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diff --git a/old/53007-0.txt b/old/53007-0.txt deleted file mode 100644 index 3116203..0000000 --- a/old/53007-0.txt +++ /dev/null @@ -1,12599 +0,0 @@ -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) - - - - - - - -[Transcriber's Note: - -This project uses utf-8 encoded characters. If some characters are -not readable, check your settings of your browser to ensure you have a -default font installed that can display utf-8 characters. - -Characters preceded by a caret {^} are superscript. If more than one -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.] - - - - - - -End of the Project Gutenberg EBook of Observations on the Diseases of Seamen, by -Gilbert Blane - -*** END OF THIS PROJECT GUTENBERG EBOOK OBSERVATIONS ON DISEASES OF SEAMEN *** - -***** This file should be named 53007-0.txt or 53007-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/3/0/0/53007/ - -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) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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