p>In this state of the disease, the articles of
-lesser powers, such as malt and melasses,
-may be of service by preventing its farther
-progress, or the appearance of actual symptoms,
-and by restoring the constitution.</p>
-
-<p>In some of the early stages of this disease
-the effervescing mixture of acids with fixed
-alkali may probably also be of use. I never
-could perceive any sensible benefit in those
-cases in which I tried it, though some of
-the gentlemen of the fleet reported to me
-that they thought it of service.</p>
-
-<p>There is no article of the <i>Materia Medica</i>
-yet known that possesses any considerable
-power over this disease without the assistance
-of proper diet. With this assistance, however,
-it is found, that whatever tends to increase
-the fluid secretions, hastens very much
-<span class="pagenum" id="Page_507">507</span>
-the recovery of the scorbutic patient. I
-have observed a very striking instance of this
-in the effects of a spontaneous diarrhoea;
-for I have seen those hard livid swellings on
-the legs, that form one of the most constant
-symptoms of this disease, almost disappear,
-and the hams, from being contracted,
-become flexible in the course of twelve
-hours after the purging came on. I have
-endeavoured to imitate this with purgatives,
-but never with the same effects as the natural
-looseness. A free flow of urine is also
-found to promote the recovery, and vinegar
-of squills is one of the most effectual medicines
-in this intention. It is likewise of
-singular service to excite sweat; for an obstruction
-of perspiration seems to be one of
-the principal constituents of the disease. The
-goose skin, which is an early and constant
-symptom of this disease, seems to be owing
-to a constriction of the exhaling vessels.
-Dover’s powder has been employed with
-advantage as a sudorific, with decoction of
-the woods drank warm, and plentiful warm
-dilution. Camphor, combined with nitre,
-<span class="pagenum" id="Page_508">508</span>
-has been found one of the best remedies,
-and it acts both as a diaphoretic and diuretic.</p>
-
-<p>Such external applications as relax the
-skin are found also to forward the cure.
-The contraction of the hams and the livid
-hardness of the calves of the legs are relieved
-by emollient cataplasms. Burying the
-legs in the earth, which has a sensible good
-effect, seems to act on the same principle,
-for it makes the parts sweat profusely.</p>
-
-<p>There can be no doubt that in the scurvy
-there takes place in certain parts of the
-body a stagnation of the humours in the
-small vessels, particularly of the lower extremities,
-and that it is to this circumstance
-that the livid hardness of the fleshy parts of
-the legs is owing. The effect of medicine
-in removing this, must be to restore the action
-of those torpid vessels, so as to bring
-the stagnated fluids again into circulation<a id="FNanchor_121" href="#Footnote_121" class="fnanchor">121</a>
-<span class="pagenum" id="Page_509">509</span>
-Purgatives seem to act upon it as they do in
-the dropsy, by exciting absorption. The irritation
-of the bowels and their increased
-secretion thus affecting the minute vessels in
-all parts of the body, is the result of that
-sympathy or balance established between
-every part of the system, in order to support
-the harmony and effect the purposes of
-the animal œconomy.</p>
-
-<p>It has long appeared to me, that the scurvy
-is owing rather to a defect of nourishment
-than to a vitiated state of it. In fact,
-that sort of food which is supposed most
-commonly to induce the scurvy, is, in most
-cases, not putrid, but is in an unnatural and
-depraved state by being drained of its juices,
-which run off in brine; and perhaps some
-<span class="pagenum" id="Page_510">510</span>
-of the more subtile and nutritious parts are
-wasted by evaporation. It is not found that
-salt of itself has any effect in inducing the
-scurvy, and indeed it can be induced under
-a state of diet in which there is no salt, as
-we know from some instances quoted by Dr.
-Lind; and some cases are related by Dr.
-Monro and Dr. Milman, in the Medical
-Transactions, which are in proof of the same
-opinion. But the case most in point to prove
-that it depends on a defect of aliment, is
-that of Dr. Stark, who, by way of experiment
-on himself, reduced his diet to the
-least quantity he could subsist upon, and was
-thereupon affected with the symptoms of the
-sea scurvy. I have also known some symptoms
-of it arise in old people in consequence
-of long abstinence, owing to the want of
-appetite.</p>
-
-<p>It would appear that the aliment we take
-in acts in two ways in increasing the vigour
-of the body. First, by assimilation, whereby
-it affords the matter of which the solids
-of the body are made, in order to carry on
-growth in youth; and to repair the waste of
-<span class="pagenum" id="Page_511">511</span>
-parts in adult age. A very small quantity
-of matter is necessary for these purposes;
-and as a proof of it, we see people supported
-equally well with very different quantities
-and qualities of food. Secondly, Food is
-necessary as a stimulus, either by a power it
-has of soothing the nerves of the stomach,
-and the other surfaces to which it is applied,
-or by its volume in distending the intestines
-and blood vessels. It is upon this principle
-that luxury renders the great quantities of
-food we take in necessary; and those species
-of food which satisfy most by their stimulus
-are by no means such as are the most nutritious.
-It is also upon this principle, that
-in cases of accidental hardship from want
-of food, or in barren and inclement countries
-where food is scarce, the body is supported,
-in some measure, by what contains
-little or no nutritious matter, such as pure
-water, or the bark of trees powdered and
-kneaded into a sort of bread, as we are told
-of the inhabitants of Lapland.</p>
-
-<p>There are other familiar and well-established
-facts, which prove, that either from
-<span class="pagenum" id="Page_512">512</span>
-the influence of disease, from habits of life,
-or the nature of particular animals, life can
-go on for a length of time with little or no
-aliment. This is the case in fevers, in sea-sickness,
-in certain singular cases that have
-been recorded<a id="FNanchor_122" href="#Footnote_122" class="fnanchor">122</a>, in torpid animals, and in
-animals of cold blood. Though a man in
-health will die if deprived of food for a very
-few days, it does not follow that this is owing
-to the want of matter to repair the
-waste of the body. The craving for food,
-and the faintness from long abstinence, arise
-from the want of the accustomed stimulus,
-especially in those who are used to live well;
-and a person feels himself most refreshed by
-food and drink when newly taken in, and
-before it can be applied to the purpose of
-nutrition.</p>
-
-<p>As there is a continual waste and decay,
-however, both of our fluids and solids, some
-degree of reparation is absolutely necessary,
-especially to animals of warm blood; and
-<span class="pagenum" id="Page_513">513</span>
-such <i>ingesta</i> as would give the stimulus of
-food, without being possessed of any nutritious
-principle, would indeed continue life
-for a certain time; but disease would ensue.
-The provision used at sea answers, in a great
-measure, to this description; for unless the
-powers of digestion and assimilation are remarkably
-strong, salt beef and biscuit, which
-have been long kept, do not contain much
-more nourishment than saw-dust, or the bark
-of a tree, and the disease induced by this
-diet is the scurvy.</p>
-
-<p>The nature and symptoms of the scurvy
-countenance this opinion: for as the means
-of renewing the animal matter of our bodies
-is withdrawn under this course of diet, nature,
-in consequence of an accommodating
-principle, observes a sort of frugality, and
-the animal œconomy adopts such measures
-as may be productive of the least possible
-waste and corruption of the fluids. Accordingly
-all the secretions become scanty; and,
-in particular, one of the first symptoms of
-this disease is a suppression of perspiration,
-as appears by the goose-skin that attends it.
-<span class="pagenum" id="Page_514">514</span>
-There is a paucity of urine. There is also
-a great languor in the circulation, which
-may be considered either as a means adopted
-by nature to prevent that vitiated and effete
-state of the fluids which a brisker action
-might induce; or it may happen from a
-want of that due supply of nourishment necessary
-to produce a vigorous action of all
-the functions.</p>
-
-<p>We have a proof of this general languor
-not only from the great aversion to motion,
-and the great disposition to syncope, but
-from the inspection of the dead body, from
-which it appears that the whole circulating
-system, being more flaccid and less elastic,
-is subject to preternatural distention. The
-heart is accordingly found enlarged in bulk,
-the size of the cavities being increased; and
-in the extremities, where the circulation is
-naturally most languid, the small vessels
-carrying the colourless part of the blood, are
-so far enlarged as to admit the red part of it,
-as appears by the livid colour; and where
-this is the case, these vessels being unable to
-carry on the circulation, a stagnation ensues,
-<span class="pagenum" id="Page_515">515</span>
-as is evident in those livid appearances most
-common about the calves of the leg, which
-feel like a hard cake. I have examined
-those parts in the dead subject, and found a
-want of fluidity in the contents of the vessels,
-but could not discover any thing like
-<i>eechymosis</i>; from which I concluded that the
-colour was owing to an <i>error loci</i>, and the
-hardness to stagnation and coagulation of
-the fluids, and a want of action of the
-vessels.</p>
-
-<p>The incurable state of ulcers, so common
-in this disease, is also what we might expect
-from the defect of fresh assimilated
-juices; for where a breach is made, either
-by nature or accident, in the solids, particularly
-of the extremities, the proper suppuration
-is prevented by the depraved state
-both of the fluids and vessels; and we cannot
-expect that renewal of solid parts in
-which healing consists, where both the instruments
-and materials of its formation are
-so defective.
-<span class="pagenum" id="Page_516">516</span></p>
-
-<p>I shall conclude what I have to say on
-this subject, by shortly considering whether
-or not this disease is ever contagious.</p>
-
-<p>There is something in the nature and
-history of the scurvy that would lead us at
-once to pronounce that it is not infectious;
-for the external causes on which it depends
-are so obvious, and seem so adequate to account
-for its appearance and prevalence upon
-certain occasions, as at first sight to exclude
-every other external cause.</p>
-
-<p>But it seems extremely unphilosophical to
-deny the reality or possibility of any thing
-in Nature, from our supposed knowledge of
-the means and causes she employs, particularly
-in a branch of science so obscure as the
-animal œconomy. Could we, therefore,
-prove the point as a matter of fact, it would
-be in vain to deny it, from our fancied acquaintance
-with Nature’s modes of operation.</p>
-
-<p>The facts which give a suspicion of the
-scurvy being infectious are, 1st, What is
-<span class="pagenum" id="Page_517">517</span>
-related by Dr. Lind, that the sea scurvy
-spread at one time from the naval hospital to
-the people of the adjacent country. 2dly,
-There occurred several instances, in the first
-part of this work, of this disease prevailing
-to a much greater degree in some<a id="FNanchor_123" href="#Footnote_123" class="fnanchor">123</a> particular
-ships than others, though upon the most
-accurate inquiry there was found no difference
-in the diet, or any other external or
-predisposing cause adequate to account for
-this. We can conceive, that those ships
-having accidentally a few men, whose constitutions
-were remarkably predisposed to
-this disease, might catch it earlier than in
-other ships, and communicate it to the rest
-of the crew.</p>
-
-<p>The only practical inference that would lie
-from the establishment of this fact would be,
-that when the disease begins first to appear,
-the men affected should be separated from the
-rest; and this is a good practice, whether
-this opinion is true or not; for such men
-<span class="pagenum" id="Page_518">518</span>
-ought to be put in one mess, in order that
-they all may live upon the same antiscorbutic
-articles of diet, and that they may more easily
-be debarred from the use of their common
-provisions, of which this disease does
-not make them lose the relish.
-<span class="pagenum" id="Page_519">519</span></p>
-
-<h2 id="PART_III_CHAP_IV">CHAP. IV.</h2>
-
-<h3 id="OF_THE_WOUNDS_RECEIVED_IN_THE_ACTIONS_OF_APRIL_1782">Of the <span class="smcap">Wounds</span> received in the Actions of
-April, 1782.</h3>
-
-<blockquote>
-
-<p>Loss in the Battle and from Wounds&mdash;Fatality of the
-locked Jaw&mdash;Treatment of it&mdash;Some Ships more
-subject to it than others&mdash;Different from other Cases
-of Tetanus&mdash;It is not cured by the Removal of the
-Part&mdash;It may come on after the Part is cured&mdash;Effect
-of Climate in producing it&mdash;Accidents from the
-Wind of a Ball&mdash;Accidents from the Explosion of
-Gunpowder&mdash;Means of preventing them&mdash;General
-Observations on Sores and Wounds.</p></blockquote>
-
-<p>Though surgery was not properly in
-my department, yet, having had a fair opportunity
-of collecting facts concerning this
-branch of practice, I thought it my duty to
-pay some attention to it.</p>
-
-<p>The whole number of men wounded in
-the actions of April, 1782, amounted to eight
-hundred and ten.
-<span class="pagenum" id="Page_520">520</span></p>
-
-<p>Of these, sixty died on board before the
-end of the month, five in the course of the
-following month, and two in June.</p>
-
-<p>There were ninety-seven wounded men
-sent to the hospital at Port Royal, of whom
-there had died twenty-one when the fleet left
-Jamaica on the 17th of July.</p>
-
-<p>So that the whole loss of men in the battles
-of April, and their consequences, is as
-follows:</p>
-
-<table>
-  <tr>
-    <td>Killed outright</td>
-    <td class="tdr">266</td>
-  </tr>
-  <tr>
-    <td>Died of their wounds on board</td>
-    <td class="tdr">67</td>
-  </tr>
-  <tr>
-    <td>Died of their wounds at the hospital</td>
-    <td class="tdr">21</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="bt tdr">354</td>
-  </tr>
-</table>
-
-<p>Of those who died on board, fifteen<a id="FNanchor_124" href="#Footnote_124" class="fnanchor">124</a> were
-carried off with the Symptoms of the locked
-<span class="pagenum" id="Page_521">521</span>
-jaw; but of those sent to the hospital, only
-one. The reason that so few in proportion
-were affected with it in the hospital may
-have been, that none of the wounded were
-landed till near the end of the third week
-after the principal action. The danger of
-this symptom was then, in a great measure,
-past, though I have known it to take place
-in every period from the second or third day
-till the fourth week.</p>
-
-<p>Only three men in the whole fleet recovered
-from this alarming complaint; and as
-it is interesting to know every thing relating
-to so desperate a symptom, I shall give a
-short account of each.</p>
-
-<p>The first was a seaman of the Montagu,
-<span class="pagenum" id="Page_522">522</span>
-who had his thigh wounded by a splinter
-which carried away part of the integuments
-and <i>membrana adiposa</i>, and lacerated in a small
-degree the <i>vastus externus</i> muscle. The
-wound did extremely well till the 23d day,
-when the jaw became almost entirely fixed,
-and the whole muscles of the wounded side
-were thrown into frequent spasms. Mr.
-Young, the surgeon, who was always anxious
-and assiduous in his duty, consulted with me,
-and we had immediate recourse to the warm
-bath, which gave a degree of instantaneous
-relief, and was repeated twice a day for half
-an hour. He was sensibly better every time;
-in nine days was entirely free of the symptom,
-and continued afterwards to do well.
-The only other means taken for this man’s
-recovery, besides what were used with the
-other wounded men, were from three to five
-grains of opium, which he took every day,
-in divided doses.</p>
-
-<p>The next was a seaman of thirty years of
-age, belonging to the Magnificent, who had
-the <i>humerus</i> broken and shattered by a splinter
-which entered the deltoid muscle. Several
-<span class="pagenum" id="Page_523">523</span>
-large portions of bone were extracted,
-and the artery was laid bare on the inside.
-On the fifth day there came on a large ichorous
-discharge, with a low quick pulse and
-depressed spirits, and the jaws began to close,
-with pain and stricture on both sides about
-the articulation of the lower jaw. He had
-every day since the accident taken half an
-ounce of Peruvian bark, combined with
-opium or rhubarb, according as it made him
-loose or costive. This was continued, and
-the part externally was kept constantly moist
-all round with volatile liniment, to which a
-fourth part of <i>tinctura thebaica</i> was added.
-Next day the jaw was almost entirely fixed,
-so that it was with difficulty that a little
-wine and water could be introduced with a
-spoon. Mr. Harris, the surgeon, now wisely
-determining to do something vigorous in
-this unpromising situation, beat up twelve
-ounces of opium moistened to the consistence
-of a cataplasm with the thebaic tincture,
-and applied one half to each side of
-the jaw. The patient this day swallowed
-a pint of the bark decoction with half an
-ounce of nitre, and took a diaphoretic
-<span class="pagenum" id="Page_524">524</span>
-draught of twenty drops of thebaic tincture
-and thirty of antimonial wine. He had
-also the smoke of tobacco thrown up his
-nostrils.</p>
-
-<p>On the third day after the attack he could
-open his mouth half an inch. The cataplasms
-were taken off, beat up afresh with
-the tincture, and applied anew. The bark
-and other medicines were continued. On
-the fourth day the stricture and pain of the
-jaw went entirely off, but the cataplasm and
-volatile liniment were applied for three days
-longer. The wound produced a laudable
-discharge, every symptom became favourable,
-and he continued to recover.</p>
-
-<p>The only other person who recovered from
-this symptom was a man in the Bedford.
-Several died of it on board of this ship; and
-as the same means of relief were skilfully
-employed in all the cases by Mr. Wickes,
-the surgeon, the success seemed owing more
-to something favourable in the man’s constitution,
-than any thing peculiar in the treatment,
-which consisted in the administration
-<span class="pagenum" id="Page_525">525</span>
-of the warm bath, opium and camphor, with
-mercurial friction on the jaw.</p>
-
-<p>This accident affected some ships remarkably
-more than others, particularly the Barfleur
-and Bedford, though their wounds had
-nothing peculiar, nor were in a greater proportion
-than in the rest of the fleet. Four
-were carried off by it in each of these ships.
-It has formerly been observed, that great
-ships acquire peculiar habits, or dispositions,
-which incline the constitutions of the men to
-one disease more than another. This complaint
-took a run in some particular ships last
-year also after the battle of the Chesapeak;
-and I have known it prevail in some particular
-hospitals more than others. In the
-present instance, it may have been owing
-either to something peculiar in the constitution,
-or air of the ships; or we can conceive
-it to be owing to some sort of nervous
-sympathy, just as the <i>epilepsy</i><a id="FNanchor_125" href="#Footnote_125" class="fnanchor">125</a> has been
-known to spread from one boy to another,
-<span class="pagenum" id="Page_526">526</span>
-at a school, in consequence of imitation,
-dread, horror, or some such delicate nervous
-or mental affection. We have in yawning
-an example of a spasmodic affection spreading
-from one person to another. If this is
-the case in the locked jaw, those affected by
-it should be removed from the presence of
-the other wounded men, lest the idea of the
-sufferings of others should be so fixed in
-their mind, or so impress them with the
-fear of the like, as to invite the attack of
-the same complaint.</p>
-
-<p>Though the locked jaw, in consequence of
-wounds, resembles frequently in its symptoms
-the tetanus which arises without any
-external accident, yet there are many cases
-of the former which differ materially from
-the violent symptoms of the other, as described
-by authors. In most cases of the
-locked jaw from wounds the spasms are not
-<span class="pagenum" id="Page_527">527</span>
-so general, so violent, nor attended with
-such exquisite pain. It sometimes happens
-that the convulsive twitchings are even accompanied
-with a sort of pleasure, as in the
-case of a lieutenant of the Montagu, whose
-case was related to me by Mr. Young, the
-surgeon of that ship, a man of skill and observation
-in his profession, and upon whose fidelity
-and accuracy I could perfectly rely. This
-officer had been wounded in the elbow at the
-battle of St. Christopher’s by a splinter,
-whereby the capsular ligament of the joint
-was injured. On the ninth day, symptoms
-of the locked jaw came on, and soon after
-the whole muscles of the wounded side were
-affected with frequent convulsive twitchings,
-which, as he himself said, afforded a pleasant
-sensation, exciting laughing like an agreeable
-titillation. He died on the fourth day after
-it came on, and had no pain to the last.</p>
-
-<p>The locked jaw from accident differs also
-from other cases of tetanus, in respect to its
-cure; for the latter has been successfully
-treated by cold bathing, as is related by
-<span class="pagenum" id="Page_528">528</span>
-Dr Wright<a id="FNanchor_126" href="#Footnote_126" class="fnanchor">126</a> and Dr. Cochrane<a id="FNanchor_127" href="#Footnote_127" class="fnanchor">127</a>; but it is
-acknowledged by the latter that this treatment
-did not answer when the complaint
-proceeded from a wound.</p>
-
-<p>It is to be remarked, that the locked jaw
-did not take place in those cases in which the
-wounds had a foul and gangrenous appearance
-more than others; for those that digested
-and cicatrized favourably, were equally
-apt to be affected by it; and though amputations
-are most liable to this symptom, the
-slightest injuries, even a scratch, will sometimes
-bring it on.</p>
-
-<p>It would be difficult, therefore, to establish
-any particular treatment that would
-tend to prevent accidents of this kind; but
-Mr. Bassan, surgeon of the Arrogant, one
-of the line-of-battle ships engaged on the
-12th of April, mixed laudanum with the
-dressings of all the wounds, and no locked
-jaw occurred.
-<span class="pagenum" id="Page_529">529</span></p>
-
-<p>In the Bedford there occurred a curious
-circumstance concerning this complaint. In
-one of the cases that proved fatal, the symptoms
-did not come on till the wound was so
-far healed that all dressing had been laid
-aside.</p>
-
-<p>Mr. Wood, surgeon of the hospital at Jamaica,
-informed me, that in cases of the
-locked jaw from injuries to small members,
-such as fingers, he had tried the effect of
-amputating the part after the symptoms had
-come on, but without any effect in putting
-a stop to them.</p>
-
-<p>Would it not appear, from the two last
-mentioned facts, that this symptom is not
-kept up, nor even takes place in the first instance,
-from an immediate present irritation,
-but that the constitution comes to be so modified,
-or receives such an impulse, as it
-were, that the complaint runs its course
-independent of the presence of that <i>stimulus</i>
-which excites it?</p>
-
-<p>It would be difficult to assign a satisfactory
-reason why this accident is more frequent in
-hot than in cold climates. The effect of
-<span class="pagenum" id="Page_530">530</span>
-external heat upon the living body is not to
-raise its temperature even when the heat of
-the air exceeds that of the body<a id="FNanchor_128" href="#Footnote_128" class="fnanchor">128</a>; so that we
-are to seek for the effects of it in some of
-those affections peculiar to animal life. And
-as the outward temperature of the air does
-not affect the general mass of the body, all
-the effects produced by it must depend on
-impressions made on the external surface of
-the body and lungs; and the skin, which
-may be considered as a large expanded tissue
-of nervous fibres endowed with universal
-sympathy and great sensibility, affects every
-organ and every function of the body, according
-to the state of the air in contact with
-it, whether cold or hot, moist or dry, pure
-or vitiated. This sympathetic sensibility of
-the skin is chiefly affected by the state of
-the perspiring pores on its surface; for it is
-only when these are open that the impression
-of the air on the skin produces catarrhs,
-rheumatisms, and internal inflammations in
-cold climates; and the external temperature
-in hot climates being such as to keep the
-<span class="pagenum" id="Page_531">531</span>
-pores almost always open, this seems to be a
-principal reason of that universal irritability
-prevailing there, and of the general sympathy
-that prevails between every part, particularly
-as connected with the organs of perspiration<a id="FNanchor_129" href="#Footnote_129" class="fnanchor">129</a>.
-This readiness of one part to
-be affected by another in hot climates is well
-illustrated by the sudden translation of certain
-diseases. I have seen, for instance, a
-catarrh cease, and be converted, as it were,
-into a diarrhœa, and this as quickly disappearing,
-a pain in the foot would arise, like
-an attack of the gout. All this would happen
-in the space of a few hours.</p>
-
-<p>But, in cold climates, wounds are by no
-means exempt from the locked jaw; for it
-sometimes occurs in England, where I have
-seen it even in the winter season<a id="FNanchor_130" href="#Footnote_130" class="fnanchor">130</a>.
-<span class="pagenum" id="Page_532">532</span></p>
-
-<p>Since my return to England I have received
-some new and useful information on
-this subject in conversing with Dr. Warren,
-physician to the King; and as any observations
-derived from so much acknowledged
-skill and sagacity must be valuable, I shall
-here relate what he was so kind as to communicate
-to me.</p>
-
-<p>This eminent physician, in attending a
-case in which he was nearly interested, and
-in which his endeavours were rewarded with
-success, found the greatest benefit from
-opium and the warm bath. The opium was
-given in the form of tincture, in moderate,
-but pretty frequent, doses. The bath was
-composed of milk and water, and the addition
-of milk was, no doubt, an improvement;
-for there is something in this as well
-as oil extremely soothing to the human
-nerves. Dr. Warren had intended to make
-trial of a bath of oil in case this had failed.
-He mentioned the following observation,
-with regard to the external application of
-oil, which could only have been suggested
-by that anxious attention that was paid to
-the case. It was found, that the uneasiness
-<span class="pagenum" id="Page_533">533</span>
-arising from the spasm was allayed by constantly
-drawing a feather wetted with oil
-over the temples, which had an evident effect
-in lulling the pain and spasm; for when
-this operation was left off, there was an immediate
-recurrence of these symptoms<a id="FNanchor_131" href="#Footnote_131" class="fnanchor">131</a>.</p>
-
-<p>It would appear, therefore, from this as
-well as the former cases, that opium and
-the warm bath are the only remedies yet
-known which are of service in this complaint,
-and much will depend on the judicious management
-of them. The method of administering
-the opium, recommended by Dr.
-Warren, seems to be the most judicious,
-especially in constitutions not habituated to
-this medicine.
-<span class="pagenum" id="Page_534">534</span></p>
-
-<p>There is a certain medium in giving opium,
-by which its best effects are obtained, for in
-an under dose it will produce disturbance instead
-of rest; and when it is given in large
-quantities it frequently defeats the very end
-for which it is given, by throwing the body
-into convulsions which terminate in death.
-The rule for judging of the proper limits of
-this dose is, by its effect in inducing that
-stupor or insensibility which renders the
-senses incapable of irritation; for in this,
-as well as in every other case of disease, the
-cure seems ultimately to be the work of nature,
-the effect of medicine being only a secondary
-operation, by which it removes
-some obstacle to the natural efforts of the
-constitution. Though a dose of opium
-greater than ordinary is required to produce
-this insensibility in cases of spasm, and
-though the constitution in that situation will
-bear more, yet even here it may be given to
-excess; and by beginning with small quantities,
-and giving it in frequent rather than
-large doses, the constitution will thereby be
-better reconciled to it, and it will also with
-more convenience admit of that gradual increase
-which is peculiarly necessary with this
-<span class="pagenum" id="Page_535">535</span>
-medicine. These ideas were suggested to me
-by Dr. Warren; and it may be farther added,
-in recommendation of his method, that the
-liquid form is preferable to the solid, as the
-effects of it will sooner be seen, and a better
-judgement can be formed how far it is proper
-to push it.</p>
-
-<p>Great attention is also necessary in regulating
-the heat of the bath; for if it is not
-sufficiently warm, it will not have the effect
-of producing a due relaxation; and if it
-should be too hot, it will stimulate too
-much, and will have the farther inconvenience
-of making the patient very faint in a
-short time. It cannot be well regulated
-without a thermometer, and 93&deg; upon Fahrenheit’s
-scale is perhaps the best temperature.
-I have kept a patient in a bath of
-that heat for six hours, which he could not
-have endured for half an hour had the heat
-been three or four degrees higher.</p>
-
-<p>The circumstance next in consequence, in
-the cure of this complaint, is the keeping
-up a moisture on the skin, and guarding the
-surface of the body from the access of the
-<span class="pagenum" id="Page_536">536</span>
-air. This is particularly necessary with regard
-to the part itself, which should be constantly
-enveloped in warm, anodyne, and
-emollient applications. The good effects of
-this is particularly exemplified in the case
-which recovered under the care of Mr. Harris,
-who gave the diaphoretic medicine, composed
-of antimonial wine and laudanum, and
-applied the anodyne cataplasm to the external
-<i>fauces</i>. It was remarked, that the locked
-jaw was most incident to those wounded
-men who lay in parts of the hospital where
-they were exposed to a current of air; and
-the cases of tetanus that most usually occur
-in the West Indies, independent of wounds,
-are those of slaves who fall asleep in the
-night-time in the open air.</p>
-
-<p>Since the first edition of this work, there
-has appeared an Essay on the Locked Jaw
-by Dr. Rush, physician to the American
-army in the late war, in which he recommends,
-from his own observation, Peruvian
-bark, wine, and blisters, and to dress the
-wounds with mercurial ointment, in the
-cure of this complaint. From some trials I
-have since made of the bark in St. Thomas’s
-<span class="pagenum" id="Page_537">537</span>
-hospital, I have reason to think well of it as
-a remedy in this disease.</p>
-
-<p>There is a singular species of accident to
-which engagements at sea are liable, the <small>WIND
-OF A BALL</small>, as it is called. If a cannon ball
-in its flight passes close to any part of the body,
-it renders it livid and numb for some time<a id="FNanchor_132" href="#Footnote_132" class="fnanchor">132</a>.
-It is most dangerous when it approaches the
-stomach; and there was an instance of a
-man in the last battle, who, upon a ball
-passing close to his stomach, dropped down
-dead instantaneously, without the least visible
-marks of injury. Another, in consequence
-<span class="pagenum" id="Page_538">538</span>
-of a ball passing close to his belly,
-remained without sense or motion for some
-time, and a large livid tumor arose on the
-part, but he recovered. I attended a man
-at the hospital at Barbadoes, who had the
-buttons of his trowsers carried off by a
-cannon ball, without its having touched the
-body. The <i>pubis</i> was livid and swelled for
-some time after: he suffered exquisite pain
-from strangury, which seemed to proceed
-from a <i>paralysis</i> of the bladder, for he voided
-no water without a catheter for near three
-months, after which time he recovered. I
-know a brave young officer<a id="FNanchor_133" href="#Footnote_133" class="fnanchor">133</a> in the army,
-who had his epaulette carried off by a cannon
-ball at Charlestown, in consequence of
-which the shoulder and adjacent parts of the
-<span class="pagenum" id="Page_539">539</span>
-neck were affected for some time. A like
-accident happened to a marine officer in one
-of the late engagements; but in neither of
-these was the head materially affected, nor
-is it so apt to be affected in this way as the
-stomach. I never knew death the consequence
-of the wind of a ball on the head;
-though an officer<a id="FNanchor_134" href="#Footnote_134" class="fnanchor">134</a> in the Sultan, at the battle
-of Grenada, was so stunned by a shot
-passing near his temple, as to be insensible
-for some time, but he recovered entirely in a
-few hours<a id="FNanchor_135" href="#Footnote_135" class="fnanchor">135</a>.</p>
-
-<p>The class of wounds most peculiar to a sea
-engagement are scorches from the accidental
-explosion of gunpowder; and in most of the
-campaigns in which I have served they have
-been very frequent and fatal. Few accidents,
-however, of this kind happened in the late
-engagements; so that we had but little experience
-of this sort of wounds in April, 1782.
-But on former occasions they were very frequent,
-and the best application to the burnt
-<span class="pagenum" id="Page_540">540</span>
-parts was found to be linseed oil, which
-some of the surgeons mixed with lime water,
-others with cerusse, and both compositions
-answered well. Opium was found of
-great use in alleviating pain and procuring
-rest, care being taken to guard against costiveness
-by the use of clysters. In the battles
-of 1780 and 1781, one-fourth part of
-the whole killed and wounded was from this
-sort of accident; but on the 9th and 12th of
-April, 1782, only two accidental explosions
-of gunpowder happened in the whole fleet,
-by one of which one life was lost, by the
-other, two. This difference was owing
-partly to greater experience and habits of
-caution acquired in the course of the war,
-and partly to certain improved methods in
-working the artillery introduced by Sir
-Charles Douglas, which, like all his other
-valuable improvements, tend to give facility
-and expedition, as well as to save the lives of
-men. The circumstances which tend to prevent
-explosions are, 1st, The wetting of the
-wads, which prevents their inflaming and
-blowing back when they fight the weather
-side of the ship; a circumstance which, without
-this precaution, gives occasion to a number
-<span class="pagenum" id="Page_541">541</span>
-of accidents by the burning parts catching
-the loose powder, or setting fire to the
-cartridges. 2dly, The use of goose-quill
-tubes and small priming boxes, made of tin,
-instead of the large horns formerly in use,
-whereby great quantities of powder were
-scattered about and exposed to accidental fire.
-3dly, The use of locks, which was practised
-with great success in several ships, and
-was found to make the operation both more
-safe and more expeditious.</p>
-
-<p>It frequently happens that men bleed to
-death before assistance can be procured, or
-lose so much blood as not to be able to go
-through an operation. In order to prevent
-this, it has been proposed, and on some occasions
-practised, to make each man carry
-about him a garter, or piece of rope-yarn, in
-order to bind up a limb in case of profuse
-bleeding. If it should be objected, that this,
-from its solemnity, may be apt to intimidate
-common men, officers at least should make
-use of some such precaution, especially as
-many of them, and those of the highest rank,
-are stationed on the quarter deck, which is
-one of the most exposed situations, and far
-<span class="pagenum" id="Page_542">542</span>
-removed from the cockpit, where the surgeon
-and his assistants are placed. This was
-the cause of the death of Captain Bayne, of
-the Alfred, who, having had his knee so
-shattered with a round shot, that it was necessary
-to amputate the limb, expired under
-the operation, in consequence of the weakness
-induced by loss of blood in carrying him
-so far. As the Admiral, on these occasions,
-allowed me the honour of being at his side,
-I carried in my pocket several tourniquets of
-a simple construction, in case accidents to
-any person on the quarter deck should have
-required their use.</p>
-
-<p>It sometimes happens, however, that no
-h&aelig;morrhage arises from a limb being carried
-off by a ball. The surgeon of the Fame related
-to me an instance of this, in which the
-thigh was cut through by a shot near its upper
-part, all except a little flesh and skin, and
-yet not the least h&aelig;morrhage followed. This
-may have been owing to the limb being entirely
-severed, or nearly so, whereby the vessels
-contracted more easily than if they had
-been partially divided. All that was done for
-this man was to remove the limb, and to
-<span class="pagenum" id="Page_543">543</span>
-saw off the jagged end of the bone. He
-survived six days, still without bleeding, and
-died of the locked jaw.</p>
-
-<p>I was informed by several of the surgeons,
-that the method of taking up the vessels
-by the <i>tenaculum</i> was found to answer extremely
-well; and many of them imagined
-that the locked jaw was not so apt to be
-brought on by this mode of operation as by
-that of the needle. But it is hardly to be
-attempted in time of action, for want of
-steadiness and a good light, and it was chiefly
-at the hospitals that this practice was found
-so successful.</p>
-
-<p>Mr. Alanson’s method of amputation by a
-great retraction of the muscles, so that the
-fleshy parts shall meet over the bone and unite
-in the first intention, was attended with great
-success in the West Indies, particularly at the
-hospital at St. Lucia, under the care of Mr.
-Bulcock.</p>
-
-<p>It may be remarked, that though all sores
-and wounds in the foot and leg are difficult
-<span class="pagenum" id="Page_544">544</span>
-of cure in a hot climate, I have observed,
-that, where the constitution is good, those
-in the thighs, arms, trunk, and head, are
-rather more easy of cure than in Europe,
-and that parts divided by incision very readily
-unite by the first intention. In reasoning
-upon this, it may be said, that as healing
-depends on a certain degree of vigour in
-the powers of life, this should not err either
-on the side of excess or defect. If it is too
-great, as in the case of a hale, plethoric
-constitution in a cold climate, too much inflammation
-is apt to be excited; and if too
-feeble, as happens in a hot climate, in the
-lower extremities, which are far removed
-from the source of life and circulation, the
-salutary effort is not strong enough to generate
-new organised parts. But in the trunk
-of the body, in such a climate, the powers
-of the animal œconomy are in that just medium
-which is most favourable to this operation
-of nature.</p>
-
-<h5>THE END.
-<span class="pagenum" id="Page_545">545</span></h5>
-
-<p class="ph1" id="APPENDIX_TO_PART_III">APPENDIX<br />
-
-<span class="x-small">TO</span><br />
-
-<span class="x-large">PART III.</span></p>
-
-<p>It has been suggested to me, that it would
-add to the utility of this Work to subjoin a
-list of the remedies best suited to the practice
-of physic at sea, with their quantities,
-and to give a set of formulas for the direction
-of young practitioners. I have accordingly
-made out a gross computation of the
-requisite quantities of the most useful and
-necessary articles of the Materia Medica, and
-also a few of the most commodious and simple
-forms of administering some of the most
-efficacious remedies for the most common
-diseases.</p>
-
-<p>It is of consequence every where, but
-especially on board of a ship, to simplify
-practice, as much as possible, with regard to
-the number, the preparation, and the administration
-of medicines. Where a great
-number of compound medicines are given,
-it is extremely difficult to ascertain, by accurate
-and satisfactory observations, what
-<span class="pagenum" id="Page_546">546</span>
-are their real effects; and as there are not
-conveniences at sea for great pharmaceutical
-nicety, the plainest forms should be adhered
-to. And as all operations are rendered more
-practicable and easy by being reduced to a
-stated method, this is an additional inducement
-for studying plainness and simplicity
-in preparing and administering remedies.
-This uniformity is more attainable in the
-public service than in private practice; for
-in the former all the patients are of one sex,
-they are all adults, and they are generally
-of robust constitutions.</p>
-
-<p>In the list hereto subjoined the articles
-are distinguished into <small>PRINCIPAL</small> and <small>SECONDARY</small>;
-and when a surgeon considers how
-limited his funds are, I hope he will not
-think that I have made a disproportionate
-assortment in reducing the number and quantities
-of the latter, my view in this having
-been that he may better afford an ample
-proportion of such medicines as are
-really efficacious and indispensable in the
-cure of diseases. It may be affirmed, without
-vanity or arrogance, that the printed
-list of articles with which the navy surgeons
-are enjoined to supply themselves is
-very injudicious considering the present improved
-state of the medical art; and it is of
-great importance that the due proportion of
-each article should be ascertained as nearly as
-<span class="pagenum" id="Page_547">547</span>
-possible, that no unnecessary expence may
-be incurred, and that the chest may not be
-encumbered with unnecessary articles.</p>
-
-<p>There are no simple distilled waters in the
-following list, as they are very corruptible,
-and too bulky to carry to sea. Their place
-is supplied by a small quantity of oil of mint,
-which may be occasionally added to common
-water, in the proportion of a drop to an
-ounce. There are no tinctures inserted, except
-laudanum, the traumatic balsam, and
-compound spirit of lavender, as the surgeon,
-having a proper supply of spirit of wine
-or rum, may make them on board of the
-ship.</p>
-
-<p>In the following list the surgical articles
-are not enumerated. There is a new article
-which I beg leave to recommend, as it has
-lately been found extremely useful, and is
-now used in large quantities in the hospitals
-in London. This is linseed meal for poultices.
-The surgeon should also be provided
-with a sufficient quantity of linseed oil, as it
-has been found to be one of the best ingredients
-in dressings for scorches. <a href="#Page_540">See page
-540.</a></p>
-
-<p>The quantity of each article is adapted to
-an hundred men for one year, so that a calculation
-can easily be made for any number
-of men, and for any length of time.
-<span class="pagenum" id="Page_548">548</span></p>
-
-<h4 class="ph1" id="ASSORTMENT_OF_MEDICINES_TO_BE_CARRIED_TO_SEA">
-<span class="large">ASSORTMENT <small>OF</small> MEDICINES</span><br />
-
-<span class="x-small">TO BE</span><br />
-
-<span class="medium">CARRIED TO SEA,</span><br />
-
-<span class="x-small">FOR</span><br />
-
-<span class="large">ONE HUNDRED MEN, FOR ONE YEAR.</span></h4>
-
-<h5>PRINCIPAL ARTICLES.</h5>
-
-<p>Peruvian bark, ten pounds, and if the ship is destined
-for a hot climate, twenty pounds. This article should be provided
-by the Public. <a href="#Page_359">See p. 359</a>.&mdash;Calomel, two ounces and a
-half&mdash;<i>a</i> Emetic tartar, one ounce and a half&mdash;Ipecacoanha,
-four ounces&mdash;Opium, one ounce&mdash;<i>b</i> Purging salts, ten pounds&mdash;Senna
-leaves, two pounds.</p>
-
-<h5>SECONDARY ARTICLES.</h5>
-
-<p>Aloes, half an ounce&mdash;Ammoniacum, two ounces&mdash;Balsam
-of copaiva, three ounces&mdash;<i>c</i> Traumatic balsam, four ounces&mdash;Camphor,
-three ounces&mdash;Cantharides, one ounce&mdash;Capsicum,
-three drachms&mdash;Castor, an ounce and a half&mdash;Cham&aelig;mile
-flowers, or hops, two pounds&mdash;Cinnamon, an ounce&mdash;Prepared
-chalk, or oystershells, six ounces&mdash;Conserve of roses,
-half a pound&mdash;<i>d</i> Cordial confection, two ounces&mdash;<i>e</i> Cathartic
-extract, half an ounce&mdash;Extract of hemlock, three ounces&mdash;Extract
-of logwood, one ounce&mdash;Gentian, five ounces&mdash;Ginger,
-three ounces&mdash;Gum arabic, four ounces&mdash;Gum guaiacum,
-three ounces&mdash;Powder of jalap, one ounce and a half&mdash;<i>f</i> Laudanum,
-four ounces&mdash;Linseed, one pound&mdash;Magnesia, six
-ounces&mdash;Manna, eight ounces&mdash;Whole mustard seed, half a
-pound&mdash;Myrrh, four ounces&mdash;<i>g</i> Crude mercury, two ounces&mdash;</p>
-
-<h6><i>Names in the last Edition of the London Pharmacopœia.</i></h6>
-
-<p><i>a</i> Antimonium tartarisatum.&mdash;<i>b</i> Either Glauber’s salts, natron
-vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s
-salt answers better in a hot climate, being less deliquescent
-from the heat and moisture of the climate.&mdash;<i>c</i> Balsamum benzoes
-compositum.&mdash;<i>d</i> Confectio aromatica;&mdash;<i>e</i> Extractum colocynthidis
-compositum.&mdash;<i>f</i> Tinctura opii.&mdash;<i>g</i> Hydrargyrus.
-<span class="pagenum" id="Page_549">549</span></p>
-
-<p><i>a</i> Corrosive sublimate, an ounce&mdash;Nitre, eight ounces&mdash;Oil of
-almonds, one pint&mdash;<i>b</i> Castor oil, half a pint&mdash;Linseed oil,
-three pints&mdash;Essential oil of mint, one ounce&mdash;<i>c</i> Jamaica
-pepper, four ounces&mdash;<i>d</i> Blistering plaster, ten pounds&mdash;Quaffia,
-eight ounces&mdash;Salt of hartshorn, two ounces&mdash;<i>e</i> Salt of steel,
-half an ounce&mdash;<i>f</i> Salt of wormwood, ten ounces&mdash;Castile sope,
-half a pound&mdash;Sarsaparilla, three pounds&mdash;Serpentary, four
-ounces&mdash;Spermaceti, four ounces&mdash;Rectified spirit of wine,
-one pint&mdash;<i>g</i> Weak spirit of vitriol, half a pint&mdash;<i>h</i> Volatile
-aromatic spirit, half a pint&mdash;<i>i</i> Spirit of Mindererus, two pints,
-or the volatile salt and vinegar may be kept separately, and
-added occasionally&mdash;Spirit of turpentine, four ounces&mdash;Dried
-squills, half an ounce&mdash;Flowers of sulphur, one pound&mdash;Golden
-sulphur of antimony, half an ounce&mdash;Cream of tartar, one
-pound&mdash;Vinegar, six pints&mdash;<i>j</i> White vitriol, six drachms&mdash;Wormwood,
-one pound&mdash;<i>k</i> Flowers of zinc, two drachms.</p>
-
-<blockquote>
-
-<p><span class="smcap">Necessaries</span> <i>to be put in charge of the Purser, and served out
-to the Sick in place of the common sea provisions. <a href="#Page_358">See page
-358</a>.</i></p></blockquote>
-
-<p>BARLEY, three hundred pounds&mdash;Eggs, greased and put
-in salt, twenty dozen&mdash;Extract of spruce, twelve pounds&mdash;Lemon
-juice clarified, and preserved by adding to it a small proportion
-of ardent spirits, five gallons&mdash;Raisins, fifty pounds&mdash;Rice,
-two hundred pounds&mdash;Coarse sugar, one hundred pounds&mdash;Sago,
-twenty pounds&mdash;Salep, ten pounds&mdash;Portable soup,
-fifty pounds&mdash;Tamarinds, ten pounds&mdash;Best white wine, three
-hundred gallons&mdash;Best red wine, one hundred gallons.</p>
-
-<h4><i>Names in the last Edition of the London Pharmacopœia.</i></h4>
-
-<p><i>a</i> Hydrargyrus muriatus.&mdash;<i>b</i> Oleum ricini.&mdash;<i>c</i> Pimento.&mdash;<i>d</i>
-Emplastrum cantharidis.&mdash;<i>e</i> Ferrum vitriolatum.&mdash;<i>f</i> Kali pr&aelig;paratum.&mdash;<i>g</i>
-Acidum vitriolicum dilutum.&mdash;<i>h</i> Spiritus ammoni&aelig;
-compositus.&mdash;<i>i</i> Aqua ammoni&aelig; acetata.&mdash;<i>j</i> Zincum vitriolatum.&mdash;<i>k</i>
-Zincum calcinatum.
-<span class="pagenum" id="Page_550">550</span></p>
-
-<h4 id="FORMULAE_QUAEDAM">
-<span class="medium">FORMUL&AElig; QU&AElig;DAM</span><br />
-
-MEDICAMENTORUM<br />
-
-<span class="medium">IN MEDICINA FACIENDA APUD NAUTAS</span><br />
-
-<span class="large">ACCOMMODATIORES.</span></h4>
-
-<h5>IN FEBRE CONTINUA.</h5>
-
-<h6>PULVIS EMETICUS COMMUNIS.</h6>
-
-<blockquote>
-
-<p>℞. Pulveris radicis ipecacoanh&aelig; grana decem, antimonii
-tartarisati grana duo, misce.</p></blockquote>
-
-<h6>MISTURA CATHARTICA COMMUNIS.</h6>
-
-<blockquote>
-
-<p>℞. Foliorum fenn&aelig; uncias sex, aqu&aelig; ferventis libras sex. Macera
-donec pene refrixerit &amp; adjice vel natri vitriolati vel
-magnesi&aelig; vitriolat&aelig; libram unam cum semisse. Dein
-cola &amp; admisce tinctur&aelig; senn&aelig; uncias octo. Dosis est ad
-uncias tres.&mdash;Interdum conducit adjicere singulis dosibus,
-vel pulp&aelig; tamarindo um semunciam, vel mann&aelig; semunciam,
-vel antimonii tartarisati semigranum, vel pulveris
-jalap&igrave;i grana decem.</p></blockquote>
-
-<h6>ENEMA COMMUNE.</h6>
-
-<blockquote>
-
-<p>Aqu&aelig; marin&aelig; tepid&aelig; uncias duodecim.</p></blockquote>
-
-<h6>POTUS COMMUNIS.</h6>
-
-<blockquote>
-
-<p>Decoctum hordei.&mdash;Conveniat adjicere singulis libris pro re
-nat&agrave;, vel pulp&aelig; tamarindorum unciam dimidiam, vel
-crystallorum tartari drachmam unam, vel nitri scrupulum
-unum, vel acidi vitriolici diluti guttas decem, vel succi limonum
-unciam unam, vel gummi arabici scrupulos duos,
-vel vini uncias quatuor, vel frustum panis tosti.</p></blockquote>
-
-<h6>VINUM EMETICUM.</h6>
-
-<blockquote>
-
-<p><a id="FNanchor_136" href="#Footnote_136" class="fnanchor">136</a>℞. Antimonii tartarisati scrupulos duos, aqu&aelig; ferventis uncias
-duas, vini albi uncias octo. Solve antimonium in
-aqu&acirc; &amp; adde vinum. Assumatur drachma una omni quadrante
-hor&aelig;, donec vel vomitus cieatur, vel alvus moveatur.
-Deinde assumatur semi-drachma sext&acirc; qu&acirc;que hor&acirc;.</p></blockquote>
-
-<h6>PILULA FEBRIFUGA.</h6>
-
-<blockquote>
-
-<p>℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi
-Dris. James drachmam unam, conserv&aelig; ros&aelig; quantum
-<span class="pagenum" id="Page_551">551</span>
-latis sit. Simul contunde &amp; divide in pilulas duodecim.
-Deglutiatur una quart&acirc; vel sext&acirc; qu&acirc;que hor&acirc;.</p></blockquote>
-
-<h6>MISTURA SALINA ET ANTIEMETICA.</h6>
-
-<blockquote>
-
-<p>℞. Kali pr&aelig;parati drachmam unam, succi limonum, vel aceti,
-vel acidi vitriolici quantum satis sit ad saturandum salem,
-aqu&aelig; pur&aelig; uncias sex. Bibatur tertia pars ter die.&mdash;Conducit
-pro re nata adjicere, vel pulveris antimonialis grana
-quinque, vel acidi vitriolici diluti guttas quinque, vel
-cret&aelig; pr&aelig;parat&aelig; scrupulum unum, vel aqu&aelig; menth&aelig;
-semunciam.&mdash;Interdum conducit sumere hanc misturam
-statim postquam Kali &amp; succus limonum mixta fuerit,
-scilicet in ips&acirc; ebullitione. Hoc imprimis utile est quando
-vomitus vel nausea molestus sit, &amp; licet adhibere magnesiam
-vice Kali, &amp; acetum vice succi limonum.</p></blockquote>
-
-<h6><a id="FNanchor_137" href="#Footnote_137" class="fnanchor">137</a>PILULA DIAPHORETICA.</h6>
-
-<blockquote>
-
-<p>℞. Opii purificati grana duodecim, antimonii tartarisati grana
-sex, conserv&aelig; ros&aelig; semi-drachmam, farin&aelig; glycirrhiz&aelig;,
-vel tritici quantum satis sit. Contunde simul &amp; divide in
-pilulas viginti quatuor. Devoretur una hor&acirc; somni.
-Interdum prosit dare unam bis die.</p></blockquote>
-
-<h6><a id="FNanchor_138" href="#Footnote_138" class="fnanchor">138</a>MISTURA SEDATIVA.</h6>
-
-<blockquote>
-
-<p>℞. Mistur&aelig; camphorat&aelig; uncias sex, tinctur&aelig; opii guttas viginti
-Misce. Bibatur tertia pars ter die.&mdash;Aliquando
-conducit admiscere singulis dosibus aqu&aelig; ammoni&aelig; acetat&aelig;
-drachmas tres, vel vini emetici guttas triginta.</p></blockquote>
-
-<h4><a id="FNanchor_139" href="#Footnote_139" class="fnanchor">139</a>BOLUS SEDATIVUS.</h4>
-
-<blockquote>
-
-<p>℞. Confectionis aromatic&aelig; scrupulum unum, opii purificati
-grani quartam partem, castorei Russici grana decem,
-tinctur&aelig; opii guttas quatuor. Misce. Assumatur sext&acirc;
-qu&acirc;que hor&acirc;.</p></blockquote>
-
-<h6>BOLUS SERPENTARI&AElig; COMPOSITUS.</h6>
-
-<blockquote>
-
-<p>℞. Pulveris serpentari&aelig; Virginian&aelig; grana decem, camphor&aelig;
-grana quatuor, confectionis aromatic&aelig; quantum satis sit.
-<span class="pagenum" id="Page_552">552</span>
-Assumatur ter die.&mdash;Interdum conducit addere pulveris
-corticis Peruviani drachmam dimidiam, vel superbibere
-decocti corticis Peruviani uncias duas.</p></blockquote>
-
-<h6>ELECTUARIUM AD CONVALESCENTES.</h6>
-
-<blockquote>
-
-<p>℞. Pulveris corticis Peruviani, florum cham&aelig;meli, singulorum
-unciam unam, pulveris zinziberis scrupulos duos, syrupi
-quantum satis fit. Dosis est circiter drachma ter die.&mdash;Interdum
-adjiciantur vel rubiginis ferri drachm&aelig; tres, vel
-pulveris terpentari&aelig; Virginian&aelig; drachm&aelig; du&aelig;.</p></blockquote>
-
-<h5>IN FEBRE INTERMITTENTE.</h5>
-
-<p>Adhibeantur in initio eadem medicamenta ac in initio febris
-continu&aelig;. Deinde</p>
-
-<p>Sumatur corticis Peruviani drachma una, secund&acirc; vel terti&acirc;
-qu&acirc;que hor&acirc;, vel etiam singulis horis, absente paraxysmo febrili.&mdash;Interdum
-confert dare singulas doses ex spirit&ucirc;s vini tenuis
-(<i>rum</i> dicti) unci&acirc; un&acirc;.</p>
-
-<p>Si cortex frustra adhibeatur fauste adhiberi possint medicamenta
-infra pr&aelig;scripta.</p>
-
-<blockquote>
-
-<p><a id="FNanchor_140" href="#Footnote_140" class="fnanchor">140</a>℞. Zinci calcinati semi-drachmam, conserv&aelig; ros&aelig; quantum
-satis fit. Contunde simul &amp; divide in pilulas quindecim.
-Sumatur una ter die, augendo dosim si premerit morbus
-&amp; si ferat ventriculus.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p>℞. Zinci vitriolati grana duodecim aqu&aelig; pur&aelig; uncias tres
-Sumatur tertia pars ter die augendo dosim si opus fuerit
-&amp; si ferat ventriculus.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p><a id="FNanchor_141" href="#Footnote_141" class="fnanchor">141</a>℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas
-sex. Misce. Sumatur paucas horas ante paroxysmum.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p><a id="FNanchor_142" href="#Footnote_142" class="fnanchor">142</a>Cortice Peruviano frustra dato, aliquando conferat dare ægro
-quotidie, vel calomelanos, vel pilularum ex hydrargyro
-quantum &amp; quamdiu sufficiat ad levem ciendum ptyalismum,
-&amp; deinde instituere curam de integro cum cortice
-Peruviano.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p><a id="FNanchor_143" href="#Footnote_143" class="fnanchor">143</a>Sumantur tincturæ opii guttæ viginti quinque, incipiente æstu.
-febrili, ex poculo potûs communis.</p></blockquote>
-<p><span class="pagenum" id="Page_553">553</span></p>
-
-<h5>IN DIARRHŒA SIMPLICI.</h5>
-
-<h6>BOLUS AD DIARRHOEAM.</h6>
-
-<blockquote>
-
-<p>℞. Cret&aelig; pr&aelig;parat&aelig; scrupulum unum, pulveris rhabarbari
-grana quindecim, pulveris corticis cinnamomi grana sex,
-opii purificati granum dimidium, tinctur&aelig; opii guttas
-quinque, syrupi quantum satis fit. Semel sumatur.</p></blockquote>
-
-<blockquote>
-
-<p>℞. Mistur&aelig; cretace&aelig; (Pharm. Lond.) cum duplici gummi
-arabico libram unam, tinctur&aelig; opii guttas decem. Absumatur
-totum partitis vicibus nychthemero, incipiendo
-duodecim horas post datum medicamentum novissime pr&aelig;scriptum.&mdash;Interdum
-adjiciatur tinctur&aelig; cinamomi uncia
-dimidia.</p></blockquote>
-
-<h5>IN CHOLERA MORBO.</h5>
-
-<blockquote>
-
-<p>℞. Decocti hordei vel aven&aelig; libras tres, pulveris gummi arabici
-unciam unam cum semisse, tinctur&aelig; opii guttas triginta.
-Hauriatur quam primum libra una, &amp; deinde libra
-dimidia omni hor&acirc; usque ad levamen mali.&mdash;Si parabilis
-fuerit caro vitulina, vel pullus, jusculum tenue ex altero
-utro factum vice decocti supra dicti adhibeatur.</p></blockquote>
-
-<h5>IN DYSENTERIA ACUTA.</h5>
-
-<p>Sumat &aelig;ger quamprimum emeticum commune.</p>
-
-<blockquote>
-
-<p>℞. Decocti hordei libras duas, salis cathartici unciam unam cum
-semisse, antimonii tartarisati grana duo. Misce. Hauriatur
-tepide prim&ograve; libra dimidia, &amp; deinde unci&aelig; quatuor omni
-hor&acirc; donec alvus copiose &amp; iteratim dejecerit.</p></blockquote>
-
-<blockquote>
-
-<p>℞. Pulveris ipecacoanh&aelig; grana duodecim, conserv&aelig; ros&aelig; quantum
-satis fit. Contunde simul &amp; divide in pilulas duodecim.
-Sumatur una ter die. Si &aelig;ger vehementer febricit&acirc;rit
-satius erit dare ter die vini emetici drachmam unam
-ex cyatho amplo decocti hordei tepidi.</p></blockquote>
-
-<blockquote>
-
-<p><a id="FNanchor_144" href="#Footnote_144" class="fnanchor">144</a>℞. Pulveris ipecacoanh&aelig; grana duo, pulveris opii purificati
-exsiccati granum unum, nitri grana octo. Misce. Sumatur
-hor&acirc; somni.</p></blockquote>
-
-<h6>ENEMA EMOLLIENS.</h6>
-
-<blockquote>
-
-<p>℞. Amyli unciam dimidiam, aqu&aelig; pur&aelig; uncias decem. Coque
-ad idoneam spissitudinem.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p>℞. Seminum lini drachmas sex, aqu&aelig; pur&aelig; uncias duodecim.
-Coque per quadrantem hor&aelig; &amp; cola liquorem pro enemate.</p></blockquote>
-<p><span class="pagenum" id="Page_554">554</span></p>
-
-<h6>ENEMA ANODYNUM.</h6>
-
-<blockquote>
-
-<p>℞. Enematis emollientis uncias quatuor, tinctur&aelig; opii guttas
-quadraginta. Misce.</p></blockquote>
-
-<h5>IN DYSENTERIA CHRONICA.</h5>
-
-<h6>BOLUS CATHARTICUS.</h6>
-
-<blockquote>
-
-<p>℞. Pulveris rhabarbari grana quindecim, calomelanos grana
-quinque, conserv&aelig; ros&aelig; quantum satis fit ut fiat bolus.
-Mane sumendus, &amp; repetendus post paucos dies si opus
-fuerit.&mdash;Vice hujus interdum conducat dare mistur&aelig; cathartic&aelig;
-communis uncias duas.</p></blockquote>
-
-<h6>SOLUTIO CAMPECHENSIS.</h6>
-
-<blockquote>
-
-<p>℞. Extracti ligni Campechensis drachmam unam cum semisse,
-tinctur&aelig; cinamomi unciam unam. Tere simul &amp; admisce
-aqu&aelig; pur&aelig; uncias quinque. Sumatur uncia una
-ter die.</p></blockquote>
-
-<h6>DECOCTUM AMARUM.</h6>
-
-<blockquote>
-
-<p>℞. Corticis simaroub&aelig; vel quassi&aelig; drachmam unam, aqu&aelig; pur&aelig;
-libram unam cum semisse. Decoque ad libram unam.
-Absumatur totum quotidie tribus vicibus. Adjici possint
-singulis dosibus pro ratione symptomatum, vel cret&aelig; pr&aelig;parat&aelig;
-scrupulus unus, vel pulveris ipecacoanh&aelig; granum
-unum, vel tinctur&aelig; cinamomi drachm&aelig; du&aelig;, vel tinctur&aelig;
-opii gutt&aelig; quinque.</p>
-
-<p><a id="FNanchor_145" href="#Footnote_145" class="fnanchor">145</a>In casibus rebellibus confert illinere quotidie hypogastrium
-unguenti ex hydrargyro drachm&acirc; dimidi&acirc;.</p>
-
-<p>Sit pro potu communi in hoc morbo aqua pura, frusto
-panis recens tosti adjecto, &amp; pauxillo spiritus vini tenuis
-(<i>rum</i> dicti) admixto. Sit pro victu communi salab, vel
-farina tritici in pulmentum tenue ex aqu&acirc; pur&acirc; cocta.</p></blockquote>
-
-<h5>IN INTESTINIS INFLAMMATIS.</h5>
-
-<h6><a id="FNanchor_146" href="#Footnote_146" class="fnanchor">146</a>SOLUTIO SALIS CATHARTICI.</h6>
-
-<blockquote>
-
-<p>℞. Decocti hordei libram unam, magnesi&aelig; vitriolat&aelig; uncias
-duas. Misce ut fiat solutio. Bibatur, post sanguinis
-missionem, uncia una omni semihor&acirc; donec alvus bis dejecerit.</p>
-
-<p>Adhibeantur hypogastrio cucurbitul&aelig; cruent&aelig;, vel hirudines
-plures. Applicetur ibidem epispasticum satis amplum.
-Injiciatur enema cum oleo &amp; pauxillo sale cathartico.</p></blockquote>
-<p><span class="pagenum" id="Page_555">555</span></p>
-
-<p>IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus
-&aelig;stuosis <i>DRY BELLY ACHE</i> dicto.</p>
-
-<h6><a id="FNanchor_147" href="#Footnote_147" class="fnanchor">147</a>PILUL&AElig; CATHARTICO-ANODYN&AElig;.</h6>
-
-<blockquote>
-
-<p>℞. Extracti colocynthidis compositi drachmam dimidiam,
-opii granum unum &amp; dimidium, olei menth&aelig; guttam unam.
-Contunde in massam &amp; divide in pilulas decem. Sint
-pro una dosi. Paucas post horas, si alvus non rite responderit,
-exhibeantur mistur&aelig; cathartic&aelig; unci&aelig; du&aelig;, vel<a id="FNanchor_148" href="#Footnote_148" class="fnanchor">148</a>
-olei ricini uncia una, &amp; repetantur ut opus fuerit.&mdash;Interdum
-in hoc malo divexat vomitus cui auxilio est, mistura
-antiemetica. Vide page 551.</p>
-
-<p>Perfricetur hypogastrium oleo tepido.</p>
-
-<p>Ineat &aelig;ger in balneum tepefactum ad 93&deg; therm.
-Fahren. per horam unam vel etiam diutius.</p>
-
-<p>Denique suffletur in anum fumus nicotian&aelig;.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<blockquote>
-
-<p>℞. Nicotian&aelig; drachmas duas aqu&aelig; pur&aelig; ferventis libram
-unam.&mdash;Fiat infusum &amp; cola pro enemate.</p></blockquote>
-
-<h5>IN H&AElig;MORRH&Ouml;IDE.</h5>
-
-<h6>BOLUS H&AElig;MORRHOIDALIS.</h6>
-
-<blockquote>
-
-<p>℞. Florum sulphuris drachmam dimidiam, conserva&aelig; ros&aelig;, vel
-pulp&aelig; tamarindorum quantum satis fit. Assumatur bis
-die.</p>
-
-<p>Si sanguinis ex ano profluentis magna fuerit vis, &amp; pr&aelig;cipue
-si ex alto fonte effluxerit, valde proderit medicamentum
-infra pr&aelig;scriptum.</p></blockquote>
-
-<blockquote>
-
-<p><a id="FNanchor_149" href="#Footnote_149" class="fnanchor">149</a>℞. Olei lini recens expressi drachmas sex, tinctur&aelig; rhabarbari
-drachmas duas. Misce. Sumatur bis die.&mdash;Vice olei
-lini adhibere licet olei amygdal&aelig; unciam dimidiam, cum
-mucilaginis gummi arabici drachmis duabus.</p></blockquote>
-
-<h5>IN ALVO ASTRICTA.</h5>
-
-<h6>PILUL&AElig; LAXANTES.</h6>
-
-<blockquote>
-
-<p>℞. Aloes socotrin&aelig; drachmam unam, syrupi quantum satis sit.
-Contunde &amp; divide in pilulas viginti. Sumantur du&aelig; pro
-re nat&acirc;.&mdash;Aliquando conducit adjicere vel pulveris zinzberis
-<span class="pagenum" id="Page_556">556</span>
-vel pulveris capsici grana quindecim, vel olei menth&aelig;
-guttas decem.&mdash;Vice aloes licet adhibere extractum
-colocynthidis compositum.</p></blockquote>
-
-<h5>ELECTUARIUM ECCOPROTICUM.</h5>
-
-<blockquote>
-
-<p>℞. Pulveris jalapii unciam dimidiam, pulp&aelig; tamarindorum
-unciam unam, pulveris zinziberis semi-drachmam, syrupi
-<i>melasses</i> dicti quantum satis sit. Sumatur circiter drachma
-pro re nat&acirc;.&mdash;Interdum prosit adjicere crystallorum
-tartari drachmas duas.</p></blockquote>
-
-<h5>IN CATARRHO.</h5>
-
-<h6>LINCTUS.</h6>
-
-<blockquote>
-
-<p>℞. Conserv&aelig; ros&aelig; unciam unam, mucilaginis gummi arabici
-unciam dimidiam, olei amygdal&aelig; drachmas duas, succi
-limonis, vel acidi vitriolici quantum satis sit ad gratum
-saporem conciliandum. Misce. Sumatur pauxillum
-s&aelig;pius.&mdash;Interdum adjiciatur vel salis nitri drachma
-una, vel tinctur&aelig; opii gutt&aelig; decem.</p>
-
-<p>Sit pro potu communi decoctum hordei in quo coquatur
-uvarum passarum uncia una, &amp; sub finem coctur&aelig;
-seminum lini drachmas duas pro singulis libris
-decocti.</p>
-
-<p>Si febricit&acirc;rit &aelig;ger, sumantur mistura salina &amp; pilula
-febrifuga ter die.</p></blockquote>
-
-<h5>IN PLEURITIDE ET PERIPNEUMONIA.</h5>
-
-<blockquote>
-
-<p>℞. Decocti hordei libras duas, pulp&aelig; tamarindorum quantum
-satis-fit ad gratum saporem, nitri drachmam unam. Misce.
-Hauriatur affatim pro potu communi. N. B. Si tamarindi
-moverint alvum s&aelig;pius quam semel aut bis die adhibeatur
-vice ejus syrupus <i>melasses</i> dictus.</p>
-
-<p>Sumatur mistura salina &amp; pilula febrifuga sext&acirc; vel
-quart&acirc; qu&acirc;que hor&acirc;.</p></blockquote>
-
-<h5>IN H&AElig;MOPT&Ouml;E.</h5>
-
-<p>Hauriat &aelig;ger infusi ros&aelig; uncias tres quater die. Interdum adjiciatur
-vel tinctur&aelig; opii gutt&aelig; quatuor, vel nitri grana decem.</p>
-
-<h6>HAUSTUS OLEOSUS.</h6>
-
-<blockquote>
-
-<p><a id="FNanchor_150" href="#Footnote_150" class="fnanchor">150</a>℞. Olei amygdalini, aqu&aelig; menth&aelig; simplicis singulorum unciam
-unam, manr&aelig; drachmas tres. Misce. Sumatur
-ter die. S&aelig;pe conducit adjicere singulis dosibus tinctur&aelig;
-opii guttas quatuor vel quinque.</p></blockquote>
-<p><span class="pagenum" id="Page_557">557</span></p>
-
-<h5>IN TUSSI ASTHMATICA.</h5>
-
-<h6>PILUL&AElig; PECTORALES.</h6>
-
-<blockquote>
-
-<p><a id="FNanchor_151" href="#Footnote_151" class="fnanchor">151</a>℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis
-drachmas duas, pulveris radicis scill&aelig; grana sex opii purificati
-grana tria, syrupi <i>melasses</i> dicti quantum satis sit.
-Contunde simul &amp; divide in pilulas quadraginta octo.
-Sumantur quatuor bis die.</p></blockquote>
-
-<h5>IN ASTHMATE A DIATHESI HYDROPICA
-PROVENIENTE.</h5>
-
-<h6>PILUL&AElig; SCILLITIC&AElig;.</h6>
-
-<blockquote>
-
-<p>℞. Radicis scill&aelig; arid&aelig; grana duodecim, conserv&aelig; ros&aelig; quantum
-satis sit. Contunde simul &amp; divide in pilulas duodecim.
-Sumatur una vel du&aelig; bis vel ter die.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<h6><a id="FNanchor_152" href="#Footnote_152" class="fnanchor">152</a>HAUSTUS DIURETICUS.</h6>
-
-<blockquote>
-
-<p>℞. Aqu&aelig; pur&aelig; unciam unam &amp; dimidiam, pulveris scill&aelig; arid&aelig;
-grana duo, tinctur&aelig; lavendul&aelig; composit&aelig; guttas trigint&aelig;,
-kali pr&aelig;parati grana decem. Misce. Sumatur bis vel ter
-die.&mdash;Interdum adjicere liceat haustui vespertino tinctur&aelig;
-opii guttas viginti.</p></blockquote>
-
-<h5>Vel,</h5>
-
-<h6>BOLUS C&AElig;RULEUS CUM SCILLA.</h6>
-
-<blockquote>
-
-<p><a id="FNanchor_153" href="#Footnote_153" class="fnanchor">153</a>℞. Pilularum ex hydrargyro grana quinque vel usque ad decem,
-pulveris radicis scill&aelig; grana duo. Misce. Sumatur
-hor&acirc; decubit&ucirc;s, per tres vel quatuor noctes consequentes.</p></blockquote>
-
-<h5>IN RHEUMATISMO ACUTO.</h5>
-
-<h6>MISTURA DIAPHORETICA.</h6>
-
-<blockquote>
-
-<p>℞. Aqu&aelig; pur&aelig; uncias tres, aqu&aelig; ammoni&aelig; acetat&aelig; unciam
-unam &amp; dimidiam, pulveris antimonialis grana quindecim.
-Sumatur tertia pars ter die.&mdash;Interdum adjiciantur
-nitri grana quinque singulis dosibus.</p>
-
-<p>Bibatur affatim decoctum hordei tepidum, cum nitri
-scrupulis duobus in singulis libris.</p></blockquote>
-<p><span class="pagenum" id="Page_558">558</span></p>
-
-<h6>HAUSTUS SUDORIFICUS.</h6>
-
-<blockquote>
-
-<p>℞. Mistur&aelig; camphorat&aelig; unciam unam &amp; dimidiam, aqu&aelig; ammoni&aelig;
-acetat&aelig; unciam dimidiam, vini emetici guttas
-quadraginta, tinctur&aelig; opii guttas viginti. Misce. Sumatur
-hor&acirc; somni, vel etiam s&aelig;pius sed cum dimedia tinctura.</p></blockquote>
-
-<h5>IN RHEUMATISMO CHRONICO.</h5>
-
-<blockquote>
-
-<p>℞. Tinctur&aelig; guaiaci volatilis drachmas duas. Sumatur ex
-cyatho pot&ucirc;s communis ter die. Vel sumatur gummi
-guaici semidrachma super bibendo haustum ex salis cornu
-cervi serupula aqu&aelig; unciis tribus.</p></blockquote>
-
-<blockquote>
-
-<p>℞. Pulveris ipecacoanh&aelig; compositi (Pharm. Lond.) scrupulum
-unum. Sumatur hora somni alternis noctibus.</p>
-
-<p>In casibus rebellibus pro remedio efficaci compertum
-est dare quotidie calomelanos granum unum vel grana
-duo.</p></blockquote>
-
-<h5>IN HYDROPE.</h5>
-
-<h6>PULVIS HYDRAGOGUS.</h6>
-
-<blockquote>
-
-<p>℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana
-quindecim, pulveris zinziberis grana quinque. Misce
-fiat pulvis, fumatur alternis diebus.</p></blockquote>
-
-<h6>MISTURA DIURETICA.</h6>
-
-<blockquote>
-
-<p>℞. Infusi gentian&aelig; uncias decem, spiritus vini tenuis uncias
-duas, kali pr&aelig;parati drachmam unam. Misce. Hauriamur
-unci&aelig; tres bis die.<a id="FNanchor_154" href="#Footnote_154" class="fnanchor">154</a>Vice infusi gentian&aelig; licet adhibere
-infusum absynthii.</p></blockquote>
-
-<h6>TINCTURA SCILL&AElig;. Pharm. Lond.</h6>
-
-<p>Sumatur drachma una bis die ex haustu pot&ucirc;s communis.</p>
-
-<h6>PILULA EX ELATERIO.</h6>
-
-<blockquote>
-
-<p>℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur
-in pilulas sex. Sumatur una bis die.</p>
-
-<p><a id="FNanchor_155" href="#Footnote_155" class="fnanchor">155</a>&AElig;gro licet, imo prodest hoc morbo laboranti bibere
-ad libitum ex liquore aliquo siti extinguend&aelig; accommodato,
-veluti aqu&acirc; hordei cum crystallis tartari.</p></blockquote>
-
-<h5>IN ERYSIPELATE.</h5>
-
-<blockquote>
-
-<p><a id="FNanchor_156" href="#Footnote_156" class="fnanchor">156</a>℞. Pulveris corticis Peruviani drachmam unam. Sumatur
-omni hor&acirc; vel interpositis duabus vel tribus horis.</p></blockquote>
-
-<p><span class="pagenum" id="Page_559">559</span></p>
-
-<h5>IN MORBO VENEREO.</h5>
-
-<h6>1. IN GONORRHOEA.</h6>
-
-<p>Hauriatur ad libitum infusum lini, vel decoctum hordei cum
-gummi arabici drachmis sex in singulis libris.</p>
-
-<p>Sumantur calomelanos grana duo quotidie per viginti circiter
-dies.</p>
-
-<blockquote>
-
-<p><a id="FNanchor_157" href="#Footnote_157" class="fnanchor">157</a>℞. Aqu&aelig; pur&aelig; distillat&aelig; uncias octo, hydrargyri muriati
-granum unum. Misce. Injiciatur pauxillum in urethram
-bis vel ter die.</p></blockquote>
-
-<h6>IN GONORRHOEA BENIGNA.</h6>
-
-<blockquote>
-
-<p>℞.  Balsami capaiv&aelig; drachmam unam, tinctur&aelig; lavendul&aelig; composit&aelig;
-guttas triginti. Misce. Sumatur bis die.</p></blockquote>
-
-<h6>2. IN ULCUSCULIS.</h6>
-
-<p>In initio feliciter adhibetur causticum.</p>
-
-<blockquote>
-
-<p>℞. Calomelanos drachmam dimidiam, conserv&aelig; ros&aelig; quantum
-satis sit. Contunde in massam &amp; divide in pilulas triginta.
-Sumatur una quotidie, vel interdum dimidia ter die, ut
-cieatur ptyalismus modicus. Perstet &aelig;ger in usu medicamenti
-hujus per dies acto postquam sanata fuerint ulcuscula.</p>
-
-<p>Pro medicamento topico, utile erit inspergere ulcusculum
-cum pulvere hydrargyri nitrati.</p></blockquote>
-
-<h6>3. IN BUBONE.</h6>
-
-<p>Illinatur artus lateris affecti infra inguen cum unguenti ex
-hydrargyro drachm&acirc; dimidi&acirc; quotidie.</p>
-
-<p>Si abierit bubo in ulcus mali moris omittatur pro tempore
-usus hydrargyri &amp; sumatur quotidie <a id="FNanchor_158" href="#Footnote_158" class="fnanchor">158</a>opii purificati granum
-unum primo semel, dein bis, denique ter die vel etiam s&aelig;pius,
-&amp; pulveris corticis Peruviani drachma una ter quaterve die.&mdash;Interdum
-conducit sumere pulveris sars&aelig;parill&aelig; drachmas duas
-ter die, vel extracti cicut&aelig; grana tria ter die, augendo paullatim
-usque ad grana decem.</p>
-
-<h6>4. <small>IN VERA LUE</small>, angin&acirc; scilicet osteocopiis, exostosibus &amp;
-def&aelig;datione cutis.</h6>
-
-<p>Illinantur membra quotidie cum unguenti ex hydrargyro
-<span class="pagenum" id="Page_560">560</span>
-drachmis duabus quotidie usque dum cieatur ptyalismus<a id="FNanchor_159" href="#Footnote_159" class="fnanchor">159</a> per dies
-triginta ad minimum vel donec evanuerint symptomata.&mdash;Interdum
-vice lit&ucirc;s adhibere conveniat vel calomelanos granum
-unum ter die, vel pilularum ex hydrargyro grana quinque
-bis die, vel</p>
-
-<blockquote>
-
-<p>℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram
-unam. Fiat solutio, &amp; sumatur uncia dimidia bis die.
-In ulceribus tonsillarum pernotabili est auxilio suffitum
-ex cinnabare in fauces inhalare semel vel bis quotidie.</p>
-
-<p>Si ulcera mali moris exorta fuerint in quavis corporis
-parte, eadem, ut jam de bubone dictum est, fiant.</p></blockquote>
-
-<h5>IN SCORBUTO MARINO.</h5>
-
-<p>Sumat &aelig;ger quotidie succi limonum unciam unam ter quaterve
-die.</p>
-
-<blockquote>
-
-<p>℞. Aqu&aelig; pur&aelig; paullulum tepefact&aelig; congios triginta, syrupi
-<i>melasses</i> dicti libras sedecim pondere, extracti pini uncias
-octo pondere, spum&aelig; vel f&aelig;cis cerevisi&aelig; libras duas mensur&acirc;.
-Misce &amp; agita valide cum baculo, dein sinatur
-abire in fermentationem, ut fiat cerevisia, deinde servetur
-in vase clauso. Ut diutius servari potest, proderit admiscere
-spirit&ucirc;s vini tenuis Gallici, vel qui <i>rum</i> dicitur, libras
-duas aut tres. Si infirma fuerint viscera adjicere
-juvabit vel lupuli vel summitatum absinthii vel quassi&aelig;,
-vel zinziberis quantum satis sit. Hauriat &aelig;ger libras
-duas quotidie.</p></blockquote>
-
-<blockquote>
-
-<p>℞. Farin&aelig; avenace&aelig; libras tres, aqu&aelig; pur&aelig; congios quatuor.
-Misce. Macera donec liquor fiat acidulus, dein effunde
-dimidium &amp; adjiciatur par copia aqu&aelig; pur&aelig;, &amp; coque ad
-idoneam spissitudinem, ut cogatur in pulmentum. Sit
-pro victu assiduo cum vini &amp; sacchari non purificati, vel
-syrupi <i>melasses</i> dicti quantum sufficiat ad gratum saporem
-conciliandum.</p>
-
-<p>Ad alvum solvendam commode adhiberi potest electuarium
-eccoproticum cum crystallis tartari. Vid. p. 556.</p></blockquote>
-
-<h5>THE END.</h5>
-<p><span class="pagenum" id="Page_Ii">i</span></p>
-
-<h2 id="INDEX">INDEX.</h2>
-
-<ul class="index"><li class="ifrst">A.</li>
-
-<li class="indx"><span class="smcap">Absorbents</span> useful in fluxes, <a href="#Page_491">491</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Action</i>, close, the advantages of it, <a href="#Page_103">103</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Air</i>, superiority of that at sea, <a href="#Page_225">225</a>.</li>
-<li class="isub1">&mdash;Noxious effects of it at land in a hot climate, <a href="#Page_227">227</a>.</li>
-<li class="isub1">&mdash;Extent of its influence, <a href="#Page_228">228</a>.</li>
-
-<li class="indx"><i>Alcide</i>, sickly on the passage to America, <a href="#Page_36">36</a>.</li>
-<li class="isub1">&mdash;Subject to various forms of fevers, <a href="#Page_39">39</a>.</li>
-
-<li class="indx"><i>Aliment</i>, want of proper, chief cause of scurvy, <a href="#Page_300">300</a>.</li>
-<li class="isub1">&mdash;Increases the vigour of the body in two ways, <a href="#Page_510">510</a>.</li>
-
-<li class="indx"><i>America, North</i>, hotter in summer than the West Indies, <a href="#Page_30">30</a>.</li>
-<li class="isub1">&mdash;Fleet goes there to avoid the hurricanes, <a href="#Page_35">35</a>, <a href="#Page_146">146</a>.</li>
-<li class="isub1">&mdash;Uncommon season there, <a href="#Page_156">156</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Amputation</i>, the number that died of it at Barbadoes, <a href="#Page_190">190</a>.</li>
-
-<li class="indx"><i>Amputation</i>, Mr. Alanson’s method of performing it, <a href="#Page_543">543</a>.</li>
-
-<li class="indx"><i>Antimonials</i>, best adapted to bilious fevers, <a href="#Page_420">420</a>.</li>
-<li class="isub1">&mdash;A caution with regard to them, <a href="#Page_422">422</a>.
-<span class="pagenum" id="Page_Iii">ii</span></li>
-
-<li class="indx"><i>Army</i> at St. Lucia, diseases in it, <a href="#Page_127">127</a>.</li>
-<li class="isub1">&mdash;Mortality in it, <a href="#Page_27">27</a>, <a href="#Page_228">228</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Asthma</i>, climate in the West Indies favourable to it, <a href="#Page_97">97</a>.</li>
-
-<li class="ifrst">B.</li>
-
-<li class="indx"><i>Barbadoes</i>, more refreshments at it than any other island, <a href="#Page_27">27</a>.</li>
-<li class="isub1">&mdash;Ravaged by a hurricane, <a href="#Page_41">41</a>.</li>
-<li class="isub1">&mdash;Composed of coral rock, <a href="#Page_89">89</a>.</li>
-<li class="isub1">&mdash;Conjecture concerning its origin, <i>ibid.</i></li>
-
-<li class="indx"><i>Barfleur</i>, fevers on board in consequence of recruits from a French jail, <a href="#Page_142">142</a>.</li>
-
-<li class="indx"><i>Bark, Peruvian</i>, its effects in preventing fevers, <a href="#Page_230">230</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;When useful in continued fevers, <a href="#Page_390">390</a>, <i>&amp; seq.</i>, <a href="#Page_402">402</a>, <a href="#Page_422">422</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Bark, Peruvian, red</i>, some account of it, <a href="#Page_457">457</a>.</li>
-
-<li class="indx"><i>Barricading a ship</i>, what meant by it, <a href="#Page_21">21</a>.</li>
-
-<li class="indx"><i>Bath, warm</i>, of use in the dysentery, <a href="#Page_480">480</a>.</li>
-<li class="isub1">&mdash;In the locked jaw, <a href="#Page_522">522</a>.</li>
-<li class="isub1">&mdash;Its proper temperature, <a href="#Page_535">535</a>.</li>
-
-<li class="indx"><i>Battle</i>, the ardour of, favourable to health, <a href="#Page_22">22</a>, <a href="#Page_77">77</a>, <a href="#Page_101">101</a>.</li>
-<li class="isub1">&mdash;Number killed in, <a href="#Page_209">209</a>.</li>
-<li class="isub1">&mdash;Loss in those of April, 1782, <a href="#Page_520">520</a>.</li>
-
-<li class="indx"><i>Bedding</i>, utility of airing it, <a href="#Page_260">260</a>.</li>
-
-<li class="indx"><i>Bile</i>, a defect of it in the worst cases of yellow fever, <a href="#Page_429">429</a>,<i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Theoretical disquisition on its influence in fevers, <i>ibid.</i></li>
-
-<li class="indx"><i>Bile</i>, the marks of a redundance of it in dysenteries, <a href="#Page_477">477</a>.</li>
-<li class="isub1">&mdash;Its tendency to prolong fluxes, <a href="#Page_483">483</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Blindness</i> from the scurvy, <a href="#Page_24">24</a>, <a href="#Page_501">501</a>.</li>
-
-<li class="indx"><i>Blisters</i> of use in the ship fever, <a href="#Page_399">399</a>.</li>
-<li class="isub1">&mdash;For removing irritability of stomach in the yellow fever, <a href="#Page_453">453</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Of service in dysentery, <a href="#Page_480">480</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Blood</i>, a remark concerning the buff upon it, <a href="#Page_450">450</a>.
-<span class="pagenum" id="Page_Iiii">iii</span></li>
-
-<li class="indx"><i>Bloodletting</i>, cautions with regard to it in ship fevers, <a href="#Page_388">388</a>.</li>
-<li class="isub1">&mdash;In bilious fevers, <a href="#Page_418">418</a>.</li>
-<li class="isub1">&mdash;In the yellow fever, <a href="#Page_450">450</a>.</li>
-
-<li class="indx"><i>Butter</i>, objections to its use, <a href="#Page_310">310</a>.</li>
-
-<li class="ifrst">C.</li>
-
-<li class="indx"><i>Calomel</i>, in certain cases, the best purgative, <a href="#Page_421">421</a>.</li>
-
-<li class="indx"><i>Camphor</i>, estimate of its virtues, <a href="#Page_407">407</a>.</li>
-
-<li class="indx"><i>Catarrh, epidemic</i>, one in Europe affected men at sea, <a href="#Page_157">157</a>.</li>
-<li class="isub1">&mdash;Communicated by strangers not affected with it themselves, in one of the Western Islands, <a href="#Page_244">244</a>.</li>
-
-<li class="indx"><i>Causes</i>, a combination of them necessary to produce diseases, <a href="#Page_126">126</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Chronic complaints</i> brought on by hardship, <a href="#Page_218">218</a>.</li>
-
-<li class="indx"><i>Cleanliness</i> the principal means of health, <a href="#Page_254">254</a>, <a href="#Page_337">337</a>.</li>
-
-<li class="indx"><i>Clothing</i>, its great influence upon health, <a href="#Page_238">238</a>.</li>
-<li class="isub1">&mdash;Advantages and disadvantages of it, <a href="#Page_334">334</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Cocoa</i> substituted, with advantage, for butter, <a href="#Page_311">311</a>.</li>
-
-<li class="indx"><i>Cold</i> favourable to infection, <a href="#Page_258">258</a>.</li>
-
-<li class="indx"><i>Cold</i> hurtful in all climates, <a href="#Page_297">297</a>.</li>
-
-<li class="indx"><i>Colica pictonum</i>, forms of medicines adapted to it, <a href="#Page_555">555</a>.</li>
-
-<li class="indx"><i>Coma</i>, a symptom in the ship fever, <a href="#Page_373">373</a>.</li>
-
-<li class="indx"><i>Commission, Ships long in</i>, most healthy, <a href="#Page_54">54</a>, <a href="#Page_79">79</a>, <a href="#Page_93">93</a>, <a href="#Page_167">167</a>.</li>
-
-<li class="indx"><i>Constitution</i>, the great variety of it, <a href="#Page_294">294</a>.</li>
-<li class="isub1">&mdash;Regard to be had to it in practice, <a href="#Page_406">406</a>.</li>
-
-<li class="indx"><i>Coppers</i>, cautions with regard to them, and instance of poison from neglect of them, <a href="#Page_317">317</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Cordials</i>, a caution with regard to them, <a href="#Page_410">410</a>.</li>
-
-<li class="indx"><i>Crowding</i>, bad effects of it, <a href="#Page_192">192</a>.</li>
-
-<li class="indx"><i>Cruises</i> to windward of Martinico, <a href="#Page_48">48</a>, <a href="#Page_180">180</a>.</li>
-<li class="isub1">&mdash;Near Jamaica, <a href="#Page_120">120</a>.</li>
-<li class="isub1">&mdash;How long they ought to be continued
-<span class="pagenum" id="Page_Iiv">iv</span>
-consistent with health, <a href="#Page_148">148</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;A long one off St. Domingo, without the scurvy appearing, <a href="#Page_154">154</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Cullen, Dr.</i>, his opinion of the origin of nervous fevers, <a href="#Page_237">237</a>.</li>
-<li class="isub1">&mdash;His great merit, <a href="#Page_445">445</a>.</li>
-
-<li class="ifrst">D.</li>
-
-<li class="indx"><i>Delirium</i>, a remarkable symptom in the ship fever, <a href="#Page_373">373</a>.</li>
-<li class="isub1">&mdash;Explanation of it, <i>ibid.</i>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Means of removing it, <a href="#Page_398">398</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Sudden and violent in bilious fevers, <a href="#Page_416">416</a>.</li>
-
-<li class="indx"><i>Diaphoretic</i>, what safest and best, <a href="#Page_395">395</a>.</li>
-
-<li class="indx"><i>Diet</i>, a table of the daily allowance of it in the navy, <a href="#Page_311">311</a>.</li>
-<li class="isub1">&mdash;A method of providing what is suitable to the sick, <a href="#Page_335">335</a>.</li>
-
-<li class="indx"><i>Diet</i>, a caution with regard to it in convalescent fevers, <a href="#Page_358">358</a>.</li>
-
-<li class="indx"><i>Diet</i>, what best in fluxes, <a href="#Page_494">494</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Dilution</i>, the great advantage of it, <a href="#Page_391">391</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Discipline</i>, advantage of, to health, <a href="#Page_348">348</a>, <a href="#Page_355">355</a>.</li>
-
-<li class="indx"><i>Diseases</i>, list of all those on board of the fleet, <a href="#Page_94">94</a>.</li>
-<li class="isub1">&mdash;What sorts seamen are most subject to, and most exempt from, <a href="#Page_216">216</a>.</li>
-
-<li class="indx"><i>Diseases</i>, acute, tend naturally to wear themselves out, <a href="#Page_70">70</a>.</li>
-<li class="isub1">&mdash;Imputed anciently to supernatural influence, <a href="#Page_220">220</a>.</li>
-<li class="isub1">&mdash;Owing to neglect, <i>ibid.</i></li>
-
-<li class="indx"><i>Dropsy</i>, medicines adapted to it, <a href="#Page_558">558</a>.</li>
-
-<li class="indx"><i>Dysentery</i> depends on the same cause as fevers, <a href="#Page_36">36</a>.</li>
-<li class="isub1">&mdash;Arises in the Prince George from cold weather, <a href="#Page_79">79</a>.</li>
-<li class="isub1">&mdash;More fatal in its acute state in a cold than a hot climate, <a href="#Page_155">155</a>.
-<span class="pagenum" id="Page_Iv">v</span></li>
-
-<li class="indx"><i>Dysentery</i>, appearances upon dissection, <a href="#Page_471">471</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Dysentery</i>, forms of medicines adapted to it, <a href="#Page_553">553</a>.</li>
-
-<li class="ifrst">E.</li>
-
-<li class="indx"><i>Earthquakes</i> frequent in the West Indies, <a href="#Page_88">88</a>.</li>
-
-<li class="indx"><i>Effluvia</i>, what kind of them produce diseases, <a href="#Page_134">134</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Elephantiasis</i>, peculiar to Barbadoes, <a href="#Page_235">235</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>England</i>, health of the fleet there compared to that in the West Indies, <a href="#Page_67">67</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Fleet there more sickly at particular periods than in the West Indies, <a href="#Page_208">208</a>.</li>
-
-<li class="indx"><i>English</i>, their cleanliness only of modern date, <a href="#Page_282">282</a>.</li>
-
-<li class="indx"><i>Erasmus</i>, his account of the causes of pestilential diseases in England, <a href="#Page_282">282</a>.</li>
-
-<li class="indx"><i>Erysipelas</i>, Peruvian bark the best medicine in it, <a href="#Page_558">558</a>.</li>
-
-<li class="indx"><i>Exercise</i>, the advantage of it, <a href="#Page_343">343</a>.</li>
-
-<li class="indx"><i>Exercise</i> in the sun very pernicious, <a href="#Page_233">233</a>.</li>
-
-<li class="indx"><i>Expeditions</i>, list of, frustrated by disease alone, <a href="#Page_214">214</a>.</li>
-
-<li class="indx"><i>Explosions</i> of gunpowder, frequent and destructive, <a href="#Page_539">539</a>.</li>
-<li class="isub1">&mdash;Means of preventing them, <a href="#Page_540">540</a>.</li>
-
-<li class="ifrst">F.</li>
-
-<li class="indx"><i>Fatigue</i> tends to shorten life, <a href="#Page_346">346</a>.</li>
-
-<li class="indx"><i>Fevers</i> depend on the same cause as fluxes, <a href="#Page_36">36</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;More prevalent in port than fluxes, <a href="#Page_113">113</a>, <a href="#Page_127">127</a>.</li>
-<li class="isub1">&mdash;Assume a different type upon the importation of infection, <a href="#Page_182">182</a>.</li>
-<li class="isub1">&mdash;Difference of its infection from that of some other diseases, <a href="#Page_244">244</a>, <a href="#Page_249">249</a>.</li>
-
-<li class="indx"><i>Fever, ship</i>, description of it, <a href="#Page_371">371</a>.</li>
-<li class="isub1">&mdash;Treatment of it, <a href="#Page_386">386</a>.</li>
-
-<li class="indx"><i>Fever, inflammatory</i>, principal symptoms of it, <a href="#Page_384">384</a>.
-<span class="pagenum" id="Page_Ivi">vi</span></li>
-
-<li class="indx"><i>Fevers, intermittent</i>, some unusual remedies for them, <a href="#Page_456">456</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Forms of medicines adapted to them, <a href="#Page_552">552</a>.</li>
-
-<li class="indx">Fires, the most effectual means of sweetening the air of a ship, <a href="#Page_117">117</a>.</li>
-<li class="isub1">&mdash;The most powerful means of destroying infection, <a href="#Page_276">276</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Flour</i> preferable to bread for exportation, <a href="#Page_307">307</a>.</li>
-
-<li class="indx"><i>Fluxes</i> depend on the same cause as fevers, <a href="#Page_36">36</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Prevail least when fevers most violent, <a href="#Page_44">44</a>, <a href="#Page_113">113</a>.</li>
-<li class="isub1">&mdash;Apt to arise in ships soon after their arrival in the West Indies, <a href="#Page_19">19</a>, <a href="#Page_84">84</a>, <a href="#Page_183">183</a>.</li>
-<li class="isub1">&mdash;More frequent at sea than in port, <a href="#Page_113">113</a>.</li>
-<li class="isub1">&mdash;More frequent in ships that have been subject to fevers, <a href="#Page_183">183</a>.</li>
-<li class="isub1">&mdash;Why so frequent and fatal at West India hospitals, <a href="#Page_192">192</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Observations on them, <a href="#Page_466">466</a>.</li>
-<li class="isub1">&mdash;Treatment of them, <a href="#Page_473">473</a>.</li>
-
-<li class="indx"><i>Formidable</i>, extraordinary degree of health on board of her, <a href="#Page_107">107</a>, <a href="#Page_128">128</a>, <a href="#Page_365">365</a>.</li>
-<li class="isub1">&mdash;Causes of it, <a href="#Page_72">72</a>, <a href="#Page_108">108</a>.</li>
-<li class="isub1">&mdash;Fever arises in her from men lent to another ship, <a href="#Page_128">128</a>.</li>
-<li class="isub1">&mdash;From pressed men, <a href="#Page_161">161</a>.</li>
-
-<li class="indx"><i>French ships</i>, their discipline and œconomy inferior to British, <a href="#Page_114">114</a>.</li>
-
-<li class="indx"><i>Frigates</i> more healthy than ships of the line, causes of this, <a href="#Page_54">54</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;More healthy when their fire place was between decks, <a href="#Page_287">287</a>.</li>
-<li class="isub1">&mdash;A contrivance for ventilating them, <a href="#Page_292">292</a>.</li>
-
-<li class="indx"><i>Fumigation</i>, method of performing it, <a href="#Page_270">270</a>, <i>&amp; seq.</i></li>
-
-<li class="ifrst">G.</li>
-
-<li class="indx"><i>Gibraltar</i> relieved by Lord Rodney, <a href="#Page_19">19</a>.</li>
-<li class="isub1">&mdash;Admissions and deaths at the hospital there, <a href="#Page_187">187</a>, <a href="#Page_205">205</a>.
-<span class="pagenum" id="Page_Ivii">vii</span></li>
-
-<li class="indx"><i>Gibraltar</i> man of war, account of her, <a href="#Page_53">53</a>.</li>
-
-<li class="indx"><i>Grosislet Bay</i>, description of it, <a href="#Page_28">28</a>.</li>
-
-<li class="indx"><i>Gunpowder</i>, accidents from it, <a href="#Page_190">190</a>, <a href="#Page_539">539</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Guthrie, Dr.</i>, his observations on infection in Russia, <a href="#Page_279">279</a>.</li>
-
-<li class="ifrst">H.</li>
-
-<li class="indx"><i>Habit</i>, effect of it in resisting infection, <a href="#Page_294">294</a>.</li>
-
-<li class="indx"><i>H&aelig;morrhages, internal</i>, oil and tincture of rhubarb of eminent service in them, <a href="#Page_486">486</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>H&aelig;morrhage</i>, a limb sometimes carried off without any ensuing, <a href="#Page_542">542</a>.</li>
-
-<li class="indx"><i>H&aelig;morrhoids</i>, medicines adapted to them, <a href="#Page_555">555</a>.</li>
-
-<li class="indx"><i>Hardship</i> impairs health and shortens life, <a href="#Page_218">218</a>.</li>
-
-<li class="indx"><i>Heat</i> communicated to the hand, a symptom of the ship fever, <a href="#Page_378">378</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Hemisphere, Northern</i>, a cold summer general all over it, <a href="#Page_157">157</a>.</li>
-
-<li class="indx"><i>Herodotus</i>, his account of the clothing and health of the ancient &AElig;gyptians, <a href="#Page_284">284</a>.</li>
-
-<li class="indx"><i>Hospitals</i> not so proper for the sick as their own ships, <a href="#Page_60">60</a>.</li>
-<li class="isub1">&mdash;Account of diseases sent to them, <a href="#Page_185">185</a>.</li>
-<li class="isub1">&mdash;At Gibraltar, <a href="#Page_187">187</a>.</li>
-<li class="isub1">&mdash;At Barbadoes, <a href="#Page_189">189</a>, <a href="#Page_197">197</a>.</li>
-<li class="isub1">&mdash;At St. Christopher’s, <a href="#Page_195">195</a>.</li>
-<li class="isub1">&mdash;At St Lucia, <i>ibid.</i></li>
-<li class="isub1">&mdash;At Jamaica, <a href="#Page_198">198</a>.</li>
-<li class="isub1">&mdash;At New York, <a href="#Page_201">201</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;General view of them all, <a href="#Page_205">205</a>.</li>
-<li class="isub1">&mdash;Proportion of deaths in them no criterion of the success of practice, <a href="#Page_195">195</a>, <a href="#Page_200">200</a>.</li>
-
-<li class="indx"><i>Hurricane months</i>, <a href="#Page_28">28</a>.</li>
-
-<li class="indx"><i>Hurricane</i>, a violent one in the West Indies&mdash;its good effect on the health of the inhabitants, <a href="#Page_40">40</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Hypochondriac</i> complaints do not affect the laborious part of mankind, <a href="#Page_219">219</a>.
-<span class="pagenum" id="Page_Iviii">viii</span></li>
-
-<li class="ifrst">I.</li>
-
-<li class="indx"><i>Jaw, locked</i>, account of those affected by it in the battles of April, 1782, <a href="#Page_520">520</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Its symptoms different from those of the tetanus, <a href="#Page_526">526</a>.</li>
-<li class="isub1">&mdash;Wherefore most frequent in hot climates, <a href="#Page_529">529</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Indolence</i> a cause of scurvy, <a href="#Page_345">345</a>.</li>
-
-<li class="indx"><i>Infection</i>, the obscurity of and difficulty of investigating it, <a href="#Page_238">238</a>.</li>
-<li class="isub1">&mdash;Various ways in which it is introduced into a ship, <a href="#Page_241">241</a>.</li>
-<li class="isub1">&mdash;It may arise without the presence of fever, <a href="#Page_242">242</a>.</li>
-<li class="isub1">&mdash;Habit renders people insensible to it, <i>ibid. &amp; seq.</i></li>
-<li class="isub1">&mdash;It never affects all indiscriminately who are exposed to it, <a href="#Page_245">245</a>.</li>
-<li class="isub1">&mdash;It does not pass from one species of animal to another, <a href="#Page_249">249</a>.</li>
-<li class="isub1">&mdash;How to prevent the production of it, <a href="#Page_254">254</a>.</li>
-<li class="isub1">&mdash;Means of eradicating it, <a href="#Page_264">264</a>.</li>
-<li class="isub1">&mdash;Method of guarding against it, <a href="#Page_293">293</a>.</li>
-<li class="isub1">&mdash;Less frequent in hot climates than cold, <a href="#Page_276">276</a>.</li>
-
-<li class="indx"><i>Inflammatory</i> complaints most frequent in ships where no infection, <a href="#Page_172">172</a>.</li>
-
-<li class="indx"><i>Inoculation</i>, conjecture concerning the cause of its safety, <a href="#Page_247">247</a>.</li>
-
-<li class="indx"><i>Intermittent fevers</i> sometimes arise on board of a ship, <a href="#Page_32">32</a>.</li>
-<li class="isub1">&mdash;Some unusual remedies for them, <a href="#Page_456">456</a>, &amp; <i>seq.q.</i></li>
-
-<li class="indx"><i>Intestines</i>, great, the principal seat of the dysentery, <a href="#Page_470">470</a>.</li>
-
-<li class="ifrst">L.</li>
-
-<li class="indx"><i>Labour</i> necessary to health, <a href="#Page_217">217</a>.</li>
-<li class="isub1">&mdash;Pernicious if in excess, <i>ibid.</i></li>
-<li class="isub1">&mdash;What diseases it tends to avert, <a href="#Page_219">219</a>.</li>
-<li class="isub1">&mdash;Scurvy prevented by it, <a href="#Page_344">344</a>.
-<span class="pagenum" id="Page_Iix">ix</span></li>
-
-<li class="indx"><i>Land wind</i> at Jamaica, <a href="#Page_119">119</a>.</li>
-<li class="isub1">&mdash;Not at the small islands, <i>ibid.</i></li>
-
-<li class="indx"><i>Lemon juice</i>, extraordinary instance of its efficacy in scurvy, <a href="#Page_86">86</a>.</li>
-<li class="isub1">&mdash;The most effectual remedy in scurvy, <a href="#Page_303">303</a>.</li>
-
-<li class="indx"><i>Lemons and limes</i>, their juice the best detergent in scorbutic ulcers, <a href="#Page_502">502</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Lientery</i>, a symptom in obstinate fluxes, <a href="#Page_489">489</a>.</li>
-
-<li class="indx"><i>Limes</i>, instance of their great antiscorbutic effect, <a href="#Page_56">56</a>.</li>
-
-<li class="indx"><i>Liver</i>, inflammation of it seldom known in the West Indies, <a href="#Page_95">95</a>.</li>
-<li class="isub1">&mdash;But appeared at New York in men belonging to the West-India fleet, <a href="#Page_156">156</a>.</li>
-
-<li class="ifrst">M.</li>
-
-<li class="indx"><i>Magnesia</i>, given with acids, removes sickness of the stomach, <a href="#Page_452">452</a>.</li>
-
-<li class="indx"><i>Malt liquor</i>, the utility of it, <a href="#Page_320">320</a>.</li>
-
-<li class="indx"><i>Malt, essence of</i>, a weak antiscorbutic, <a href="#Page_57">57</a>, <a href="#Page_504">504</a>.</li>
-<li class="isub1">&mdash;Of service in the beginning of scurvy, <a href="#Page_146">146</a>, <a href="#Page_164">164</a>.</li>
-
-<li class="indx"><i>Manners, Lord Robert</i>, his death lamented, <a href="#Page_520">520</a>.</li>
-
-<li class="indx"><i>Marshes</i>, their exhalations cause fevers, <a href="#Page_43">43</a>.</li>
-
-<li class="indx"><i>Melasses</i>, method of using it, <a href="#Page_305">305</a>.</li>
-<li class="isub1">&mdash;Great utility of it, <a href="#Page_308">308</a>.</li>
-
-<li class="indx"><i>Mixing of men</i>, bad consequences of, <a href="#Page_252">252</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Moisture</i>, the bad effects of it, <a href="#Page_288">288</a>.</li>
-
-<li class="indx"><i>Mortality</i>, method of calculating the proportion of it, <a href="#Page_88">88</a>.</li>
-<li class="isub1">&mdash;Greater at sea from the want of an hospital and of proper diet, <a href="#Page_143">143</a>.</li>
-<li class="isub1">&mdash;In the fleets and hospital at different periods, <a href="#Page_205">205</a>.</li>
-<li class="isub1">&mdash;In the army in the West Indies, <a href="#Page_206">206</a>.</li>
-<li class="isub1">&mdash;In England, <a href="#Page_207">207</a>.</li>
-<li class="isub1">&mdash;Total in the fleet for three years and three months, <a href="#Page_209">209</a>.
-<span class="pagenum" id="Page_Ix">x</span></li>
-
-<li class="indx"><i>Mortification</i>, an uncommon instance of it in the shoulder, <a href="#Page_83">83</a>.</li>
-
-<li class="ifrst">N.</li>
-
-<li class="indx"><i>Necessaries</i>, Surgeons, their quantity very inadequate, <a href="#Page_302">302</a>.</li>
-
-<li class="indx"><i>New York</i>, the fleet therein 1780, <a href="#Page_38">38</a>.</li>
-<li class="isub1">&mdash;in 1782, <a href="#Page_150">150</a>.</li>
-
-<li class="indx"><i>Nyctalopia</i>, a symptom of the scurvy, <a href="#Page_24">24</a>, <a href="#Page_501">501</a>.</li>
-
-<li class="indx"><i>Nymph</i> frigate, account of her health, <a href="#Page_164">164</a>.</li>
-
-<li class="ifrst">O.</li>
-
-<li class="indx"><i>Oatmeal</i>, the abuse of it, <a href="#Page_308">308</a>.</li>
-
-<li class="indx"><i>Observations</i>, the difficulty of making them, <a href="#Page_9">9</a>.</li>
-
-<li class="indx"><i>Officers</i>, more affected by foul air than common men, <a href="#Page_116">116</a>, <a href="#Page_137">137</a>.</li>
-
-<li class="indx"><i>Opium</i>, advantage of combining with antimonials, <a href="#Page_392">392</a>.</li>
-<li class="isub1">&mdash;With neutral salts, <a href="#Page_395">395</a>.</li>
-<li class="isub1">&mdash;Its use in continued fevers, <a href="#Page_404">404</a>, <a href="#Page_408">408</a>.</li>
-<li class="isub1">&mdash;Cautions and directions with regard to it in fluxes, <a href="#Page_476">476</a>, <a href="#Page_479">479</a>.</li>
-<li class="isub1">&mdash;Its use in ulcers, <a href="#Page_504">504</a>.</li>
-<li class="isub1">&mdash;The best method of giving it in the locked jaw, <a href="#Page_532">532</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Osbridge</i>, Lieut, his ingenious contrivance for sweetening water, <a href="#Page_331">331</a>.</li>
-
-<li class="ifrst">P.</li>
-
-<li class="indx"><i>Pediluvia</i> hurtful in inflammatory fevers, <a href="#Page_397">397</a>.</li>
-
-<li class="indx"><i>Petechi&aelig;</i>, a symptom in the ship fever, <a href="#Page_377">377</a>.</li>
-
-<li class="indx"><i>Phthisis pulmonalis</i>, not so common in the West Indies as Europe, <a href="#Page_97">97</a>.</li>
-<li class="isub1">&mdash;but more rapid, <i>ibid.</i>
-<span class="pagenum" id="Page_Ixi">xi</span></li>
-
-<li class="indx"><i>Phœnix</i>, Spanish Admiral’s ship, her excellent materials and construction, <a href="#Page_53">53</a>.</li>
-
-<li class="indx"><i>Pigeon Island</i>, remarkable proof of its healthiness, <a href="#Page_228">228</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Plague</i>, its infection does not spread far, <a href="#Page_298">298</a>.</li>
-<li class="isub1">&mdash;Means of preventing it from spreading, <i>ibid.</i> and <a href="#Page_299">299</a>.</li>
-<li class="isub1">&mdash;Never known in tropical climates, <a href="#Page_277">277</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Porter</i>, its effect in preventing scurvy, <a href="#Page_320">320</a>.</li>
-
-<li class="indx"><i>Potatoes, raw</i>, a remedy for scurvy, <a href="#Page_60">60</a>.</li>
-<li class="isub1">&mdash;Proposed as an article of victualling, <a href="#Page_309">309</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Prudent</i>, effects of soaking her timbers in pickle, <a href="#Page_81">81</a>.</li>
-
-<li class="indx"><i>Pulmonic</i> complaints, medicines adapted to them, <a href="#Page_556">556</a>.</li>
-
-<li class="indx"><i>Putrefaction</i>, simple, effluvia of it may produce fevers, <a href="#Page_134">134</a>, <i>&amp; seq.</i></li>
-
-<li class="ifrst">Q.</li>
-
-<li class="indx"><i>Quick lime</i>, the best preservative of water, <a href="#Page_326">326</a>, <i>&amp; seq.</i></li>
-
-<li class="ifrst">R.</li>
-
-<li class="indx"><i>Recruits</i>, new raised, the cause of sickness, <a href="#Page_180">180</a>.</li>
-
-<li class="indx"><i>Returns</i>, intention of them, <a href="#Page_6">6</a>, <a href="#Page_7">7</a>.</li>
-<li class="isub1">&mdash;Specimens of them, <a href="#Page_23">23</a>.</li>
-<li class="isub1">&mdash;Method of forming them into tables, <a href="#Page_24">24</a>.</li>
-
-<li class="indx"><i>Rheumatism</i>, forms of medicines adapted to it, <a href="#Page_557">557</a>.</li>
-
-<li class="indx"><i>Royal Oak</i>, cause of her health, <a href="#Page_80">80</a>.</li>
-<li class="isub1">&mdash;Method of curing the scurvy on board, <a href="#Page_81">81</a>.</li>
-
-<li class="indx"><i>Ruby</i>, remarkably healthy, <a href="#Page_167">167</a>.
-<span class="pagenum" id="Page_Ixii">xii</span></li>
-
-<li class="ifrst">S.</li>
-
-<li class="indx"><i>St. Lucia</i>, woody, mountainous, and rainy, <a href="#Page_27">27</a>.</li>
-<li class="isub1">&mdash;Proportion of deaths at the hospital there, <a href="#Page_195">195</a>.</li>
-
-<li class="indx"><i>Salt</i>, the good effects of it in diet, <a href="#Page_314">314</a>.</li>
-
-<li class="indx"><i>Sandwich</i>, health of, on her first arrival, <a href="#Page_19">19</a>.</li>
-
-<li class="indx"><i>Scorches</i>, great numbers killed and wounded in this manner, <a href="#Page_190">190</a>.</li>
-
-<li class="indx"><i>Scurvy</i>, in a cruise to windward of Martinico, <a href="#Page_49">49</a>.</li>
-<li class="isub1">&mdash;In a cruise near Jamaica, <a href="#Page_121">121</a>.</li>
-<li class="isub1">&mdash;High degree of it in the Nonsuch, <i>ibid.</i></li>
-<li class="isub1">&mdash;On the passage to New York, <a href="#Page_148">148</a>.</li>
-<li class="isub1">&mdash;Why less of it in the ships last from England, <a href="#Page_147">147</a>.</li>
-<li class="isub1">&mdash;Its rapid progress in the latter part of a cruise, <a href="#Page_148">148</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;Method of curing it on board of the fleet at New York, <a href="#Page_151">151</a>.</li>
-<li class="isub1">&mdash;Numbers that died of it according to Sir Richard Hawkins, <a href="#Page_214">214</a>.</li>
-<li class="isub1">&mdash;In Commodore Anson’s Squadron, <i>ibid.</i></li>
-
-<li class="indx"><i>Scurvy</i>, observations on it, <a href="#Page_499">499</a>.</li>
-<li class="isub1">&mdash;What meant by the latent state of it, <a href="#Page_505">505</a>.</li>
-<li class="isub1">&mdash;The best remedies for it, <a href="#Page_506">506</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;In what manner the nature of the diet induces it, <a href="#Page_509">509</a>.</li>
-<li class="isub1">&mdash;Whether it is infectious, <a href="#Page_516">516</a>.</li>
-
-<li class="indx"><i>Seasons</i> in the West Indies, account of them, <a href="#Page_28">28</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Ships</i>, new, not more unhealthy than others, <a href="#Page_19">19</a>, <a href="#Page_52">52</a>.</li>
-<li class="isub1">&mdash;Disadvantage in changing their commanders, <a href="#Page_80">80</a>.</li>
-<li class="isub1">&mdash;Why large ones most sickly, <a href="#Page_128">128</a>, <a href="#Page_133">133</a>, <a href="#Page_253">253</a>.</li>
-
-<li class="indx"><i>Shingle ballast</i>, the advantage of it, <a href="#Page_289">289</a>.</li>
-
-<li class="indx"><i>Shoes</i> of great use to seamen, <a href="#Page_339">339</a>.</li>
-
-<li class="indx"><i>Sick</i>, what the best place for them in a ship, <a href="#Page_262">262</a>.</li>
-
-<li class="indx"><i>Sickness</i>, method of calculating the proportion of it, <a href="#Page_90">90</a>.</li>
-
-<li class="indx"><i>Situation</i>, effects of the difference of it upon health, <a href="#Page_28">28</a>.</li>
-
-<li class="indx"><i>Small-pox</i> very prevalent in the fleet, <a href="#Page_85">85</a>.
-<span class="pagenum" id="Page_Ixiii">xiii</span></li>
-
-<li class="indx"><i>Sope</i> supplied on board of the fleet, <a href="#Page_145">145</a>.</li>
-<li class="isub1">&mdash;Its great utility, <a href="#Page_151">151</a>, <a href="#Page_257">257</a>.</li>
-
-<li class="indx"><i>Sour krout</i>, manner of using it, <a href="#Page_305">305</a>.</li>
-
-<li class="indx"><i>Splinters</i> more destructive than balls, <a href="#Page_103">103</a>.</li>
-
-<li class="indx"><i>Spices</i> good against noxious air, <a href="#Page_230">230</a>.</li>
-
-<li class="indx"><i>Spruce beer</i>, the great advantage of it, <a href="#Page_320">320</a>.</li>
-
-<li class="indx"><i>Strangers</i> communicate disease to each other without any apparent previous disease, <a href="#Page_243">243</a>.</li>
-
-<li class="indx"><i>Surf</i>, danger from it in watering at St. Lucia, <a href="#Page_88">88</a>.</li>
-
-<li class="indx"><i>Surgeons</i>, a greater proportion of mortality among them and their mates, <a href="#Page_134">134</a>.</li>
-<li class="isub1">&mdash;Advantage of encouraging them, <a href="#Page_266">266</a>.</li>
-
-<li class="indx"><i>Sweating</i> of use in curing the ship fever, <a href="#Page_388">388</a>, <i>&amp; seq.</i></li>
-<li class="isub1">&mdash;In the dysentery, <a href="#Page_475">475</a>.</li>
-
-<li class="indx"><i>Sweet vegetables</i> more antiscorbutic and medicinal in their natural state, <a href="#Page_58">58</a>.</li>
-
-<li class="ifrst">T.</li>
-
-<li class="indx"><i>Tables</i>, method of forming them, <a href="#Page_90">90</a>.</li>
-
-<li class="indx"><i>Tenaculam</i> recommended in amputation, <a href="#Page_543">543</a>.</li>
-
-<li class="indx"><i>Thermometer</i>, general range of it in the West Indies, <a href="#Page_29">29</a>.</li>
-<li class="isub1">&mdash;Observations on it at Port Royal, <a href="#Page_124">124</a>.</li>
-
-<li class="indx"><i>Thucydides</i>, his observations on the plague at Athens, <a href="#Page_296">296</a>.</li>
-
-<li class="ifrst">U.</li>
-
-<li class="indx"><i>Ulcers</i> keep pace with scorbutic and feverish complaints, <a href="#Page_132">132</a>.</li>
-<li class="isub1">&mdash;Proportion of them, <a href="#Page_150">150</a>.</li>
-<li class="isub1">&mdash;Very frequent in the Barfleur, <i>ibid.</i></li>
-<li class="isub1">&mdash;Great effect of a cold climate in diminishing them, <a href="#Page_156">156</a>.
-<span class="pagenum" id="Page_Ixiv">xiv</span></li>
-<li class="isub1">&mdash;Form a considerable part of sea complaints, <a href="#Page_221">221</a>.</li>
-<li class="isub1">&mdash;Apt to arise in scorbutic habits, <a href="#Page_339">339</a>, <a href="#Page_500">500</a>, <a href="#Page_505">505</a>.</li>
-
-<li class="indx"><i>Uniform</i> for common seamen recommended, <a href="#Page_336">336</a>.</li>
-
-<li class="indx"><i>Union</i> remarkably healthy, <a href="#Page_167">167</a>.</li>
-<li class="isub1">&mdash;Subject only to inflammatory complaints, <a href="#Page_173">173</a>, <a href="#Page_297">297</a>.</li>
-
-<li class="indx"><i>Urine</i>, appearance of it in the yellow fever, <a href="#Page_437">437</a>, <a href="#Page_440">440</a>, <i>&amp; seq.</i></li>
-
-<li class="ifrst">V.</li>
-
-<li class="indx"><i>Venereal disease</i>, the medicines best adapted to the various forms of it, <a href="#Page_559">559</a>.</li>
-
-<li class="indx"><i>Vernon</i>, Admiral, health of his fleet compared with Lord Rodney’s, <a href="#Page_131">131</a>, <a href="#Page_198">198</a>.</li>
-<li class="isub1">&mdash;The first who caused the spirits allowed the seamen to be diluted, <a href="#Page_324">324</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Victory</i>, 12th of April, 1782, <a href="#Page_99">99</a>.</li>
-<li class="isub1">&mdash;Its effects on the health of the men, <a href="#Page_101">101</a>, <i>&amp; seq.</i></li>
-
-<li class="indx"><i>Ville de Paris</i>, sickness and mortality on board after being captured, <a href="#Page_115">115</a>.</li>
-<li class="isub1">&mdash;Foundered, <a href="#Page_210">210</a>.</li>
-
-<li class="indx"><i>Vinegar</i>, use of it in the navy, <a href="#Page_302">302</a>.</li>
-<li class="isub1">&mdash;In the Roman armies, <i>ibid.</i></li>
-
-<li class="indx"><i>Vitriol, white</i>, used as a remedy in intermittent fevers, <a href="#Page_462">462</a>.</li>
-
-<li class="indx"><i>Vomit, black</i>, the most dangerous symptom in the yellow fever, <a href="#Page_436">436</a>.</li>
-
-<li class="ifrst">W.</li>
-
-<li class="indx"><i>Wall, Dr.</i> recommends opium in low fevers, <a href="#Page_393">393</a>.</li>
-
-<li class="indx"><i>War</i>, why fleets most sickly in the beginning of it, <a href="#Page_69">69</a>.
-<span class="pagenum" id="Page_Ixv">xv</span></li>
-
-<li class="indx"><i>Warren, Dr.</i>, his successful treatment of a case of the locked jaw, <a href="#Page_532">532</a>.</li>
-
-<li class="indx"><i>Water</i> of springs preferable to running water, <a href="#Page_324">324</a>.</li>
-<li class="isub1">&mdash;Quick lime the best preservative of it, <a href="#Page_326">326</a>.</li>
-<li class="isub1">&mdash;Various other means of correcting it, <a href="#Page_329">329</a>.</li>
-<li class="isub1">&mdash;Distillation from sea water recommended, <a href="#Page_332">332</a>.</li>
-
-<li class="indx"><i>Watering duty</i> dangerous and unwholesome, <a href="#Page_88">88</a>, <a href="#Page_118">118</a>.</li>
-
-<li class="indx"><i>Well</i> of a ship, great danger of foul air in it, <a href="#Page_285">285</a>.</li>
-<li class="isub1">&mdash;Method of preventing it, <i>ibid.</i></li>
-
-<li class="indx"><i>Wind of a ball</i>, the effects of it, <a href="#Page_537">537</a>.</li>
-
-<li class="indx"><i>Wine</i>, the great advantage of it in the French fleet, <a href="#Page_322">322</a>.</li>
-<li class="isub1">&mdash;Superior to spirits, <a href="#Page_324">324</a>.</li>
-<li class="isub1">&mdash;Its utility in continued fevers, <a href="#Page_410">410</a>.</li>
-
-<li class="indx"><i>Women</i>, why not so subject to acute diseases in the West Indies as men, <a href="#Page_234">234</a>.</li>
-
-<li class="indx"><i>Wounds</i>, number that died of, <a href="#Page_209">209</a>.</li>
-<li class="isub1">&mdash;Account of those received in April, 1782, <a href="#Page_520">520</a>.</li>
-
-<li class="ifrst">Y.</li>
-
-<li class="indx"><i>Yams</i> used in place of bread, <a href="#Page_76">76</a>.</li>
-
-<li class="indx"><i>Yellow fever</i>, <a href="#Page_425">425</a>.</li>
-
-<li class="indx"><i>Yellowness</i> of the skin not always a symptom of malignity, <a href="#Page_181">181</a>.</li>
-
-<li class="ifrst">Z.</li>
-
-<li class="indx"><i>Zinc</i>, effects of it in obstinate intermittent fevers, <a href="#Page_456">456</a>.</li>
-<li class="isub1">&mdash;Cases in which it is proper, <a href="#Page_461">461</a>.</li></ul>
-
-<div class="footnotes">
-
-<h2 id="FOOTNOTES">FOOTNOTES:</h2>
-
-<div class="footnote">
-
-<p><a id="Footnote_1" href="#FNanchor_1" class="label">1</a>
- These were the Conqueror, the Cornwall, and the
-Boyne, which were so damaged in the battles, that they
-were obliged to bear away for St. Lucia.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_2" href="#FNanchor_2" class="label">2</a>
- The following may serve as a specimen of these
-returns:</p>
-
-<h3><span class="smcap">State</span> of <span class="smcap">Health</span> of His Majesty’s Ship <span class="smcap">Alcide</span>.
-Carlisle Bay, Barbadoes, 1st June, 1781.</h3>
-
-<table class="bbox">
-  <tr>
-    <th colspan="2">Sick now on Board.</th>
-    <th colspan="2">Died in the course<br />of last Month.</th>
-    <th colspan="2">Sent to the Hospital<br />in the course of<br />last Month.</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">4</td>
-    <td rowspan="5" style="vertical-align: top">Of Fever</td>
-    <td rowspan="5" class="tdr" style="vertical-align: top">1</td>
-    <td rowspan="5" style="vertical-align: top"> Ill of Scurvy</td>
-    <td rowspan="5" class="tdr" style="vertical-align: top">35</td>
-  </tr>
-  <tr>
-    <td>Flux</td>
-    <td class="tdr">5</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">26</td>
-  </tr>
-  <tr>
-    <td>Catarrh and Rheumatism</td>
-    <td class="tdr">7</td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">42</td>
-  </tr>
-</table>
-
-<h4>REMARKS.</h4>
-
-<p>During the course of last month we had one hundred
-and fourteen of the men, who contracted the scurvy in
-the late long cruise, recovered by the use of limes, which
-were procured at Montserrat. A pint of wine, with an
-equal quantity of water, made agreeable with sugar and
-tamarinds, is served to each patient daily. The regimen
-is exactly the same as mentioned last month.</p>
-
-<p>Since we came into port, very few have been seized
-with scurvy, but several complain daily of fluxes and
-feverish complaints, none of which seem at present to be
-of any consequence.</p>
-
-<p>Four patients have last month complained of an almost
-total blindness towards evening, accompanied with
-head-ach, vertigo, nausea, and a sense of weight about
-the precordia. The pupil is then extremely dilated, but
-contracts readily when a strong light is presented to it.
-Two of them had the scurvy in a high degree, one of
-them slightly, and the other seemed entirely free from it.
-I am not well acquainted with the nature or cure of this
-disease, which I believe is called Nyctalopia by some
-systematic writers.</p>
-
-<p>I gave those who were affected with it an emetic,
-which brought up a great deal of bile, and relieved the
-symptoms both of the head and stomach. This encouraged
-me to a repetition of it, which seemed also to be
-attended with benefit. I likewise applied blisters behind
-the ears, and gave bark and elixir of vitriol, with the
-antiscorbutic course, to those that required it.</p>
-
-<p>I can form no probable conjecture concerning the
-cause of this disease. I have observed a dilation of the
-pupil in scorbutic patients, and they complained of a
-cloud before their eyes, with imperfect vision, which
-disappeared as the scurvy went off.</p>
-
-<p class="author">WILLIAM TELFORD.</p>
-
-<p>
-To Dr. <span class="smcap">Blane</span>,<br />
-Physician to the Fleet.
-</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_3" href="#FNanchor_3" class="label">3</a>
- Although this hurricane, in itself and its consequences,
-was so destructive to the lives and health of
-men, yet, with regard to the inhabitants on shore, it
-had a surprising and unexpected effect in mending their
-health. I wrote an account of this hurricane to the
-late Dr. Hunter, who communicated it to the Royal
-Society, and the following passage is extracted from it:</p>
-
-<p>“The consequences of this general tumult of nature,
-on the health of man, was none of the least curious of
-its effects. I made much inquiry on this head, not
-only of the medical gentlemen who had the charge of
-hospitals, and of the physicians of the country, but of
-the inhabitants, and every one had some cure to relate
-either of themselves or their neighbours, in a variety of
-diseases. Nor could I find that either those who were
-in health, or those who were ill of any disease whatever
-suffered from it, otherwise than by its mechanical
-violence; but, on the contrary, that there was a general
-amendment of health. This is a fact, which I could
-neither credit, nor would venture to relate, were it not
-supported by so many concurring testimonies. It had
-a visible good effect on the acute diseases of the climate.
-The chronic fluxes, of which there were then some at
-the naval hospital, were cured or much relieved by it.
-But the diseases upon which it had most evident and
-sensible effects, were pulmonic consumptions. Some
-recent cases of phthisis, and even the acute state of
-pleurisy, was cured by it; and in the advanced and incurable
-state of it, the hectic fever was removed, and
-remarkable temporary relief afforded. A delicate lady
-of my acquaintance, who was ill of a pleurisy at the
-time, and passed more than ten hours in the open air,
-sitting generally several inches deep in water, found
-herself free of complaint next day; had no return of it;
-and when I saw her a few weeks after, was in much
-better health and looks then usual. The people observed
-that they had remarkably keen appetites for
-some time after, and the surviving part of them became
-uncommonly healthy; some of both sexes, whom I
-had left fallow and thin a few months before, looking
-now fresh and plump.</p>
-
-<p>It is very difficult to account for this, as well as every
-thing else in the animal œconomy; but it was probably
-owing in part, at least, to the very great coldness and
-purity of the air from the upper regions of the atmosphere.
-Great agitation of mind sometimes also produces
-a revolution in health; and we know that the
-effect of external impressions in general is very different
-when the mind is vacant, from what it is when occupied
-and interested by objects, whether of pleasure and satisfaction,
-or of danger and suffering.”</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_4" href="#FNanchor_4" class="label">4</a>
- In order to ascertain more exactly the degree of
-sickness in each month, a column was afterwards added
-to the form of the returns, expressing the number taken
-ill of the several diseases in the course of the month.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_5" href="#FNanchor_5" class="label">5</a>
- I was informed by Captain Caldwell, that when he
-commanded the Hannibal, of 50 guns, his crew was so
-much afflicted with the scurvy, in a passage of nine
-weeks from St. Helena to Crookhaven, in Ireland, that
-ninety-two men were confined to their hammocks in the
-last stage of that disease, though they had been supplied
-with sugar at St. Helena, and served with it on the passage.
-They remained three weeks at Crookhaven; at
-the end of which time every man was fit for duty: and
-though they had fresh provision, they had no fresh vegetables,
-so that their cure is to be ascribed to the use of
-lemons and oranges, which the Captain very humanely
-ordered to be purchased for them from on board of a
-foreign ship that happened to put into the same harbour.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_6" href="#FNanchor_6" class="label">6</a>
- <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_7" href="#FNanchor_7" class="label">7</a>
- They were the Formidable and Namur, of 90 guns;
-the Arrogant, Conqueror, Marlborough, Hercules, and
-Fame, of 74 guns; the Yarmouth, Repulse, Proth&eacute;e,
-Anson, and Nonsuch, of 64 guns.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_8" href="#FNanchor_8" class="label">8</a>
- These were the Prince George, of 90; the Bedford,
-Canada, and Royal Oak, of 74; the America and Prudent,
-of 64 guns.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_9" href="#FNanchor_9" class="label">9</a>
- This is a term in use for the different articles of
-seamen’s cloathing, particularly shirts and trowsers.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_10" href="#FNanchor_10" class="label">10</a>
- The mortification in the shoulder, mentioned above,
-was somewhat singular. It happened to a man in the
-Yarmouth, who, after being for a week ill of a fever
-and flux, was one day, early in the morning, seized
-with a pain in the upper part of the right arm, which
-immediately began to mortify. He soon after became
-convulsed, and died the same day about two o’clock.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_11" href="#FNanchor_11" class="label">11</a>
- Earthquakes are frequent in the West Indies, and
-perhaps proceed from a weaker operation of the same
-cause that originally produced the islands themselves,
-which seem all to have been raised from the sea by subterraneous
-fire. There are evident vestiges of volcanoes
-in them all, except Barbadoes; but there are other unequivocal
-marks of this island having been raised from
-the bottom of the sea; for it is entirely formed of coral,
-and other sub-marine productions, of which the strata
-are broken, and the parts set at angles to each other, as
-might be expected from such a cause. There is, perhaps,
-at all times in the caverns of the earth, elastic
-vapour struggling to vent itself, and when near the surface,
-it may sometimes overcome the incumbent masses
-of matter, and produce certain convulsions of nature.
-In the account of the hurricane which I wrote to Dr.
-Hunter, I gave reasons for believing, from the testimony
-of the inhabitants, that hurricanes are attended with
-earthquakes; and if a conjecture might be advanced concerning
-the cause of this, it might be said, that as the
-atmosphere is lighter at that time, by several inches of
-the barometer, the elastic vapour, confined by the weight
-of the incumbent earth and atmosphere, being less compressed,
-may exert some sensible effects, producing a sort
-of explosion.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_12" href="#FNanchor_12" class="label">12</a>
- Since the publication of the first edition of this
-work I have been informed that this complaint is not so
-rare on shore as in the fleet, which may be partly owing
-to the greater coolness of the air at sea, and partly from
-the seamen not having been a sufficient length of time in
-the climate to be affected with this disease, as few of
-them had been more than two years from England.
-But as this affection of the liver was very common in the
-fleets and naval hospitals in the East Indies, it is evident
-that there is a great difference of the climates in this respect.
-It is worth remarking, that it sometimes breaks
-out in the West-India Islands like an epidemic. The
-complaint, for instance, was very little known in the
-island of Grenada, till about the year 1785, when it
-became very frequent in a particular quarter of the island;
-and the gentleman who sent the description of it to England
-alledged, that there were the most unequivocal
-proofs of its being contagious. It was most successfully
-treated by very copious bloodletting, and in exciting a
-salivation by mercury. See Dr. Duncan’s Medical Commentaries,
-Decad. 2, vol. I.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_13" href="#FNanchor_13" class="label">13</a>
- Dr. Lind, on the authority of Mr. Ives, surgeon
-to Admiral Matthews.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_14" href="#FNanchor_14" class="label">14</a>
- London Gazette, <i>June</i>, 1781.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_15" href="#FNanchor_15" class="label">15</a>
- This is well illustrated by the manner in which
-Captain Nott, of the Centaur, was killed in Fort-Royal
-Bay. This brave man, having carried his Ship nearer
-the enemy than the rest of the line, but nevertheless at a
-great distance, had his signal made to keep the line, and
-having gone into his cabin, as it is said, to examine the
-import of the signal, a cannon ball struck him in the groin,
-and it was so far spent, that it stuck in his body. It tore
-away a whole plank of the ship’s side, the splinters of
-which killed a young gentleman, the only person near
-him.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_16" href="#FNanchor_16" class="label">16</a>
- I have seen an account of the diseases of the army
-at St. Lucia for a whole year, kept by Mr. Everard
-Home, an ingenious gentleman belonging to the army
-hospital, and it appears, that, during ten months out of
-the twelve, the dysentery was the predominant disease.
-This seems to contradict the opinion, that the land air
-is more apt to occasion fevers than fluxes; but it is to
-be remarked, that the sickness of the soldiers on this
-island was not so much owing to the malignant influence
-of the air, the situation of the garrison being high and
-airy, as to the bad accommodations and provisions, together
-with hard labour.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_17" href="#FNanchor_17" class="label">17</a>
- See Essay on the Yellow Fever, by Dr. Hume, in a
-Collection of Essays published by Dr. D. Monro.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_18" href="#FNanchor_18" class="label">18</a>
- Campbell’s Lives of the Admirals, Vol. IV.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_19" href="#FNanchor_19" class="label">19</a>
- The late Dr. William Hunter.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_20" href="#FNanchor_20" class="label">20</a>
- <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_21" href="#FNanchor_21" class="label">21</a>
- Captain Samuel Thompson.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_22" href="#FNanchor_22" class="label">22</a>
- As my own stay at different ports was short, and
-as my own knowledge could not extend beyond that
-period, Dr. Farquarson, First Commissioner of Sick and
-Wounded Seamen, very politely gave me leave to inspect
-the books of the different hospitals at his office,
-and I collected from them the fate of all the men that
-were landed.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_23" href="#FNanchor_23" class="label">23</a>
- It is proper to mention, that the name of the disease
-in the hospital books being taken from the ticket sent
-on shore with each sick person, great accuracy is not to
-be expected, as this is frequently done in a careless manner.
-My returns were made with great exactness; and,
-in the latter part of the war, the hospital books may also
-be depended upon in this respect, the tickets, at my request,
-having been made out with accuracy.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_24" href="#FNanchor_24" class="label">24</a>
- In this, and the other tables, the smaller fractions
-are neglected.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_25" href="#FNanchor_25" class="label">25</a>
- <a href="#PART_III_CHAP_IV">See the last chapter of Part III</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_26" href="#FNanchor_26" class="label">26</a>
- In the year 1741, the fleet under Admiral Vernon
-was at Jamaica at the same time of the year; and the
-following is the account of the men sent to the hospital
-in May and June:</p>
-
-<table class="bbox">
-  <tr>
-    <th>DISEASES.</th>
-    <th>Admitted.</th>
-    <th>Died.</th>
-    <th>Proportion.<br />NEARLY<br />ONE IN</th>
-  </tr>
-  <tr>
-    <td>Fevers</td>
-    <td class="tdr">957</td>
-    <td class="tdr">255</td>
-    <td class="tdr">3&frac12;</td>
-  </tr>
-  <tr>
-    <td>Fluxes</td>
-    <td class="tdr">267</td>
-    <td class="tdr">73</td>
-    <td class="tdr">3&frac12;</td>
-  </tr>
-  <tr>
-    <td>Scurvy</td>
-    <td class="tdr">314</td>
-    <td class="tdr">41</td>
-    <td class="tdr">7&frac12;</td>
-  </tr>
-  <tr>
-    <td>Other Complaints</td>
-    <td class="tdr">167</td>
-    <td class="tdr">26</td>
-    <td class="tdr">6 </td>
-  </tr>
-  <tr>
-    <td class="tdc">Total</td>
-    <td class="tdr">1703</td>
-    <td class="tdr">395</td>
-    <td class="tdr">4 </td>
-  </tr>
-</table>
-
-<p>There was on board of this fleet about two thirds of
-the number of men that was on board of the fleet in
-1782. I cannot ascertain how many died on board of
-the ships in Admiral Vernon’s fleet; but the deaths at
-the hospital alone are somewhat more than what happened
-to our fleet both on board and at the hospital.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_27" href="#FNanchor_27" class="label">27</a>
- I was enabled, after coming to England, to ascertain
-the deaths in that part of the squadron from which I
-happened at any time to be absent, by having leave from
-the Navy Board to inspect the ships’ books deposited at
-their office.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_28" href="#FNanchor_28" class="label">28</a>
- <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_29" href="#FNanchor_29" class="label">29</a>
- The mortality of the army in the West Indies is
-much greater; for it appears by the returns of the War
-Office, that there died in the year 1780, two thousand
-and thirty-six soldiers, which being calculated by the
-numbers on the station, and those who arrived in the convoy
-in March and July, the annual mortality is found to
-be one in four. The greatness of this mortality will appear
-in a still stronger light, when it is considered that
-those who serve in the army are the most healthy part of
-the community. When I was at the encampment at
-Coxheath in the year 1779, I was politely favoured with
-a sight of the returns, both of the general officers and
-physician, and it appeared that in an army of ten thousand
-and eighty-nine men, there died, from the 10th of
-June to the 2d of November, forty-three, exclusive of
-twelve who died of small pox. This being calculated,
-is equal to an annual mortality of one in a hundred and
-nine; and it was not half so much in the encampment of
-the former year. It appears by Mr. Simpson’s tables,
-that the mortality of mankind in England, from the age
-of twenty to forty-five, which includes the usual age of
-those who serve in the navy and army, is one in fifty.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_30" href="#FNanchor_30" class="label">30</a>
- See <a href="#TABLE_II">Table II</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_31" href="#FNanchor_31" class="label">31</a>
- See <a href="#TABLE_II">Table II</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_32" href="#FNanchor_32" class="label">32</a>
- None are comprehended but those who were killed
-or wounded in battles in which the whole fleet was present,
-this account not including those who fell in single
-actions in frigates or other ships.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_33" href="#FNanchor_33" class="label">33</a>
- It would appear, that, anciently, though the slaughter
-in battle was greater than in modern times, yet that
-disease was still more destructive than the sword. One
-of the oldest testimonies to this purpose is in the History
-of Alexander’s Expedition, by Arrian&mdash;τους μεν ἐν ταῖς
-μαχαις ἀπολωλεκασιν, ὁι δε ἐκ των τραυματων ἀπομαχοι γεγενημενοι,
-ὁι πλειοῦς δε νοσω ἀπολωλεσαν.&mdash;Arrian. Hist. Alex. Exped.</p>
-
-<p class="author">Lib. v. cap. 26.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_34" href="#FNanchor_34" class="label">34</a>
- Upwards of three thousand were also lost at sea in
-ships of war belonging to the same fleets in the hurricane
-of October, 1780, and in the storm in September, 1782,
-in which the Ville de Paris and the other French prizes
-were lost on their passage to England.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_35" href="#FNanchor_35" class="label">35</a>
- The authors from whom I have borrowed have been
-chiefly Dr. Lind and Capt. Cook. To the former we
-are indebted for the most accurate observations on the
-health of seamen in hot climates; of the improvements
-made by the latter, an excellent compendium may be
-seen in Sir John Pringle’s Discourse before the Royal
-Society, on the occasion of adjudging a prize medal to
-Capt. Cook for his paper upon this subject.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_36" href="#FNanchor_36" class="label">36</a>
- In the late war sickness alone was not the cause of
-want of success in any instance, except in the last action
-in the East Indies, in which so many men were ill of the
-scurvy, that there were not hands enow to manage the
-guns.</p>
-
-<p>There is another fact in history, which, though not
-so applicable to this subject as those above recited, forcibly
-evinces how important a study the health of men
-ought to be in military affairs. When Henry V. was
-about to invade France, he had an army of fifty thousand
-men; but owing to a sickness which arose in the
-army, in consequence of some delays in the embarkation,
-their number was reduced to ten thousand at the
-battle of Agincourt. The disease of which they chiefly
-died was the dysentery.</p>
-
-<p class="author"><span class="smcap">Rapin.</span></p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_37" href="#FNanchor_37" class="label">37</a>
- It is not meant by this to insinuate that every
-commander is absolutely accountable for the health of
-his ship’s company, and censurable when they are sickly;
-for this may depend on his predecessor in command, or a
-stubborn infection may have prevailed from the original
-fitting out or manning of the ship which he may not
-have superintended.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_38" href="#FNanchor_38" class="label">38</a></p>
-
-<div class="poetry">
-<div class="poem"><div class="stanza">
-<span class="i0">Οὐ γαρ ἐγωγέ τι οῗδα κακώτερον ἄλλο θαλάσσης,<br /></span>
-<span class="i0">Ανδεά τε συγχεῦαι, εἰ καὶ μάλα καρτερὸς εἴη.<br /></span>
-</div>
-<p class="author">ΟΜΗΡ. ΟΔΥΣ. Θ.</p>
-</div></div>
-
-<div class="poetry">
-<div class="poem"><div class="stanza">
-<span class="i0">Dire is the ocean, dread in all its forms!<br /></span>
-<span class="i0">Man must decay, when man contends with storms.<br /></span>
-</div>
-<p class="author smcap">Pope.</p>
-</div></div></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_39" href="#FNanchor_39" class="label">39</a>
- Wherever causes are obscure, superstition naturally
-ascribes them to some preternatural influence; and what
-seemed farther to have encouraged this, anciently, was,
-that violent epidemics occurred most frequently in camps
-and at sieges where great political conjunctures were
-likely to arise, in which superior powers were supposed to
-interest themselves. Thus we read in Homer of fatal
-diseases being sent as punishments by the gods. But the
-pestilential diseases so often mentioned by poets and historians
-as prevailing in cities and armies, were probably
-nothing else but fevers, produced partly perhaps by the
-scarcity and bad quality of provisions, but probably still
-more by corrupted human effluvia, which was very apt
-to he produced by the want of personal cleanliness, to
-which the mode of cloathing among the ancients would
-more particularly subject them, especially in camps and
-besieged towns.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_40" href="#FNanchor_40" class="label">40</a>
- If the experiments of modern philosophy are to be
-depended on, they go a certain way to account for the
-unwholesomeness of air from woods in hot climates, and
-in wet weather; for Dr. Ingenhousz found that the
-effluvia of plants in the night time, and in the shade, are
-more poisonous in hot than in cold weather; but though
-there is a salubrity in the effluvia in sunshine, the heat of
-the weather makes no difference with regard to this.
-He found also that vegetables, when wet, yield an unwholesome
-air.</p>
-
-<p>It is difficult to ascertain how far the influence of vapours
-from woods and marshes extend; but there is reason
-to think that it is to a very small distance. When
-the ships watered at Rock Fort, they found that if they
-anchored close to the shore, so as to smell the land air,
-the health of the men was affected; but upon removing
-two cables length, no inconvenience was perceived. I
-was informed of the following fact, in proof of the same,
-by the medical gentlemen who attended the army in Jamaica:&mdash;The
-garrison of Fort Augusta, which stands
-very near some marshes, to which it is to leeward when
-the land wind blows, was yet remarkably healthy; but
-it became at one time extremely sickly upon the breaking
-in of the sea in consequence of a high tide, whereby the
-water which was retained in the hollows of the fort produced
-a putrid moisture in the soil, exhaling a vapour
-offensive to the smell, and with all the noxious effects
-upon health commonly arising from the effluvia of
-marshes.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_41" href="#FNanchor_41" class="label">41</a>
- Dr. Hendy has lately published an ingenious treatise
-upon this disease.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_42" href="#FNanchor_42" class="label">42</a>
- See Sydenham’s Works.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_43" href="#FNanchor_43" class="label">43</a>
- <a href="#BOOK_II_CHAP_VI">See Part I. Book II. Chap. VI</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_44" href="#FNanchor_44" class="label">44</a>
- We have a proof of this fact in particular, in the
-account of the jail distemper, which broke out at the
-Old Bailey in the year 1750.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_45" href="#FNanchor_45" class="label">45</a>
- See Martin’s History of the Western Islands, and
-Medical Communications, Vol. I. page 68.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_46" href="#FNanchor_46" class="label">46</a>
- There are some contagious diseases which cannot be
-propagated but by their own peculiar infections, as has
-been before observed, just as the seeds of vegetables are
-necessary to continue their several species; so that if the
-infectious poison were lost, so would the disease. Of
-this kind are the small pox, and the other diseases to
-which man is subject but once during life. There are
-other diseases which produce infection without having
-themselves proceeded from it. Of this kind are fevers
-and fluxes.</p>
-
-<p>But there is no infection of any kind, however virulent,
-that affects indiscriminately all persons exposed to
-it. If a number of persons, who never have had the
-small pox, are equally exposed to it, some will be seized,
-while others will escape, who will be affected at another
-time, when they happen to be more susceptible. It is
-doubtful how far the habit of being exposed to such specific
-infections renders the body insensible to them, as
-was said with regard to fevers; but there is another
-principle of the animal œconomy laid down and illustrated
-by Mr. Hunter, which goes at least a certain
-length in explaining this variable state of the body with
-respect to its susceptibility of infectious diseases. This
-principle is, that the body cannot be affected by more
-than one morbid action at the same time. If a person is
-exposed to the small pox, for instance, while he labours
-under a fever, or while he is under the influence of the
-measles, he will not catch the first till the other has run
-its course. It may happen, therefore, that people escape
-the effect of contagion in consequence of being at the
-time under the influence of some other indisposition, either
-evident or latent: and supposing the body to be exposed
-to a number of noxious powers at the same time,
-one only could take effect. But it seems difficult to explain
-why some of those who are actually seized, and
-who have previously been to all appearance in equally
-good health, shall have it in a very mild degree, while
-in others it will be malignant and fatal. This is very remarkable
-with regard to the small pox, which are in some
-cases so slight, that they can hardly be called a disease,
-while in others they are so malignant, as hardly to admit
-of any alleviation from art. May not this, in some
-measure, be explained from some of the principles above
-mentioned, in the following manner:&mdash;The small pox,
-in their mildest form, are attended with little or no fever,
-which, therefore, is not essential to them; and
-when we see them attended with various forms of fever,
-and thereby prove fatal even in the most hale constitutions,
-we ought not to attribute this to any thing in the
-nature of the small pox, but rather to say, that they have
-served as an agent in exciting a fever, for which there
-happened to be some previous latent disposition, that
-would not otherwise have exerted itself, and that this
-disposition, or contamination, as it may be called, may
-have been induced by some past exposure to morbid effluvia,
-which either from habit, or some other circumstance,
-may not have been sufficiently powerful to excite
-the constitution to fever without some such stimulus.
-Any other occasional circumstance producing disturbance
-or irregularity in the functions of the body, may,
-in like manner, excite any particular kind of fever to
-which the body may at that time be disposed. Thus the
-amputation of a limb will have this effect; also exposure
-to cold or fatigue, and intemperance in eating or drinking.</p>
-
-<p>It would appear from these considerations, that there
-are certain circumstances, or temporary situations of
-constitution, which invite infection, and render its effect
-more certain and violent in one case than another.
-There are artificial methods, however, of obtruding it,
-as it were, upon the constitution, though not particularly
-disposed, or even though averse to receive it; and
-may not this, in some measure, account for the greater
-safety of some diseases when communicated by inoculation,
-than when caught in the natural way?</p>
-
-<p>But these, as well as many other facts in animal nature,
-do not admit of a satisfactory explanation upon any principle
-as yet known. Even the most common operations
-of the body, such as digestion and generation, when
-considered in their causes and modes of action, are so obscure
-and mysterious, as to be almost beyond the reach
-of rational conjecture. A little reflection will teach us
-the utmost modesty with regard to our knowledge of
-such things; for nature seems to have innumerable ways
-of working, particularly in the animal functions, to
-which neither our senses can extend, nor perhaps could
-our intellects comprehend them. Had we not, for instance,
-been endowed with the sense of sight, nothing
-could have led us even to suspect the existence of such a
-body as light; and there may be numberless other subtile
-and active principles pervading the universe, relative to
-which we have no senses, and from the knowledge of
-whose nature and exigence we must for ever be debarred.
-We have, indeed, become acquainted with electricity by
-an operation of reason; and animals have lately been
-discovered to which the electric fluid serves as a medium
-of sense through organs calculated to excite it, and to
-receive and convey its impressions.</p>
-
-<p>But there are few subjects we can study that are more
-subtle and obscure than the influence of one living body
-on another. There is a familiar instance of the great
-subtilety of animal effluvia, and also of the fineness of
-sense in a dog’s being able to trace his master through
-crowds, and at a great distance; and we can conceive
-that infectious matter may adhere, and be communicated
-in a similar manner. We have endeavoured to illustrate
-the great obscurity of its operation by an allusion to generation,
-digestion, and other animal functions, with
-which it is equally obscure and inexplicable. It is similar
-to generation in this, that its influence does not pass
-from one species of animal to another; for the poison of
-the plague, that of the small pox, that of fever, and the
-venereal disease, do not affect brutes<a id="FNanchor_47" href="#Footnote_47" class="fnanchor">47</a>, nor do the infectious
-diseases of brutes affect different species of them,
-nor the human species. The only exception to this, that
-we know of, is the bite of a mad dog.</p>
-
-<p>From these facts, and also from what was formerly
-mentioned of contagion not affecting indiscrimately all
-that may be exposed to it, it would appear that some nice
-coincidence of circumstances is necessary to modify an
-animal body, so as to receive its action. There must be
-a sort of unison, as it were, or sympathy, betwixt different
-living bodies, so as to render them susceptible of
-each other’s influence.</p>
-
-<p>It is none of the least curious facts with regard to infection,
-that there are some species of it by which the
-body is liable to be affected only once in life. When
-this is considered, it is indeed conformable to what happens
-in the course of the disease itself; for, unless there
-was in the body a power of resisting it, there could be no
-such thing as recovery. Where the disease actually exists,
-the continued presence of the poison, which is also infinitely
-multiplied, would infallibly prove fatal in all
-cases, unless the living powers were to become insensible
-to it<a id="FNanchor_48" href="#Footnote_48" class="fnanchor">48</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_47" href="#FNanchor_47" class="label">47</a>
- Hunter’s Experiments.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_48" href="#FNanchor_48" class="label">48</a>
- Mr. Hunter’s Lectures.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_49" href="#FNanchor_49" class="label">49</a>
- It is sincerely to be wished that this were adopted,
-and it is surprising that an article so salutary and necessary,
-and so difficult to be procured on foreign stations,
-should not have been the object of public attention, rather
-than a mere article of luxury, such as tobacco.
-But in order that it might not be a matter of choice
-with seamen, it would be worth while to supply them
-with it at prime cost, or even as a gratuity, and then
-they might be compelled to use it for the purpose of
-cleanliness. There are other articles of less importance,
-but being necessary to enable men upon foreign stations
-to keep themselves neat and clean, deserve to be made
-the object of public instruction. These are handkerchiefs
-for the neck, thread, worsted, needles, buckles,
-and knives.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_50" href="#FNanchor_50" class="label">50</a>
- At the time I am writing this, (March 8th, 1785)
-there has occurred a fact which proves the effect of time
-in generating infection. There now prevails a contagious
-fever in several of the hospitals in London, and, among
-others, in that to which I am physician. In another hospital
-it has been so violent, that there has been a vulgar
-report that the plague had broke out in it. The same
-fever also prevails among the poor at their own houses.
-The cause of it seems to be, that the cold weather has
-been uncommonly long and severe; for the frost began
-early in December, and the cold has hitherto been more
-like that of winter than spring. The thermometer all
-this month has varied from 30&deg; to 35&deg;. Cold is favourable
-to infection, by preventing ventilation; for people
-exclude the air in order to keep themselves warm, and
-the poor in particular do so on account of their bad
-clothing, and their not being able to afford fuel to make
-good fires. Heat is the great destroyer of infection, and
-seems to act by evaporating, and thereby dissipating it;
-and the effect of fires in apartments is to produce a constant
-change of air, thereby preventing its stagnation and
-corruption, and the accumulation of unwholesome effluvia.
-With this view, a chimney is of great use, even
-though no fire should be kept in it, as it serves for a ventilator.
-But if an aperture were to be made in an apartment
-merely with a view to ventilation, it should be
-placed in that part of the wall next the ceiling; for foul
-air naturally tends upwards, and the external air entering
-at the top of a room, would not be so apt to subject
-those within to the effect of cold, as it would not blow
-directly upon them. There would also be this advantage
-in jails, that apertures in this situation would not be so
-liable to be forced for the purpose of escape as if they
-were nearer the floor; and in hospitals they would be out
-of reach of those who, wishing to indulge in warmth,
-at the expence of pure air, might be induced to shut
-the windows. But an external communication with the
-air any where is of the utmost importance; and it is
-observable in Mr. Howard’s account of prisons, that
-the jail distemper was most frequently to be met with
-where there was no chimney.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_51" href="#FNanchor_51" class="label">51</a>
- It is of some consequence to attend to the materials
-of the seamen’s beds; for, instead of flock, they are
-frequently fluffed with chopped rags, which, consisting
-of old clothes, emit a disagreeable smell, and may even
-contain infection.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_52" href="#FNanchor_52" class="label">52</a>
- By a <i>berth</i> is understood the interval between two
-guns, or any space between decks, which is sometimes
-formed into a sort of apartment by means of a partition
-made of canvass.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_53" href="#FNanchor_53" class="label">53</a>
- It is remarkable that this method of purifying was
-practised in the most ancient times, as we learn from the
-following passage in Homer, where Ulysses is represented
-fumigating the apartments of his palace in which the
-suitors had been slain:</p>
-
-<div class="poetry">
-<div class="poem"><div class="stanza">
-<span class="i0">Τὴν δ᾿ἀπαμειζόμενος προσεφη Πολυμητις Ὀδυσσευς<br /></span>
-<span class="i0">Πυρ νυ̃ν μοι πρώτιστον ἐνὶ μεγάροισι γενέσθω.<br /></span>
-<span class="i0">Ως ἔφαθ’. ουδ’ἀπιθησε φιλη τροφος Ἐυρυκλειος<br /></span>
-<span class="i0">Ἠνεγκεν δ᾿ ἄρα πυρ και θηιον. αυταρ Ὀδυσσευς<br /></span>
-<span class="i0">Ἒυ διεθέιωσεν μέγαρον και δῶμα και ἀυλήν.<br /></span>
-</div>
-<p class="author">ΟΜΗΡ. ΟΔΥΣ. Χ.</p>
-</div></div>
-
-<div class="poetry">
-<div class="poem"><div class="stanza">
-<span class="i0">Bring sulphur straight, and fire, the Monarch cries;<br /></span>
-<span class="i0">She heard, and at the word obedient flies.<br /></span>
-<span class="i0">With fire and sulphur, cure of noxious fumes,<br /></span>
-<span class="i0">He purg’d the walls and blood-polluted rooms.<br /></span>
-</div>
-<p class="author smcap">Pope.</p>
-</div></div>
-
-<p>This practice was probably founded in superstition,
-rather than the knowledge of nature. That some divine
-influence should be ascribed to fire was very natural, as
-the principal deities of the ancients were only personifications
-of the elements; and it is worthy of remark,
-that their name for sulphur signifies <i>something divine</i>
-το θεῖον, which was probably owing to its being found in
-those chasms of the earth, in Sicily and Italy, which
-were supposed to communicate with the infernal regions;
-for the whole Greek mythology relating to these was
-taken from the ph&aelig;nomena attending the subterraneous
-fires in those parts. It is curious farther to remark, in
-other instances, how facts useful to mankind, the truth
-of which has been confirmed in later times by the more
-enlightened knowledge of nature, were first suggested by
-some superstitious circumstance. Thus the wound received
-by Sarpedon could not be cured, according to the
-Poet, till, by divine intimation, he was desired to apply
-to it the rust of the spear with which it had been inflicted,
-in consequence of which it healed. But the
-weapons in those days were made of brass, so that the
-rust of the spear must have been the <i>&aelig;rugo &aelig;ris</i>, which
-has been found by the experience of modern surgery to be
-one of the best detergents in ill-conditioned sores. It is
-probably, from a false analogy, founded on some such incident,
-that an idea prevails among the vulgar, which
-has become proverbial, that some part taken from the
-offending body is good in all external injuries. Thus
-some part of a mad dog is said to have a virtue in curing
-his bite. Herein may be seen the difference of that
-knowledge which is suggested by superstition, and that
-which is acquired by the observation of nature.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_54" href="#FNanchor_54" class="label">54</a>
- A loggerhead is a large round mass of iron, with a
-long handle to it.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_55" href="#FNanchor_55" class="label">55</a>
- A fact, related in Anson’s Voyage, is also strongly
-in proof of the same opinion. When the rich Spanish
-prize was taken, it was necessary to crowd the prisoners
-into the hold, for fear of an insurrection, which was to
-be dreaded from their numbers; yet, when they arrived
-in China, none of them had died, nor had any disease
-broke out. They suffered only in their looks, being
-wan and emaciated to a great degree.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_56" href="#FNanchor_56" class="label">56</a>
- It may be brought as a farther proof of a warm
-climate being unfavourable to every sort of infection,
-that though the itch is very common in ships and hospitals
-in Europe, I do not remember ever to have met
-with it in the West Indies, except in ships newly arrived
-from England.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_57" href="#FNanchor_57" class="label">57</a>
- This circumstance, in the character of the English,
-is only of modern date; for we learn from Erasmus, who
-was in England about two hundred and fifty years ago,
-that they were then extremely slovenly. The following
-passage is extracted from a letter he wrote to a physician
-in York, after his return to Holland:&mdash;“Conclavia sol&acirc;
-fere strata sunt argill&acirc;, tum scirpis palustribus, qui subinde
-sic renovantur ut fundamentum maneat aliquoties
-annos viginti sub se fovens sputa, vomitus, mictum
-canum et hominum, projectam cerevisiam et piscium
-reliquias, aliasque sordes non nominandas.” He
-adds, that the windows were very ill calculated for ventilation,
-and imputes to the closeness and filthiness of the
-houses the frequent and long continued plagues with
-which England was infested, and particularly the sweating
-sickness, which, he says, seemed peculiar to this country.
-He mentions that his own country had been freed
-from the pestilence by certain changes that the State had
-made in the houses, in consequence of the advice of some
-learned man. Erasm. Lib. xxii. Epistol. 13.&mdash;It is
-probable that the greater number of those epidemics,
-called plagues, were only bad infectious fevers. What
-would contribute still more to the production of infection
-was the want of linen, which was hardly in use in
-those days. The disappearance, or at least the great diminution
-of such complaints in modern times, particularly
-in London, has been ascribed to the great increase
-in the proportion of vegetable food; but it is certainly
-more owing to the improvement in personal cleanliness,
-and to the greater spaciousness and neatness of houses.
-As a farther proof of this, it may be mentioned that in
-the charity, called the Charterhouse, in London, founded
-by Henry the Eighth, for the maintenance and education
-of poor boys, their sustenance is all animal food,
-as it was at the original institution, yet they are extremely
-healthy. The same observation applies to Winchester
-school, which was founded some ages before that.</p>
-
-<p>There are some passages in ancient history in confirmation
-of the same opinion. Herodotus relates, that the
-ancient Egyptians were the most healthy of all the nations,
-except the Libyans, and he imputes this to the invariableness
-of their weather, and the serenity of their
-sky. But he mentions in another part of his works, that
-they were also the most cleanly of all people, not only in
-their household utensils, but in their persons, and that
-their clothing was chiefly of linen, which it was one of
-the principal studies of their life to wash and keep clean&mdash;ἑιματα
-δε λινεα φορεουσι ἀιει νεοπλυτα ὲπιτηδευοντες τουτο μαλισα.
-Herodot. Euterp. 37.&mdash;It is remarkable that he makes
-no mention of the plague, though he gives a very minute
-account of the country from his own observation, from
-whence it may be naturally inferred, that it did not then
-exist there, though Egypt is now so subject to it, that the
-plague is supposed by many to be an endemial disease in it.
-It would appear also from another passage in this historian,
-that he uses the word λοιμος, which we translate <i>plague</i> in
-a loose sense to signify any violent acute distemper; for
-he relates that a great part of the army of Xerxes, in
-their retreat from Greece, perished by the <i>plague</i> λοιμου and
-dysentery, in consequence of famine. Herod. Lib. viii.
-cap. 115.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_58" href="#FNanchor_58" class="label">58</a>
- It is proper also to observe here, that those ships
-which are built of winter-felled timber are much drier
-than those built of what is summer felled; and this circumstance
-should have been mentioned with regard to the
-Montague, for the cause of her healthiness, notwithstanding
-her being a new ship, was probably from being
-built of winter-felled timber. It should, therefore, be
-strictly enjoined to fell the wood in winter; for those
-who are employed to do it have an interest in doing it
-in summer, on account of the value of the bark.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_59" href="#FNanchor_59" class="label">59</a>
- A windsail is a long cylinder of canvass, open at
-both ends, kept extended with hoops, and long enough
-to reach from the lowermost parts of the ship through all
-the hatchways into the open air.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_60" href="#FNanchor_60" class="label">60</a>
- It is not necessary that seamen should have chests,
-for bags or wallets answer their purpose equally well, and
-are much more convenient in respect of stowage.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_61" href="#FNanchor_61" class="label">61</a>
- Since the first edition of this work, I have met with
-a fact in confirmation of this principle, with regard to the
-cutaneous complaint called the <i>ring-worm</i>. This had
-prevailed in a private school in the neighbourhood of
-London, which I visited, but it had to all appearance
-become extinct; yet it nevertheless affected those boys
-who were newly sent to the school.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_62" href="#FNanchor_62" class="label">62</a>
- It is mentioned by Thucydides, that while the plague
-raged at Athens, the people were affected with no other
-disease; from which it would appear that those persons
-who would otherwise have been attacked with some particular
-indisposition, were seized with the plague in place
-of it. Vide note p. 247.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_63" href="#FNanchor_63" class="label">63</a>
- Part I. Book II. Chap. VI.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_64" href="#FNanchor_64" class="label">64</a>
- It is related by the travellers into Turkey, that the
-Christians save themselves from it, merely by shutting
-themselves up in their houses, and the inhabitants, who
-sleep on the open roofs of the houses, do not catch it
-even from those of the adjacent buildings, though the wall
-that separates them is of no great heighth.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_65" href="#FNanchor_65" class="label">65</a>
- Vide Opera Ambrosii Parei.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_66" href="#FNanchor_66" class="label">66</a>
- See Essay on Sea Diseases.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_67" href="#FNanchor_67" class="label">67</a>
- Limes, shaddocks, and perhaps all the other fruits
-of that class, possess the same virtues; but I have most
-frequently observed good effects from lemons.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_68" href="#FNanchor_68" class="label">68</a>
- In the course of the passage from England to the
-West Indies in February, 1782, the following directions
-for using the sour krout and melasses were given in public
-orders by the Admiral to the different ships of the
-squadron:</p>
-
-<p>“The allowance of sour krout made by the public
-boards in England, is two pounds to each man every
-week; and the Admiral orders that from a pound and
-a half to two pounds (beginning with the lesser quantity,
-and increasing as the men may find it palatable)
-be boiled with every gallon of pease on a pease day.
-The cooks are desired not to wash it, nor to put it
-into the coppers till the pease are sufficiently broken.
-“Half a pound is directed to be issued raw to each man
-on beef days, and a quarter of a pound on pork days.
-It is recommended that the allowance of vinegar be
-saved, particularly on meat days. When sour krout
-runs short, the pease and beef days to have the preference;
-when shorter still, the pease days. Melasses
-having been allowed in lieu of part of the oatmeal, in
-the proportion of eleven pounds to two gallons, the
-Admiral directs, that a pound of melasses be boiled
-with every gallon of oatmeal on Mondays, Wednesdays,
-and Fridays, mixing it and stirring it round
-with the burgoo immediately after it is drawn off.
-He directs that half a pound of melasses be issued
-with every three pounds of flour over and above the
-common proportion of raisins; and to prevent any
-abuse, it is directed that the purser’s steward pour it
-into the platter with the flour of which the pudding is
-made. The Admiral forbids the use of pease in lieu of
-oatmeal, as has sometimes been the practice.”</p>
-
-<p>These rules were suggested by Sir Charles Douglas,
-captain of the fleet, whose benevolence is equal to his
-known professional skill; and he had ascertained the utility
-of the preceding directions when captain of the
-Duke in the former part of the war.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_69" href="#FNanchor_69" class="label">69</a>
- In the French ships of war there is an oven large
-enough to supply not only all the officers and sick, but
-part of the crew, with soft bread every day. The advantages
-attending the use of flour in place of bread are
-so great and obvious, that the former will probably, in
-time, be substituted entirely for the latter. There is a
-proof of its being practicable to use it in place of bread
-in British ships of war, even with their present conveniences,
-communicated to me by Captain Caldwell.
-When he commanded the Agamemnon, of 64 guns, at
-New York, in the end of 1782, there happened to be no
-bread in store to supply that ship on her passage to the
-West Indies, and flour was given in place of it. The
-men, without any inconvenience, were able to bake it
-into bread for themselves, and it proved so salutary, that
-Captain Caldwell ascribed the uncommon degree of
-health which his men enjoyed to the use of the flour.
-The only objection that can be made to it is the greater
-consumption of wood occasioned by baking; but this
-may be obviated by adopting the grates invented by
-Mr. Brodie, in which the ovens are heated by the same
-fire with which the victuals are boiled.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_70" href="#FNanchor_70" class="label">70</a>
- Mr. Napeane, afterwards Under Secretary of State,
-was at that time purser of the Foudroyant, and acted a
-very benevolent and disinterested part, by being instrumental
-in introducing this reform in the navy victualling.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_71" href="#FNanchor_71" class="label">71</a>
- Half a pound of cocoa, and as much sugar, was
-allowed in place of a pound of butter.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_72" href="#FNanchor_72" class="label">72</a>
- <span class="smcap">Table</span>, exhibiting the daily Allowance of Provisions
-for each Man in the Navy.</p>
-
-<table class="bbox">
-  <tr>
-    <th />
-    <th>Biscuit.</th>
-    <th>Beer.</th>
-    <th>Beef.</th>
-    <th>Pork.</th>
-    <th>Pease.</th>
-    <th>Oatmeal.</th>
-    <th>Butter.</th>
-    <th>Cheese.</th>
-  </tr>
-  <tr>
-    <th />
-    <th>lbs.</th>
-    <th>galls.</th>
-    <th>lbs.</th>
-    <th>lbs.</th>
-    <th>Pint.</th>
-    <th>Pint.</th>
-    <th>ozs.</th>
-    <th>ozs.</th>
-  </tr>
-  <tr>
-    <td>Sunday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc"></td>
-    <td class="tdc">1</td>
-    <td class="tdc">half</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-  </tr>
-  <tr>
-    <td>Monday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc">1</td>
-    <td class="tdc">2</td>
-    <td class="tdc">4</td>
-  </tr>
-  <tr>
-    <td>Tuesday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc">2</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-  </tr>
-  <tr>
-    <td>Wednesday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc">half</td>
-    <td class="tdc">1</td>
-    <td class="tdc">2</td>
-    <td class="tdc">4</td>
-  </tr>
-  <tr>
-    <td>Thursday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc"></td>
-    <td class="tdc">1</td>
-    <td class="tdc">half</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-  </tr>
-  <tr>
-    <td>Friday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc">half</td>
-    <td class="tdc">1</td>
-    <td class="tdc">2</td>
-    <td class="tdc">4</td>
-  </tr>
-  <tr>
-    <td>Saturday</td>
-    <td class="tdc">1</td>
-    <td class="tdc">1</td>
-    <td class="tdc">2</td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-    <td class="tdc"></td>
-  </tr>
-</table>
-
-<p>This has continued from the last century till the alterations
-above mentioned, all of which, except the introduction
-of vinegar, have been made in the three last
-years of this war. When the stock of small beer is exhausted,
-half a pint of spirits is allowed daily, diluted
-with four or five times its quantity of water. When
-wine is supplied, the daily allowance of it to a man is
-one pint.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_73" href="#FNanchor_73" class="label">73</a>
- Instead of leaving this to the management of the
-men themselves, it might be done with greater advantage
-to them by instituting short allowance in the following
-manner:&mdash;Let a certain proportion, suppose one
-third, of the salt provisions, bread, and pease, particularly
-the first, be stopped, and let the amount of this,
-for the whole crew be thrown into one estimate. Let
-the agent victualler pay into the purser’s hands the value
-of these provisions in money, at the contract price, with
-such a discount as will allow for the use of the money.
-Let the purser, in return, give him a receipt, as if for
-so much provisions checked. This money, being distributed
-in the name of short allowance, will enable the
-men to purchase vegetables, and the provisions will be
-saved for a time of want, or for a cruise.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_74" href="#FNanchor_74" class="label">74</a>
- The sailors in the squadron of Commodore Anson
-never murmured more under any of their hardships than
-when they were fed with fresh turtle for a length of
-time in the South Sea.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_75" href="#FNanchor_75" class="label">75</a>
- Since the first edition of this work was printed, I
-have met with a book published by Mr. Fletcher, a
-navy surgeon, in which he mentions that spices, being
-antiseptic bodies, might be substituted for part of the
-salt in curing provisions, and this would, no doubt, be
-an improvement in the sea victualling. The quantity of
-spice he proposes for every barrel of beef or pork is four
-ounces of black pepper, and as much allspice, and also
-eight ounces of nitre in powder. It may be farther alledged
-as an advantage of spice over salt, that it would
-be less apt to run into brine, which robs the meat of the
-greater part of its nourishment.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_76" href="#FNanchor_76" class="label">76</a>
- This accident happened in the Cyclops frigate in
-September, 1780. Mr. Gordon, the surgeon, favoured
-me with the following account of it:</p>
-
-<p>“Mr. Smith, an officer, John Barber and Anthony
-Wright, seamen, having eat some victuals prepared in
-a foul copper, complained soon after of violent gripes,
-giddiness, and vomiting, and they had a few loose
-stools. There was intense heat; the pulse was quick,
-full, and hard; a tremor of the hands and tongue,
-and wildness of the eyes. The looseness was soon
-succeeded by obstinate costiveness, tension of the abdomen,
-difficult breathing, and loss of deglutition.
-In the night, towards the morning, there came on
-insensibility, with an increase of all the symptoms,
-except the heat. The body was violently convulsed,
-with cold clammy sweats and coldness of the extremities.
-The abdomen subsided a short time before
-they died, and, before they expired, a small quantity
-of greenish matter, mixed with phlegm, issued from
-the mouths of two of them.</p>
-
-<p>Thirty three other men were put upon the sick list
-with similar symptoms in a less degree, and some of
-them continued on the list for five or six weeks before
-they perfectly recovered.”</p>
-
-<p>It is not said what means were attempted for the recovery
-of these men; but, besides emetics and milk, or
-oil, a dilute solution of the fixed alkali in water has been
-recommended against this poison.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_77" href="#FNanchor_77" class="label">77</a>
- I was furnished by Dr. Clephane, physician to the
-fleet at New York, with the following fact, as a strong
-proof of the excellence of this liquor:</p>
-
-<p>In the beginning of the war two store ships, called the
-Tortoise and Grampus, sailed for America under the convoy
-of the D&aelig;dalus frigate. The Grampus happened to
-be supplied with a sufficient quantity of porter to serve
-the whole passage, which proved very long. The other
-two ships were furnished with the common allowance of
-spirits. The weather being unfavourable, the passage
-drew out to fourteen weeks, and, upon their arrival at
-New York, the D&aelig;dalus sent to the hospital a hundred
-and twelve men; the Tortoise sixty-two; the greater
-part of whom were in the last stage of the scurvy. The
-Grampus sent only thirteen, none of whom had the
-scurvy.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_78" href="#FNanchor_78" class="label">78</a>
- We have a remarkable proof of this in comparing
-the fleet under the command of Admiral Byron with that
-under the Count d’Estaing, when they both arrived
-from Europe on the coast of America in the year 1778,
-some of the British ships having been unserviceable from
-the uncommon prevalence of scurvy, while the French
-were not affected with it.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_79" href="#FNanchor_79" class="label">79</a>
- See an article in Rozier’s Journal de Medicine for
-July, 1784, by Dr. Ingenhousz.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_80" href="#FNanchor_80" class="label">80</a>
- Since I came to England I have met with a pamphlet
-published by Mr. Henry, of Manchester, in which
-an ingenious method, founded on chemical principles, is
-proposed for separating the quick lime from water; but I
-fear it is too nice and complex to be brought into common
-practice. It would certainly be worth the trouble;
-but there are so many duties in a ship of war to call off
-the attention of the men, and they are so little accustomed
-to nice operations, that it would be difficult to
-persuade officers to attend to it and enforce it. If a sufficient
-quantity should not be precipitated by the air in
-the water, and by the accidental exposure to the atmosphere,
-it might be more effectually exposed to the air by
-Osbridge’s machine, to be described hereafter, or by a
-long-nozzled bellows, and if a small impregnation should
-be left, this is rather to be desired than avoided.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_81" href="#FNanchor_81" class="label">81</a>
- See Dr. Lind on the Health of Seamen.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_82" href="#FNanchor_82" class="label">82</a>
- The want of this apparatus may be supplied, in case
-of exigency, by a contrivance mentioned by Dr. Lind,
-consisting of a tea-kettle with the handle taken off, and
-inverted upon the boiler, with a gun barrel adapted to the
-spout, passing through a barrel of water by way of refrigeratory,
-or kept constantly moist with a mop.</p>
-
-<p>In this place I cannot help mentioning also, that in case
-of great extremity it has been found that the blood may
-be diluted, and thirst removed, by wetting the surface of
-the body even with sea water, the vapour of which is always
-fresh, and is inhaled by those pores of the skin
-whose natural function it is to imbibe moisture, of which
-there is always more or less in the common air of the
-atmosphere.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_83" href="#FNanchor_83" class="label">83</a>
- When we consider that linen was not in use among
-the ancient Romans, we might be apt to wonder that
-they were not more unhealthy; but their substitute for
-this was frequent bathing, which not only served to remove
-the <i>sordes</i> adhering to the surface of the body, but
-to air that part of the clothing which was usually in contact
-with the skin. The washing of the bodies of men
-suspected of infection upon their first entrance into a
-ship, has already been mentioned, and I have known
-some commanders who made their men frequently bathe
-themselves with great seeming advantage.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_84" href="#FNanchor_84" class="label">84</a>
- A coarse woollen stuff so called.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_85" href="#FNanchor_85" class="label">85</a>
- He makes the following computation of the additional
-expence for each man in some of the articles that
-have been mentioned:</p>
-
-<table>
-  <tr>
-    <th />
-    <th>&pound;.</th>
-    <th><i>s.</i></th>
-    <th><i>d.</i></th>
-  </tr>
-  <tr>
-    <td>For 3 handkerchiefs, at 1s. 6d.</td>
-    <td class="tdc">0</td>
-    <td class="tdc">4</td>
-    <td class="tdc">6</td>
-  </tr>
-  <tr>
-    <td>For 12 pounds of sope, at 6d.</td>
-    <td class="tdc">0</td>
-    <td class="tdc">6</td>
-    <td class="tdc">0</td>
-  </tr>
-  <tr>
-    <td>For 1 knife, at 1s.</td>
-    <td class="tdc">0</td>
-    <td class="tdc">1</td>
-    <td class="tdc">0</td>
-  </tr>
-  <tr>
-    <td>For 1 pair of buckles, at 9d.</td>
-    <td class="tdc">0</td>
-    <td class="tdc">0</td>
-    <td class="tdc">9</td>
-  </tr>
-  <tr>
-    <td></td>
-    <td class="bt tdc">0</td>
-    <td class="bt tdc">12</td>
-    <td class="bt tdc">3</td>
-  </tr>
-  <tr>
-    <td>Suppose 3 shirts a year, the difference</td>
-    <td class="tdc">0</td>
-    <td class="tdc">2</td>
-    <td class="tdc">3</td>
-  </tr>
-  <tr>
-    <td>Suppose 3 pair of trowsers, ditto</td>
-    <td class="tdc">0</td>
-    <td class="tdc">2</td>
-    <td class="tdc">3</td>
-  </tr>
-  <tr>
-    <td>Suppose 1 milled cap</td>
-    <td class="tdc">0</td>
-    <td class="tdc">2</td>
-    <td class="tdc">0</td>
-  </tr>
-  <tr>
-    <td class="tdr">Total &pound;.</td>
-    <td class="bt tdc">0</td>
-    <td class="bt tdc">18</td>
-    <td class="bt tdc">9</td>
-  </tr>
-</table>
-</div>
-
-<div class="footnote">
-
-<p><a id="Footnote_86" href="#FNanchor_86" class="label">86</a>
- <a href="#PART_I">See Part I</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_87" href="#FNanchor_87" class="label">87</a>
- Had I then known the salutary effects of porter
-and spruce beer, of which I have since been convinced,
-I should have proposed them as substitutes for rum.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_88" href="#FNanchor_88" class="label">88</a>
- The authenticity of this fact, as well as every other
-assertion in this work relating to the mortality in the
-fleet, may be proved from the ship’s books, deposited at
-the Navy Office.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_89" href="#FNanchor_89" class="label">89</a>
- I fancied that my reasoning on this subject was in
-a great measure new; but I lately met with the following
-passages in Celsus and Hippocrates, which seem to
-be illustrative of the same idea:&mdash;Quibus causa doloris,
-neque sensus ejus est, his mens laborat. Celsus, Lib. ii.
-cap. vii. which is nearly a translation of the following
-aphorism of Hippocrates:&mdash;[Greek hOkosoi poneontes ti tou s&ocirc;matos, ta
-polla t&ocirc;n pon&ocirc;n ouk a sthanontai, touteoisin h&ecirc; gn&ocirc;m&ecirc; noseei]. Hippoc.
-Aphor. Lib. ii. Aphor. 6.</p>
-
-<p>The same principle is ingeniously explained by Mr.
-Hunter in his Lectures.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_90" href="#FNanchor_90" class="label">90</a>
- <a href="#Page_181">See page 181</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_91" href="#FNanchor_91" class="label">91</a>
- <a href="#Page_125">See pages 125 and 126</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_92" href="#FNanchor_92" class="label">92</a>
- The form of administering this medicine was to add
-twenty drops of thebaic tincture, from half a grain to a
-grain of emetic tartar, and from five to ten grains of
-nitre, to two ounces of water or camphorated julep, of
-which one half was given about two hours before the
-common hour of rest, and the remainder at that hour.
-If spiritus Mindereri is preferred to the nitre, it may be
-given from two drachms to half an ounce for a dose, and
-it is better to administer it separately; for if it should not
-be exactly neutralized, it may decompose the antimonial,
-and render it inactive.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_93" href="#FNanchor_93" class="label">93</a>
- Since the publication of the first edition of this
-work, there has appeared a small tract on the treatment
-of low fevers, by Dr. Wall, of Oxford, and as his ingenuity
-and learning give him a just claim to the high
-rank he holds in his profession, attention is due to what
-he advances. The principal scope of the work is to recommend,
-from his own observation, the early use of
-opiates in those fevers, and the Doctor’s authority, as
-well as my own experience, convince me of the propriety
-of this practice in many cases occurring in this
-country, particularly among the lower sort of people,
-for whom spare diet and hard labour render evacuations
-less necessary than among the better sort. The inferior
-class of people are also more subject to this sort of fever
-from their houses and persons being less clean, and their
-apartments being worse ventilated; so that practice in
-these, as well as other cases, is to be varied according to
-the constitution and previous habits of life.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_94" href="#FNanchor_94" class="label">94</a>
- I first learned this, as well as many other useful
-and practical facts, from Mr. Farquhar, Surgeon in
-London, who has laid me under the greatest obligations
-by communicating many of his observations, derived
-from the most extensive experience and a truly penetrating
-sagacity.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_95" href="#FNanchor_95" class="label">95</a>
- I owe this piece of instruction, as well as many
-others, to Dr. Cullen’s Lectures.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_96" href="#FNanchor_96" class="label">96</a>
- In a review of Haslar hospital made in person by
-that excellent officer, Vice-admiral Barrington, in 1780,
-it was very judiciously proposed, among other salutary
-improvements, that there should be two apartments for
-the reception of the sick upon their first landing; one
-wherein they should be stripped of their dirty clothes,
-and another in which they should go into the warm bath,
-and put on the hospital dress, that they might not carry
-infection into the wards.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_97" href="#FNanchor_97" class="label">97</a>
- The following is the form of it, and it was first introduced
-by Mr. Whitfield, apothecary to the hospital,
-under the name of Bolus Sedativus:&mdash;℞. Confection.
-Damorat. [dram]ss. Castor. Russic. pulv. [scruple]ss. Tinct. Thebaic.
-g<sup>tt.</sup> iv. Syr. sim. q.s. Fiat bolus sexta quaque hora
-sumendus.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_98" href="#FNanchor_98" class="label">98</a>
- Great nicety is required in all cases with regard to
-the times and doses of cordials; for it by no means follows
-that these should be in proportion to the lowness
-and loss of strength. This is well illustrated by Mr.
-Hunter in his Lectures, where he explains the distinction
-between the powers of the body and its <i>actions</i>.
-There must be a certain degree of strength to bear the
-excitement occasioned by stimulating and strengthening
-medicines or diet; for nothing is more pernicious, or
-even fatal, than that any part or function should make
-exertions beyond its strength; and there is the more
-danger in ill-timed remedies of this kind, as a state of
-weakness is generally a state of irritability.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_99" href="#FNanchor_99" class="label">99</a>
- See a method proposed for obviating this, <a href="#Page_358">page 358</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_100" href="#FNanchor_100" class="label">100</a>
- <a href="#Page_381">Page 381</a> et seq.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_101" href="#FNanchor_101" class="label">101</a>
- Sailor’s fever.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_102" href="#FNanchor_102" class="label">102</a>
- See pages <a href="#Page_161">161</a>, <a href="#Page_181">181</a>, and <a href="#Page_380">380-1</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_103" href="#FNanchor_103" class="label">103</a>
- I have in the whole of this work been extremely
-cautious in reasoning concerning causes, from an opinion
-that they are very obscure, and that the theoretical
-part of physic is very imperfect and fallacious. This
-is perhaps in no instance more remarkable than in those
-opinions that prevail concerning the nature and influence
-of bile in producing diseases. An increased secretion of
-bile commonly attends the feverish complaints of hot
-climates, and those of the hot seasons of temperate and
-cold climates. It is not unnatural, therefore, to impute
-the disease then prevailing to this redundancy of bile:
-but, upon considering the matter more closely, it will
-appear to be rather a concomitant symptom, or effect,
-than a cause of those fevers; for, in the first place, in
-those cases in which there is the greatest secretion of bile,
-as in the <i>cholera morbus</i>, there is no fever. The only
-danger in this disease arises from the violent irritation
-produced in the bowels by such an extraordinary quantity
-of this secretion which commonly passes downwards;
-though I have seen it prove fatal when it flowed
-into the stomach, and produced perpetual retching and
-excoriation of the fauces; but in this case also without
-any fever. Secondly, in the most fatal of all fevers, in
-the West Indies, there are no marks of an increased secretion
-of bile, but, on the contrary, a preternatural
-defect of it, as appears by its not being evacuated either by
-stool or vomiting, by the white stools which sometimes
-attend the yellow fever, and by its not appearing in the
-first passages, nor in its own receptacles after death.
-Perhaps also that state of the bowels which renders it so
-difficult to procure stools may be in part owing to the
-want of this natural stimulus. It is nevertheless true,
-that in the intermitting and remitting fevers of hot climates
-and seasons there is perhaps always an accumulation
-of bile at the beginning, and an increased secretion
-of it during their course. It is farther true, that this
-adds to the patient’s uneasiness, and aggravates the
-symptoms, and that the cure consists partly in the evacuation
-of the bile. But it is also true, that in the
-very worst sort of fevers in hot climates it is a favourable
-symptom where the secretion of the liver is restored
-and increased, a bilious diarrhœa being one of the most
-auspicious symptoms that can occur in a yellow fever;
-and in those that are protracted and afford hopes of recovery,
-there is generally a gush of bile from time to
-time.&mdash;We may therefore lay down the following positions:
-1. That in cases in which bile is most freely and
-copiously secreted no fever exists, as in <i>cholera morbus</i>.
-2. That in the worst sort of fevers there is no preternatural
-secretion of bile, but, on the contrary, a defect of
-it. 3. That nevertheless there is an uncommon quantity
-of bile secreted in most of the fevers of hot climates,
-and that part of the cure consists in evacuating
-it.</p>
-
-<p>I am extremely diffident, as I have said, in all matters
-depending on our supposed knowledge of the animal œconomy;
-but the preceding circumstances seem to countenance
-the following reasoning:&mdash;The bile, according to
-Dr. Maclurg, who has given one of the best dissertations
-on its nature and properties, is composed of two parts;
-the gross part, which is coagulable by acids, and that
-part in which the bitter principle resides. The first
-constitutes the principal part in point of quantity, and
-seems to be that portion of the mass of fluids which
-loses the property of sound healthy blood, by a tendency
-to putrefaction, and is thrown out by this secretion.
-I will not undertake to vouch for the truth of
-this, but shall assume it as true in the following reasoning:&mdash;According
-to this theory, therefore, the greater
-part of the bile is what may be called the effete part
-of the circulating mass, or perhaps only of the red
-globules or gluten, the watery and saline part, which
-passes off by urine being the corrupted part of the serum.
-This part of the bile being very liable to putrefaction,
-the bitter part is considered by Dr. Maclurg as
-intended to correct this, and also to answer some good
-purpose in digestion. One of the effects of the bile in
-this operation is to extinguish acidity, whether proceeding
-from substances taken in, or generated in the stomach.
-The blood in all climates, and in all situations
-of life, is subject to have part of it thus corrupted,
-which, being separated from the common mass by the
-liver, is mingled and discharged with the common <i>feces</i>;
-but external heat continued for any length of time tends
-to augment this corruption of the fluids, and therefore
-to increase the secretion of bile; and it has been observed
-both by myself and others, that the bile found in
-those bodies that have been inspected after death, in consequence
-of fevers in hot climates, is less bitter, and not
-so penetrating to the fingers, being therefore deficient in
-the antiseptic principle. But since external heat makes
-no alteration in the degree of temperature of the fluids
-themselves, this effect must take place through the medium
-of the solids, in consequence of that general languor
-and want of energy which too much external heat
-induces in the functions, particularly in that power
-by which the living body preserves itself from putrefaction.
-Now if this portion of the blood, thus altered
-and depraved, is readily secreted and speedily thrown
-out, as in <i>cholera morbus</i>, no harm befals the constitution,
-nor any inconvenience but what arises from the
-irritation of the <i>prim&aelig; vi&aelig;</i>. But this may not take
-place if the body should be otherwise deranged; for the
-removal of this noxious matter from the mass of blood
-depends upon a due irritability of the blood vessels, the
-liver, and the bowels, whereby they are stimulated to
-contract, and thereby expel it. According to the principle
-of Mr. John Hunter, (whose deep and industrious
-researches into the animal œconomy place him high in
-the list of those few on whom nature has bestowed real
-genius, and who are capable of adding something new to
-the stock of human knowledge,) there is in a state of
-health a relative habitude or mutual harmony existing
-between the solids and fluids, whereby they stimulate
-and produce actions in each other, in which the healthy
-state of the functions consists, whether employed in the
-formation of what is found, or the expulsion of what is
-noxious: so that where it happens that the solids have a
-morbid insensibility to the impressions of corrupted and
-acrimonious fluids, the retention of these adds still more
-to the general derangement. To illustrate this, it may
-be observed, that the stomach and bowels, when they are
-endowed, as it were, with their natural perception, immediately
-expel any preternatural accumulations of bile
-that may take place; but when they are insensible to
-this stimulus through disease, no effort is made to relieve
-nature till it is excited by medicine. The same reasoning
-may be applied to the various vessels and ducts.
-Thus when we see the liver gorged with bile, without
-any free excretion of it into the gall bladder, as I have
-sometimes found to be the case upon inspecting the body
-in some of the worst cases of fever, would it not appear
-that the gall ducts have lost that natural irritability
-whereby the bile is expelled? Or, in consequence of a
-depraved state of action, connected with febrile affection,
-may it not happen that the absorbents, which, in
-their natural state, only absorb particular substances, and
-in a given quantity, will suffer a change in this natural
-action, and absorb whatever happens to be applied to
-their orifices? In case of jaundice, the bile, which is
-perhaps not at all absorbed in a state of health, is taken
-up in large quantities, and mingled with the mass of
-blood, which proves a seasonable relief in the state of accumulation
-and distension occasioned by the obstruction.
-This may happen in cases of fever, not indeed as a relief
-to nature, but from a depraved state of irritability in the
-lymphatics, induced by disease. Though no increased
-quantity of bile, therefore, is found in the gall bladder,
-there may have been an increased excretion of it, a preternatural
-absorption having been excited. So that it
-may admit of a question whether the colour of the skin,
-in the yellow fever, is owing to this, or if the idea of it
-given in the text<a id="FNanchor_104" href="#Footnote_104" class="fnanchor">104</a> is more just; but in either case
-it seems probable that the extreme tendency to putrefaction
-in the whole body is owing either to the presence
-of bile, in consequence of absorption, or the retention of
-something in the blood from a defect of its secretion.</p>
-
-<p>This reasoning concerning the bile in hot climates
-may, in some sort, be illustrated by what happens to the
-urine in cold climates. The urine is the vehicle of an
-excrementitious part of the blood, of which an increased
-proportion is generated in certain fevers, and if it is
-thrown out in the form of high-coloured, turbid urine,
-the fever will most probably be slight and short; but if
-it becomes pellucid, or <i>crude</i>, as it is called, the general
-derangement will be increased, the fever will be more
-violent and dangerous, and the first sign of returning
-health will be a turbid appearance and sediment.</p>
-
-<p>If the reasoning in the above discussion should appear
-to some readers unsatisfactory, or ill connected, I can
-only say that if it is deserving of this character, I am
-willing to have it considered not only as an illustration,
-but an example of the nicety and fallacy of theoretical
-disquisitions.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_104" href="#FNanchor_104" class="label">104</a>
- <a href="#Page_437">See page 437-8</a>.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_105" href="#FNanchor_105" class="label">105</a>
- I have been very cautious of admitting any theory
-into this work; but I cannot help adopting the doctrine of
-my much-valued master, Dr. Cullen, on this point, viz.
-that a great part of the symptoms of fever arise from reaction,
-or that effort which nature makes to overcome
-the morbid cause. I am happy in any opportunity of acknowledging
-my obligations to this learned professor, to
-whom the medical world in general is so much indebted,
-as well for the rational views of the animal œconomy,
-which he teaches, as for that spirit of study and inquiry
-which he infuses into the minds of his pupils.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_106" href="#FNanchor_106" class="label">106</a>
- M. Desportes, who wrote a treatise on the diseases
-of St. Domingo.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_107" href="#FNanchor_107" class="label">107</a>
- There is a difference in the appearance of the blood
-when sizy, perhaps not sufficiently insisted on by practical
-writers; for though there should even be a very
-thick buff, yet, if the surface is flat, and the <i>crassamentum</i>
-tender, no great inflammation is indicated, in comparison
-of that state of the blood wherein the surface is
-cupped, the <i>crassamentum</i> contracted so as to afford the
-appearance of a large portion of <i>serum</i>, and where it
-feels firm and tenacious, though perhaps but thinly covered
-with buff. This is a distinction well worth attending
-to in practice; for it is in these last circumstances
-that blood-letting gives most relief, and where the patient
-will bear the repetition of it with most advantage.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_108" href="#FNanchor_108" class="label">108</a>
- See the same observation in Mr. Hume’s Essay on
-this Disease, published by Dr. Donald Monro.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_109" href="#FNanchor_109" class="label">109</a>
- The state of the stomach is very much affected by
-that of the external surface of the body; and it is sagaciously
-observed by Sydenham, that the stomach being
-commonly very irritable in the plague, the most effectual
-means of making it retain what was administered internally
-was to excite a sweat.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_110" href="#FNanchor_110" class="label">110</a>
- The red bark was brought to England in a Spanish
-prize in the year 1781, and a very accurate account of
-its medical and chemical properties was published the year
-after by Dr. William Saunders, of Guy’s hospital. None
-of it had been brought to the West Indies before the
-peace, so that I had no opportunity of trying it in that
-climate.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_111" href="#FNanchor_111" class="label">111</a>
- Mr. Telford related to me, that he had cured several
-intermittents that had baffled the bark, by means of
-white vitriol, whilst he was surgeon of the Yarmouth
-in 1779. He gave it in doses of five grains every four
-hours in the intermission, and was successful in every
-case except two, in which the patients were far advanced
-in the dropsy.</p>
-
-<p>He met with several cases of the same kind in the Alcide,
-in 1782, in which he was successful with the flowers
-of zinc, after having given large quantities of bark to no
-purpose. He preferred, however, the white vitriol, as
-being milder in its operation, and less apt to disagree with
-the patient’s stomach.</p>
-
-<p>He did not employ either of them in the recent state
-of the disease, nor does he assert that they are universal or
-infallible remedies; but only alledges, that he has experienced
-the most evident good effects from them in an
-advanced stage of the disease, and a reduced state of the
-patient, where the common remedy had failed.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_112" href="#FNanchor_112" class="label">112</a>
- Dr. Huck Saunders, whose recent loss the world has
-reason to regret on account of his experience and sagacity
-as a physician, as well as his virtues as a man, communicated
-to me, in conversation, some observations on the
-cure of obstinate intermittents, which deserve to be mentioned
-here. When he was physician to the army at the
-Havannah he cured a number of agues which had resisted
-the bark, by giving two ounces of the vinous tincture of
-rhubarb and six drams of the tincture of sena seven or
-eight hours before the fit. This being repeated two or
-three times, carried off the disease. He also informed
-me, that he had met with agues in England which did
-not yield to the bark; but, upon leaving it off, and putting
-the patients on a course of mercury, they were cured
-upon returning to the use of the bark.</p>
-
-<p>Arsenic has also been found to be an effectual remedy
-in intermittent fevers. I was informed by Dr. Huck
-Saunders, that when he was in North America, in the
-war before the last, there was an expedition undertaken
-against the Cherokee Indians, whose country is extremely
-subject to agues; and as an adequate quantity of bark
-would have been very cumbersome where light service
-was necessary, Mr. Russel, who had the medical management
-of the expedition, provided a great number of
-pills, containing each one eighth part of a grain of arsenic,
-by the proper use of which he was enabled to cure
-the intermittent fevers with which the troops were seized.</p>
-
-<p>I shall here mention another unusual remedy in intermitting
-fevers; and though I can bring only one instance
-in proof of its efficacy, yet this is so strong as to make it
-deserve farther trial. A man, on board of the Sandwich,
-had an obstinate intermittent which had resisted the bark,
-and was stopped by applying to the stomach a plaster,
-composed of gum plaster, epispastic plaster, and opium,
-in proportions which I do not now recollect.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_113" href="#FNanchor_113" class="label">113</a>
- Sir John Pringle on the Diseases of the Army.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_114" href="#FNanchor_114" class="label">114</a>
- This is elegantly expressed as follows, in Sir George
-Baker’s learned Dissertation on this disease:&mdash;“Primo
-neglectus tractatu asperior occurrebat: etenim corpus
-extenuatum atque confectum ut morbo fervido impar
-erat, ita ipsi impar curationi. Itaque optimum erat
-occurrere ipsis principiis atque auxilia mature pr&aelig;ripere.
-In hoc enim corporis affectu aliquod certe in
-medicina opus est, haud multum in natur&aelig; beneficio.”</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_115" href="#FNanchor_115" class="label">115</a>
- In Dr. Griffith’s form of his medicine for the piles,
-six drachms of fresh-drawn linseed oil are joined with
-two drachms and a half of the vinous tincture of rhubarb,
-and given twice a day in a draught. I commonly
-used oil of almonds at the hospital. This may be considered
-as another instance of those useful combinations of
-medicines, which experience alone sometimes discovers.
-I have found it of use also in other internal h&aelig;morrahages.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_116" href="#FNanchor_116" class="label">116</a>
- See Diseases of the Army, p. 273. 6th Edit.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_117" href="#FNanchor_117" class="label">117</a>
- Since coming to England, I have been informed by
-Dr. Garden, a learned and ingenious practitioner from
-South Carolina, that this medicine, in order to produce
-its proper effect, should be given in a very weak decoction;
-for that after having almost abandoned it in consequence
-of its failure when he gave it in strong decoctions,
-and in substance, he was again convinced of its
-efficacy by using it in a very weak decoction, a scruple
-being boiled in a pint of water to half a pint.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_118" href="#FNanchor_118" class="label">118</a>
- <a href="#Page_345">See page 345</a>. A fact mentioned in Capt. Cooke’s
-Voyage to the North Pacific Ocean, may be also alledged
-in favour of this opinion. He remarks, that the
-Kamschadales, who were habituated to hard labour,
-were free from scurvy, while the Russians and Cossacks,
-who were in garrison in their country, and led indolent
-lives, were subject to it.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_119" href="#FNanchor_119" class="label">119</a>
- I was informed of this fact by Mr. Cairncross, an
-ingenious surgeon belonging to one of the battalions that
-served there during the siege.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_120" href="#FNanchor_120" class="label">120</a>
- I imagined that this was a new practice; but I find,
-since the first edition of this work was printed, that it
-has been recommended by Pere Labat in his voyage to
-the Antilles.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_121" href="#FNanchor_121" class="label">121</a>
- There is a symptom which takes place when men are
-beginning to recover from scurvy, (particularly when
-the cure is rapidly effected by the use of lemon and
-orange juice) upon which I have frequently reflected,
-but for which I have never been able to account. This
-consists in acute pains, which are felt in the breast and
-limbs, resembling rheumatic pains. I once knew the
-crew of a ship which was much affected with scurvy,
-and had about ninety men under cure by lemons and
-oranges, who were most of them affected with this
-symptom in one night, and made such a noise by crying
-out as to alarm the officers who were upon duty.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_122" href="#FNanchor_122" class="label">122</a>
- See the Medical Essays of Edinburgh. Sennertus,
-lib. iii. part i. sect. ii.&mdash;Haller Elem. Physiolog. lib. xix.
-sect. ii.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_123" href="#FNanchor_123" class="label">123</a>
- In the Princessa, 1781, and the Nonsuch, Prince
-George, and Royal Oak, in 1782.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_124" href="#FNanchor_124" class="label">124</a>
- Since this was first written, the melancholy tidings
-have arrived of another case to be added to this fatal list.
-It is that of the amiable and gallant Lord Robert Manners,
-who commanded the Resolution on the 12th of
-April, and having lost his leg, besides receiving a wound
-in his arm and breast, died of this untractable symptom
-on his passage to England; and though he shared a fate to
-be envied by every lover of true glory, his loss can never
-be enough deplored by his country and friends, being
-formed by his great virtues and accomplishments, joined
-to the lustre of his rank, to hold out an example of all
-that was good and great as a man and an officer.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_125" href="#FNanchor_125" class="label">125</a>
- See Kaau Boerhaave’s account of this epilepsy in a
-school at Harlaem, in a book, entitled Impetum faciens
-dictum Hippocrate per corpus consentiens (page 355.)
-A fact of the same kind is also related in a pamphlet,
-entitled Rapport des Commissaires charg&eacute;s par le Roi de
-l’examen du Magnetisme Animal.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_126" href="#FNanchor_126" class="label">126</a>
- London Medical Observations and Inquiries, Vol. VI.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_127" href="#FNanchor_127" class="label">127</a>
- Medical Commentaries, Vol. III., and a Thesis printed
-at Edinburgh, 1784.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_128" href="#FNanchor_128" class="label">128</a>
- See experiments on a heated room. Philosophical
-Transactions, 1775, Vol. LXV.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_129" href="#FNanchor_129" class="label">129</a>
- That species of locked jaw, called by authors the
-<i>Trismus Infantium</i>, to which children are liable the first
-week after birth, is probably owing to the contact of
-the external air upon the skin, which is accustomed in
-the womb to a moist and warm medium.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_130" href="#FNanchor_130" class="label">130</a>
- Aret&aelig;us Cappadox says, that tetanus in general is
-even more apt to occur in winter than in summer. De
-Cauf. &amp; Sign. Morb. Acut. lib. i. cap. vi.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_131" href="#FNanchor_131" class="label">131</a>
- There are several valuable practical remarks on this
-complaint in some of the ancient authors, especially
-Aret&aelig;us. Their principal means of cure consisted in
-the application of warm oil to the whole surface of the
-body, particularly of the part affected. This author
-also recommends clysters of warm oil, occasionally combined
-with a medicine called <i>hiera</i>, which consisted of
-certain spices and gums, with some purgative, such as
-aloes or colocynth. Aret&aelig;us Cappad. de Curat. Morb.
-Acut. cap. vi. Celsus, lib. iv. cap. iii. Gor&aelig;aus in
-vocabulum,ἱερα.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_132" href="#FNanchor_132" class="label">132</a>
- This is a fact which does not admit of doubt; but
-the manner in which the effect is here produced is a matter
-of conjecture. It is most probably owing to the
-compression and tremor of the air in consequence of its
-resistance to the motion of the ball. We can also conceive,
-that, with regard to an yielding part, such as the
-stomach or abdomen, a body flying with great velocity
-may even, for a moment, displace a portion of it by
-passing through the same space, without any other mechanical
-injury than contusion, in a manner similar to
-what happens to two balls in the act of collision in philosophical
-experiments made to illustrate the nature of
-elasticity; or the compressed air may even, in this case,
-act, as it were, like a cushion, preventing the sudden
-impulse and contact of the ball. This explanation furnishes
-a reason why the parts of the body above mentioned
-should be more liable to be affected by accidents
-of this kind than the head. Perhaps this difference may
-also, in part, arise from the principle laid down by Mr.
-Hunter, that the stomach is more essential to life, and
-more immediately the seat of it, than the head or any
-other member or organ of the body, and that an injury
-to this part is more immediately destructive of life than
-any other.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_133" href="#FNanchor_133" class="label">133</a>
- The honourable Captain Fitzroy.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_134" href="#FNanchor_134" class="label">134</a>
- Colonel Markham.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_135" href="#FNanchor_135" class="label">135</a>
- Animals are affected by these accidents as well as
-men. A cow in one of the ships was killed in one of
-the actions in April, by a double-headed shot passing
-close to the small of her back.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_136" href="#FNanchor_136" class="label">136</a>
- H&aelig;c formula ex Pharmacopœia Nosocomii Sti. Thom&aelig; excerpta
-est.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_137" href="#FNanchor_137" class="label">137</a>
- H&aelig;c formula ex Pharmacopœia Nosocomii Sti. Thom&aelig; deprompta
-est.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_138" href="#FNanchor_138" class="label">138</a>
- Vide pag. 408.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_139" href="#FNanchor_139" class="label">139</a>
- Vide pag. 409. H&aelig;c formul&aelig; ex Pharmacopœia Nosocomii
-Sti.Thom&aelig; excerpta est. sed vice confectionis Damocratis hodie obsolet&aelig;,
-adhibentur confectio aromatica &amp; opium purificatum, ratione
-habit&acirc; ad portionem fingulorum adeo ut parem edant effectum
-ac in vetere formul&acirc;.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_140" href="#FNanchor_140" class="label">140</a>
- Vide pag. 456.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_141" href="#FNanchor_141" class="label">141</a>
- Ex auctoritate Cl. Huck Saunders.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_142" href="#FNanchor_142" class="label">142</a>
- Ex auctoritate Cl. Huck Saunders.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_143" href="#FNanchor_143" class="label">143</a>
- Ex auctoritate Cl. Lind.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_144" href="#FNanchor_144" class="label">144</a>
- Vide pag. 479.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_145" href="#FNanchor_145" class="label">145</a>
- Vide pag. 489.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_146" href="#FNanchor_146" class="label">146</a>
- Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo
-de morbis castrensibus.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_147" href="#FNanchor_147" class="label">147</a>
- H&aelig;c formula ex Pharmacopœi&acirc; Nosocomii Sti. Thom&aelig;, excerpta
-est.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_148" href="#FNanchor_148" class="label">148</a>
- Vice olei ricini dare licet olei amygdal&aelig; unciam unam cum
-tinctur&aelig; senn&aelig; unci&acirc; dimidi&acirc;. Vide Pharm. Nosoc. Sti.Thom&aelig;.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_149" href="#FNanchor_149" class="label">149</a>
- H&aelig;c formula ex auctoritate Cl. Griffiths. In periculis a me
-ipso factis felicissimum successum ex hoc medicamento percepi.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_150" href="#FNanchor_150" class="label">150</a>
- Hoc medicamentum speciatim his h&aelig;morrhagiis accommodatum
-qu&aelig; ex aliquo viscere l&aelig;so vi externa exoriantur quales in
-nave s&aelig;pius quam alicubi accidere solent, ex pr&aelig;cipitiis &amp; ex corpore
-colliso a molimine machinarum &amp; tormentorum.&mdash;Prodest
-quoque in his casibus pulvis ipecacoanh&aelig; compositus.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_151" href="#FNanchor_151" class="label">151</a>
- H&aelig;c formula ex Pharmacopœia Nosocomii Sti. Thom&aelig; deprompta
-est.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_152" href="#FNanchor_152" class="label">152</a>
- H&aelig;c est quam proxime formula a Cl. Mead legata Nosocomio
-Sti. Thom&aelig; ubi olim munere medici functus est, &amp; ibi ex eo
-tempore usque hodie feliciter in hydrope adhibita est.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_153" href="#FNanchor_153" class="label">153</a>
- Cl&deg;. Huck Saunders qui dyspnœ&acirc; hydropic&acirc; laboravit ipse,
-auxilio notabili erat hoc medicamentum. In talibus malis interdum
-summopere prodest decoctum digitalis purpure&aelig;, ut medicus
-supra memoratus in suo casu compertus est.&mdash;Vid. Medical Transactions,
-Vol. III.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_154" href="#FNanchor_154" class="label">154</a>
- Vide Cl. Pringle in opere suo de morbis castrensibus.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_155" href="#FNanchor_155" class="label">155</a>
- Hujus doctrin&aelig; auctor est Hippocrates, qu&aelig; restaurata est
-auctaque a  Cl. Milman in opusculo suo de hydrope.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_156" href="#FNanchor_156" class="label">156</a>
- H&aelig;c methodus medendi qu&aelig; &aelig;que efficax ac simplex est,
-primo excogitata fuit a Cl. Georgio Fordyce medico nosocomii Sti.
-Thom&aelig;, ubi &amp; ipse felicissimo cum successu eandem expertus sum,
-in muneribus meis ibi fungendis.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_157" href="#FNanchor_157" class="label">157</a>
- Vide opus Cl. Johannis Hunter de morbo venereo.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_158" href="#FNanchor_158" class="label">158</a>
- Vires opii in isto morbo primo innotuerunt ex experienti&acirc;
-Cl. Nooth, dum pr&aelig;fuit nosocomiis militaribus in America, &amp;
-pro optimo remedio a peritissimis medicis &amp; chirurgis jam habetur.</p></div>
-
-<div class="footnote">
-
-<p><a id="Footnote_159" href="#FNanchor_159" class="label">159</a>
- Non hic intelligitur ptyalismum veram esse causam qu&acirc; efficitur
-medela morbi, sed pr&aelig;cipitur ut pro argumento sit hydrargyrum
-in vasa minima permeasse adeo ut effectum edat in subigendo
-morbo. Vide Opus Hunteri.</p></div></div>
-
-<div class="transnote">
-
-<h3>Transcriber's Note:</h3>
-
-<p>Inconsistent spelling and hyphenation are as in the original.</p>
-
-</div>
-
-
-
-
-
-
-
-
-<pre>
-
-
-
-
-
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