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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) - - - - - - -</pre> - - -<p><span class="pagenum" id="Page_i">i</span></p> - -<div class="figcenter"> -<img id="coverpage" src="images/cover.jpg" alt="" /> -</div> - -<h1> -<span class="x-large">OBSERVATIONS</span><br /> - -<span class="medium">ON THE</span><br /> - -<span class="x-large">DISEASES</span><br /> - -<span class="medium">OF</span><br /> - -SEAMEN.<br /> - -<span class="medium">BY</span><br /> - -<span class="large">GILBERT BLANE, M. D.<br /> - -F. R. S. S. LOND. <small>AND</small> EDIN.</span><br /> - -<span class="small table">PHYSICIAN EXTRAORDINARY TO THE PRINCE OF WALES,<br /> -PHYSICIAN TO THE DUKE OF CLARENCE,<br /> -AND TO ST. THOMAS’S HOSPITAL.</span><br /> - -<span class="large">THE SECOND EDITION,</span><br /> - -<span class="medium">WITH CORRECTIONS AND ADDITIONS.</span><br /> - -<span class="medium">LONDON:</span><br /> - -<span class="small table">Printed by <span class="smcap">Joseph Cooper</span>;<br /> -And sold by <span class="smcap">John Murray</span>, No. 32 Fleet Street;<br /> -<span class="smcap">J. Johnson</span>, St. Paul’s Church Yard;<br /> -And by <span class="smcap">William Creech</span>, in Edinburgh.<br /> -<br /> -M.DCC.LXXXIX.</span><br /> -</h1> -<p><span class="pagenum" id="Page_ii">ii</span></p> - -<blockquote> - -<p>Nec Medici, nec Imperatores, nec Oratores, quamvis -artis præcepta perceperint, quidquam magna laude -dignum sine usu et excercitatione consequi possunt.</p> - -<p class="author"> -<span class="smcap">Cicero.</span><br /> -</p></blockquote> - -<p><span class="pagenum" id="Page_iii">iii</span></p> - -<h2 id="CONTENTS">CONTENTS.</h2> - -<table class="toc"> - <tr> - <th colspan="2"><a href="#PART_I">PART I.</a></th> - </tr> - <tr> - <th colspan="2"><a href="#PART_I_BOOK_I">BOOK I.</a></th> - </tr> - <tr> - <td colspan="2" class="x-small tdr">Page</td> - </tr> - <tr> - <td><a href="#PART_I_BOOK_I">Comprehending the Medical History of the Fleet, from March 1780, till August 1781</a></td> - <td class="tdrb">17</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_I_CHAP_I">CHAP. I.</a></th> - </tr> - <tr> - <td><a href="#BOOK_I_CHAP_I"><span class="smcap">Account</span> of the Health of the Fleet from March 1780, till July following</a></td> - <td class="tdrb"><i>ib.</i></td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_I_CHAP_II">CHAP. II.</a></th> - </tr> - <tr> - <td><a href="#BOOK_I_CHAP_II"><span class="smcap">Account</span> of the Health of the Fleet from August 1780, till December following</a></td> - <td class="tdrb">35<span class="pagenum" id="Page_iv">iv</span></td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_I_CHAP_III">CHAP. III.</a></th> - </tr> - <tr> - <td><a href="#BOOK_I_CHAP_III"><span class="smcap">Account</span> of the Health of the Fleet from January 1781, till July 1781, both Months included</a></td> - <td class="tdrb">46</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_I_BOOK_II">BOOK II.</a></th> - </tr> - <tr> - <td><a href="#PART_I_BOOK_II">Continuation of the Medical History of the Fleet, from August 1781, till the Conclusion of the War in April 1783</a></td> - <td class="tdrb">63</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_I">CHAP. I.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_I">Some <span class="smcap">Account</span> of the Interval between the Campaigns of 1781, and the Junction of the Reinforcement from England in April 1782</a></td> - <td class="tdrb"><i>ib.</i></td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_II">CHAP. II.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_II"><span class="smcap">Account</span> of the Health of the Fleet from the Junction of the Squadron from England, till the general Rendezvous at St. Lucia, in the beginning of April</a></td> - <td class="tdrb">75</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_III">CHAP. III.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_III"><span class="smcap">State</span> of <span class="smcap">Health</span> of the Fleet in April 1782</a></td> - <td class="tdrb">98<span class="pagenum" id="Page_v">v</span></td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_IV">CHAP. IV.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_IV"><span class="smcap">Account</span> of the Health of the Fleet while it lay at Jamaica, during May, June, and part of July, 1782</a></td> - <td class="tdrb">109</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_V">CHAP. V.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_V"><span class="smcap">Account</span> of the Health of the Fleet from its leaving Jamaica on the 17th of July 1782, till its Departure from New York on the 25th of October following</a></td> - <td class="tdrb">139</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_II_CHAP_VI">CHAP. VI.</a></th> - </tr> - <tr> - <td><a href="#BOOK_II_CHAP_VI"><span class="smcap">Account</span> of the Health of the Fleet from its Departure from New York till the Conclusion of the War</a></td> - <td class="tdrb">158</td> - </tr> - <tr> - <th colspan="2"><a href="#BOOK_III">BOOK III.</a></th> - </tr> - <tr> - <td><a href="#BOOK_III">Of the <span class="smcap">Numbers</span> and <span class="smcap">Mortality</span> of different <span class="smcap">Diseases</span> sent to Hospitals, with a general View of the whole Mortality during the War</a></td> - <td class="tdrb">185<span class="pagenum" id="Page_vi">vi</span></td> - </tr> - <tr> - <th colspan="2"><a href="#PART_II">PART II.</a></th> - </tr> - <tr> - <td><a href="#PART_II">Of the <span class="smcap">Causes</span> of Sickness in Fleets, and the Means of <span class="smcap">Prevention</span></a></td> - <td class="tdrb">211</td> - </tr> - <tr> - <td><a href="#PART_II_INTRODUCTION">Introduction</a></td> - <td class="tdrb"><i>ib.</i></td> - </tr> - <tr> - <th colspan="2"><a href="#PART_II_CHAP_I">CHAP. I.</a></th> - </tr> - <tr> - <td><a href="#AIR">Of Air</a></td> - <td class="tdrb">225</td> - </tr> - <tr> - <td><a href="#CHAP_I_SECT_I">Sect. I. Of the noxious Effects of Land Air in particular Situations</a></td> - <td class="tdrb">227</td> - </tr> - <tr> - <td><a href="#CHAP_I_SECT_II">Sect. II. Of the Effects of foul Air from the Neglect of Cleanliness in Men’s Persons—<span class="smcap">Infection</span></a></td> - <td class="tdrb">237</td> - </tr> - <tr> - <td class="i4"><a href="#MEANS_OF_PREVENTING_THE_INTRODUCTION_OF_INFECTION">1. Means of preventing the Introduction of Infection</a></td> - <td class="tdrb">240</td> - </tr> - <tr> - <td class="i4"><a href="#MEANS_OF_PREVENTING_THE_PRODUCTION_OF_INFECTION">2. Means of preventing the Production of Infection</a></td> - <td class="tdrb">254</td> - </tr> - <tr> - <td class="i4"><a href="#MEANS_OF_ERADICATING_INFECTION">3. Means of eradicating Infection</a></td> - <td class="tdrb">264</td> - </tr> - <tr> - <td><a href="#CHAP_I_SECT_III">Sect. III. Of the foul Air generated in a Ship</a></td> - <td class="tdrb">281</td> - </tr> - <tr> - <td><a href="#CHAP_I_SECT_IV">---- IV. Means of guarding against Infection and bad Air</a></td> - <td class="tdrb">293<span class="pagenum" id="Page_vii">vii</span></td> - </tr> - <tr> - <th colspan="2"><a href="#CHAP_II">CHAP. II.</a></th> - </tr> - <tr> - <td><a href="#OF_ALIMENT">Of Aliment</a></td> - <td class="tdrb">300</td> - </tr> - <tr> - <td><a href="#SECT_I_of_Solid_Food">Sect. I. Of solid Food</a></td> - <td class="tdrb"><i>ib.</i></td> - </tr> - <tr> - <td><a href="#SECT_II_of_Drink">---- II. Of Drink</a></td> - <td class="tdrb">319</td> - </tr> - <tr> - <td class="i4"><a href="#OF_WATER">Of Water</a></td> - <td class="tdrb">324</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_II_CHAP_III">CHAP. III.</a></th> - </tr> - <tr> - <td><a href="#OF_CLOTHING">Of Clothing</a></td> - <td class="tdrb">334</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_II_CHAP_IV">CHAP. IV.</a></th> - </tr> - <tr> - <td><a href="#OF_EXERCISE">Of Exercise</a></td> - <td class="tdrb">343</td> - </tr> - <tr> - <td><a href="#CONCLUSION"><span class="smcap">Conclusion</span></a></td> - <td class="tdrb">349</td> - </tr> - <tr> - <td><a href="#APPENDIX_TO_PART_II"><span class="smcap">Appendix</span> to <span class="smcap">Part II.</span></a></td> - <td class="tdrb">352</td> - </tr> - <tr> - <td class="i4"><a href="#MEMORIAL_TO_THE_ADMIRALTY">Memorial to the Admiralty</a></td> - <td class="tdrb"><i>ib.</i></td> - </tr> - <tr> - <td class="i4"><a href="#SUPPLEMENT_TO_THE_MEMORIAL">Supplement to the Memorial</a></td> - <td class="tdrb">364</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_III">PART III.</a></th> - </tr> - <tr> - <td><a href="#DESCRIPTION_AND_TREATMENT"><span class="smcap">Description</span> and <span class="smcap">Treatment</span> of the Diseases most frequently occurring in Fleets in hot Climates</a></td> - <td class="tdrb">368</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_III_CHAP_I">CHAP. I.</a></th> - </tr> - <tr> - <td><a href="#OF_FEVERS">Of Fevers</a></td> - <td class="tdrb">370</td> - </tr> - <tr> - <td class="i4"><a href="#OF_THE_INFECTIOUS_SHIP_FEVER">1. Of the infectious Ship Fever</a></td> - <td class="tdrb">371</td> - </tr> - <tr> - <td class="i4"><a href="#OF_THE_BILIOUS_REMITTING_FEVER">2. Of the bilious Remitting Fever</a></td> - <td class="tdrb">415<span class="pagenum" id="Page_viii">viii</span></td> - </tr> - <tr> - <td class="i4"><a href="#OF_THE_YELLOW_FEVER">3. Of the Yellow Fever</a></td> - <td class="tdrb">425</td> - </tr> - <tr> - <td class="i4"><a href="#INTERMITTENT_FEVERS">4. Of the Effects of some unusual Remedies in the Cure of obstinate Intermittent Fevers</a></td> - <td class="tdrb">456</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_III_CHAP_II">CHAP. II.</a></th> - </tr> - <tr> - <td><a href="#OF_FLUXES">Of Fluxes</a></td> - <td class="tdrb">466</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_III_CHAP_III">CHAP. III.</a></th> - </tr> - <tr> - <td><a href="#OF_SCURVY">Of Scurvy</a></td> - <td class="tdrb">499</td> - </tr> - <tr> - <th colspan="2"><a href="#PART_III_CHAP_IV">CHAP. IV.</a></th> - </tr> - <tr> - <td><a href="#OF_THE_WOUNDS_RECEIVED_IN_THE_ACTIONS_OF_APRIL_1782">Of the <span class="smcap">Wounds</span> received in the Actions of April 1782</a></td> - <td class="tdrb">519</td> - </tr> - <tr> - <td><a href="#APPENDIX_TO_PART_III"><span class="smcap">Appendix to Part III.</span></a></td> - <td class="tdrb">545</td> - </tr> - <tr> - <td class="i4"><a href="#ASSORTMENT_OF_MEDICINES_TO_BE_CARRIED_TO_SEA">Assortment of Medicines to be carried to Sea</a></td> - <td class="tdrb">548</td> - </tr> - <tr> - <td class="i4"><a href="#FORMULAE_QUAEDAM">Formulæ Medicamentorum</a></td> - <td class="tdrb">550<span class="pagenum" id="Page_1">1</span></td> - </tr> -</table> - -<h2 id="DEDICATION">DEDICATION.<br /> - -<span class="small">TO HIS</span><br /> - -<span class="medium">ROYAL HIGHNESS</span><br /> - -<span class="large"><span class="smcap">Prince</span> WILLIAM-HENRY.</span></h2> - -<p class="small">SIR,</p> - -<p>The following Work is the fruit -of several years labour employed in -the Public Service, chiefly under that -great and successful Admiral, Lord -Rodney, in a series of Naval Operations, -which have been productive of -<span class="pagenum" id="Page_2">2</span> -events more glorious than any recorded -in the Annals of Britain. As -your Royal Highness was present during -some part of the service which is -the subject of these Observations, and -as You have not only honoured the -Sea Service by embracing it as a profession, -and enrolling your illustrious -Name among its officers, but in undergoing -the dangers and fatigues of -actual service, which is so necessary to -attain that practical Skill which Your -Royal Highness is well known to possess, -I have, upon these grounds, presumed -to lay this Work at Your feet. -I should do this with greater satisfaction, -<span class="pagenum" id="Page_3">3</span> -were it more worthy of Your acceptance; -but however inadequate my -abilities may have been to the talk, -it has been my sincere aim to produce -a work of some utility to that only -Bulwark of our Country, the British -Navy, of which your Royal Highness -is the Pride and the Hope.</p> - -<p>Your Royal Highness’s Permission -to inscribe this work to You, and -the personal Notice and Protection -with which you have been pleased to -honour me, I consider as the first -Distinctions of my life, and of which -I shall ever entertain a becoming -<span class="pagenum" id="Page_4">4</span> -sense, by cherishing those indelible -sentiments of Respect, Gratitude, and -Attachment, which are due to Your -Royal Highness from</p> - -<div class="poem"><div class="stanza"> -<span class="i0">Your Royal Highness’s<br /></span> -<span class="i2">Most faithful,<br /></span> -<span class="i4">Most obedient, and<br /></span> -<span class="i6">Most devoted Servant,<br /></span> -<span class="i4">GILBERT BLANE.<br /></span> -</div><div class="stanza"> -<span class="i0"><span class="smcap">London</span>,<br /></span> -<span class="i0">May 1, 1785.<br /></span> -</div></div> - -<p><span class="pagenum" id="Page_5">5</span></p> - -<h2 id="PREFACE">PREFACE.</h2> - -<p>Having been appointed by Lord Rodney -Physician to the Fleet under his command, -in the beginning of the year 1780, I determined -to avail myself, to the utmost of my -abilities, of the advantages which this field -of observation afforded. This I was led to -do, in order to satisfy my own mind as a -matter of duty, as well as to find out, if -possible, the means of bettering the condition -of a class of men, who are the bulwark -of the state, but whose lot is hardship -and disease, above that of all others. -<span class="pagenum" id="Page_6">6</span></p> - -<p>A fleet, consisting seldom of less than -twenty ships of the line of battle, and -sometimes exceeding forty, which I attended -in the different scenes of active service in -that distant and unhealthy region, for more -than three years, has afforded me opportunities -of making observations upon a large -scale.</p> - -<p>My object has been prevention as much as -cure; and as the former must more particularly -depend on a knowledge of the external -causes of disease, I have collected and arranged -all the facts upon this subject that -came within my reach, considering these as -the only grounds from whence the remote -causes of health and sickness could be deduced.</p> - -<p>When I entered upon my employment, the -Commander in Chief gave an order, that -every surgeon in the fleet should send me a -<span class="pagenum" id="Page_7">7</span> -monthly return, stating the degree of prevalence -of different diseases, the mortality, -and whatever else related to the health of -the respective ships. This was done with -a view to enable me to regulate the reception -of men into hospitals, so that each ship -might have a due proportion of relief, according -to the degree of sickness on board, -taking care at the same time that the hospitals -should not be overcrowded; and also -to acquaint the Commander in Chief, from -time to time, of the state of sickness, or -the predominance of particular diseases, in -order to recommend such articles of diet, -or other means, as might tend to cure them, -or to check their progress. These returns -have served also in this work as a method -of collecting a multitude of well-established -facts, tending to ascertain the causes and -course of disease. -<span class="pagenum" id="Page_8">8</span></p> - -<p>While the fleet was in port, I also superintended -and visited daily the hospitals, of -which there is one at almost every island on -the station; and having kept an account of -the different kinds of disease that were admitted, -and of their mortality, I have in -this way likewise been furnished with a -number of facts that may throw light on -the history of human maladies.</p> - -<p>Nevertheless, I do not boast of having -made great discoveries; and every person of -a correct judgement must be aware how difficult -it is to ascertain truths, and to draw -fair and solid inferences, on medical subjects. -I have attempted little more than to -amass, from my own observation, and by -the assistance of the surgeons of the fleet, a -number of well-established facts, and to arrange -them in such a methodical manner, as -to prove a groundwork for investigation; -and I am persuaded that others, of more -<span class="pagenum" id="Page_9">9</span> -sagacity and enlarged knowledge than myself, -may be able to deduce from them, observations -that may have escaped me especially -if these new, but imperfect, attempts -should come to be compared with similar -ones that may be made by other observers in -other climates, and in other circumstances -of service.</p> - -<p>I met with several obstacles in instituting -inquiries, purely medical, to the extent I -could have wished. There is, in the first -place, from the nature of the subject, a -great difficulty attending all practical inquiries -in medicine; for, in order to ascertain -truth, in a manner that is satisfactory to -a mind habituated to chaste investigation, -there must be a series of patient and attentive -observations upon a great number of -cases, and the different trials must be varied, -weighed, and compared, in order to -<span class="pagenum" id="Page_10">10</span> -form a proper estimate of the real efficacy of -different remedies and modes of treatment.</p> - -<p>But besides this difficulty belonging to -the nature of the subject, there were others -connected with the nature of the service; -for the hospitals were at times so inadequate -in point of size, and so ill provided -with necessary articles and accommodations, -particularly during the first part of my attendance, -that my principal care was to remedy -these defects by proper superintendence -and representation.</p> - -<p>A due attention to air, diet, and cleanliness, -is not only more essential than mere -medical treatment, but the sick cannot be -considered as fit subjects for evincing the -powers of medicine till they are properly -provided for in these respects. These inconveniences -were owing, in a great measure, -to the unusual extent of the service; -<span class="pagenum" id="Page_11">11</span> -for there was a much greater naval force in -those seas, at this period, than was ever -before known, and there was of course a -proportional want of accommodation for -the sick. Towards the end of the war -these difficulties were much obviated, so -that a fairer field of observation presented -itself.</p> - -<p>Another obstacle to my practical inquiries -was, that the fleets I belonged to seldom -remained more than six weeks or two -months at any one place, so that any series -of observations that might have been instituted -was interrupted, and I was in a great -degree deprived of the fruits of them, by -not seeing the event of cases under my -management.</p> - -<p>The peace in the spring of the year 1783 -put an end to all my inquiries, and particularly -prevented me from following out some -<span class="pagenum" id="Page_12">12</span> -practical researches. I have ventured, however, -in one part of this work, to give the -result of my experience in some diseases, -more especially such as are peculiar to the -climate and mode of life.</p> - -<p>Upon the whole, I have, in the following -work, humbly attempted to follow what I -conceive to be the only true method of cultivating -any practical art, that is, to collect -and compare a great number of facts. A -few individual cases are not to be relied on -as a foundation of general reasoning, the -deductions from them being inconclusive -and fallacious, and they are liable to be -turned and glossed, according as the mind -of the observer may he biassed by a favourite -prepossession or hypothesis. It has been -my study to exhibit a rigid transcript of -truth and nature upon a large scale, and to -take the average of numberless particular -facts, to serve as a groundwork for observation; -<span class="pagenum" id="Page_13">13</span> -and I have endeavoured to analyse -and collate these facts, by throwing the -monthly returns that were made to me into -the form of Tables, as the most certain -and compendious way for finding their general -result. If the materials are not sufficiently -ample, or if the method should be -found faulty and imperfect, let it be remembered, -that I had no example to go by in -this field of observation. It is to be regretted, -that ages have passed without any -attempts being made to transmit regular records -of this kind to posterity. It would -not only be extremely curious, as a piece -of natural knowledge, but would conduce -greatly to medical improvement and public -utility, were we possessed of such information -concerning the causes and nature of -the diseases prevailing at sea, in various circumstances -of weather, climate, and diet, -in remote ages and countries, or even in -our own age and country, as might enable -<span class="pagenum" id="Page_14">14</span> -us to compare them with present facts, and -to ascertain more precisely the means of -preventing and removing such diseases.</p> - -<p>The favourable reception which the first -edition of this work has met with, renders -it necessary to offer another to the Public; -and though no new opportunities have occurred -of making additional observations in -the naval service I have endeavoured, during -the last two years, from a pretty extensive -experience in a large hospital, and from -private practice, to add some new information -on some practical points; and I hope -this edition will be found throughout more -full and correct than the former.</p> - -<p>The method I propose to follow in this -work, is, First, to deliver the history of -the different voyages and expeditions, so far -as relates to health, giving an account of -the prevalence and nature of the diseases -<span class="pagenum" id="Page_15">15</span> -and mortality on board of ships and in hospitals.</p> - -<p>Secondly, To deduce, from observations -founded on these facts, and also from the -former experience of others, the causes of -sickness in fleets, and the means of prevention.</p> - -<p>Thirdly, To deliver some practical observations -on the cure of the most common -diseases incident to fleets, particularly in hot -climates. -<span class="pagenum" id="Page_16">16</span> -<span class="pagenum" id="Page_17">17</span></p> - -<p class="ph1">OBSERVATIONS.<br /> - -<span id="PART_I">PART I.</span></p> - -<h2 id ="PART_I_BOOK_I">BOOK I.</h2> - -<blockquote> - -<p>Comprehending the <span class="smcap">Medical History</span> -of the <span class="smcap">Fleet</span>, from March, 1780, till -August, 1781.</p></blockquote> - -<h2 id="BOOK_I_CHAP_I">CHAP. I.</h2> - -<blockquote> - -<p>Containing an Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> -from March, 1780, till July following.——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.</p></blockquote> - -<p>During the war, which broke out -with France in 1778, and with Spain in -1779, the West Indies was the principal -seat of naval operations, and much greater -<span class="pagenum" id="Page_18">18</span> -fleets were then employed in that quarter of -the world than in any former period.</p> - -<p>Though there had been a great squadron -on the Caribbee station during the greater -part of 1779, no physician was appointed -to it till the beginning of the next year, -when I arrived there in that character with -my friend and protector, Lord Rodney.</p> - -<p>There were then sixteen ships of the line -on that station, most of which had been -upwards of twelve months in the climate; -and they were reinforced at this time by five -more from England.</p> - -<p>The squadron which we found on the -station was then extremely healthy, and in -several of the ships there was not a man -unfit for duty. We were told, however, -that they had all been subject to sickness, -particularly to the dysentery, soon after -their arrival in that climate. Of the five -with which the fleet was at this time reinforced, -all but the Intrepid left England -at Christmas, making part of the squadron -<span class="pagenum" id="Page_19">19</span> -which effected the first relief of Gibraltar, -under the command of Lord Rodney, who -continued his route to the West Indies, in -order to take the command on the Windward -station, where he arrived on the 16th -of March. The Intrepid had arrived with -a convoy the day before. These five ships -were all pretty healthy on their passage, except -the Sandwich and Terrible, in which -a fever prevailed; but they had almost recovered -from it before they arrived in the -West Indies. A dysentery broke out in -April in all the ships newly arrived, and it -prevailed to the greatest degree in those -which had been most affected with fevers -in Europe, namely, in the Terrible and -Intrepid. The Sandwich and Ajax were -also affected, though in a less degree; but -the Montagu, though this was her first -voyage, and though she was just off the -stocks, had been the most healthy of any -of them from the time of leaving England, -and continued so during all this campaign. -I have not observed that new ships are more -unhealthy than others, unless they are built -of ill-seasoned timber; and they have this -<span class="pagenum" id="Page_20">20</span> -advantage, that there is no previous infection -adhering to them. What may have -contributed also to the superior health of -the Montagu, was the precaution that was -taken when this ship was first manned and -fitted out, of stripping and washing the -men that were brought from the guardship -to complete the crew.</p> - -<p>The Intrepid, while in England, had been -afflicted with fevers to a most uncommon -degree; for, being one of the fleet in the -Channel cruise the year before, almost the -whole crew either died at sea, or were sent -to the hospital upon arriving at Portsmouth. -This ship, after refitting, was pretty healthy -for a little time; but, probably from -the operation of the old adhering infection, -she became extremely sickly immediately -after joining our fleet, and sent two hundred -men to the hospital the first two months -after arriving in the West Indies. Most of -these were ill of the dysentery.</p> - -<p>The Pegasus frigate arrived with the ships -from Gibraltar, and we have here an instance -<span class="pagenum" id="Page_21">21</span> -of the superior health commonly enjoyed -by this class of ships over ships of -the line; for when she was dispatched to -England in the end of April, there had not -been a man taken ill from the time of her -arrival on the station.</p> - -<p>This season was a very active one in the -operations of war; for, besides the general -battle of the 17th of April, there were two -partial actions in May; and, from the 15th -of the former month till the 20th of the -latter, our fleet was constantly in the face of -the enemy’s, except for a few days that it -was refitting at St. Lucia after the first battle. -This was extremely harrassing to the -men, not only from the incessant labour necessary -in the evolutions of the fleet, but by -their being constantly at quarters with the -ships clear for action; for, in that situation, -they had nothing to sleep upon but the bare -decks, the hammocks and bedding being -removed from between decks, where they -might embarrass the men in fighting, and -they become useful on the quarter deck, by -serving to barricade the ship, which is done -<span class="pagenum" id="Page_22">22</span> -by placing them in ranges on the gunwale, -to cover the men from the enemy’s grape -and small shot. These hardships were productive -of some sickness, though much less -than might have been expected; for the -weather is at all times warm, and it was at -this time extremely moderate and dry. Besides -we shall see in other instances as well -as this, that, in the ardour inspired by the -presence of an enemy, men are less exhausted -by their exertions than on ordinary -and less interesting occasions.</p> - -<p>Almost the whole of the sick and wounded, -to the number of 750, were put on -shore at Barbadoes, where all the fleet, except -three ships<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">1</a>, arrived on the 22d of -May.</p> - -<p>I now began to keep regular and methodical -accounts of the sickness and mortality -in the fleet, though in a manner more imperfect -and less accurate than was afterwards -<span class="pagenum" id="Page_23">23</span> -adopted. I was embarked on board of the -Sandwich, where the Commander in Chief -had his flag, so that I was always present -with the main body of the fleet, whether at -sea or in port.</p> - -<p>A form of monthly returns<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">2</a> was adopted, -which, as well as other points of method, -was afterwards improved. -<span class="pagenum" id="Page_24">24</span></p> - -<p>After collecting the returns for each month, -I made abstracts of them in tables; in one -column of which the complement of each -ship is set down, in order to form calculations -of the comparative prevalence and mortality -of different diseases at different times. One -of the abstracts is here inserted, (<a href="#TABLE_I">Table I</a>.) -by way of specimen, and the proportional -result of them for fourteen months is set -down in another table, (<a href="#TABLE_II">Table II</a>.) -<span class="pagenum" id="Page_25">25</span></p> - -<p>Though this last exhibits a tolerably just -view, yet it may be remarked, as one imperfection, -that there was no distinction made -at this time in my returns between the -killed and those who died of disease; so that -in the month of May, which stands first, -the proportion is too high; for there were -sixty-four killed, and two hundred wounded, -in the two actions of that month. -<span class="pagenum" id="Page_26">26</span></p> - -<div class="table"> -<h3 id="TABLE_I">TABLE I.<br /> -<span class="medium">ABSTRACT of RETURNS,<br /> -1st June, 1781.</span></h3> - -<p>Transcriber’s keys:<br /> -<br /> -A Complement.<br /> -B Sick and Wounded on Board.<br /> -C Sent to the Hospital in the course of last Month.<br /> -D Dead on Board in the course of last Month.</p> - -<table class="bbox"> - <tr> - <th>SHIPS’ NAMES.</th> - <th>A</th> - <th>B</th> - <th>C</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">732</td> - <td class="tdr">28</td> - <td class="tdr">36</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Barfleur</td> - <td class="tdr">767</td> - <td class="tdr">133</td> - <td class="tdr">22</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Gibraltar</td> - <td class="tdr">650</td> - <td class="tdr">67</td> - <td class="tdr">88</td> - <td class="tdr">10</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">650</td> - <td class="tdr">7</td> - <td class="tdr">9</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">650</td> - <td class="tdr">45</td> - <td class="tdr">26</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">600</td> - <td class="tdr">31</td> - <td class="tdr">57</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">600</td> - <td class="tdr">62</td> - <td class="tdr">14</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">600</td> - <td class="tdr">85</td> - <td class="tdr">24</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">600 </td> - <td class="tdr">57</td> - <td class="tdr">38</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">600</td> - <td class="tdr">44</td> - <td class="tdr">134</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">600</td> - <td class="tdr">42</td> - <td class="tdr">35</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">600</td> - <td class="tdr">30</td> - <td class="tdr">23</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Invincible</td> - <td class="tdr">600</td> - <td class="tdr">50</td> - <td class="tdr">63</td> - <td class="tdr">9</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">600</td> - <td class="tdr">107</td> - <td class="tdr">54</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">550</td> - <td class="tdr">20</td> - <td class="tdr">10</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Princessa</td> - <td class="tdr">560</td> - <td class="tdr">88</td> - <td class="tdr">40</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Belliqueux</td> - <td class="tdr">500</td> - <td class="tdr">19</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Prince William</td> - <td class="tdr">500</td> - <td class="tdr">25</td> - <td class="tdr">14</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Panther</td> - <td class="tdr">420</td> - <td class="tdr">16</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">200</td> - <td class="tdr">5</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">200</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">200</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">11979</td> - <td class="tdr">977</td> - <td class="tdr">696</td> - <td class="tdr">64</td> - </tr> -</table> -</div> - -<p><span class="pagenum" id="Page_27">27</span></p> - -<p>The main body of the fleet lay at Barbadoes -till the 6th of June, and the men had -recruited extremely by their stay there; for -vegetables, fruit, and other refreshments, -can be procured at an easier rate, and in -much greater plenty, at this island, than -any other on the station.</p> - -<p>The fleet arrived at St. Lucia the next day -after it sailed from Barbadoes, and remained -there till the 18th of June. The whole -of this month was showery at this island, -though it is not accounted the common -rainy season; for more rain falls here than -at any of the other islands at that time in -our possession, being the most mountainous, -as well as the most woody and uncultivated, -of them all. These rains produced some -increase of sickness, but very little, when -compared to what took place at the same -time in the army on shore, and in the ships -refitting at the Carenage. There died about -this time from fifty to fifty-five men every -week in an army of not quite two thousand -men. -<span class="pagenum" id="Page_28">28</span></p> - -<p>The difference in point of health between -the Carenage (which, as the word implies, -is the place where ships go to be hove down, -or otherwise repaired) and Gros-Islet Bay, -where the main body of the fleet lay, affords -a striking proof of the effects of situation. -The Carenage is a land-locked creek, with a -marsh adjacent to it, whereas the other is a -road open to the fine air of the sea, the only -land sheltering it to windward being a small, -dry island, consisting of one hill, of half a -league in circumference, and some of the -cliffs of the main island of St. Lucia.</p> - -<p>The increase of sickness here was farther -prevented by the men having little labour -to perform on shore, nor any haunts to encourage -intemperance, a vice which the -Admiral endeavoured still more effectually -to prevent, by ordering all the rum stills in -the neighbourhood to be destroyed.</p> - -<p>It may be proper here to introduce a general -account of the seasons and temperature -of the West Indies, as there will be -frequent occasion hereafter to make allusions -<span class="pagenum" id="Page_29">29</span> -to them. With regard to the heat, though -the range of the temperature is very small, -in comparison of what it is in Europe, the -variations follow the same seasons; for July -and August are the hottest months, and December -and January the coolest. This we -would naturally expect, as our plantations -lie all in the northern hemisphere, between -the 10th and 20th degree of N. latitude, -and therefore bear the same relation as Europe -does to the sun’s annual course. The -hurricanes happen in the same season in -which the periodical rains chiefly fall, that -is, in the months of August, September, -and October, which are called the hurricane -months, and this is also the most unhealthy -season. The time of the year which is most -apt to be rainy, next to this, is from the -middle of May to the middle or end of -June, but this is not invariable. The lowest -I ever observed the thermometer was at 69°; -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 -<span class="pagenum" id="Page_30">30</span> -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.</p> - -<p>The comparative mortality in June is -small, owing to the fleet’s having been cleared -of all the bad cases at Barbadoes before it -sailed from thence. Though the proportion -of sick in July is less, that of the mortality -is greater, (see <a href="#TABLE_II">Table II</a>.) which seems to be -owing to this circumstance, that the cases -taken ill during the rainy weather of June -did not terminate fatally till the succeeding -month.</p> - -<p>In the course of this summer the fleet -was reinforced by several ships of the line -<span class="pagenum" id="Page_31">31</span> -from England. The Triumph arrived in -May, without any sick on board; but a flux -prevailed a few weeks afterwards, without -any evident cause, except the influence of -the climate, and the exposure and fatigues -during the operations of May. The disease, -however, soon subsided, and the ship -being kept in excellent order and discipline, -continued healthy during all the remaining -time in which she served with us.</p> - -<p>In June, the Russel, of 74 guns, arrived -from North America, and the Shrewsbury, -a ship of the same rate, from England. -The former left England in 1778, but was -obliged to put back by stress of weather and -sickness, and upon arriving afterwards on the -coast of America, was extremely afflicted -both with fevers and the scurvy. These -were removed to the hospital, and this ship -had become free of all sickness before sailing -for the West Indies, except that a few of the -men were seized with fevers, and she remained -healthy after arriving there, not suffering -from any regular attack of sickness, -such as affected the ships in general from -<span class="pagenum" id="Page_32">32</span> -Europe. The Shrewsbury left England -healthy, but was soon attacked with a fever -and flux, which continued to prevail till the -end of the year.</p> - -<p>The fever in these two ships resembled -rather the low ship fever of Europe than -the bilious one peculiar to the climate. -This last, indeed, seldom or never prevails -to a great degree on board of a ship, unless -it has been caught on the watering duty, or -from some other exposure to the air of the -land. I have, however, known a few instances -of bilious fevers in men who never -had been on shore from the time they left -England; I have even known men of the -same description attacked with intermittent -fevers, which are supposed to depend still -more on land air. This is perhaps owing -either to the quantity of water in a great -ship, part of which is always more or less -putrid, or to the fresh-cut wood of the country -taken on board for fuel, the steam of all -which must resemble a good deal the effluvia -of woods and marshes, which are supposed -to give rise to intermittents. -<span class="pagenum" id="Page_33">33</span></p> - -<p>In the beginning of July our fleet was -reinforced with the Culloden, Egmont, and -Centaur, all of 74 guns. In the end of the -same month we were joined by the Alcide -and Torbay, of the same rate, and also directly -from England. The fleet was at this -time at St. Christopher’s, having arrived -there on the 22d of the month, with a large -convoy from England, which had joined it -at St. Lucia, under protection of the Thunderer -and Berwick, two ships of the line, -which being bound to Jamaica, I do not -reckon as belonging to our fleet. -<span class="pagenum" id="Page_34">34</span></p> - -<div class="table"> -<h3 id="TABLE_II">TABLE II.</h3> - -<blockquote> - -<p>Shewing the proportional Sickness and Mortality, in -relation to the whole Numbers on board, for fourteen -Months.</p></blockquote> - -<p class="table"> -<span class="trow">Transcriber’s keys:</span> -<span class="trow">A Proportion of Sick and Wounded on board on the First of the Month.</span> -<span class="trow">B Proportion of Sick and Wounded sent to the Hospital in the Course of the Month.</span> -<span class="trow">C Proportion of Deaths on board in the Course of the Month.</span></p> - -<table class="bbox"> - <tr> - <th rowspan="2">Months.</th> - <th>A</th> - <th>B</th> - <th>C</th> - </tr> - <tr> - <th>ONE IN</th> - <th>ONE IN</th> - <th>ONE IN</th> - </tr> - <tr> - <td>May, 1780</td> - <td class="tdr">18½</td> - <td class="tdr">20½</td> - <td class="tdr">87</td> - </tr> - <tr> - <td>June</td> - <td class="tdr">13</td> - <td class="tdr">68½</td> - <td class="tdr">418</td> - </tr> - <tr> - <td>July</td> - <td class="tdr">17½</td> - <td class="tdr">80</td> - <td class="tdr">163</td> - </tr> - <tr> - <td>August</td> - <td class="tdr">18</td> - <td class="tdr">227</td> - <td class="tdr">80</td> - </tr> - <tr> - <td>September</td> - <td class="tdr">9</td> - <td class="tdr">6</td> - <td class="tdr">188</td> - </tr> - <tr> - <td>October</td> - <td class="tdr">14</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>November</td> - <td class="tdr">33½</td> - <td class="tdr">192</td> - <td class="tdr">265</td> - </tr> - <tr> - <td>December</td> - <td class="tdr">16</td> - <td class="tdr">67</td> - <td class="tdr">185</td> - </tr> - <tr> - <td>January, 1781</td> - <td class="tdr">14</td> - <td class="tdr">60½</td> - <td class="tdr">316</td> - </tr> - <tr> - <td>February</td> - <td class="tdr">18</td> - <td class="tdr">413</td> - <td class="tdr">214</td> - </tr> - <tr> - <td>March</td> - <td class="tdr">15½</td> - <td class="tdr">30</td> - <td class="tdr">201</td> - </tr> - <tr> - <td>April</td> - <td class="tdr">11</td> - <td class="tdr">59</td> - <td class="tdr">169</td> - </tr> - <tr> - <td>May</td> - <td class="tdr">9½</td> - <td class="tdr">17</td> - <td class="tdr">188</td> - </tr> - <tr> - <td>June</td> - <td class="tdr">12</td> - <td class="tdr">40</td> - <td class="tdr">701</td> - </tr> - <tr> - <td>Mean Proportion</td> - <td class="tdr">15½</td> - <td class="tdr">93</td> - <td class="tdr">227</td> - </tr> -</table> -</div> -<p><span class="pagenum" id="Page_35">35</span></p> - -<h2 id="BOOK_I_CHAP_II">CHAP. II.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from August, -1780, till December following.——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.</p></blockquote> - -<p>The hurricane months approaching, the -season for active operations in the West -Indies was now over. The whole force of -the enemy, consisting of thirty-fix French -and Spanish ships of the line, having gone -to St. Domingo in the end of July, ten sail -of the line were detached after them from -our station, for the protection of Jamaica. -The Admiral sailed for North America in -August, with eleven ships of the line, leaving -six for the protection of the islands.</p> - -<p>There was little alteration in the general -state of the sick during the voyage to America, -<span class="pagenum" id="Page_36">36</span> -and indeed we found no diminution of -the West-India heat, which at this season -is at the greatest height, until we came to -the 33° of N. latitude.</p> - -<p>The only material alteration in point of -health was in the Alcide and Torbay, which -had arrived from England with a few men -ill of fevers; but in the course of this -voyage these two ships became as unhealthy -as any that ever came under my observation. -There was a greater number of sick on board -of them than all the fleet besides, and it -increased to such a degree, that upon their -arrival at New York, which was in the -middle of September, after a passage of three -weeks, near one half of their men were unfit -for duty. In the Alcide it was a fever that -raged; in the Torbay it was a dysentery; -and the unusual degree of sickness and mortality -which appears in the Table for the -month of September, was owing to the -very sickly state of these two ships.</p> - -<div class="table"> -<h3 id="TABLE_III">TABLE III.</h3> - -<p>Shewing the Number of <span class="smcap">Fevers</span> and <span class="smcap">Fluxes</span> on board on the First of each Month, and the Number sent to the Hospital in the Course of the Month.</p> - -<p>Key: -B On board. -H Sent to the Hospital.</p> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th> - <th colspan="4">MAY, 1780.</th> - <th colspan="4">JUNE.</th> - <th colspan="4">JULY.</th> - </tr> - <tr> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - </tr> - <tr> - <td>Sandwich, 16th March</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">16</td> - <td class="tdr">19</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">5</td> - <td class="tdr">16</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Terrible, 16th March</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">40</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">86</td> - <td class="tdr">75</td> - <td class="tdr">3</td> - <td class="tdr">25</td> - <td class="tdr">60</td> - <td class="tdr">24</td> - </tr> - <tr> - <td>Triumph, 7th May</td> - <td /> - <td class="tdr">0</td> - <td class="tdr"></td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">32</td> - <td class="tdr">17</td> - </tr> - <tr> - <td>Russell, 18th June</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td class="tdr">22</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Shrewsbury, 26th June</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide, 30th July</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Torbay, 30th July</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Monarch, 22d Nov.</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Alfred, 22d November</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th> - <th colspan="4">AUGUST.</th> - <th colspan="4">SEPTEMBER.</th> - <th colspan="4">OCTOBER.</th> - </tr> - <tr> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - </tr> - <tr> - <td>Sandwich, 16th March</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">16</td> - <td class="tdr">4</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">5</td> - <td class="tdr">9</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible, 16th March</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">30</td> - <td class="tdr">13</td> - <td class="tdr">19</td> - <td class="tdr">12</td> - <td class="tdr">41</td> - <td class="tdr">9</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triumph, 7th May</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td colspan="4" class="tdc">continued healthy.</td> - </tr> - <tr> - <td>Russell, 18th June</td> - <td class="tdr">10</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td colspan="4" class="tdc">continued healthy.</td> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Shrewsbury, 26th June</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td colspan="4" class="tdc">No return, the Ship being absent.</td> - </tr> - <tr> - <td>Alcide, 30th July</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">54</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">22</td> - <td class="tdr">20</td> - <td class="tdr">2</td> - <td class="tdr">59</td> - <td class="tdr">37</td> - </tr> - <tr> - <td>Torbay, 30th July</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">169</td> - <td class="tdr">143</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch, 22d Nov.</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Alfred, 22d November</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES,<br />AND<br />Date of their Arrival.</th> - <th colspan="4">NOVEMBER.</th> - <th colspan="4">DECEMBER.</th> - <th colspan="4">JANUARY, 1781.</th> - </tr> - <tr> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - <th colspan="2">Fever.</th> - <th colspan="2">Flux.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - <th>B</th> - <th>H</th> - </tr> - <tr> - <td>Sandwich, 16th March</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible, 16th March</td> - <td colspan="4" class="tdc">continued quite healthy.</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Triumph, 7th May</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Russell, 18th June</td> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Shrewsbury, 26th June</td> - <td colspan="4" class="tdc">No return, the Ship being absent.</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide, 30th July</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">23</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">5</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Torbay, 30th July</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">22</td> - <td class="tdr">30</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Monarch, 22d Nov.</td> - <td /> - <td /> - <td /> - <td /> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">12</td> - <td class="tdr">15</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Alfred, 22d November</td> - <td /> - <td /> - <td /> - <td /> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">15</td> - <td class="tdr">16</td> - <td class="tdr">11</td> - <td class="tdr">8</td> - </tr> -</table> -</div> - -<p>We shall hereafter see reason for supposing -that fever and dysentery proceed from the -<span class="pagenum" id="Page_37">37</span> -same cause; and as both these ships arrived -from England in a similar state with regard -to health, fevers would probably have been -the prevailing disease in both; but a part of -the 87th regiment, then serving as marines -in the fleet, was put on board of the Torbay -at St. Christopher’s, and some of them being -ill of the dysentery, gave this turn to -the disease which afterwards prevailed on -board. I have formed a Table to shew the -fluctuating state of these two diseases, and this -was one of my first and most imperfect attempts -towards a medical history of the -fleet in a methodical way. (<a href="#TABLE_III">Table III</a>.)</p> - -<p>There was but little sickness in the rest -of this squadron, except in the Terrible, -where the dysentery prevailed a good deal. -None of the ships of the line which we -found in the West Indies, upon our arrival -there, were now in company, except the -Yarmouth, and this was the most healthy -of all the ships that went to North America.</p> - -<p>The health of the fleet was very much recruited -by its short stay in America; for the -<span class="pagenum" id="Page_38">38</span> -men were supplied with fresh meat and -spruce beer, and they enjoyed the two finest -months of the year in that temperate climate. -The squadron left New York in the -middle of November, and though dispersed -by a violent storm, all the ships arrived safe -in the West Indies before the middle of -December.</p> - -<p>In October the fleet had attained such a -degree of health, that though the calculation -in the Table is made from five of the -most sickly ships, no death happened in this -month on board of any of them. In November -the mortality was also inconsiderable, -though the ships left in the West Indies are -included in the calculation; which, had it -been made upon those only that went to -North America, the deaths would have been -no more than one in seven hundred and -eleven in this month, which is rather less -than that of any other month in the Table.</p> - -<p>The amendment in health, in consequence -of the change of climate, was most remarkable -in the Terrible, which, by the -<span class="pagenum" id="Page_39">39</span> -time she left America, had entirely got rid -of the violent dysentery that had prevailed -for some time on board. This sudden change -in the health of this ship was evidently -owing to the great attention of the Captain -to cleanliness and discipline, and no less to -the assiduity and abilities of the Surgeon. -The Alcide still continued sickly, though -not so much so as the Torbay. The former -had sailed on a cruise in October, and having -met with very rough weather, the sick list -was thereby increased. The dysentery now -prevailed in that ship, as well as fevers, and -those men chiefly were attacked with fevers -who were ill of the scurvy, or recovering -from it. This was not very common; and -there were several other remarkable particulars -with regard to the fevers in this ship; -for her men were not only uncommonly -subject to this disease, both in America and -the West Indies, but to all the various forms -of it; the low, infectious, ship fever of Europe, -the bilious remitting, and the malignant -yellow fever of hot climates. It would -appear from this, as well as other instances, -that a ship may assume, as it were, a particular -<span class="pagenum" id="Page_40">40</span> -constitution, or a tendency to some -particular disease, for a length of time, and -this depending on some lurking and adhering -infection, or the manner in which she -may have been victualled, watered, disciplined, -or manned.</p> - -<p>The great benefit derived to the health of -the fleet, from the change of climate, as -well as other reasons, justified the Admiral -in going to North America; and there was -the more merit in this measure, as it was -undertaken without precedent, and without -instruction. Upon our return we found -there was great good fortune in it, as well -as wisdom; for there had happened on the -10th of October a more violent hurricane -than any in the memory of man, and the -ravage it made both by sea and land is, perhaps, -unparallelled in history. Several of -the ships of the line were exposed to it; but -though they suffered extremely, and were -in the utmost danger, none were lost. Two -of them happened to be at Antigua, which -was out of the track of this hurricane, as -it extended only from the 12th to the 15th -<span class="pagenum" id="Page_41">41</span> -degree of N. latitude; so that the only -islands that suffered by it were Barbadoes, -St. Lucia, St. Vincent, and Martinico.—Four -frigates, and as many sloops of war, -either foundered or were wrecked, and about -one thousand seamen perished in them. One -of the buildings of the hospital at Barbadoes -was entirely demolished by the impetuosity -of the sea, which, having risen to a great -height, dashed a ship against it, and twenty-three -seamen were buried in the ruins<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">3</a>. -<span class="pagenum" id="Page_42">42</span></p> - -<p>The Montague suffered most on this occasion, -and was also most subject to sickness -and mortality, brought on in consequence -of the great fatigue and hardships of the -men in bringing her into port and refitting -her; for the ship was almost torn to pieces -both in the rigging and hull, and the bedding -and other necessaries and conveniencies -were entirely destroyed. The fever that -prevailed on board at this time was of the -most malignant kind known in this climate; -<span class="pagenum" id="Page_43">43</span> -and the worst cases arose in watering, and -the other necessary duties on shore, from -which the men would sometimes return -frantic, and die in a few hours. There was -a party of soldiers on board; and as they -were not called upon to perform any duties -<span class="pagenum" id="Page_44">44</span> -on shore, they had but little sickness in companion -of the sailors.</p> - -<p>The other ships having suffered less from -the storm, were also less sickly, as it was -not necessary for them to remain so long in -the unhealthy Carenage to repair.</p> - -<p>The only disease that prevailed at this -time, in these two ships, was fevers, there -being few or no fluxes, though they had -been so frequent in the former part of the -year. Though fevers and fluxes depend on -the same general causes, yet when these -causes exist in a higher degree, it would appear -that they are more apt to produce -fevers. Thus the exhalations of the earth -from marshes are more apt to produce fevers; -and mere excesses of heat and cold, -or moisture, are more apt to produce fluxes; -just as in Europe a catarrh, which may be -considered as a local febrile affection, as well -as a dysentery, will be excited by exposure -to cold or damp, without any specific bad -quality in the air. -<span class="pagenum" id="Page_45">45</span></p> - -<p>The Ajax and Montague are the only two -ships of those left in the West Indies, which -are included in the estimate of sickness and -mortality in November and December, and -they bear a very great proportion to the -whole; for out of forty-four that died in -fourteen ships of the line in November, -twenty died in the Montague, and five in the -Ajax; and out of forty-three, the whole -number of deaths in December in twenty-one -ships of the line, ten were of the -Montague, and eleven of the Ajax. -<span class="pagenum" id="Page_46">46</span></p> - -<h2 id="BOOK_I_CHAP_III">CHAP. III.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from January, -1781, till July, 1781, both Months included.——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.</p></blockquote> - -<p>We are now come to that period in which -our fleet was reinforced with seven ships of -the line, which arrived at Barbadoes from -England on the 5th of January, 1781, -under the command of Lord Hood. This -addition, with two which had arrived in -November, made the force upon this station -again amount to twenty-one ships of the -line.</p> - -<h3 id="TABLE_IV">TABLE IV.<br /> - -<span class="medium">Shewing the Number of each Disease on board on the First of each Month, the Numbers sent to the Hospital, and Dead, in the Course of the Month.</span></h3> - -<div class="table"> -<p> -KEY:<br /> -B On board.<br /> -H Sent to the Hospital.<br /> -D Dead.</p> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th> - <th colspan="9">FEBRUARY, 1781.</th> - </tr> - <tr> - <th colspan="3">Fever.</th> - <th colspan="3">Flux.</th> - <th colspan="3">Scurvy.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>D</th> - <th>B</th> - <th>H</th> - <th>D</th> - <th> B</th> - <th>H</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Barfleur</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Gibraltar</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">21</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">40</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Invincible</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">6</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Princessa</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Intrepid</td> - <td class="tdr">18</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">10</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Belliqueux</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prince William</td> - <td class="tdr">21</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Panther</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">15</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">4</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">197</td> - <td class="tdr">2</td> - <td class="tdr">19</td> - <td class="tdr">158</td> - <td class="tdr">7</td> - <td class="tdr">21</td> - <td class="tdr">93</td> - <td class="tdr">19</td> - <td class="tdr">10</td> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th> - <th colspan="9">MARCH.</th> - </tr> - <tr> - <th colspan="3">Fever.</th> - <th colspan="3">Flux.</th> - <th colspan="3">Scurvy.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>D</th> - <th>B</th> - <th>H</th> - <th>D</th> - <th> B</th> - <th>H</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">8</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Barfleur</td> - <td class="tdr">28</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">35</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">27</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>* Gibraltar</td> - <td class="tdr">8</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">22</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">24</td> - <td class="tdr">18</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">50</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">5</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">3</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">56</td> - <td class="tdr">16</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">61</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">15</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Invincible</td> - <td class="tdr">6</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - </tr> - <tr> - <td>* Princessa</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">102</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Intrepid</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Belliqueux</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">52</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prince William</td> - <td class="tdr">23</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">47</td> - <td class="tdr">62</td> - <td class="tdr">5</td> - <td class="tdr">6</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Panther</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">3</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">174</td> - <td class="tdr">24</td> - <td class="tdr">16</td> - <td class="tdr">238</td> - <td class="tdr">67</td> - <td class="tdr">18</td> - <td class="tdr">202</td> - <td class="tdr">265</td> - <td class="tdr">27</td> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th> - <th colspan="9">APRIL.</th> - </tr> - <tr> - <th colspan="3">Fever.</th> - <th colspan="3">Flux.</th> - <th colspan="3">Scurvy.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>D</th> - <th>B</th> - <th>H</th> - <th>D</th> - <th> B</th> - <th>H</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">9</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Barfleur</td> - <td class="tdr">24</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">33</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Gibraltar</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">18</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">55</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">23</td> - <td class="tdr">27</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">26</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">116</td> - <td class="tdr">44</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">44</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">16</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Invincible</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">4</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">15</td> - <td class="tdr">4</td> - <td class="tdr">2</td> - <td class="tdr">30</td> - <td class="tdr">5</td> - <td class="tdr">10</td> - </tr> - <tr> - <td>* Princessa</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">40</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Intrepid</td> - <td class="tdr">9</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">13</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">1</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>* Belliqueux</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prince William</td> - <td class="tdr">19</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">147</td> - <td class="tdr">40</td> - <td class="tdr">0</td> - <td class="tdr">16</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Panther</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">115</td> - <td class="tdr">5</td> - <td class="tdr">9</td> - <td class="tdr">317</td> - <td class="tdr">49</td> - <td class="tdr">9</td> - <td class="tdr">428</td> - <td class="tdr">115</td> - <td class="tdr">26</td> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th> - <th colspan="9">MAY.</th> - </tr> - <tr> - <th colspan="3">Fever.</th> - <th colspan="3">Flux.</th> - <th colspan="3">Scurvy.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>D</th> - <th>B</th> - <th>H</th> - <th>D</th> - <th> B</th> - <th>H</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">2</td> - <td class="tdr">2</td> - <td class="tdr">1</td> - <td class="tdr">10</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">18</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Barfleur</td> - <td class="tdr">12</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">16</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">54</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Gibraltar</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">30</td> - <td class="tdr">22</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">8</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">15</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">44</td> - <td class="tdr">31</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">2</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">57</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">10</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">15</td> - <td class="tdr">10</td> - <td class="tdr">1</td> - <td class="tdr">11</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">130</td> - <td class="tdr">25</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">132</td> - <td class="tdr">102</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">40</td> - <td class="tdr">35</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Invincible</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">6</td> - <td class="tdr">8</td> - <td class="tdr">4</td> - <td class="tdr">31</td> - <td class="tdr">54</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">15</td> - <td class="tdr">45</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">22</td> - <td class="tdr">6</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">4</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Princessa</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">30</td> - <td class="tdr">40</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Intrepid</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>* Belliqueux</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prince William</td> - <td class="tdr">5</td> - <td class="tdr">5</td> - <td class="tdr">2</td> - <td class="tdr">53</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Panther</td> - <td class="tdr">3</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">76</td> - <td class="tdr">30</td> - <td class="tdr">12</td> - <td class="tdr">166</td> - <td class="tdr">39</td> - <td class="tdr">7</td> - <td class="tdr">641</td> - <td class="tdr">436</td> - <td class="tdr">22</td> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="3">SHIPS’ NAMES.<br />N. B. Those marked<br />*, arrived with<br />Lord Hood.</th> - <th colspan="9">JUNE.</th> - </tr> - <tr> - <th colspan="3">Fever.</th> - <th colspan="3">Flux.</th> - <th colspan="3">Scurvy.</th> - </tr> - <tr> - <th>B</th> - <th>H</th> - <th>D</th> - <th>B</th> - <th>H</th> - <th>D</th> - <th> B</th> - <th>H</th> - <th>D</th> - </tr> - <tr> - <td>Sandwich</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Barfleur</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">58</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Gibraltar</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">48</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triumph</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">15</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">16</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">4</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">36</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Terrible</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">14</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">26</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">19</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">14</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">4</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">26</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Invincible</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">22</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">84</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Shrewsbury</td> - <td class="tdr">3</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">4</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">20</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Princessa</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">40</td> - <td class="tdr">0</td> - <td class="tdr">70</td> - <td class="tdr">154</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Intrepid</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td>* Belliqueux</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prince William</td> - <td class="tdr">4</td> - <td class="tdr">4</td> - <td class="tdr">2</td> - <td class="tdr">13</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - <td class="tdr">8</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Panther</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Triton</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Hyena</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Cyclops</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - <td class="tdr">§</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">101</td> - <td class="tdr">12</td> - <td class="tdr">6</td> - <td class="tdr">149</td> - <td class="tdr">57</td> - <td class="tdr">5</td> - <td class="tdr">480</td> - <td class="tdr">198</td> - <td class="tdr">4</td> - </tr> -</table> - -<p>N. B. Where the Spaces are marked thus, §, no Return was made. -<span class="pagenum" id="Page_47">47</span></p> -</div> - -<p>The whole fleet was tolerably healthy -during this month, the season being dry and -cool; there was, however, a small increase -of sickness at this time, and it was owing -to a descent made on St. Vincent’s in December. -The soldiers, (of whom there was -still a regiment on board of the fleet) the -marines, and some of the seamen, had been -on shore for one night only; but many of -them having lain on the ground, some having -been intoxicated, or having eaten to -excess of sugar-cane and fruit, caught fevers -and fluxes, which increased the proportion -of diseases and deaths the following months, -as appears by the Table.</p> - -<p>I have exhibited, in another Table, a view -of the sickness and mortality of this fleet for -the five succeeding months. (<a href="#TABLE_IV">Table IV</a>.) -This account, as well as most of those that -are to follow, is confined to three diseases, -that may be called the sea epidemics. These -are, fever, flux, and scurvy.</p> - -<p>The whole fleet met at Barbadoes on the -13th of January, and no service was undertaken -<span class="pagenum" id="Page_48">48</span> -till the accounts of the Dutch war -arrived on the 30th of that month. In consequence -of this intelligence, the greater -part of the ships of war went against St. -Eustatius, which was taken on the 3d of -February.</p> - -<p>Ten days after this a squadron of seventeen -ships of the line was sent to cruise to -windward of Martinico, with a view to intercept -a French squadron which was then -said to be on its passage from Europe. The -cruise was there continued for six weeks; -after which small divisions of the ships were -sent to water and refit, by turns, at St. -Lucia, and were relieved by the ships left -for the protection of that island.</p> - -<p>Soon after this, the whole squadron came -to leeward of Martinico; and though the -former intelligence had proved false, the -greater part of our fleet still kept the sea, in -order to block up the enemy in Fort-Royal -Bay. This they continued to do till the -29th of April, when a French fleet of -twenty-two ships of the line, from Europe, -<span class="pagenum" id="Page_49">49</span> -joined by four from Martinico, forced their -way into their own port, pushing to leeward -our fleet, consisting only of eighteen ships of -the line; so that the greater part of them did -not get into port till they came to an anchor -at Barbadoes on the 23d of May.</p> - -<p>It was in this season of cruising, and -keeping the sea, that the fleet contracted -such a degree of scurvy as had never before -been known in the West Indies. This disease -is not so apt to arise in a hot climate as -in a cold one; and the prevalence of it on -this occasion was owing to the men having -been for a great length of time upon sea -victualling; for one part of the fleet had not -had a fresh meal from the time of leaving -America, that is, for six months; and that -part of it which came last from England had -been in the same circumstances for seven -months; nor had any of them been in a -place capable of supplying vegetable refreshments -from the time they left Barbadoes in -the end of January. But though no fresh -meat or vegetables could be procured at St. -Lucia or St. Eustatius, yet the scurvy did -<span class="pagenum" id="Page_50">50</span> -not make such progress in the ships that lay -at anchor there, as in those that were at sea; -and it appears that the time in which it -prevailed most was, while the greatest number -of ships was at sea, that is, in the month -of March. It appears, indeed, by the Table, -that there was a greater number ill of this -complaint on the 1st of May than on the 1st -of April; but it appears also, that more were -sent to the hospital in March than in April, -and very near half of the May list must -have been taken ill in March<a id="FNanchor_4" href="#Footnote_4" class="fnanchor">4</a>. The difference -of being in port and at sea consists -chiefly, 1st, In there being plenty of water -while in port, so that it can be used freely, -not only to drink, but to wash the clothes; -and we know that cleanliness tends greatly -to ward off the scurvy. 2dly, Though no -fresh meat nor vegetables could be procured -at those ports, sugar, which may be considered -as a very antiscorbutic article of diet, -<span class="pagenum" id="Page_51">51</span> -could always be procured at a very cheap -rate, and the seamen, when in port, used to -exchange their salt provisions for it. 3dly, -There is at sea a dismal uniformity of life, -favourable to indolence and sadness, and -therefore tending to hasten the progress and -aggravate the symptoms of the scurvy; -whereas the change of scene and variety of -objects, when in port, tend to cheer and recreate -the mind, and thereby to avert this -disease.</p> - -<p>The squadron that came from England -under Lord Hood, suffered, upon the whole, -much less from acute diseases, during the -first months of their service in this climate, -than the ships that arrived with Lord Rodney, -which was probably owing, in part at -least, to the former having arrived at the -driest and coolest season of the year. The -Barfleur, however, had a large proportion of -all the three prevailing diseases; and large -ships are in general more subject to them -than those of a smaller rate. But of all the -ships in the fleet, the Alfred had the greatest -proportion of the three sea epidemics. The -<span class="pagenum" id="Page_52">52</span> -Prince William suffered more than any other -ship in the fleet from the flux, and the -Princessa from the scurvy. In some instances, -reasons can be assigned for the prevalence -of particular diseases in particular -ships, such as accidental infection, or the -manner in which they have been victualled, -manned, or disciplined; but in many cases -the cause is so subtile or obscure as to elude -our inquiry.</p> - -<p>The most healthy of the new squadron, -during this campaign, were the Belliqueux -and Panther; the former was a new ship, -and came from England with a very irregular -and ill-disciplined crew. Soon after arriving -in the climate, she was threatened with a -dysentery, which, though it spread a good -deal, did not prove severe nor mortal; but -being left at St. Eustatius on this account, -while the rest of the fleet was cruising, she -soon became very healthy, and remained so. -This is the second instance we have had -occasion to remark of a new ship being -healthy. -<span class="pagenum" id="Page_53">53</span></p> - -<p>The Panther preserved her health by -being on small separate cruises, and frequently -in port, not being attached to the -main squadron. The Sandwich was the -only other ship not engaged in the long -cruise.</p> - -<p>Of the ships lately from England, that -were employed in this cruise, the Gibraltar -seems to have been the least sickly. This -ship left England healthy; but having received -a draft of dirty men when upon the -eve of sailing, a fever of the infectious kind -broke out on the passage, so that she arrived -in the West Indies in a sickly state. This -fever disappeared very soon after; and it is -proved by this, as well as other facts, that -a warm climate, so far from tending to generate, -or even to foster the infection of -fever, tends rather to extinguish it. The -Gibraltar had been put under excellent discipline -by her former commander, while in -the Channel service; and this being afterwards -kept up, the men were always clean -and regular. This was the Spanish Admiral’s -ship, taken by the fleet under the -<span class="pagenum" id="Page_54">54</span> -command of Lord Rodney off Cape St. -Vincent’s, in January 1780. She was then -called the Phœnix, and was of a singular -excellence both with respect to materials -and construction. Whether the cedar, of -which a great part of her timbers consisted, -contributed to the healthiness, by its balsamic -effluvia, I will not pretend to determine.</p> - -<p>The Invincible was also uncommonly -healthy during this cruise, which may likewise -be ascribed to good discipline, and to -her having been more than three years in -commission before sailing from England, -whereby the men were brought into order, -and accustomed to each other and to a sea -life. This ship was almost singular in having -no acute diseases for several months -after arriving from Europe; but at length -paid the tribute to the climate in May and -June, as may be seen in the Table.</p> - -<p>From the account of the three frigates -at the bottom of the list in the Table, it -appears how much more healthy they are -than ships of the line. The total complements -<span class="pagenum" id="Page_55">55</span> -of the three is exactly equal to that -of one seventy-four-gun ship; but their -whole sickness and mortality is less than -that of any one ship of the line of that class, -although the Triton was uncommonly sickly -for a frigate.</p> - -<p>There seem to be several causes for the -superior degree of health usually enjoyed -by this smaller class of ships. There is less -chance of mixtures of men in frigates, as -their complement is smaller, and it is more -easy for the captain and officers to keep an -eye over a few men than a great number; -for, in a great ship, there are generally men, -who, concealing themselves in the most retired -parts, no one takes cognizance of -them, and they destroy themselves, and -infect others, by their laziness and filth. -In the next place, there is a greater proportion -of volunteers and real seamen in frigates, -and more landmen and pressed men -in ships of the line, the former being more -in request, on account of the greater chance -of prize money. Lastly, a small ship is -more easily ventilated, and the mass of foul -<span class="pagenum" id="Page_56">56</span> -air issuing from the hold, from the victuals, -water, and other stores, as well as the effluvia -exhaling from the men’s bodies, is less than -in a large ship.</p> - -<p>Many other and more minute remarks -might be made on different ships in this -season of hard service; but to do this would -be tedious, and the inspection of the Tables -may suggest observations to the reader. -There is a striking and instructive fact, -however, with regard to two ships, which -I cannot help relating. The Alcide and -Invincible, both of seventy-four guns, in -working to windward, after the action with -the French fleet, on the 29th of April, anchored -at Montserrat on the 11th of May, -in order to water. They remained there -only part of two days, and they procured -no refreshment, except a few bushels of -limes. The scurvy then prevailed to a great -degree in both ships; but between this time -and the 23d of May, when they came to an -anchor at Barbadoes, sixty men, who had -been confined with this disease, were discharged, -as fit for duty, from the sick list of -<span class="pagenum" id="Page_57">57</span> -the Invincible, and a hundred and fourteen -from that of the Alcide. These were the -only two ships that had the advantage of the -limes; and during these twelve remaining -days of the voyage the scurvy continued to -increase in all the other ships. Dr. Lind is -the first author who gives a decided preference -to lemons, limes, and oranges, over every -other antiscorbutic; and the above-mentioned -fact proves as demonstrably as possible the infinite -advantage of this species of acid in -scurvy.</p> - -<p>The fleet was supplied with essence of -malt during all this campaign; and though -it was, no doubt, of service, it was far from -having that powerful and manifest effect -that the acid fruits had, and certainly did -by no means prevent the scurvy in all cases. -I have strong testimonies, however, of its -beneficial effects from the surgeons of several -of the ships, particularly of the Gibraltar, -Centaur, Torbay, and Alcide, in all of which -it was found either to cure the scurvy in its -first beginning, to retard its progress, or to -<span class="pagenum" id="Page_58">58</span> -mend the appearance of scorbutic ulcers, and -dispose them to heal.</p> - -<p>I had conceived that melasses, being a -vegetable sweet, must have been a very -powerful antiscorbutic; but the greatest part -of the last reinforcement of seven ships -came from England furnished with this as -an article of victualling, as a substitute for a -certain proportion of oatmeal, which was -withheld agreeably to a late very judicious -order of the Admiralty. But though I am -persuaded that this article of diet mitigated -the disease, it was very far from preventing -it; and the Princessa in particular, which -suffered most from the scurvy, was well -supplied with it.</p> - -<p>There is reason to think that it is not in -the vegetable sweet alone that the antiscorbutic -principle resides, but in this in conjunction -with the natural mucilage, such as -exists in the malt. I suspect likewise that -the change which the essence undergoes in -its preparation tends also to rob it of some -of its original virtue. But the melasses are -<span class="pagenum" id="Page_59">59</span> -still farther altered by being deprived of the -natural mucilage by means of quick lime, -with which all sugar is clarified in the boilers. -Dr. Hendy, of Barbadoes, to whom I have -been obliged for several remarks, informed -me, that the liquor, before it undergoes this -operation, has been found by him to produce -the most salutary effects in the scurvy; but -as this cannot be had at sea, we had no opportunity -of comparing it with other antiscorbutics. -It is certain also that the medical -effects of the native sweet juices are, -in other respects, very different from what -they are in their refined state; for manna, -wort, and the native juice of the sugar cane, -are purgative; whereas sugar itself is not at -all so<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">5</a>. This affords a presumption, that they -may be also different in their antiscorbutic -quality; and there is reason to think, from -<span class="pagenum" id="Page_60">60</span> -experience, that the more natural the state in -which any vegetable is, the greater is its -antiscorbutic quality. Vegetables, in the -form of sallads, are more powerful than -when prepared by fire; and I know, for -certain, that the rob of lemons and oranges -is not to be compared to the fresh fruit. -Raw potatoes have been used with advantage -in the fleet, particularly by Mr. Smith, of -the Triton, who made the scorbutic men eat -them, sliced with vinegar, with great benefit. -This accords also with what Dr. -Mertans, of Vienna, has lately communicated -to the Royal Society of London.</p> - -<p>When the fleet arrived at Barbadoes on -the 23d of May, it was found that the number -of sick on board amounted to sixteen hundred, -and that there was not accommodation for -more than two hundred at the hospital. As -<span class="pagenum" id="Page_61">61</span> -there was hardly any complaint but scurvy, -the Admiral, at my representation, issued an -order for serving the sick on board of their -own ships with fruit and other vegetables -and refreshments, such as milk and soft -bread. This course of diet commenced in -the beginning of June; and as the greater -part of the fleet was near four weeks thereafter -in port, they enjoyed the advantages of -it during that time; and the very great diminution -of sickness and mortality, which -appears by the Tables in that month, sufficiently -evinces the benefit derived from it. -In less than four weeks the fleet, from being -very sickly, became extremely healthy.</p> - -<p>It was remarked, that the men recovered -faster on board than on shore; and it would -appear that land air, merely as such, has no -share in the cure of the scurvy, and that the -benefit arises from the concomitant diet, -cleanliness, and recreation. The expedient -of curing men on board of their ships was -here suggested by necessity; but it succeeded -so well, that it was adopted afterwards in -preference to an hospital, which is indeed a -<span class="pagenum" id="Page_62">62</span> -useful relief to a fleet where there are contagious, -acute disorders; but with regard to -scurvy, I am convinced, that on foreign stations, -at least, where the accommodations of -the sick are more indifferent than in England, -many advantages would arise from supplying -men with refreshments on board of their -ships. It appears that only four men died of -this disease in the whole fleet in the month -of June, though there were so many ill of -it; whereas it appears by the books of hospitals, -that scorbutic men die there in a -much greater proportion, and chiefly in consequence -of other diseases, particularly the -flux, which they catch by infection, or bring -on by intemperance. It is farther in favour -of this scheme, that great numbers of those -sent on shore are lost by desertion. It is also -a great saving to Government, the expence -not being a fourth part of what it would -cost at an hospital.</p> - -<p>The fleet left Barbadoes on the 10th and -12th of July, and continued healthy till the -greater part of it sailed for North America -in the beginning of August. -<span class="pagenum" id="Page_63">63</span></p> - -<h2 class="ph1" id="PART_I_BOOK_II">PART I.<br /> - -<span id="BOOK_II" class="x-large">BOOK II.</span></h2> - -<blockquote> - -<p>Continuation of the <span class="smcap">Medical History</span> of -the <span class="smcap">Fleet</span>, from August, 1781, till the -Conclusion of the War in April, 1783.</p></blockquote> - -<h2 id="BOOK_II_CHAP_I">CHAP. I.</h2> - -<blockquote> - -<p>Some Account of the Interval between the Campaign -of 1781 and the Junction of the Reinforcement from -England in April, 1782.——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.</p></blockquote> - -<p>When the main body of the fleet went -to America in August, Lord Rodney went to -England for the recovery of his health.—Wishing -<span class="pagenum" id="Page_64">64</span> -to lay before the public boards several -reforms that suggested themselves to -me in the course of the late service, I accompanied -the Admiral, purposing to return -when the season for hostile operations should -have brought back the fleet from the coast -of America.</p> - -<p>Soon after arriving in England, I presented -a memorial<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">6</a> to the Board of Admiralty, -proposing such means for the preservation of -the health of the fleet as had occurred to -me during my past service.</p> - -<p>The Board of Admiralty considered this -memorial with all the attention that could -be expected in the general hurry of service, -inseparable from a great and extensive war; -and I am happy in being able to say, that, -in consequence of my application, most of -the particulars recommended have since been -so far carried into effect as to produce a -practical conviction of their utility. -<span class="pagenum" id="Page_65">65</span></p> - -<p>Lord Rodney having recovered his health, -hurried out to his station with all the force -that could then be equipped, as the enemy -were expected at the Caribbee Islands, with -a superior force, after their successes against -us in the autumn campaign in America.</p> - -<p>I had again the honour to accompany the -Admiral. He first sailed from Portsmouth, -with four ships of the line, on the 14th of -December, and was to have been joined by -two more that lay ready at Plymouth; but -by the time we arrived off this harbour the -wind became contrary, whereby we were -detained there till the 14th of January, -1782. During this time more ships were -got ready, and six were added to the squadron; -for the public anxiety at that time -called forth every exertion to strengthen this -reinforcement, upon which the fate of the -whole West Indies was supposed to depend.</p> - -<p>This fleet cleared the Channel in the midst -of a storm, and with the wind at the same -time so scanty, that we barely weathered -Ushant; but Lord Rodney’s perseverance -<span class="pagenum" id="Page_66">66</span> -and resolution, stimulated by the exigency -of the occasion, banished all hesitation and -timidity. The rough weather, and contrary -winds, continued through the variable latitudes; -but having met with fresh blowing -trade winds, common at that season, we -had the good fortune to get safe to Barbadoes -with the whole squadron on the 19th of -February.</p> - -<p>All the twelve ships<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">7</a> of this reinforcement -had been on service for a considerable -length of time since they had been last commissioned, -except the Anson, a new ship, -which had never before been at sea, and the -Fame and Yarmouth, which had lately undergone -a thorough repair, since which time -they had been only for a few weeks at sea in -the Channel before they were ordered on this -expedition.</p> - -<p>The only ship that was sickly when we -left England was the Fame, on board of -<span class="pagenum" id="Page_67">67</span> -which some pressed men, with the infection -about them, had been received from the -Conquestadore guardship; and the fever -which broke out in Plymouth Sound, where -I was first sent for to visit that ship, was -probably owing to the infection which these -men brought with them. The other ships -were, upon the whole, healthy; for it appeared -by the weekly accounts delivered to -the Admiral, that the mortality, including -even that of the Fame, for the four weeks -before we sailed, had been only one in thirteen -hundred, and that there had been about -one in twenty-nine on the sick list.</p> - -<p>An opportunity offered on this occasion of -comparing the health of ships of war in -England with that in the West Indies. -The health of the fleet in general at home -was at this time about the proportion above -mentioned; but it is to be remarked, that it -was healthier then than in the former part of -the war.</p> - -<p>Plymouth hospital, which is calculated -for twelve hundred men, was not half full; -<span class="pagenum" id="Page_68">68</span> -and there were not at this time more than -six hundred men at that of Haslar, which is -calculated to contain two thousand; but the -latter was generally full during the first two -or three years of the war, from the great -fleets that put into Portsmouth. At one -time part of the sick were even obliged to -be accommodated with tents in the neighbourhood -of the hospital, for want of room. -But towards the end of the year 1781 the -infectious fever, which constitutes a great -part of the sickness in the European seas, -was almost extirpated, and in a cruise of -five weeks in the north part of the Bay of -Biscay, under Admiral Darby, in September -and October of this year, only six men were -buried in that time from twenty-eight ships -of the line.</p> - -<p>This was chiefly owing, as I apprehend, -to the length of time which the war had -continued, in consequence of which the -men of the respective ship’s companies had -been accustomed to each other, and habituated -to the mode of life peculiar to a man -of war, regulating themselves according to -<span class="pagenum" id="Page_69">69</span> -certain rules of good order and cleanliness. -The causes of the fever above mentioned, -as shall be more fully illustrated hereafter, -are chiefly connected with the circumstances -occurring in the beginning of a war, when -men of all descriptions are mixed, without -proper precautions being taken to guard -against the infection imported from jails or -guardships. The sickness in the French -fleet was still greater in the beginning of -the war than in the British; and this has -been the case in all the wars of this century. -In the fleet commanded by the Comte d’Orvilliers, -in 1779, the sickness was so great -as to disable many of the ships from service, -and great numbers of men were landed at -Brest, with a fever so malignant as to infect -the inhabitants of the town and country -adjacent. I believe, besides, that the general -health prevailing at this time in the fleet in -England, was, in part, owing to the sour -crout and melasses, which were now supplied -more amply than had ever been done before. -The entire exemption from scurvy in particular -is to be ascribed to these improvements -in diet. -<span class="pagenum" id="Page_70">70</span></p> - -<p>There is a tendency in acute diseases to -wear themselves out, both in individuals -that labour under them, and when the infection -is introduced into a community. -Unless there was such a <i>vis medicatrix</i>, there -could be no end to the fatality of these -distempers; for the infectious matter would -go on multiplying itself without end, and -would necessarily destroy every person who -might be actually attacked, and would infect -every person who might be exposed to it. -But animal nature is so constituted, that this -poison, after exciting a certain set of motions -in the body, loses its effect, and recovery -takes place; and those who happen -not to be infected at first, become in some -measure callous to its impression, by being -habitually exposed to it. There is, therefore, -a natural proneness to recovery, as -well with regard to that indisposition which -takes place among a set of men living together, -as with regard to a single individual -who actually labours under the disease. -Thus the most prevailing period of sickness -is when men are new to their situation and -<span class="pagenum" id="Page_71">71</span> -to each other, so that time of itself may -prove the means of prevention as well as -of cure.</p> - -<p>This consideration, however, ought not to -supersede any part of our attention with regard -to the scurvy, which does not become -spontaneously extinct like acute diseases.</p> - -<p>During the three first weeks of this passage -from England to the West Indies, there -was wet and boisterous weather, but it had -very little effect in augmenting sickness; -and though it not only subjected the men to -fatigue, cold, and damp, but prevented the -ships from opening their lower-deck ports -till the 2d of February, between the 31st -and 32d degree of latitude, thereby producing -close air and moisture where the -men sleep, yet, in the whole squadron, from -its leaving England till this time, there were -only seven deaths, four of which were in -the Fame.</p> - -<p>The only sea epidemic that made its appearance -was the infectious ship fever, -<span class="pagenum" id="Page_72">72</span> -which, in many cases, was attended with -pleuritic, rheumatic, and other inflammatory -symptoms, owing to the cold and wet, to -which the men were exposed in the variable -latitudes. The warm, dry, fresh breezes -which we had during the remainder of the -passage, were probably what prevented any -bad consequences from the former hardships, -for there died only four men from the above-mentioned -date till we arrived at Barbadoes; -and it appeared by the Admiral’s weekly -account, that the proportion of the sick -neither increased nor diminished from the -time we got into a warm climate and fine -weather till our arrival on the 19th of -February.</p> - -<p>This squadron left England with several -advantages in point of victualling, which no -ships had before enjoyed. They were amply -supplied with sour crout and melasses; they -had all more or less wine, of an excellent -quality; and the Formidable had an entire -supply of it, in place of spirits, of which -none was put on board. This slip had hitherto, -<span class="pagenum" id="Page_73">73</span> -and did for some months afterwards, -enjoy an extraordinary, perhaps an unparallelled, -degree of health. What farther contributed -to the health of this ship was, -that she had been long in commission, and -most of the recruits with which the crew -had been completed were men turned over -from other ships. There was also extraordinary -medical attention paid, particularly -in watching the first beginnings of complaints.</p> - -<p>Upon the arrival of the squadron at Barbadoes, -it was found, that, the two hostile -fleets having returned from North America -in the beginning of December, the campaign -had opened with the siege of St. -Christopher’s, which had been invested by -twenty-eight ships of the line, and a considerable -army. Our fleet, under Lord Hood, -having attempted, with great enterprise and -skill, but without success, to relieve it, -Lord Rodney made haste to join them with -the reinforcement he had brought from -England. He remained at anchor at Barbadoes -<span class="pagenum" id="Page_74">74</span> -only one night, and in a few days -came off Antigua, where he was informed -of the surrender of St. Christopher’s; and -here, on the 25th of February, he was -joined by the rest of the fleet in their return -to windward. -<span class="pagenum" id="Page_75">75</span></p> - -<h2 id="BOOK_II_CHAP_II">CHAP. II.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from the Junction -of the Squadron from England, till the general -Rendezvous at St. Lucia in the Beginning of April.——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.</p></blockquote> - -<p>The fleet which was found in the West -Indies consisted of all the sixteen that went -from thence to America in August, 1781, -(except the Terrible, which had been lost) -together with six ships of the line<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">8</a> from the -<span class="pagenum" id="Page_76">76</span> -American station, the St. Albans, which arrived -from England in November, and the -Russel, which had remained in the West -Indies during the hurricane months. They -were all extremely healthy, having only -one man in twenty-eight on the sick list, -and very few had been sent to hospitals.</p> - -<p>This fleet, after arriving from America, -had lain at anchor for three weeks at Barbadoes, -where it had the advantage of the -vegetable refreshments which that island -affords; but during three weeks that it lay -at anchor, in the face of the enemy, at St. -Christopher’s, the men were excluded from -all communication with the shore, and had -no vegetable food, except some yams, with -which they were supplied from Antigua, in -place of biscuit, of which there was at this -time a scarcity. These ships had therefore -been in no port for six weeks, except for a -few days that they lay in the road of Antigua -refitting, and putting the sick and -wounded on shore. -<span class="pagenum" id="Page_77">77</span></p> - -<p>The men had also been deprived of their -natural rest, and exposed to the air during all -the time that the fleet was at anchor before -St. Christopher’s; for they had been twice -attacked by the enemy in that situation, -and were therefore under the necessity of -keeping the ships constantly clear for action; -yet no increase of sickness followed. This -might partly be owing to the eagerness and -alacrity of spirits naturally excited in such -a situation, and also to the fleet not lying -under the lee of any land, and having springs -upon their cables, so that they had all the -perflation and all the purity of air which -ships enjoy when at sea. The fumigation -which ships undergo in battle, has also -been thought to contribute to their health.</p> - -<p>To whatever cause it was owing, the fleet -we found in the West Indies was at this -time healthier than that which had just come -from England; and there was but little difference -in the degree of health of the different -ships that composed it. Of those which -left the West Indies in August, and returned -in December, the only one that could be -<span class="pagenum" id="Page_78">78</span> -said to have any epidemic disease was the -Prince William, which had never got entirely -free from the dysentery that was formerly -mentioned as prevailing so much on -board of this ship last year. The disease -was kept up, by the ship never having been -cleared of the men affected with it, and by -the crew in general being ill provided with -slops<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">9</a>, a circumstance that would render -them more susceptible of whatever infection -they might be exposed to.</p> - -<p>There were also some remains of the same -disease in the Intrepid, the seeds of it having -been more or less continued from the summer -of 1780, at which time it prevailed to -a most violent degree. The Alfred had a -few of all the sea epidemics, and had been -for a long time before more or less in the -same situation, from a neglect of cleanliness, -particularly of the men’s persons.</p> - -<p>The only ship in which there was any -thing like an epidemic was the Canada, -<span class="pagenum" id="Page_79">79</span> -This ship, when at home, had for many -months before she sailed been in unremitting -service, and very little in port. On the passage -from England to America, in August, -1781, there broke out a severe dysentery, -to which the scorbutic habit of the men, -from being so long at sea, probably predisposed -them. Though it had abated much -in February, 1782, it was then by no means -extinct, and continued till April. The -Prince George had been in commission all -the war, and was a model of discipline and -cleanliness, and consequently of health. This -continued till the passage from America, -when, upon the first cold weather after leaving -New York, there broke out a violent -dysentery, of which sixteen men died. This -is agreeable to what Dr. Lind observes, that -the flux may be brought on by a sudden -transition, either from cold to heat, or from -heat to cold. All the men that were ill of -this disease having been sent to the hospital -at Barbadoes, and the usual attention to -cleanliness having been kept up, the disease -entirely vanished. -<span class="pagenum" id="Page_80">80</span></p> - -<p>All the other ships of the American station -had been more or less visited with sickness -after they left England, except the Bedford. -This was probably owing to this ship having -been longer in commission than any of the -others, that is, for four years, and all that -time under the same commander. This last -circumstance falls to the lot of few ships; -but a great advantage attends it; for the -mutual knowledge and attachment of the -captain and ship’s company is naturally -productive of regularity and good discipline, -and thereby of health.</p> - -<p>The Royal Oak, Prudent, and America, -which left England with the Bedford, -though they had been afflicted with the -scurvy and other complaints soon after arriving -in America, had been quite healthy -for some time before coming to the West -Indies, and were so much so at this period, -that, though there were a few sores and -slight complaints on their sick lists, there -was not a man confined with illness, so as -properly to be called sick. The Royal Oak, -having been the flag ship of Admiral Arbuthnot, -<span class="pagenum" id="Page_81">81</span> -was manned with choice seamen, -which is a circumstance generally conducive -to health; for these being accustomed to a -sea life, are more provident, more handy -and methodical in all that relates to diet, -cloathing, and cleanliness. The scurvy, -which infected her upon first arriving in -America, was successfully treated on board -by serving to those who were ill of it a -mess, composed of soft bread, baked on -purpose, and mixed with wine and essence -of malt.</p> - -<p>The Prudent, though now quite healthy, -had been sickly soon after being put into -commission in Europe, and upon first arriving -in America. She had been uncommonly -sickly, when a new ship, upon her -first voyage, which was to the East Indies, -during the peace. This remarkable degree -of sickness was probably owing to a particular -experiment that was made in preparing -the wood of which she was built. This -experiment consisted in soaking the timber -for a length of time in a strong pickle, in -order to make it less corruptible. The only -<span class="pagenum" id="Page_82">82</span> -other ship on which the trial of this was -made was the Intrepid; and it has been already -mentioned that this was an extremely -sickly ship. The effect of it upon the wood -was to cause a constant moisture and mouldiness -in the orlops and holds. In the Intrepid, -the sickness was never conquered till -a practice was followed of pumping and -bailing her with great care, and putting a -fire into the well for six hours every day, -by which means the dampness, and the -mildew produced by it, were removed and -prevented, and the ship thereby rendered -healthy.</p> - -<p>The two squadrons being united, and -consisting of thirty-four ships of the line, -proceeded to St. Lucia, where they arrived -on the 1st of March.</p> - -<p>I received monthly returns as formerly, -and the form of them was improved by -adding a column for the numbers taken ill -of the several diseases in the course of the -month. The returns of February are not -complete, there being none for the 1st of -<span class="pagenum" id="Page_83">83</span> -that month, as we had not then arrived; -but as the returns of the 1st of March have -relation to the preceding month, a judgement -may be formed of the sickness and -mortality of February from the following -table:</p> - -<h3><span class="smcap">Extract</span> from the <span class="smcap">Returns</span> of the -1st of March, 1782.</h3> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Put on the<br />Sick List<br />last Month.</th> - <th>Died last<br />Month.</th> - <th>Sent to the<br />Hospital<br />last Month.</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">53</td> - <td class="tdr">15</td> - <td class="tdr">9</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">263</td> - <td class="tdr">67</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">121</td> - <td class="tdr">2</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">618</td> - <td class="tdr">25</td> - <td class="tdr">59</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">1555</td> - <td class="tdr">109</td> - <td class="tdr">73</td> - </tr> -</table> - -<p>This account is abstracted from the returns -of twenty-nine ships of the line, and -two frigates. -<span class="pagenum" id="Page_84">84</span></p> - -<p>The diseases and deaths under the head of -“Other Complaints,” is much more numerous -in this month than usual, which is -chiefly owing to the preceding actions with -the enemy, and to the prevalence of the -small pox. Of the deaths under this head, -seventeen were in consequence of wounds, -six from small pox, one from a mortification<a id="FNanchor_10" href="#Footnote_10" class="fnanchor">10</a> -in the shoulder, and one from consumption.</p> - -<p>None of the epidemics affected one part -of the squadron more than another, except -that the ships last from England had a less -proportion of the flux than the rest; and -the few cases of this disease that were in -these ships arose after their arrival in the -climate. The Conqueror and Fame, which -<span class="pagenum" id="Page_85">85</span> -were the two most sickly ships, had no -complaints but fevers.</p> - -<p>The fevers had now begun to take on -some of the characteristic symptoms of the -climate; the chief of which is a greater -abundance of bile. In the Repulse, two -men had the yellow colour of the skin, -which is so peculiar to the fevers of this -climate.</p> - -<p>The crew of the Anson caught an infectious -fever from a guardship in England; -and when the 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.</p> - -<p>The small pox prevailed more at this -time in the fleet than I have ever known -it to do either before or since, and that -both in the squadron from England and in -that from North America. There were six -cases in the Formidable, all of which did -<span class="pagenum" id="Page_86">86</span> -well, though two were of the confluent -kind.</p> - -<p>Though there needs hardly any additional -proof of the extraordinary efficacy of lemon -juice in curing the scurvy, yet it may be of -service to impress so useful a truth on the -mind by mentioning such striking proofs of -it as occurred from time to time. The Arrogant -spoke with a Portuguese vessel near -Madeira, from which some of this fruit was -procured, and the only scorbutic man on -board happening to have some of the most -desperate symptoms, such as putrid gums, -contracted hams, the calves of the leg hard -and livid, and frequent faintings, a fair opportunity -offered for trying its virtues. -The man was allowed two of them daily, -and was perfectly well in sixteen days, during -all which time the ship was at sea, so -that it was impossible to ascribe the cure to -any other cause.</p> - -<p>The fleet remained at St. Lucia from the -1st till the 18th of March, completing the -water, provisions and stores, landing the sick -<span class="pagenum" id="Page_87">87</span> -at the hospital, and also watching the motions -of the enemy, who arrived about the -same time at Martinico from the siege of -St. Christopher’s. During this time we -were reinforced with the Duke, of 90 guns, -and the Warrior and Valiant, of 74 guns, -from England. On the 18th the whole -fleet, except the Invincible, which was detached -with a convoy to Jamaica, sailed on -a cruise to windward of Martinico, in quest -of a French convoy expected from Europe; -which having eluded us, and got into their -own harbour, the whole fleet returned to -St. Lucia on the 30th of March, excepting -the Prudent, which was sent to Barbadoes.</p> - -<p>We found at St. Lucia the Magnificent, -of 74, and the Agamemnon, of 64 guns, -which were the last reinforcement of this -campaign, making the British fleet on this -station amount to forty ships of the line, -a much greater force than was ever before -employed on foreign service. They were -all copper bottomed. -<span class="pagenum" id="Page_88">88</span></p> - -<p>The weather continued fine all this month, -yet there was some increase of sickness, owing -chiefly to the hardship the men underwent -in wooding and watering. In Choc -Bay, where the fleet watered, there was at -this time a higher surf than was ever remembered, -which made the operation of -watering (at all times noxious in this climate) -uncommonly toilsome and dangerous. -It was, indeed, next to impracticable; for -many longboats were staved on the beach, -by which several men had their limbs broken, -and some lost their lives, by being -crushed or drowned; but the necessity of -the service admitted of no relaxation or delay. -There was no increase of wind to account -for this surf, so that it was owing -either to something in the currents, or to -some subterraneous cause; and there had -been felt at Barbadoes and St. Lucia, about -this time, a slight shock of an earthquake<a id="FNanchor_11" href="#Footnote_11" class="fnanchor">11</a>, -<span class="pagenum" id="Page_89">89</span> -to which many imputed this extraordinary -surf. In other respects, there were fewer -causes of sickness than usually occur to a -fleet in port in this part of the world; for -the air of the road is remarkably pure, and -there were fewer temptations and opportunities -of intemperance than at the other -islands.</p> - -<p>The monthly returns of the surgeons -were very full and complete; but as it -would be tedious to insert at length those -of every particular ship, and as the number -of ships fluctuated in different months, I -shall do no more hereafter than set down -the general results from calculation, so as -to shew the proportional prevalence of disease -and mortality in each month. -<span class="pagenum" id="Page_90">90</span></p> - -<h3><span class="smcap">Table</span>, shewing the proportional Sickness -and Mortality in March.</h3> - -<div class="table"> - -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the -Course of this Month.<br /> -<br /> -B Proportion of those who died, in -relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">20</td> - <td class="tdr">64</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">35</td> - <td class="tdr">71</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">126</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">33</td> - <td class="tdr">108</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">9</td> - <td class="tdr">76</td> - </tr> -</table> -</div> - -<p>The first column is formed by dividing -the whole number on board by the number -<span class="pagenum" id="Page_91">91</span> -taken ill. The second column is formed by -first adding the number ill on board on the -first of the month to the number taken ill -during the month, subtracting from this -sum the number sent to the hospital, and -dividing the remainder by the number of -deaths.</p> - -<p>The number on the sick list of twenty-eight -ships of the line, and two frigates, -on the first of this month, was eight hundred -and forty-five; the number put on the -lists in the course of the month was one -thousand eight hundred and eighty-four; -and the number sent to the hospital in the -same time was three hundred and seventy-three; -and there died on board thirty-one. -<span class="pagenum" id="Page_92">92</span></p> - -<p>The total mortality this month, in relation -to the whole number of men on board, -was one in six hundred and seven.</p> - -<p>It almost always happens, that ships of -war are more or less short of complement, -and allowance is made for this in all the -calculations; for having had an opportunity -of inspecting the weekly accounts delivered -to the Admiral, it was always in my -power to be informed how many there were -short of the legal complement of men in -each ship.</p> - -<p>It appears, from comparing the Tables of -this month with those of the preceding, -that there had been a great increase of -fevers and fluxes, particularly of the latter. -The fevers prevailed chiefly in the ships -lately from England, especially the Fame -and Conqueror. In the Duke there were a -great number ill of fevers; but this ship -not having arrived from England till after -the first of the month, is not included in -the calculation. The fluxes were most prevalent -in the ships we found on the station, -<span class="pagenum" id="Page_93">93</span> -particularly the Canada, Resolution, and -Nymph frigate. The scurvy had increased -very little, but prevailed most in the ships -we found here. The only ships of the -new squadron that had this disease to a -considerable degree, were the Conqueror -and Nonsuch. The former had indeed a -good many ill of it; but the return having -been made in an imperfect manner, this -ship is not included in the calculation.</p> - -<p>But the ships that were by far the most -healthy were those that had been the longest -from England, the Ajax, Russel, Montague, -Royal Oak, and Prudent. There had been -formerly a great mortality in all these ships; -and it would appear that this uncommon -degree of health was owing, in some measure -at least, to this circumstance, that the -most weakly had been swept off by the -different distempers to which they were exposed; -so that only the more hardy and -robust had survived.</p> - -<p>Under the head of “Other Complaints,” -a much smaller number were put on the -<span class="pagenum" id="Page_94">94</span> -list, and still fewer died, in this than the -preceding month. This difference is owing -to the number that died of wounds last -month.</p> - -<p>There died on board, in the course of -this month, thirteen of fevers, seven of -fluxes, and seven of other complaints, of -whom five died of small pox, one of asthma, -and one of wounds he received at St. Christopher’s.</p> - -<p>In order to show more fully and minutely -what are the complaints incident to fleets -in this climate, I shall set down a list of -the numbers taken ill of the different diseases -and accidents during this month, extracted -from the returns of twenty-eight -ships of the line, and two frigates.</p> - -<table> - <tr> - <td>Fevers</td> - <td class="tdr">806</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">463</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">130</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">129</td> - </tr> - <tr> - <td>Small pox</td> - <td class="tdr">49</td> - </tr> - <tr> - <td>Pectoral complaints</td> - <td class="tdr">40</td> - </tr> - <tr> - <td>Venereal complaints</td> - <td class="tdr">32</td> - </tr> - <tr> - <td>Colds</td> - <td class="tdr">30<span class="pagenum" id="Page_95">95</span></td> - </tr> - <tr> - <td>Rheumatism</td> - <td class="tdr">18</td> - </tr> - <tr> - <td>Angina</td> - <td class="tdr">10</td> - </tr> - <tr> - <td>Gravel</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Dropsy</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Ophthalmia</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Leprosy</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Fistula in ano</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Hernia humoralis</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Abscess</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Fractures</td> - <td class="tdr">3</td> - </tr> - <tr> - <td style="max-width: 5em">Various slight accidents, as bruises, cuts, scalds, &c.</td> - <td class="tdr">163</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">1884</td> - </tr> -</table> - -<p>The number of ulcers bears here a smaller -proportion to the whole than it does in general -to the sum total of the sick list; for -being the most tedious of all complaints, -they consequently accumulate more than any -other. Thus many of the cases now set -down as slight accidents, will, in the ensuing -month, be in the state of obstinate -ulcers.</p> - -<p>Most of the diseases of one hot climate -resemble those of another, so far as I know; -but there is one disease which we hear of as -being extremely prevalent all over the East -Indies, which is hardly ever met with in -the tropical regions of the West. This is -the inflammation of the liver, of which I -<span class="pagenum" id="Page_96">96</span> -remember to have seen only one well-marked -case, and it was that of a gentleman who -had been in the East Indies, and had been -subject to it there: nor do I recollect more -than one, or at most two, cases of this sort -out of several thousand cases of various diseases -that were reported to me. This is -either owing to the greater heat and dryness -of the air in the East Indies, or some other -peculiarity with which we are not acquainted<a id="FNanchor_12" href="#Footnote_12" class="fnanchor">12</a>.</p> - -<p>Every other inflammatory complaint exists -more or less, though they are much rarer -than in cold and temperate climates. The -phthisis pulmonalis is not so common as in -cold climates, but proves sooner fatal to -<span class="pagenum" id="Page_97">97</span> -most constitutions. There are certain pulmonic -complaints, particularly those of the -asthmatic kind, to which the climate of the -West Indies is remarkably favourable; but -those in which there are tubercles and ulceration -seem to be hurried faster to a fatal -termination. The climates, from the thirtieth -to the fortieth degree of latitude, seem -to be best suited to consumptive complaints. -The rheumatisms that occur in hot climates -are mostly of the chronic kind. -<span class="pagenum" id="Page_98">98</span></p> - -<h2 id="BOOK_II_CHAP_III">CHAP. III.</h2> - -<blockquote> - -<p>State of Health of the Fleet in April 1782——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.</p></blockquote> - -<p>This month being interesting, on account -of the memorable engagements that happened -in it, the remarks shall, for this reason, be -somewhat more full and particular.</p> - -<p>Three ships of the line having been sent to -protect convoys to Jamaica, and one having -been sent to protect a convoy to Barbadoes, -there remained thirty-six at St. Lucia in the -beginning of this month. By the end of the -first week their damages were repaired, their -water and provisions complete, and the sick in -a great measure recovered. -<span class="pagenum" id="Page_99">99</span></p> - -<p>An equal force of the enemy lay over -against us at Martinico, the two powers of -Britain and France being to make this distant -quarter of the world the theatre for trying -their strength, and deciding the sovereignty -of the seas. In the view of this great event, -our commander forwarded the necessary duties -of the fleet with such zeal and diligence, -and watched the motions of the enemy with -such vigilance, that he overtook their grand -squadron a few hours after they left their own -port, and engaged them two several days, -with a success, glorious and complete.</p> - -<p>Nothing had been wanting to equip this -fleet for the great and decisive exertion it was -to make. Every ship, except two, might be -said to be healthy, most of them were complete -in men, well appointed with officers, -and well found in stores and provisions.—Conformable -to this was the eagerness, the -confidence, and resolution, which led them -to success and victory.</p> - -<p>After this battle, the whole fleet, with the -prizes, bore away for Jamaica, where part -<span class="pagenum" id="Page_100">100</span> -of it arrived on the last days of April, but the -greater part of it kept the sea, till after the -middle of May.</p> - -<p>As this month is more than usually interesting, -the tables are given at full length, -and a column is added for the wounded.</p> - -<p>The sum total, of the numbers of the men -on board of the thirty-six ships that composed -the line of battle on the 12th of April, was -21,608, and the mortality during the month, -exclusive of those who were killed or died of -wounds, was one in 862.</p> - -<p>There was less sickness, and less death, -from disease in this month, than any of the -former twenty-three months, in which I -kept records of the fleet, and less than in any -subsequent month, till the fleet got to the -coast of America.</p> - -<p>To account for this, it is to be observed, -that the men had not been exposed to the -noxious air of the shore in watering, as in -the preceding month: they had received - -<span class="pagenum" id="Page_101">101</span> -from England a fresh supply of provisions, -among which was sour krout, melasses, and -essence of malt, all in addition to the ordinary -articles of victualling: many of the -ships were supplied with wine, in place of -rum, and as the weather was all along dry -and fine, the men suffered the less from the -exposure and want of sleep, which are the -necessary consequences of keeping ships -clear for battle for several days and nights -together.</p> - -<h3 id="TABLE_V">TABLE V.<br /> - -<span class="medium">ABSTRACT of the RETURNS for APRIL, 1782.</span></h3> - -<div class="table"> -<p> -Transcriber's Keys:<br /> -F Sick on board on the 1st of the Month.<br /> -M Put on the List during the Month.<br /> -D Dead.<br /> -H Sent to the Hospital.<br /> -</p> - -<table class="bbox"> - <tr> - <th rowspan="2">SHIPS’ NAMES</th> - <th colspan="4">FEVER.</th> - <th colspan="4">FLUX.</th> - </tr> - <tr> - <th>F</th> - <th>M</th> - <th>D</th> - <th>H</th> - <th>F</th> - <th>M</th> - <th>D</th> - <th>H</th> - </tr> - <tr> - <td>* Formidable</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Barfleur</td> - <td class="tdr">6</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">5</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>Prince George</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">2</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">18</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Duke</td> - <td class="tdr">57</td> - <td class="tdr">78</td> - <td class="tdr">2</td> - <td class="tdr">32</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Namur</td> - <td class="tdr">5</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">11</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Royal Oak</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">11</td> - <td class="tdr">23</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">8</td> - <td class="tdr">46</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">6</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">2</td> - <td class="tdr">1</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>* Valiant</td> - <td class="tdr">§</td> - <td class="tdr">10</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">5</td> - <td class="tdr">21</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Warrior</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">12</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">10</td> - <td class="tdr">15</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Magnificent</td> - <td class="tdr">0</td> - <td class="tdr">21</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Bedford</td> - <td class="tdr">11</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">27</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Canada</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">24</td> - <td class="tdr">70</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">19</td> - <td class="tdr">25</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">21</td> - <td class="tdr">27</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Hercules</td> - <td class="tdr">2</td> - <td class="tdr">38</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">5</td> - <td class="tdr">18</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">3</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Fame</td> - <td class="tdr">36</td> - <td class="tdr">50</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">8</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">10</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Princessa</td> - <td class="tdr">1</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>* Conqueror</td> - <td class="tdr">30</td> - <td class="tdr">§</td> - <td class="tdr">1</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Arrogant</td> - <td class="tdr">2</td> - <td class="tdr">16</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">33</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Marlborough</td> - <td class="tdr">7</td> - <td class="tdr">19</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">21</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Yarmouth</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Belliqueux</td> - <td class="tdr">43</td> - <td class="tdr">118</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - </tr> - <tr> - <td>Prince William</td> - <td class="tdr">4</td> - <td class="tdr">27</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">24</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Repulse</td> - <td class="tdr">20</td> - <td class="tdr">40</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>St. Albans</td> - <td class="tdr">1</td> - <td class="tdr">22</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Agamemnon</td> - <td class="tdr">2</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prothée</td> - <td class="tdr">6</td> - <td class="tdr">13</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">49</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>America</td> - <td class="tdr">2</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Anson</td> - <td class="tdr">3</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">26</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Nonsuch</td> - <td class="tdr">6</td> - <td class="tdr">11</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">2</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">7</td> - <td class="tdr">16</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ramillies</td> - <td class="tdr">§</td> - <td class="tdr">26</td> - <td class="tdr">1</td> - <td class="tdr">4</td> - <td class="tdr">§</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Nymph</td> - <td class="tdr">2</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">8</td> - <td class="tdr">9</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Flora</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">312</td> - <td class="tdr">743</td> - <td class="tdr">15</td> - <td class="tdr">65</td> - <td class="tdr">195</td> - <td class="tdr">516</td> - <td class="tdr">7</td> - <td class="tdr">19</td> - </tr> -</table> - -<table class="bbox"> - <tr> - <th rowspan="2">SHIPS’ NAMES</th> - <th colspan="4">SCURVY.</th> - <th colspan="4">WOUNDS.</th> - </tr> - <tr> - <th>F</th> - <th>M</th> - <th>D</th> - <th>H</th> - <th>F</th> - <th>M</th> - <th>D</th> - <th>H</th> - </tr> - <tr> - <td>* Formidable</td> - <td class="tdr">0</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">37</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Barfleur</td> - <td class="tdr">6</td> - <td class="tdr">30</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">37</td> - <td class="tdr">8</td> - <td class="tdr">6</td> - </tr> - <tr> - <td>Prince George</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">14</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Duke</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">60</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Namur</td> - <td class="tdr">8</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Royal Oak</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">54</td> - <td class="tdr">5</td> - <td class="tdr">15</td> - </tr> - <tr> - <td>Alfred</td> - <td class="tdr">15</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">30</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Montagu</td> - <td class="tdr">2</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">25</td> - <td class="tdr">5</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Valiant</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">37</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Monarch</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">33</td> - <td class="tdr">2</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Warrior</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Centaur</td> - <td class="tdr">5</td> - <td class="tdr">15</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">14</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Magnificent</td> - <td class="tdr">7</td> - <td class="tdr">16</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">20</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Bedford</td> - <td class="tdr">1</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">17</td> - <td class="tdr">4</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ajax</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">30</td> - <td class="tdr">1</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Canada</td> - <td class="tdr">1</td> - <td class="tdr">8</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Resolution</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">19</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Hercules</td> - <td class="tdr">0</td> - <td class="tdr">12</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">18</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Russel</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">4</td> - <td class="tdr">29</td> - <td class="tdr">3</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Fame</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">12</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Torbay</td> - <td class="tdr">3</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">25</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Princessa</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">19</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Conqueror</td> - <td class="tdr">10</td> - <td class="tdr">§</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">23</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Arrogant</td> - <td class="tdr">4</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">11</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Marlborough</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">16</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - </tr> - <tr> - <td>* Yarmouth</td> - <td class="tdr">3</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">33</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Belliqueux</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">10</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Prince William</td> - <td class="tdr">5</td> - <td class="tdr">18</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Repulse</td> - <td class="tdr">3</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">9</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>St. Albans</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">7</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Agamemnon</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">23</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Prothée</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">24</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>America</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">1</td> - <td class="tdr">27</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Anson</td> - <td class="tdr">1</td> - <td class="tdr">1</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">13</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>* Nonsuch</td> - <td class="tdr">18</td> - <td class="tdr">25</td> - <td class="tdr">0</td> - <td class="tdr">6</td> - <td class="tdr">0</td> - <td class="tdr">2</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Alcide</td> - <td class="tdr">7</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">15</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Ramillies</td> - <td class="tdr">§</td> - <td class="tdr">3</td> - <td class="tdr">0</td> - <td class="tdr">3</td> - <td /> - <td /> - <td /> - <td /> - </tr> - <tr> - <td>Nymph</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Flora</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">103</td> - <td class="tdr">208</td> - <td class="tdr">2</td> - <td class="tdr">18</td> - <td class="tdr">8</td> - <td class="tdr">810</td> - <td class="tdr">60</td> - <td class="tdr">32</td> - </tr> -</table> - -<p>N. B. The Ships marked thus, *, came from England in February and March, 1782.</p> - -<p>All the Ships named in the Table were in the Engagements in April, except the Ramillies and the two Frigates.</p> - -<p>In the Spaces marked thus, §, no Return was made.</p> -</div> - -<p>Might not this extraordinary degree of -health have also been owing, in part, to the -effects of success upon the spirits of the men? -It is related<a id="FNanchor_13" href="#Footnote_13" class="fnanchor">13</a>, that, when the fleet under Admiral -Matthews was off Toulon, in daily expectation -for some time of engaging the combined -fleet of France and Spain, there was a -general stop put to the progress of disease, -particularly of the scurvy, from the influence -of that generous flow of spirits, with -which the prospect of battle inspires British -<span class="pagenum" id="Page_102">102</span> -seamen. But if the mere expectation and -ardour of a battle, without any happy event, -could have such a sensible effect, what must -have been the effect of the exultation of <small>VICTORY</small>, -a victory in which the naval glory of -our country was revived and retrieved, after -a series of misfortunes and disgraces, which -had well nigh extinguished the national pride -in every department of service! The plain -and honest, though unthinking seaman, is -not less affected by this than the more enlightened -lover of his country. Even the -invalids at the hospital demonstrated their -joy, upon hearing of this victory, by hoisting -shreds of coloured cloth on their crutches.</p> - -<p>It would appear, that there is something -in situations of exertion and danger, which -infuses a sort of preternatural vigour. When -the mind is interested and agitated by active -and generous affections, the body forgets its -wants and feelings, and is capable of a degree -of labour and exertion, which it could -not undergo in cold blood. The quantity -of muscular action employed in fighting at a -great gun for a few hours, is perhaps more -<span class="pagenum" id="Page_103">103</span> -that what is commonly employed in a week -in the ordinary course of life, and though -performed in the midst of heat and smoke, -and generally with the want of food and -drink, yet the powers of nature are not exhausted -nor overstrained; even the smart of -wounds is not felt; and the future health of -those who survive unhurt by external violence -is so far from being injured, that it is sometimes -mended by this violent, but salutary agitation.</p> - -<p>The loss in action, and the number of mortal -wounds, were not so great as might have -been expected in a battle continued for a whole -day. This advantage was owing to the superiority -of our fire, as well as to the closeness of -the fight, of which the Commander in Chief -set the illustrious example, by penetrating -the enemy’s line with his own ship; a bold -and singular effort which first decided the event -of the day. When ships in action are -opposed to each other at a small distance, the -velocity of cannon balls is so great, that in -penetrating a ship’s side, few or no splinters -are torn off; and by these more men are commonly -killed and wounded, than by the ball -<span class="pagenum" id="Page_104">104</span> -itself. For the same reason, a close shot does -less damage also to the ship itself, than a distant -one; for a quick-flying ball makes an -aperture less than its own diameter, whereas -a spent one produces innumerable deadly splinters, -at the same time shivering the object it -strikes, and making wide and extensive rents -in it. The proportion of the wounded to the -killed, is also greater in distant, than in close -fight, on account of the great number of -small splinters; and we have an experimental -proof of this, in comparing the action in -Fort Royal Bay in April 1781, with this -near Dominica in April 1782. In the former, -the enemy having kept far to windward, -and engaged at a great distance, the proportion -of the wounded to the killed was -considerably more than four to one<a id="FNanchor_14" href="#Footnote_14" class="fnanchor">14</a>; whereas -in the latter, where the greater part of the -battle was close, the proportion of the -wounded to the killed, was little more than -three to one<a id="FNanchor_15" href="#Footnote_15" class="fnanchor">15</a>. -<span class="pagenum" id="Page_105">105</span></p> - -<p>Though it is a remark not belonging to a -medical work, yet it may be observed, that -the greatest advantage that arose to us from -close action was, that the fire of the enemy was -thereby silenced; for the advantages would be -mutual and equal, on the supposition, that -the French, in such a situation, were to keep -the deck, and stand to their guns equally -well with the British seamen.</p> - -<p>It appears, by examining the table, that the -ships in which the fevers chiefly prevailed -this month, were those that came last from -England, and that those in which the fluxes -prevailed most were chiefly of the squadron -we found on the station, namely, the Canada, -Resolution, and Prince William. The -latter however recovered greatly in the course -<span class="pagenum" id="Page_106">106</span> -of this month. Some of the Ships that arrived -last from England, namely, the Arrogant, -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.</p> - -<p>The sum total of fevers and fluxes that -have been put on the list this month, is much -the same as that of the preceding month; -but the proportion of fluxes in April is much -greater.</p> - -<p>The proportion of scurvy is somewhat increased; -which is not to be wondered at, -when it is considered, that though the fleet -<span class="pagenum" id="Page_107">107</span> -had not been so long at sea as is necessary to -produce it, especially in this climate, yet the -men having had no refreshments when last in -port, may be considered as having been all -that time at sea.</p> - -<p>The superior degree of health in this -month will appear in a still stronger light, -if we cast our eye on the column expressing -the number sent to the hospital, the proportion -of which is, comparatively, very -small.</p> - -<p>The ships that had been the longest from -England, were still among the most healthy. -But of all the fleet, none was so free from -sickness and mortality as the Formidable. -No man belonging to this ship died of disease -for the first four months after sailing from -Plymouth, though there were at times -900 men on board, and never less than the -established complement, which is 750; and -so few were taken sick in that time, that -only thirteen were sent to hospitals, and -their complaints were small-pox and ulcers. -<span class="pagenum" id="Page_108">108</span></p> - -<p>This ship left England provided with every -thing that could be supposed to conduce to -the health of men, and may be considered -as an experiment to prove what degree of -health may be attained by proper management -and attention. She was furnished not -only with abundance of sour krout, melasses, -and essence of malt, in common with the -other ships; but what was peculiar to her, -was an entire supply of excellent wine, in -place of spirits, of which none was used -during the period mentioned. -<span class="pagenum" id="Page_109">109</span></p> - -<h2 id="BOOK_II_CHAP_IV">CHAP. IV.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> while it lay at -Jamaica during May, June, and Part of July, 1782.——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.</p></blockquote> - -<p>All the squadron that was left to windward -of Jamaica, consisting of twenty-four -ships of the line, kept the sea during great -part of May, the last division of it not -having come to Port Royal till the 25th of -that month.</p> - -<p>The whole fleet remained in harbour -during the remainder of the month, and the -<span class="pagenum" id="Page_110">110</span> -whole of the next, except the Warrior, -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. -<span class="pagenum" id="Page_111">111</span></p> - -<h3><span class="smcap">Table</span>, shewing the proportional Prevalence -of Sickness and Mortality in May.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill or wounded in the Course of the Month.<br /> -B Proportion of those that died in relation to the Numbers of Sick or wounded.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">26</td> - <td class="tdr">29</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">18</td> - <td class="tdr">63</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">57</td> - <td class="tdr">34</td> - </tr> - <tr> - <td>Wounds</td> - <td class="tdr">627</td> - <td class="tdr">60</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">44</td> - <td class="tdr">127</td> - </tr> - <tr> - <td>General Proportion, including wounded</td> - <td class="tdr">7½</td> - <td class="tdr">46</td> - </tr> - <tr> - <td>General Proportion, exclusive of Wounds</td> - <td class="tdr">8</td> - <td class="tdr">48</td> - </tr> -</table> -</div> -<p><span class="pagenum" id="Page_112">112</span></p> - -<p>The whole number of sick on board on -the first of this month, in thirty-six ships -of the line and two frigates, upon which -the preceding calculation is formed, was one -thousand four hundred and eighteen. The -whole number taken ill in the course of the -month was two thousand eight hundred and -twenty-eight; the number sent to the hospital -was one hundred and seventy-three; -and there died on board ninety-four.</p> - -<p>The proportion of those who died this -month, in relation to the whole number on -board, was one in two hundred and eighty-seven.</p> - -<p>There was a considerable increase of sickness -and mortality this month in all the -common diseases, and chiefly in that part of -the squadron which was in port. There -was less increase in the number of fevers -than either of the other two epidemics; -but such was their increased malignancy, -that more died of them than of both the -others. The number of fluxes was more -than double of what it was the preceding -<span class="pagenum" id="Page_113">113</span> -month, and the mortality from them was -also in a much greater proportion, as may -be seen from the Tables.</p> - -<p>The fevers prevailed chiefly in port, and -the fluxes at sea. A good many of the latter, -indeed, arose in the Alcide, though -constantly in port; but this seemed to be -owing to contagion conveyed by some British -soldiers, who were sent on board of -this ship after being retaken in one of the -French men of war, several of whom were -ill of this disease. But there were few -fluxes in those ships at Jamaica in which -the most malignant fevers appeared. There -were a few in those in which the fevers -arose from the air of the marshes on the -watering duty; but there were none on -board of the French prizes, nor in those -ships in which that sort of fever was -which proceeded from a similar cause, that -is, filth and animal effluvia. Upon the -whole, in those ships in which the fever -was most malignant, there the fewest fluxes -were found. -<span class="pagenum" id="Page_114">114</span></p> - -<p>Several circumstances contributed to the -increase of sickness and mortality this -month.</p> - -<p>1st. The infection, or rather the foul air, -of the French prizes, in most of which a -very bad fever broke out among the officers -and men that were sent from the ships of -our fleet to take charge of them.</p> - -<p>The discipline and internal œconomy of -the French ships of war are greatly inferior to -those of the British. Their decks are never -washed, and there is a great defect in every -point of cleanliness and order. The free -course of the air is obstructed by lumber of -every kind, and by bulkheads, which are -not taken down even in the time of battle; -and the gratings are covered night and day -with tarpaulins, even in a hot climate. -There are not even scuppers opened on the -lower deck as outlets to the water and filth, -which necessarily accumulate there, and for -which the only vent is a pipe contrived on -purpose, passing from that deck along the -ship’s side into the hold, which becomes -<span class="pagenum" id="Page_115">115</span> -thereby a common sink, inconceivably putrid -and offensive. And in addition to the -ordinary causes of corruption, there was -one peculiar to the occasion; for the blood, -the mangled limbs, and even whole bodies -of men, were cast into the orlop, or hold, -and lay there putrifying for some time. The -common sailors among the French have a -superstitious aversion to the throwing of -bodies overboard immediately after they are -killed, the friends of the deceased wishing -to reserve their remains, in order to perform -a religious ceremony over them when the -hurry and danger of the day shall be over. -When, therefore, the ballast, or other contents -of the holds of these ships, came to be -stirred, and the putrid effluvia thereby let -loose, there was then a visible increase of -sickness. For the first three weeks after the -capture, the stench proceeding from the -numbers of wounded men contributed also -to taint the air.</p> - -<p>The Ville de Paris was much more sickly -than the other prizes, not only from her being -larger, and thereby containing a greater -<span class="pagenum" id="Page_116">116</span> -mass of foul air, but by receiving the surviving -part of the crew of the Santa Monica, -one of our frigates, which had been cast -away on the Virgin Islands, and whose men -were so reduced by hardship and intemperance, -that most of them were taken ill as -soon as they came to breathe the unwholesome -air of the French prize. To whatever -cause it was owing, the fever was much more -violent here than in the other prizes, and it -generally carried men off on the third or -fourth day; and what is remarkable, the -officers were affected by it in a greater proportion -than the common men. One lieutenant, -and every warrant officer, except -the boatswain, died of it. This was a proof -that the sickliness was owing to the bad air, -and not to the intemperance and irregularity -so usual on board of prizes, which only -the common men give into; and the probable -cause of the officers being most affected -is, that they were accustomed in common to -a purer air, by living in the most clean and -airy parts of the ship. -<span class="pagenum" id="Page_117">117</span></p> - -<p>It is also remarkable, that the Ville de -Paris was healthy when taken, and had been -so ever since leaving France in March, 1781; -nor had any other of the captured ships of -the line been sickly for some time before, -except the Ardent, when she arrived at Martinico -four months before, at which time -the greater part of the crew were sent to the -hospital with fevers. This, as well as other -facts of the same kind, tends to prove, that -when men come to be much habituated to -bad air, their health is not affected by it.</p> - -<p>The French ships were purified by washing -and scraping, by fumigating daily with gunpowder -and vinegar, and by the use of wind -sails; but nothing seemed to contribute so -much to sweeten the air in them as burning -fires in the hold; for this tended both to make -the putrid matter exhale, and to carry it off, -by producing a perpetual change of air. Captain -Curgenven, who at this time commanded -the Ville de Paris, had great merit from his -very assiduous and successful endeavours in so -difficult a duty as the management and equipment -of this great ship. In consequence of -<span class="pagenum" id="Page_118">118</span> -the judicious measures taken, and the men -becoming more used to the bad air, the sickness -ceased in the course of a few weeks.</p> - -<p>In the accounts given in the tables, the -French prizes are not included, for the disorderly -state in which they were at this time -prevented my receiving regular returns: but -having made inquiry concerning the mortality -in the Ville de Paris, I found, that of -a crew of three hundred and twelve men, -there died ten in the month of May, and -there were thirty sent to the hospital, whose -cases were so unfavourable, that about one -half died. The only diseases were fevers. -The surgeon of the Ardent told me about -the same time, that one third of the crew -of that ship was ill of fevers.</p> - -<p>The second cause of the prevalence of -sickness, while the fleet was at Jamaica, -was, the watering duty, which was carried -on at Rock-fort, about three leagues from -Port Royal. It was the practice of many -of the ships to leave the water casks on shore -all night, with men to watch them; and as -<span class="pagenum" id="Page_119">119</span> -there is a land wind in the night, which -blows over some ponds and marshes, there -were hardly any of the men employed on -that duty who were not seized with a fever -of a very bad sort, of which a great many -died. The ships that followed a different -practice were somewhat longer in watering; -but this was much more than compensated -by their preserving the health and saving the -lives of their men.</p> - -<p>The land wind which blows on the shore -in the night time, is a circumstance in which -Jamaica differs from the small islands to -windward, over which the trade wind blows -without any interruption: but though this -land wind blows upon Port Royal from some -marshes at a few miles distance, it does not -seem to produce sickness, for it is a very healthy -place, and several of the ships enjoyed -as good health as in the best situations on -the windward station. The bay which forms -this harbour is bounded towards the sea by -a peninsula of a singular form, being more -than ten miles in length, and not a quarter -of a mile broad at any part. Great part of -<span class="pagenum" id="Page_120">120</span> -it is swampy and overgrown with mangroves, -and though of such small extent, we fancied -that some of the ships that lay immediately -to leeward of this part were more sickly than -those that were close to the town of Port -Royal, which stands at the very extremity of -this long peninsula upon a dry, gravelly soil.</p> - -<p>The weather this month was uniformly -dry in port; but at sea the air was moist -and hazy. Between Jamaica and Hispaniola, -where part of the squadron was left to cruise, -dead calms prevailed; and this, joined to the -moisture of the air, was probably what -caused the flux to prevail chiefly in this part -of the fleet. At Port Royal, on the contrary, -there was a strong dry breeze, which -set in every day about nine o’clock in the -morning, and blew all day so fresh, that -there was frequently danger in passing from -one ship to another in boats. This is called, -in the language of the country, the <i>fiery sea -breeze</i>, an epithet which it seems to have -got not from its absolute heat, but from the -feverish feeling which it occasions by drying -up the perspiration. It was remarked, that -<span class="pagenum" id="Page_121">121</span> -this breeze was stronger this season than had -ever been remembered; and it sometimes -even blew all night, preventing the land -breeze from taking its usual course. This -year was farther remarkable for the want of -the rains that were wont to fall in the -months of May and June. We shall have -occasion to remark hereafter, that this was -a very uncommon season also in Europe and -America. The heat, by the thermometer, -this month, on board of a ship at Port Royal, -was, in general, when lowest in the night, -at 77°, and when highest in the day, in the -shade, at 83°.</p> - -<p>There was a considerable increase of scurvy -in this month, compared with the former -months of this campaign; but very inconsiderable, -compared with what had occurred -in cruises of the same length in former years. -The last division of the fleet had been at sea -seven weeks, all but one day, when it arrived -at Port Royal; and though the scurvy had -appeared in several of the ships, it did not -prevail in any of them to a great degree, -except in the Nonsuch. Out of fourteen -<span class="pagenum" id="Page_122">122</span> -deaths which happened in the whole fleet -from this disease, in May, seven of them -were in this ship, and several were sent from -her to the hospital in the last and most desperate -stage of it. But, upon the whole, the -cases of the true sea scurvy in the fleet, in -general, were few and slight, and a great -many of those given in the reports under the -head of scurvy, were cutaneous eruptions or -ulcers, not properly to be classed with it.</p> - -<p>The cruise in the preceding year to windward -of Martinico, may be compared with -that in May of this year; for the fleet in -both cases had been at sea about the same -length of time. But the comparison is very -greatly in favour of the latter, which is most -probably to be imputed to the plentiful supply -of melasses, wine, sour krout, and essence -of malt. But no adequate reason that I -could discover can be assigned for the prevalence -of it in the Nonsuch to a degree so -much more violent than in the other ships; -and it was here farther remarkable, that it -attacked every description of men indiscriminately; -for I was assured by the officers -<span class="pagenum" id="Page_123">123</span> -and by the surgeon, that not only the helpless -and dispirited landsman was affected, but -old seamen, who had never before suffered -from it on the longest cruises. I have been -led by this, and some other facts, to suspect -that there may be something contagious in -this disease.</p> - -<h4>JUNE.</h4> - -<p>The greater part of the fleet remained at -Jamaica during this month, refitting and -watering. Twelve ships of the line were -sent to sea on the 17th, under the command -of Rear-admiral Drake, but not being able -to get to windward on account of the fresh -breezes that prevailed, they returned to Port -Royal on the 28th. Such of these ships as -were sickly, became more healthy while at -sea; but some bad fevers arose, particularly -in the Princessa; and it is a curious circumstance, -that these fevers attacked only those -men who had been on shore on the watering -duty; from which it would appear, that -something caught or imbibed, which is the -cause of the fever, lies inactive for some -<span class="pagenum" id="Page_124">124</span> -time in the constitution, some of the men -not having been affected for more than a -week after they had been at sea.</p> - -<p>The weather continued dry and windy, as -in the former month; but the heat was in -general about two degrees higher, the thermometer -varying from 79° to 84½°.</p> - -<h3><span class="smcap">Table</span>, shewing the proportional Sickness -and Mortality in June.</h3> - -<div class="table"> - -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of this Month.<br /> -B Proportion of those who died, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">11</td> - <td class="tdr">19</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">20</td> - <td class="tdr">83</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">47</td> - <td class="tdr">231</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">37</td> - <td class="tdr">97</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">6</td> - <td class="tdr">39</td> - </tr> -</table> - -<p><span class="pagenum" id="Page_125">125</span></p> - -<p>The proportion of deaths in relation to the -whole numbers on board, was one in one -hundred and thirty-eight.</p> - -<p>There was only one in thirty of the sick -sent to the hospital in the course of this -month.</p> -</div> - -<p>There was an increase both in the numbers -and fatality of fevers. This increase -was chiefly in that sort of fever which depends -on the air and climate, the greater -part of which was caught on the watering -duty. There was a diminution of those -fevers depending on infection, and the foul -air of ships, which arose in the French -prizes. The care that was taken in purifying -these ships was very effectual; for only -four died this month in the Ville de Paris, -and fewer also were sent to the hospital than -in May. The increase of the other kind of -fever was chiefly owing to there being a -greater number of ships in port, the crews -of which were employed in watering, and -partly, no doubt, to the increase of heat in -the weather. The ships in which the fevers -<span class="pagenum" id="Page_126">126</span> -were most fatal were the Monarch, the -Duke, the Torbay, and the Resolution. -The sickness in the Duke was still in a -great measure owing to the same infection -that had hitherto prevailed; for this ship -had never been cleared of the infectious -fever, for want of room at the hospital. -That which broke out in the Torbay was -also of the low infectious kind, few of them -having the symptoms of that which is peculiar -to the climate, which prevailed in the -other ships. This ship, though formerly -very subject to infectious complaints, had -been remarkably healthy for some time past; -but it would appear that there was a large -stock of latent infection, which shewed itself -from time to time.</p> - -<p>Some ships, particularly the Montague -and Royal Oak, had no increase of fevers -or other complaints, though the one lay in -port for seven, and the other for eleven -weeks, and were more or less exposed to the -causes of sickness which affected the rest of -the fleet. This is a proof, among many -others, that a particular combination of -<span class="pagenum" id="Page_127">127</span> -causes is necessary to produce a disease: no -single one, however powerful, being sufficient, -without the concurrence of others. -What seemed to be wanting here was the -predisposition requisite for the admission of -disease into the constitution; for the ships -that enjoyed this happy exemption were -such as had long-established and well-regulated -crews, accustomed to the service and -climate.</p> - -<p>There had been this month a diminution -both of the numbers and mortality of fluxes, -which is agreeable to what was before remarked, -that fevers were more apt than -fluxes to prevail in the bad air of a harbour<a id="FNanchor_16" href="#Footnote_16" class="fnanchor">16</a>. -It was also before remarked, that there were -few or no fluxes in those ships in which the -fever was most malignant; and now that the -<span class="pagenum" id="Page_128">128</span> -fever began to grow more mild in the French -prizes, the flux began to appear. In the -Barfleur, Duke, and Namur, both diseases -seemed to prevail equally; but the fevers, -though numerous, were more of the low -nervous kind than bilious or malignant; -and the fluxes chiefly attacked those who -were recovering from fevers. We may farther -remark, that these three men of war -were three-decked ships, of 90 guns, the -crews of which being more numerous, and -composed of a more mixed set of men, -were consequently subject to a greater chance -of infection, and a greater variety of complaints. -The Formidable still remained healthy -to an extraordinary degree. Some fevers -were indeed imported from the Ville de -Paris by men that had been lent to that ship, -and who were taken ill after their return. -Of these, a few of the worst cases were sent -<span class="pagenum" id="Page_129">129</span> -to the hospital, and two died on board, who, -with one that died the preceding month, -make the whole mortality of this ship, -since leaving England, amount only to the -loss of three men.</p> - -<p>There has been little or no increase of -scurvy this month; for though the numbers -put on the list appear to be greater, the -mortality is much less. It may indeed appear -a matter of surprise that there should -have been any scurvy at all, considering -that the greater part of the fleet was at anchor -all this month. But as this was the -greatest fleet that had ever visited Jamaica, -it was impossible to find fresh provisions for -the whole; and the small supply they had -did not amount to one fresh meal in a week. -Port Royal is also remote from the cultivated -part of the island, so that fruit and vegetables -were both scarce and high priced, -particularly this year, on account of the -usual rains in May and June having failed. -There was, however, an allowance of fresh -provisions and vegetables made to the sick -by public bounty; for as the hospital could -<span class="pagenum" id="Page_130">130</span> -contain but a small proportion of the sick -and wounded, an order was given for the -supply of fresh meat, fruit, and vegetables, -to the sick, and five hundred pounds of Peruvian -bark were also distributed as a public -gratuity, besides sugar, coffee, and wine.</p> - -<p>With these aids, and the various good articles -of victualling from England, the fleet -was preserved uncommonly healthy for a -West-India campaign: for though the mortality -had increased considerably during our -stay at Jamaica, yet the loss of men, upon -the whole, was small, compared with that -of other great fleets in this climate on former -occasions. The greatest squadron, next -to this, that had ever been on this station -was that under Admiral Vernon in the year -1741, at the same season. From this fleet -upwards of eleven thousand men were sent -to the hospital in the course of that and the -preceding year, of whom there died one -in seven, besides what died on board of -their own ships and in two hospital ships<a id="FNanchor_17" href="#Footnote_17" class="fnanchor">17</a>. -<span class="pagenum" id="Page_131">131</span> -The disproportion of sickness in the two -fleets will appear still greater, when it is -considered that Admiral Vernon’s contained -only fifteen thousand seamen and marines<a id="FNanchor_18" href="#Footnote_18" class="fnanchor">18</a>; -whereas that under Lord Rodney contained -twenty-two thousand. What added to the -sickness of the former was the unfortunate -expedition to Carthagena in April, 1741; -to which probably it was owing that a much -greater proportion of yellow fevers were -landed from the fleet at that time than from -ours, as appears by the papers left by Mr. -Hume, who was then surgeon of the hospital. -The hospital was then at a place called -Greenwich, on the side of the bay opposite -to Port Royal, and was very large; but it -was found to be in a situation so extremely -unhealthy, that it was soon after abandoned -and demolished, and the hospital has since -been at Port Royal.</p> - -<p>It appears by the tables, that a greater -number was put on the list under the head of -<span class="pagenum" id="Page_132">132</span> -<i>other complaints</i> in this month than the last. -This was owing to the great number of -ulcers which I have remarked to keep pace -with feverish as well as scorbutic complaints; -for when the constitution of the air is favourable -to disease, or the habit of body -prone to it, wounds and sores are found -then to be more difficult of cure. There -were twelve deaths besides those occasioned -by what have been called the three epidemics. -Of these, five perished by drowning -and other accidents, three died of ulcers, -one of wounds received in action, one of -<i>cholera morbus</i>, and one of an abscess.</p> - -<p>It has appeared that very few ships of -this numerous fleet preserved their health -while lying at anchor; and it would seem -that short and frequent cruises are very conducive -to health. It was eleven weeks from -the time that the first of our fleet came to -anchor at Jamaica till the main body of it -sailed for America on the 17th of July. -Great fleets are in time of war under the -necessity of being at one time longer at sea, -<span class="pagenum" id="Page_133">133</span> -and at another time longer in port, than is -consistent with the health of the men, the -ships being obliged to act in concert and to -co-operate with each other. This is one -reason, among others, for ships of the line -being more sickly than frigates. As ships -of war must be guided by the unavoidable -exigencies of service, it would be absurd to -consider health only; but if this were to be -the sole object of attention, a certain salutary -medium could be pointed out in dividing -the time between cruising and being in -harbour; and it is proper that this should be -known, that regard may be had to it, as far -as may be consistent with the service. I -would say, then, that in a cold climate men -ought not to be more than six weeks at sea -at one time, and need not be less than five -weeks, and that a fourth part of their time -spent in port would be sufficient to replenish -their bodies with wholesome juices. In a -warm climate men may be at sea a considerable -time longer, without contracting scurvy, -provided they have been under a course -of fresh and vegetable diet when in port. -<span class="pagenum" id="Page_134">134</span></p> - -<p>Though contagion is not so apt either to -arise or to spread in this climate as in colder -ones, there were several circumstances about -this time tending to prove that it may -exist in a hot climate. Those ships which -had their men returned to them from the -French prizes, in all of which fevers prevailed, -had an increase of sickness not only -in the men that were returned, but in the -rest of the crew. There was another presumption -of contagion, from the proportion -of mortality among the surgeons and -their mates, who were by their duty more -exposed to the breath, effluvia, and contact -of the sick. There died, during our stay -at Jamaica, three of the former, and four -of the latter, which is a greater proportion -than what died of any other class of officers -or men.</p> - -<p>It has been the opinion of some, that fevers -do not arise from any putrid <i>effluvia</i>, -except those of the living human body, or -some specific infection generated by it while -under the influence of disease. It has been -<span class="pagenum" id="Page_135">135</span> -alledged in proof of this, that the putrid -air in some great cities is breathed without -any bad effects; and a celebrated professor of -anatomy<a id="FNanchor_19" href="#Footnote_19" class="fnanchor">19</a> used to observe, that those employed -in dissecting dead bodies did not -catch acute diseases more readily than other -people. I believe this may be true, in a -climate like Europe, where cold invigorates -the body, and enables it to resist the effects -of foul air; but I am persuaded it is otherwise -in tropical climates. The external -heat of the air induces great languor and -relaxation, and we cannot breathe the same -portion of air for the same length of time -in a hot as in a cold climate, without great -uneasiness. The want of coolness must, -therefore, be compensated by a more frequent -change of air, and by its greater purity: -any foulness of the air is accordingly -more felt in a hot climate; and, according -to the modern theory, air, already loaded -with putrid phlogistic vapour, will be less -qualified to absorb the same sort of vapour -<span class="pagenum" id="Page_136">136</span> -from the blood in the lungs, in which, according -to this theory, the use of respiration -consists. Be this as it will, there is -something in purity of air which invigorates -the circulation, and refreshes the body; and -the contrary state of it depresses and debilitates, -particularly in a hot climate; and in -this way foul air may induce disease, like -any other debilitating cause, independent of -infection, or any specific quality. There -was no reason to suspect any such infection -in the Ville de Paris; for there was no -sickness on board of this ship when in possession -of the enemy, and the sickness that -prevailed after her being captured seemed to -proceed from what may be called simple putrefaction. -There was an instance of the -same kind in one of our own ships of the -line, in which a bad fever broke out in the -beginning of July, which seemed to be owing -to the foul air of a neglected hold; for -there was a putrid stench proceeding from -the pumps, which pervaded the whole ship. -I perceived this very sensibly one day, when -visiting some officers who were ill of fevers; -<span class="pagenum" id="Page_137">137</span> -and before I left the ship an alarm was given -of two men being suffocated in what is called -the <i>well</i>, which is the lowest accessible part -of the hold. This fever was of a very malignant -kind, and fell upon the officers more -than the men; for six of them were seized -with it, of whom three died on the third -day after being taken ill.</p> - -<p>The fevers, which were of the greatest -malignity at this time, affected the officers -more than the common men. Only one -captain died at Jamaica while the fleet was -there, and it was of this fever. We lost -five lieutenants, of whom four died of it; -and this was the disease which carried off -the three surgeons. But foul air was not -the only cause that produced this fever -among the officers, several of whom brought -it on by hard drinking, or fatiguing themselves -by riding or walking in the heat of -the sun. It cannot be too much inculcated -to those who visit tropical countries, that -exercise in the sun, and intemperance, are -most pernicious and fatal practices, and that -<span class="pagenum" id="Page_138">138</span> -it is in general by the one or the other -that the better sort of people, particularly -those newly arrived from Europe, shorten -their lives.</p> - -<p>Before leaving Jamaica, I sent to England -a Supplement to the Memorial given -in, last year<a id="FNanchor_20" href="#Footnote_20" class="fnanchor">20</a>. -<span class="pagenum" id="Page_139">139</span></p> - -<h2 id="BOOK_II_CHAP_V">CHAP. V.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span>, from its -leaving Jamaica on the 17th of July, till its Departure -from New York on the 25th of October.——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.</p></blockquote> - -<p>The season of the hurricanes approaching, -and all the convoys destined for England -this year being dispatched, the main -body of the fleet, consisting of twenty-four -ships of the line, left Port Royal on the -17th of July, under the command of Admiral -Pigot, in order to proceed to the coast -of America. A great convoy for England -had been sent off a few days before, protected -by the Ville de Paris and six other -ships of the line, which we overtook and -<span class="pagenum" id="Page_140">140</span> -passed at the west end of the island. When -we arrived off the Havannah, a large squadron -of the enemy was seen there in readiness -to sail, which induced the Admiral to -wait in sight of it for the convoy, which -did not come up till ten days after. Owing -to this delay, and our meeting with baffling -winds on the rest of the passage, we did not -arrive at New York till the 7th of September. -We found there the Invincible and -Warrior, which sailed after us, but arrived -before us, by having taken the windward -passage. -<span class="pagenum" id="Page_141">141</span></p> - -<h3><span class="smcap">Table</span>, shewing the proportional Prevalence -of different Diseases, and their Mortality, -in July, 1782.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">13½</td> - <td class="tdr">16</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">24</td> - <td class="tdr">49</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">91</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">20</td> - <td class="tdr">134</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">5½</td> - <td class="tdr">33</td> - </tr> -</table> - -<p>The mortality this month, in relation to -the whole numbers on board, was one in -a hundred and thirty.</p> - -<p>There were only one in thirty-eight of -the sick sent to the hospitals. -<span class="pagenum" id="Page_142">142</span></p> -</div> - -<p>The fevers arose chiefly during the first -two weeks after leaving Jamaica, which -renders it probable that the seeds of them -were brought from thence. Had they been -owing to the heat simply, they would -have been as apt to arise in some subsequent -part of the passage; for the tropical -heats at this season of the year extend to -the 30th degree of latitude, which we did -not cross till the 22d of August, that is, -near five weeks after leaving Jamaica. The -only ships in which the fever could be imputed -to infection or foul air were the Barfleur, -Alcide, and the Aimable frigate. The -first had received, as recruits, at Jamaica, -men who had been confined for some time -before in a French jail, and a fever of a -bad kind spread on board of her soon after. -The Aimable was a prize from the French; -and the sickness was here so evidently owing -to foul air, that, whenever the contents -of the hold were stirred, so as to let -loose the putrid effluvia, there was then an -evident increase of sickness. The fever in -the Alcide was of a peculiar slow kind, to -be described hereafter, and seemed to be a -<span class="pagenum" id="Page_143">143</span> -continuation of the same infection which -had so long existed in that ship.</p> - -<p>The Duke, which had hitherto been by -far the most subject to fevers of any ship -in the fleet, became more and more free -from them even in the most early part of -this passage, and might be said to be entirely -so at the time she arrived in America. -The fever had been so very prevalent in -this ship since leaving England, that there -was hardly a man who had escaped it. -Could this have any effect in making them -less liable to catch it a second time?</p> - -<p>In the course of this passage the dysenteries -came to prevail over the fevers, as we -have found to be commonly the case at sea. -It appears by the former table, compared -with the next, that the mortality in fevers -was much the same, and that in the dysentery -it was greater than while the fleet -was at Jamaica. This does not argue, however, -that the diseases were equally malignant, -but was owing to the want of an hospital, -and of those comforts of diet which -<span class="pagenum" id="Page_144">144</span> -the sick enjoyed on board while in harbour. -This last was particularly felt in the dysenteries, -in the cure of which more depends -upon diet than in most other diseases. In -all the calculations of mortality on board of -ships, if any have been sent to the hospital, -they are to be deducted from the number; -and these make a greater difference in the -mortality on board than their numbers simply -would indicate; for only the worst -cases, and those therefore who were most -likely to die, used to be sent to the hospital. -But as the fleet was at sea during the whole -of this month, no allowance of this kind is -to be made. -<span class="pagenum" id="Page_145">145</span></p> - -<h3><span class="smcap">Table</span>, shewing the proportional Sickness -and Mortality in August.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">31</td> - <td class="tdr">17</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">46</td> - <td class="tdr">35</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">25</td> - <td class="tdr">66</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">27</td> - <td class="tdr">43</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">7½</td> - <td class="tdr">31</td> - </tr> -</table> - -<p>The mortality this month, in relation to -the whole numbers on board, was one in -one hundred and sixty-nine.</p> -</div> - -<p>The scurvy began to appear very soon -upon this passage; for by the end of August, -at which time the fleet had only been -six weeks at sea, and that in a warm climate, -<span class="pagenum" id="Page_146">146</span> -and in dry weather, it had made considerable -progress. It first appeared and -prevailed most in the Prince George and -Royal Oak, though they had been ten -weeks at Jamaica. This was the first sickness -with which the latter had been affected -since arriving in the West Indies; and there -was no perceivable peculiarity in either of -them to account for their being subject to it -more early, or more violently, than the rest -of the fleet. If the disease is contagious, -as has been suspected, there might be a few -men on board of them, who, being uncommonly -prone to the disease, would be soon -affected, and communicate it, or at least -hasten the symptoms in those who might be -less predisposed to it. But this is only conjecture. -Before the end of the voyage, the -whole fleet was more or less afflicted with it, -though it had been only seven weeks and -three days at sea; but the men had received -so few refreshments while in port, that their -constitutions were prepared to fall into this -disease. The Barfleur, Alfred, and Princessa, -were most affected with it next to the two -ships mentioned above. -<span class="pagenum" id="Page_147">147</span></p> - -<p>The seventeen ships which arrived from -England in February and March were much -less affected with it than the rest of the -fleet, which was, no doubt, owing to the -wine, melasses, and sour krout, with which -they were so amply supplied. Though these -articles were all expended before leaving Jamaica, -yet the good effects of them on the -constitutions of the men were visible in the -course of this passage.</p> - -<p>The America was the most free from it of -all the ships of the old squadron; and this -was owing to the great humanity and attention -of the captain<a id="FNanchor_21" href="#Footnote_21" class="fnanchor">21</a>, who, as soon as any -of the men were taken ill, allowed them -wine and other refreshments from his private -store. There was another proof in the Conqueror -of the great importance of attending -to this disease in its earliest stage. Mr. -Lucas, the surgeon of this ship, by watching -the first beginnings of it, by a proper -regulation of diet, and the administration of -the essence of malt and juice of limes, not -<span class="pagenum" id="Page_148">148</span> -only prevented the progress of the disease, -but proved, that, with great attention, it -may even be cured at sea. It is of the utmost -consequence in this disease to put the men -on the sick list on the very first appearance of -the symptoms, so that they may early have -the advantage of proper treatment and regimen. -It is only at this period of it that the -effects of essence of malt are sensible; but -we have seen that the juice of certain fruits -will cure it in more advanced stages.</p> - -<p>There is a very important remark suggested -by comparing the two preceding tables -with that which follows. It appears -that in the month of September a much -greater number was taken ill of scurvy, and -also that there died of this disease a greater -proportion than in the two preceding months. -All the mischief from it in that month happened -in the first week of it, during which as -many died as in the whole month of August; -for the fleet came to an anchor on the 7th of -September at New York, where the worst -cases were immediately sent to the hospital, -and those that remained on board were supplied -<span class="pagenum" id="Page_149">149</span> -with every necessary refreshment. Had -the fleet remained longer at sea, the mortality -would probably have increased in the -same progression; and this circumstance -ought to be well considered in undertaking -cruises.</p> - -<h3><span class="smcap">Table</span>, shewing the proportional Prevalence -of Sickness and Mortality in September.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">49</td> - <td class="tdr">31</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">46</td> - <td class="tdr">68</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">15½</td> - <td class="tdr">39</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">68</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">62</td> - <td class="tdr">226</td> - </tr> - <tr> - <td>General Proportion,</td> - <td class="tdr">7</td> - <td class="tdr">58</td> - </tr> -</table> -<p><span class="pagenum" id="Page_150">150</span></p> - -<p>The proportion of deaths, in relation to -the whole numbers on board, was one in -three hundred and ninety-eight.</p> - -<p>About one third of all the sick were sent -to the hospital.</p> -</div> - -<p>As the proportion of ulcers was uncommonly -great, I thought it worth while to -make a calculation of it. The Barfleur had -the greatest number; and this ship, for -causes I cannot assign, was more afflicted -with bad ulcers than any other in the fleet, -for several months together.</p> - -<p>The fleet having arrived at New York in -this unhealthy state, the first care was to -make provision for the sick. There were -somewhat more than fifteen hundred on the -sick lists of all the ships, and the hospital -could accommodate little more than six hundred. -In order that it might not be overcrowded, -and that each ship might have a -just share of relief, I went round the fleet to -ascertain the due proportion of those cases -that were the most proper objects for being -<span class="pagenum" id="Page_151">151</span> -sent on shore. All the infectious and acute -Complaints, and some of the worst scorbutics, -were accordingly sent to the hospital. -Those who were kept on board being chiefly -such as were affected with the scurvy, were -supplied with various refreshments in their -respective ships, and seemed to recover as -soon as if they had been sent on shore. -They had indeed almost every advantage enjoyed -by those at the hospital; for, besides -fresh meat thrice a week, and spruce beer -daily in common with the other seamen, -each man on the sick list was supplied every -week at the public expence with four pounds -of apples and half a pound of sope. There -were also thirty casks of limes taken in a -prize, which were distributed among the -scorbutic men, and proved of infinite use. -Admiral Pigot’s great zeal for the good of -the service, as well as his natural humanity, -induced him to listen to whatever was proposed -for the benefit of the men.</p> - -<p>The supply of sope was a thing entirely -new in the service; but the good effect of -all the other articles would most probably -<span class="pagenum" id="Page_152">152</span> -have been defeated, unless the men had been -furnished with the means of cleanliness, -which is the most essential requisite of health. -The advantage of this method will appear by -the returns of next month to have been very -conspicuous; and it was on this occasion -more than any other that I saw realised in -every particular the plan proposed in the -memorial to the Admiralty. It may be -added, that the sick that were left on board -were not even without the recreation of the -shore enjoyed by those at the hospital; for -most of the captains had the attention to -send daily on shore, for amusement and exercise, -such as were able to walk. Thus -there were all the advantages of an hospital -obtained at much less expence to Government, -and without the risque of intemperance, -desertion, or infection, which are the -inconveniencies connected with an hospital. -What farther contributed to health at this -time was, a large quantity of excellent wine -with which the fleet was supplied. -<span class="pagenum" id="Page_153">153</span></p> - -<h3><span class="smcap">Table</span>, shewing the proportional Sickness -and Mortality in October.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">45</td> - <td class="tdr">250</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">61</td> - <td class="tdr">69</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">34</td> - <td class="tdr">197</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">181</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">127</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">12½</td> - <td class="tdr">196</td> - </tr> -</table> - -<p>The proportion of deaths in this month, -in relation to the whole number on board, -was only one in fourteen hundred and seventy-eight.</p> - -<p>About one in twenty-nine of the sick was -sent to the hospital. -<span class="pagenum" id="Page_154">154</span></p> -</div> - -<p>There was, upon the whole, less sickness -and mortality in this month than in any -other during which I kept records of the -fleet. This was, no doubt, owing in part -to the climate, but was chiefly the effect of -the extraordinary attention paid to the refreshments -of the men. The fleet was here -exactly in the same situation, and at the -same season, two years before, but was not -near so healthy.</p> - -<p>Nor were the advantages derived from the -great plenty of refreshments, procured at -this time at New York, merely temporary; -for the men’s constitutions were so much -improved by them, that the part of the -fleet which remained under the command of -Lord Hood was at sea for twelve weeks without -being affected by the scurvy. This was -chiefly to be ascribed to the previous refreshments; -for we have seen, that, in a passage -of seven weeks from Jamaica to New York, -the fleet was greatly affected with the scurvy, -in consequence of not having had the advantages -of fresh meat and vegetables when -last in port. The climate had, no doubt, -<span class="pagenum" id="Page_155">155</span> -also a share in keeping off the scurvy; for -the greater part of the twelve weeks was -taken up in a cruise off St. Domingo; and, -I believe, it never was known that a fleet -was so long at sea, in a cold climate, without -being greatly affected with this disease.</p> - -<p>It appears, that though the proportion of -fevers had increased somewhat this month -over that of fluxes, yet the former were less -fatal; and, I think, the true dysentery is -more frequent in this climate, and more apt -to prove fatal in its acute state, than in the -West Indies. I have indeed preferred the -term flux to that of dysentery, for this reason, -that the symptoms in many cases did -not rise so high as properly to constitute dysentery; -and the disease proves fatal in the -West Indies more frequently in the chronic -than in the acute state. The fluxes were -daily gaining ground when we left New -York, and continued to prevail to a great -degree in the Magnificent, which remained -in that climate several weeks after us. -<span class="pagenum" id="Page_156">156</span></p> - -<p>The climate and situation of the fleet had -a greater effect in diminishing ulcers than -any other complaints; for the proportion -of them in this month is little more than -one third of what it was in the last.</p> - -<p>The calculation for October was made upon -thirteen ships of the line, which sailed from -New York on the 25th of that month.</p> - -<p>The weather had then begun to grow -cold; but few or none of the diseases peculiar -to a cold climate had appeared. There -occurred, while we were at New York, -several cases of inflammation of the liver -among the officers and men who came from -the West Indies. It was remarked formerly, -that this complaint hardly ever occurred -in the West Indies; but it would -appear that the residing there disposes to an -inflammation of this organ upon changing -to a colder climate.</p> - -<p>The preceding summer had been uncommonly cold, -not only in North America, -but in the whole temperate part of the -<span class="pagenum" id="Page_157">157</span> -northern hemisphere, so far as I could learn -by inquiry. In consequence of this, the -crops failed in Europe, America, and the -northern parts of Asia. The same circumstance -had a remarkable effect on the reigning -diseases of the season at New York; -for, instead of the bilious complaints common -in the end of summer and in autumn, -a slight fever of the inflammatory kind had -prevailed. An epidemic catarrh had spread -all over Europe, and some part of Asia, in -the earlier part of the year; and perhaps -this was connected with the peculiar state -of the atmosphere about this time. It was -before observed, that there was something -unusual in the state of the weather at Jamaica -while the fleet lay there; and it is -possible that this might be owing to the -same general cause. -<span class="pagenum" id="Page_158">158</span></p> - -<h2 id="BOOK_II_CHAP_VI">CHAP. VI.</h2> - -<blockquote> - -<p>Account of the <span class="smcap">Health</span> of the <span class="smcap">Fleet</span> from its Departure -from New York till the Conclusion of the -War.——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.</p></blockquote> - -<p>Thirteen ships of the line sailed -from America for the West Indies on the -25th of October, under the command of -Admiral Pigot, and the other half of the -fleet was left under Lord Hood, to watch -the motions of the French squadron, which -was then at Boston.</p> - -<p>The day on which we left the coast of -America a storm came on, which lasted -<span class="pagenum" id="Page_159">159</span> -two days; but the rest of the passage being -fair and moderate, we arrived at Barbadoes -on the 20th of November, where -the fleet continued for the remainder of the -month.</p> - -<p>All the above-mentioned squadron, except -two ships, is comprehended in the calculation -of the following table, and also the -Magnificent, Prudent, and Nonsuch. The -two last had continued in the West Indies, -during our absence. -<span class="pagenum" id="Page_160">160</span></p> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in November.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">54</td> - <td class="tdr">25</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">78</td> - <td class="tdr">132</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">86</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">94</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">46</td> - <td class="tdr">103</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">15</td> - <td class="tdr">77</td> - </tr> -</table> - -<p>About a sixth part of the whole sick were -sent to the hospital this month, and one half -of these were sent to the hospital at Halifax -from the Magnificent.</p> - -<p>The proportion of deaths this month, in -relation to the whole number on board, was -one in eight hundred and eighty-seven. -<span class="pagenum" id="Page_161">161</span></p> -</div> - -<p>Fewer were taken ill this month than -the preceding, but more in proportion died; -which might partly be owing to the fleet -having been more at sea, and partly to the -change of climate.</p> - -<p>Fevers were now more numerous, and also -more fatal than any other disease; and we -see them follow the contrary proportion to -fluxes in the progress to the southward, that -they did in our progress to the northward. -These fevers prevailed chiefly in the Formidable -and Warrior. In the former it first -appeared among some men that had been -pressed at New York from a privateer, some -of whom were seized a few days after our -arrival at Barbadoes with the yellow fever, -and they were the only instances of it at this -time in the fleet.</p> - -<p>The scurvy continued to diminish, but -the ulcers increased as we came into the -torrid zone.</p> - -<p>Diseases in general were so slight and so -few at this time, that the whole squadron -<span class="pagenum" id="Page_162">162</span> -from America sent only forty-eight men to -the hospital at Barbadoes from its arrival to -the end of the month.</p> - -<p>It may be proper here to give an account -of some of the ships that remained on this -station, while the main body of the fleet was -in America.</p> - -<p>The Prudent, when she left us, was extremely -healthy, and continued so till a flux -broke out in July, which was communicated -by some men from a cartel, who were -ill of this disease. It spread among the ship’s -company, and prevailed for three months. -The only deaths during the seven months -that this ship was separated from the fleet -were, two from flux, and one from scurvy, -and only twenty-five were sent to hospitals. -This is a proof how much more healthy -the windward station is than that of Jamaica. -The scurvy arose at one time, in a -cruise of five weeks, though there was no -appearance of it at another time in a cruise -of six weeks. The cause of this seems to -be the difference of the weather at the two -<span class="pagenum" id="Page_163">163</span> -periods; for it was very wet in the former, -and very dry in the latter. The time in -which this ship was most exposed to sickness -was while she was under repair at Antigua, -a situation in which hardly any ship escapes -a severe visitation of sickness; yet this ship -was not at all affected by it, which seemed -to be owing to the uncommon pains taken -by the captain to prevent the men from -labouring in the sun during the hot part of -the day.</p> - -<p>The Nonsuch was five months separated -from the fleet, during which time ten men -died. Nine of these died of fevers, and one -of the dysentery. She sailed from Jamaica -for Barbadoes about the same time that the -fleet sailed for North America, and was nine -weeks on the passage. A fever was the -prevailing disease, and the men probably -inhaled the seeds of it at Jamaica, in common -with most of the other ships’ companies -that were there. The scurvy, which -had formerly prevailed so much, appeared -at this time; but it was in a very moderate -degree, considering the length of the passage. -<span class="pagenum" id="Page_164">164</span> -None died of it, and few were so ill as to require -being sent to the hospital. Had this -ship gone into a colder climate, like the -others, it would probably have prevailed -to a greater degree. The whole number -sent to the hospitals for various complaints, -during the five months, was only thirteen.</p> - -<p>The Nymph frigate was the only other -ship left in the West Indies which is included -in the tables. There happened only -two deaths in her from June to October, -both months included. One of these was -from scurvy, the other from asthma. She -was in that time upon two cruises, each of -which lasted eight weeks. During the first -the weather was dry and fine, and during -the other it was wet and sultry, with the -same effect upon health as in the Prudent; -for in the second cruise the scurvy prevailed -to a considerable degree, but not at all during -the first. This disease was prevented -from becoming violent or fatal, on either -occasion, by the great attention of Mr. Anderson, -the surgeon. He found great benefit -from the essence of malt, when given -<span class="pagenum" id="Page_165">165</span> -early in the complaint; and some limes having -been taken in a prize, while this disease -was at the worst, the scorbutic men -were so much recovered by the use of them, -that they were all able to return to duty before -the ship arrived in port. -<span class="pagenum" id="Page_166">166</span></p> - -<h4>DECEMBER.</h4> - -<p>The whole squadron remained at anchor -at Barbadoes, and nothing worth notice occurred -till the arrival of a reinforcement of -eight ships of the line, under Sir Richard -Hughes, on the 8th of December. This -squadron had been detached by Lord Howe, -after the relief of Gibraltar, and the action -with the combined fleets on the 20th of -October. It consisted of one ship of 90 -guns, one of 80, three of 74, and three of -64. They sailed from England on the 9th -of September, and from that time till their -arrival at Barbadoes they had not been in -port, except for ten days that they were at -Madeira, where they were supplied with -fresh meat, fruit, and vegetables, by which -means the scurvy, which had begun to prevail -to a considerable degree, was almost entirely -eradicated, and the health of the men -was surprisingly restored, for so short a time.</p> - -<p>When they joined us, however, there was -a good deal of sickness on board of them all, -<span class="pagenum" id="Page_167">167</span> -except the Union and Ruby. The former -had been more than three years in commission, -and in that time had never been sickly, -and had now all the advantages of a long-established -and well-regulated ship’s company. -All the rest had been newly commissioned -and manned when they left England. -The superior health of the Ruby was owing -to her having been manned with the -crews of other ships, some of which had -just arrived from the West Indies; whereas -the others had been manned chiefly by -draughts of pressed men from guardships, -or by raw volunteers, of whom a great -many were raised in Ireland about this time. -The Bellona and Berwick having been somewhat -longer in commission than the rest, -were less sickly.</p> - -<p>The following tables will shew the comparative -state of health of the squadron formerly -on the station with that which had -newly arrived from England. -<span class="pagenum" id="Page_168">168</span></p> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the old Squadron, -in December.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">32</td> - <td class="tdr">80</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">94</td> - <td class="tdr">99</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">62</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">64</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">57</td> - <td class="tdr">71</td> - </tr> - <tr> - <td>General Proportion,</td> - <td class="tdr">11½</td> - <td class="tdr">124</td> - </tr> -</table> - -<p>The proportion of the deaths this month -to the whole number of men belonging to -this part of the fleet, was one in eleven hundred -and two. There were fifty-six sent to -the hospital, which was one in eighteen of -all the sick. -<span class="pagenum" id="Page_169">169</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the new Squadron, -in December.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">11</td> - <td class="tdr">55</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">86</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">107</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">191</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">56</td> - <td class="tdr">54</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">5</td> - <td class="tdr">64</td> - </tr> -</table> - -<p>The proportion of the deaths this month -to the whole number of men belonging to -this part of the fleet, was one in four hundred -and forty. -<span class="pagenum" id="Page_170">170</span></p> -</div> - -<p>There were one hundred and eighty-nine -sent to the hospital; but the proportion to -the whole number of sick cannot be ascertained, -as we do not know how many were -on the list on the first of the month.</p> - -<p>The increase of fevers in the old squadron -was chiefly owing to their having spread in -the Nonsuch; and they seemed to partake -more of that kind which originates in jails -and ships, than of that which is peculiar to -the climate. The body of one of the men -who died of this fever was inspected at the -hospital, and there was found to be inflammation -and even perforation of the intestines, -without any previous symptom that -could lead to expect such an appearance, a -circumstance more likely to happen in the -former sort of fever than the latter.</p> - -<p>The increase of scurvy was owing to the -numbers that were taken ill of it in the -Magnificent on the passage from Halifax, -from whence she sailed in the beginning of -this month, and joined the fleet at Barbadoes -in the end of it. There was a great deal of -<span class="pagenum" id="Page_171">171</span> -sickness in this ship at Halifax, and on the -passage, owing to the want of such clothing -as was suitable to that severe climate. One -of the principal complaints was an inflammatory -sore throat.</p> - -<p>There was no change in the situation of -the fleet, only that four ships of the line -were sent on the 16th to cruise near Guadaloupe, -and they continued at sea till the -beginning of February.</p> - -<p>The new squadron was much afflicted -with the jail fever, brought from England; -and it was much more prevalent, as well as -malignant, on board of the Suffolk than any -of the rest. During the passage it prevailed -most in the Princess Amelia, not less than -twenty having died of it. It subsided in this -ship before she arrived in the West Indies; -but on board of the Suffolk it continued to -rage for some months after.</p> - -<p>As the hospital at Barbadoes was too small -to contain all the sick of this squadron, only -the cases of greatest danger and the most infectious -<span class="pagenum" id="Page_172">172</span> -were sent on shore, and those that -remained were provided with fresh vegetables -and milk on board of their own ships, in the -same manner as had been formerly practised -with such success on similar occasions. This -was continued for four weeks, during which -time they all got into tolerable health, except -the Suffolk.</p> - -<p>There appeared, by the returns of the -new squadron, to be a greater number under -the head of “Other Complaints,” which -was owing to the number of pulmonic complaints, -the consequence of the influenza -which prevailed in Europe, at sea, as well -as on shore, in the spring and beginning of -the summer of this year.</p> - -<p>Though inflammatory complaints are rare -in this climate, yet in a few of the ships -there was some appearance of them; and I -remarked that they occurred in those ships -which were in other respects most healthy, -and most free from infection. A good many -of the men were seized with inflammatory -sore throats in the Bellona a few days before -<span class="pagenum" id="Page_173">173</span> -she arrived at Barbadoes, and this was in -other respects the most healthy ship next to -the Union and Ruby. In the Union there -was no violent acute complaint whatever, -which was very singular among so great a -body of men; but several rheumatisms, -coughs, and catarrhs, arose in her this month, -and there even occurred two pleurisies in the -following month. The bowel complaints -which occurred on board of this ship were -also of an inflammatory nature. These distempers -seemed to proceed from accidental -exposure and irregularity; and is it not -highly probable that these causes, instead of -producing local inflammatory complaints, -might have been the means of exciting bad -fevers and fluxes, as in the other ships, had -the men been equally predisposed to them, -by living in foul air, or under the influence -of infection?</p> - -<p>The following tables will shew the comparative -state of health of the two squadrons -in the three first months of next year. -<span class="pagenum" id="Page_174">174</span></p> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the old Squadron in January, -1783.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">67</td> - <td class="tdr">70</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">157</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">44</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">48</td> - <td class="tdr">117</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">12½</td> - <td class="tdr">214</td> - </tr> -</table> - -<p>The mortality this month, in relation to -the whole number on board, was one in -twelve hundred and fifty-seven. About one -fifteenth of all the sick were sent to the -hospital. -<span class="pagenum" id="Page_175">175</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the new Squadron in -January, 1783.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">12</td> - <td class="tdr">48</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">29</td> - <td class="tdr">153</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">320</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">137</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">19</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">5½</td> - <td class="tdr">109</td> - </tr> -</table> - -<p>The proportion of deaths to the whole -number on board was one in five hundred -and forty. About one in thirty of all the -sick were sent to the hospital. -<span class="pagenum" id="Page_176">176</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the old Squadron in -February.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">46</td> - <td class="tdr">69</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">159</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">63</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">100</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">51</td> - <td class="tdr">136</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">13½</td> - <td class="tdr">173</td> - </tr> -</table> - -<p>The proportion of deaths to the whole -number on board was one in sixteen hundred -and ninety-seven. One ninth of all the -sick were sent to the hospital. -<span class="pagenum" id="Page_177">177</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the new Squadron in -February.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">30</td> - <td class="tdr">50</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">34</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">212</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">174</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">52</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">11</td> - <td class="tdr">185</td> - </tr> -</table> - -<p>The proportion of deaths to the whole -number was one in twelve hundred and seventy-six. -The proportion sent to the hospital -was the same this month as in the other -part of the squadron. -<span class="pagenum" id="Page_178">178</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the old Squadron, -in March.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">28</td> - <td class="tdr">12½</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">71</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">46</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">226</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">76</td> - <td class="tdr">44</td> - </tr> - <tr> - <td>General Proportion,</td> - <td class="tdr">11</td> - <td class="tdr">194</td> - </tr> -</table> - -<p>The proportion of deaths to the whole -number was one in thirteen hundred and -sixty-one. About one ninth of all the sick -were sent to the hospital. -<span class="pagenum" id="Page_179">179</span></p> -</div> - -<h3><span class="smcap">Table</span>, shewing the Prevalence of Sickness -and Mortality in the new Squadron, -in March.</h3> - -<div class="table"> -<p> -Transcriber’s Keys:<br /> -A Proportion of those taken ill in the Course of the Month.<br /> -B Proportion of Deaths, in relation to the Numbers of the Sick.</p> - -<table class="bbox"> - <tr> - <th rowspan="2">DISEASES.</th> - <th>A</th> - <th>B</th> - </tr> - <tr> - <th colspan="2">ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">44</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">49</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">123</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">183</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">38</td> - <td class="tdr">138</td> - </tr> - <tr> - <td>General Proportion</td> - <td class="tdr">12</td> - <td class="tdr">403</td> - </tr> -</table> - -<p>The proportion of deaths to the whole -number was one in four thousand and eighty-seven. -About one in eleven of all the -sick were sent to the hospital. -<span class="pagenum" id="Page_180">180</span></p> -</div> - -<p>The main body of the fleet remained at -Barbadoes till the 12th of January, when -they went to cruise to windward of Martinico, -in order to intercept a French squadron -expected from North America. This -cruise lasted four weeks; and intelligence -being received of the enemy’s having taken -a different route, the whole fleet bore away -for St. Lucia, where it came to an anchor -on the 8th of February.</p> - -<p>In the course of the three months above -mentioned, we see the two squadrons approaching -to each other, in point of health, -till they became pretty equal and similar; -and the new squadron became even somewhat -more healthy than the old.</p> - -<p>The increase of fevers in the old squadron -was owing to two causes. One was the importation -of new-raised recruits brought -from England by some ships that arrived in -the beginning of January. These were distributed -to such ships as stood most in need -of men; and being very dirty and ill cloathed, -were likely to harbour infection. They -<span class="pagenum" id="Page_181">181</span> -were evidently the cause of sickness in the -Warrior and Royal Oak; for these ships -were before that time healthy, and the fever -began with these strangers, and spread -amongst the former crew. It is remarkable -that the ships that brought them from England -were not affected by them.</p> - -<p>It was caught in the Royal Oak from six -men that came from England in the Anson, -which men, though first put on board the -Namur, communicated no fever there, having -been kept separate from the rest of the -men; but being sent to the Royal Oak, -they were themselves first taken ill with a -fever, which afterwards spread to about -thirty of the other men. What was singular -in this fever was, that the eyes and skin -of all that were affected by it became yellow, -though without any particular malignancy; -for only two died on board, and one -in the hospital. There was one whose skin -was very yellow, yet his complaint was so -slight as never to confine him to his bed. -<span class="pagenum" id="Page_182">182</span></p> - -<p>The other cause of the increased proportion -of fevers in the old squadron was, the -great number of these complaints that arose -in the Magnificent. This ship having been -sent on a cruise about the middle of February, -and the weather being rainy, squally, -and uncommonly cold, for the climate, -many fevers of the inflammatory kind appeared. -During this cruise she made prize -of a large French frigate, called the Concord, -and the greater part of the prisoners -being taken on board, the fever from that -time assumed a different type, with new and -uncommon symptoms; for, instead of being -inflammatory and requiring bleeding, as before, -it became more of a low, putrid kind, -and was attended in most cases, if not in all, -with a continual sweating; so that, instead -of evacuations, the remedies that were found -most effectual were the Peruvian bark, blisters, -and opium. Thus we see fevers variously -modified according to men’s constitutions, -the state of the air, and the noxious -<i>effluvia</i> of the strangers that intermix with -them. -<span class="pagenum" id="Page_183">183</span></p> - -<p>We find the proportion of fluxes increasing -in the new squadron in January and -February, as they had formerly done in most -of the ships soon after their arrival from -England. They were observed also to prevail -principally in those ships that had formerly -been most subject to fevers, and not -to arise till the fever had subsided. They -were found, for instance, to arise later in -the Suffolk, where the fever was obstinate -and malignant, than in the Princess Amelia, -where the fever had been at one time general -and fatal, but not so violent and lasting -as in the other.</p> - -<p>The four ships that were sent to cruise -near Guadaloupe continued at sea for seven -weeks; and it was owing to the prevalence -of scurvy in these and in the Magnificent -that the proportion of that disease was -greater at this time in the old than in the -new squadron.</p> - -<p>The fleet remained at St. Lucia till the -accounts of the peace arrived in the beginning -of April. The service was then at an -<span class="pagenum" id="Page_184">184</span> -end, and I returned to England with the -first division of the fleet, which sailed from -St. Lucia on the 12th of April, under the -command of Rear-admiral Sir Francis -Drake, who was at this time in extremely -bad health, and requested me to accompany -him. -<span class="pagenum" id="Page_185">185</span></p> - -<p class="ph1" id="PART_I_BOOK_III">PART I.<br /> - -<span class="x-large" id="BOOK_III">BOOK III.</span><br /> - -<span class="medium">Of the Numbers and Mortality of different -Diseases sent to Hospitals.</span></p> - -<h2 id="BOOK_III_CHAP_I">CHAP. I.</h2> - -<blockquote> - -<p>Hospital at Gibraltar, 1780—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.</p></blockquote> - -<p>In order to judge of the loss sustained by -disease, in the course of that service of which -a relation has been attempted, the sick sent -to the hospitals must be taken into account. -I shall, therefore, give a short view of the -different diseases admitted, and their mortality, -at the several hospitals connected with -the fleets in which I served. This will -serve also to illustrate the different effects -<span class="pagenum" id="Page_186">186</span> -that different situations have upon the health -and recovery of men<a id="FNanchor_22" href="#Footnote_22" class="fnanchor">22</a>.</p> - -<p>The fleet which effected the first relief of -Gibraltar, under the command of Lord -Rodney, consisting of twenty ships of the -line, arrived there in the third week of January, -1780, after a passage of three weeks -and a few days from England, in which -they had an action with the Spanish fleet, -and obtained a victory over them, on the -16th of that month. The whole fleet, except -one ship, sailed from Gibraltar on the -13th of February, and while it lay there, -the diseases sent to the hospital, and their -respective mortality, were as follows<a id="FNanchor_23" href="#Footnote_23" class="fnanchor">23</a>: -<span class="pagenum" id="Page_187">187</span></p> - -<div class="table"> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>ONE IN</small></th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">622</td> - <td class="tdr">65</td> - <td class="tdr">9½</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">17</td> - <td class="tdr">0</td> - <td class="tdr">0</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">13</td> - <td class="tdr">1</td> - <td class="tdr">13</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">20</td> - <td class="tdr">3</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>Wounds</td> - <td class="tdr">29</td> - <td class="tdr">9</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">12</td> - <td class="tdr">3</td> - <td class="tdr">4</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">713</td> - <td class="tdr">79</td> - <td class="tdr">9</td> - </tr> -</table> - -<p><a id="FNanchor_24" href="#Footnote_24" class="fnanchor">24</a>This comprehends not only the deaths -in the time the fleet remained there, but all -that happened afterwards. The mortality, -<span class="pagenum" id="Page_188">188</span> -from wounds and ulcers, is greater than -might be expected in so fine a climate, and -at the coolest season of the year; but as the -place was then besieged, the sick and wounded -could not be supplied with those refreshments -that were necessary to the recovery of -the men, and wounds and ulcers are complaints -very apt to be affected by the quality -of the diet. -<span class="pagenum" id="Page_189">189</span></p> -</div> - -<p>The following is an Account of the Men -admitted at the Hospital at Barbadoes in -the Campaign of 1780, that is, from the -16th of March till the end of June:</p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>ONE IN</small></th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">277</td> - <td class="tdr">43</td> - <td class="tdr">6½</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">70</td> - <td class="tdr">22</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">199</td> - <td class="tdr">47</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">92</td> - <td class="tdr">16</td> - <td class="tdr">5½</td> - </tr> - <tr> - <td>Wounds</td> - <td class="tdr">167</td> - <td class="tdr">61</td> - <td class="tdr">2½</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">129</td> - <td class="tdr">23</td> - <td class="tdr">5½</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">943</td> - <td class="tdr">212</td> - <td class="tdr">4½</td> - </tr> -</table> - -<p>The fevers were chiefly from the five line-of-battle -ships that came immediately from -Europe in March. Upon their arrival they -sent on shore one hundred and ninety-three -<span class="pagenum" id="Page_190">190</span> -men ill of fevers, only one with the flux, -fifteen with the scurvy, and five with ulcers.</p> - -<p>When these ships returned to Barbadoes -in May, along with the rest of the fleet, -the greater part of the sick were then also -on board of them. By that time the flux -and scurvy had broke out. The former -prevailed chiefly in the Terrible; the latter -in the Intrepid. That part of the fleet -which we found on the station sent on shore -a very small proportion of all the classes of -complaints, except wounds.</p> - -<p>Of the wounds, nineteen were amputations, -of which there died nine, mostly of the -locked jaw. There were forty-six scorched -by gunpowder, of whom there died fourteen; -so that, besides those who were killed -outright, and those who died on board in -consequence of accidents of this kind, before -they could be sent to an hospital, about one -fourth of all the wounds, and the same proportion -of all the deaths from wounds, at -the hospital, was owing to this cause. This -circumstance ought to induce commanders -<span class="pagenum" id="Page_191">191</span> -to take every precaution to prevent such accidents. -In the subsequent part of the war -they were less frequent, in consequence of -that greater caution, and more accurate method -of working great guns, which were -acquired by practice and experience<a id="FNanchor_25" href="#Footnote_25" class="fnanchor">25</a>.</p> - -<p>In the account of the mortality, I have -included only such as died before the 1st of -January, 1781; for if any were carried off -after that time, it was most probably by -some incidental complaint. There were sixty-five -of them at that time remaining, and -they were chiefly men disabled by lameness -waiting for a passage to England as invalids.</p> - -<p>Out of the twenty-three that were killed -by the fall of the house in the hurricane on -the 10th of October, eight were of the number -above accounted for; but these are not -included in any of the classes of deaths.</p> - -<p>The mortality among the men admitted -at this time was greater than what occurred -<span class="pagenum" id="Page_192">192</span> -afterwards in any of the hospitals that I attended, -except that at Jamaica. The principal -cause of this was, that as the fleet was -so much greater than had ever been known -here before, there was not suitable accommodation -for such numbers as it was necessary -to send on shore, and we had not then -fallen on the method of supplying refreshments -to the men on board of their ships. -The circumstance by which the men suffered -most was, the great crowding which -the want of room made necessary. There is -here no public building appropriated for an -hospital; so that this, as well as every thing -else, being found by contract, and the number -of sick being so much greater than it -was usual to provide for, the whole was at -this time conducted in a manner not very -regular.</p> - -<p>It appears that the greatest mortality in -any class of disease was that of the fluxes, -of which the greatest number sent to hospitals -are such as have languished for some -time under this disease, in which state it -<span class="pagenum" id="Page_193">193</span> -generally proves fatal in the West Indies, in -consequence of incurable ulcers in the great -intestines, to which the heat of the climate, -as well as the scorbutic habit and sea diet, is -particularly unfavourable. But the whole -of the mischief arising from it does not appear -in the table; for it was the most apt of -any disease to supervene upon other complaints -which were under cure at the hospital. -It more particularly attacked those -who were recovering from the scurvy, and -was the cause of the greater number of -deaths under this head in the table. It was -found to be more contagious than fevers, -either because the men’s constitutions were -more predisposed to it, or, perhaps, because -the infectious matter of it being more gross -and less volatile, it is not so readily dissipated -by the heat of the climate; for, either from -this, or some other circumstance, infectious -fevers are not so easily generated, nor so apt -to spread, as in Europe. That these fluxes -were owing to infection may be inferred -from hence, that, when men ill of the -scurvy were cured on board of the ships -<span class="pagenum" id="Page_194">194</span> -they belonged to, they were not liable to -this disease, neither did they prevail at these -hospitals afterwards, when great care was -taken to separate infectious diseases from the -others.</p> - -<p>The only regular hospital on this station -is that at Antigua. This island being the -seat of the royal dock yard, there is an established -hospital in time of peace as well as -war. It so happened, that great fleets never -came here to put their sick and wounded on -shore, as at Barbadoes; so that the greater -number of those received into it were from -single ships that came to careen. As there -was, therefore, less necessity for crowding, -and as the slighter cases could be admitted, -there was a less proportion of deaths here -than at most of the other hospitals.</p> - -<p>There were two other establishments for -the reception of the sick and wounded on -this station, but they were only temporary. -These were at St. Lucia and St. Christopher’s, -where the men being received in -<span class="pagenum" id="Page_195">195</span> -great numbers at a time from large fleets, -and as there were accommodations only for -the most urgent cases, the mortality approached -more nearly to that of Barbadoes. -There died at St. Christopher’s, in the years -1780 and 1781, in the proportion of one in -six, and at St. Lucia, in the same time, one -in five and a half, or two in eleven. The -air of the hospital at St. Lucia was remarkably -pure, and this degree of mortality was -owing to the sick having been accommodated -in tents and huts. In the two last -years of the war, when an hospital was -built, and regularly established, the mortality -was not much above one half of this.</p> - -<p>Some authors have endeavoured to form -an estimate of the success of practice from -the different rates of mortality; but this is -extremely fallacious; for the fatality of diseases -will depend on their violence, the proportion -of deaths being very different in -cases that are slight, from what it is in those -that are dangerous. We shall take a view, -however, of the hospital at Barbadoes at -<span class="pagenum" id="Page_196">196</span> -another period, in which there seemed little -or no difference in the violence of the disease, -and when the superior success seemed -to be owing to the hospital’s not being so -crowded, and to the better attendance and -treatment of the sick. The following is a -view of the diseases that were admitted in -the last three months of the year 1782, -the greater part of which were landed from -the reinforcement of eight ships of the line -that joined the fleet at Barbadoes in the beginning -of December: -<span class="pagenum" id="Page_197">197</span></p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th colspan="2">Proportion.</th> - </tr> - <tr> - <th /> - <th /> - <th /> - <th>NEARLY</th> - <th>ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">224</td> - <td class="tdr">29</td> - <td class="tdr">8</td> - <td /> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">17</td> - <td class="tdr">6</td> - <td class="tdr">3</td> - <td /> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">50</td> - <td class="tdr">5</td> - <td /> - <td class="tdr">10</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">25</td> - <td class="tdr">10</td> - <td /> - <td class="tdr">2½</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">46</td> - <td class="tdr">8</td> - <td class="tdr">6</td> - <td /> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">362</td> - <td class="tdr">58</td> - <td class="tdr">6</td> - <td /> - </tr> -</table> - -<p>It happened on this, as on the former occasion, -that none were sent on shore but -such as were very ill, or had contagious -complaints, the rest being provided with refreshments -on board of their ships. There -were no wounds at this time, but there was -a greater proportion of fevers; so that the -complaints, upon the whole, might be said -to be about equally dangerous. The mortality -now was, however, considerably less, -and this is to be imputed to the more favourable -situation of the hospital, which I -<span class="pagenum" id="Page_198">198</span> -did not allow to be overcrowded; and the -men had all manner of justice done them in -point of attendance and accommodation.</p> - -<p>I shall give another example of the same -kind in the hospital at Jamaica, when our -fleet went there after the battle of the 12th -of April. All the men accounted for here -were landed from the fleet under Lord Rodney -in May, June, and July, 1782<a id="FNanchor_26" href="#Footnote_26" class="fnanchor">26</a>.</p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">224</td> - <td class="tdr">71</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">65</td> - <td class="tdr">23</td> - <td class="tdr">3</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">48</td> - <td class="tdr">10</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">92</td> - <td class="tdr">21</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Wounds</td> - <td class="tdr">70</td> - <td class="tdr">18</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">40</td> - <td class="tdr">18</td> - <td class="tdr">2</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">539</td> - <td class="tdr">161</td> - <td class="tdr">3½</td> - </tr> -</table> -<p><span class="pagenum" id="Page_199">199</span></p> - -<p>This uncommon degree of mortality was -not owing to the bad air of the place, for -Port Royal is naturally as healthy as most -parts in that climate; nor was it owing to -bad accommodations, or to neglect of any -kind; but is imputable entirely to this circumstance, -that the hospital being extremely -<span class="pagenum" id="Page_200">200</span> -small, those only were sent to it who were -very ill. There were at this time upwards -of forty ships of the line at Jamaica, and an -hospital, containing only three hundred -beds, could afford but a very inadequate -relief. Some officers are unwilling that any -man should die on board of their ships, for -fear of dispiriting the others; and many -were sent to the hospital, in the most desperate -stage of sickness, that they might -there die.</p> - -<p>There cannot be a stronger proof than -this of the fallacy of judging of the success -of practice by the proportion of the deaths; -for the sick on this occasion were better accommodated, -better provided for in every -respect, and as regularly attended, as at any -other period of my service in the West Indies, -yet the mortality was greater than at -any other time.</p> - -<p>Having given instances of the common -rate of mortality in hospitals in Europe and -the West Indies, I shall next give examples -of the success we had in North America, -<span class="pagenum" id="Page_201">201</span> -when the fleet was there in the autumns of -1780 and 1782.</p> - -<p class="hang"><span class="smcap">Account</span> of the Sick landed at New York -from the West-India Fleet, consisting of -eleven Ships of the Line, in Autumn, -1780.</p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">34</td> - <td class="tdr">9</td> - <td class="tdr">4</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">229</td> - <td class="tdr">27</td> - <td class="tdr">9</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">433</td> - <td class="tdr">40</td> - <td class="tdr">11</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">47</td> - <td class="tdr">8</td> - <td class="tdr">6</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">82</td> - <td class="tdr">10</td> - <td class="tdr">8</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">825</td> - <td class="tdr">94</td> - <td class="tdr">9</td> - </tr> -</table> -<p><span class="pagenum" id="Page_202">202</span></p> - -<p class="hang"><span class="smcap">Account</span> of the Sick landed at New York -from the West-India Fleet, consisting of -twenty-six Ships of the Line, in Autumn, -1782.</p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">104</td> - <td class="tdr">14</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">131</td> - <td class="tdr">14</td> - <td class="tdr">9</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">617</td> - <td class="tdr">30</td> - <td class="tdr">20</td> - </tr> - <tr> - <td>Ulcers</td> - <td class="tdr">74</td> - <td class="tdr">10</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">70</td> - <td class="tdr">4</td> - <td class="tdr">17</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">996</td> - <td class="tdr">72</td> - <td class="tdr">14</td> - </tr> -</table> - -<p>The difference of mortality here, from -what occurred in the West Indies, is partly -imputable to climate, and partly to the -smaller number of acute diseases. In the -two accounts last stated, the difference in -<span class="pagenum" id="Page_203">203</span> -favour of the latter seemed chiefly to arise -from the superior attention to the sick, and -the better treatment of them. It was mentioned -before, that in autumn, 1782, at -New York, they were better supplied, both -at hospitals and on board of their ships, -with every thing that could be wished, and -that on this occasion almost every scheme I -had proposed was realised. The extraordinary -success in the scurvy was owing to the -great quantities of vegetables that were supplied; -for several fields of cabbages had -been planted in the neighbourhood of the -hospital for the use of the sick. This was -owing to the humane attention of Admiral -Digby, who had also caused cows to be -purchased to supply the hospital with milk. -Cleanliness, and the separation of diseases, -were also strictly attended to; and I am -persuaded that many of the scorbutic men -were saved by keeping them separated from -the fevers and fluxes; for it has been observed, -that men ill of the scurvy, or recovering -from it, are very apt to be infected, -particularly with the flux. -<span class="pagenum" id="Page_204">204</span></p> - -<p>It appears, that the disease in which climate -makes the greatest difference is the -flux. It was observable, that though the -dysentery at this time was more fatal on -board of the ships at New York than in -the West Indies, yet it was less so at -the hospital. The cause of this seems to -be, that the acute state of this disease, of -which men die on board before there is -time to remove them to an hospital, is more -fatal in a cold climate; but when it becomes -more protracted, which is the case -with most of the cases sent to hospitals, -they then do much better in a cold than in -a hot climate.</p> - -<p>I shall here subjoin an account of the -numbers that were admitted, and died, during -the whole war, at the hospitals of the -different parts at which the fleets I was -connected with touched. -<span class="pagenum" id="Page_205">205</span></p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br /><small>NEARLY<br />ONE IN</small></th> - </tr> - <tr> - <td>At Gibraltar</td> - <td class="tdr">2131</td> - <td class="tdr">203</td> - <td class="tdr">10</td> - </tr> - <tr> - <td>Barbadoes</td> - <td class="tdr">4604</td> - <td class="tdr">861</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Antigua</td> - <td class="tdr">6099</td> - <td class="tdr">914</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>St. Lucia</td> - <td class="tdr">3363</td> - <td class="tdr">478</td> - <td class="tdr">7</td> - </tr> - <tr> - <td>St. Christopher’s</td> - <td class="tdr">853</td> - <td class="tdr">142</td> - <td class="tdr">6</td> - </tr> - <tr> - <td>Jamaica</td> - <td class="tdr">10088</td> - <td class="tdr">1672</td> - <td class="tdr">6</td> - </tr> - <tr> - <td>New York</td> - <td class="tdr">17880</td> - <td class="tdr">2179</td> - <td class="tdr">7½</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">45018</td> - <td class="tdr">6449</td> - <td class="tdr">7</td> - </tr> -</table> - -<p>I have been able to calculate the numbers -of deaths from disease in this great fleet, -both on board and at hospitals, during the -period of my own service, which was three -years and three months, and they amounted -to three thousand two hundred<a id="FNanchor_27" href="#Footnote_27" class="fnanchor">27</a> independent -<span class="pagenum" id="Page_206">206</span> -of those that were killed and died of -wounds.</p> - -<p>There died of disease in the fleet I belonged -to, from July, 1780, to July, 1781, -about one man in eight, including both -those who died on board and at hospitals<a id="FNanchor_28" href="#Footnote_28" class="fnanchor">28</a>. -But the annual mortality in the West-India -fleet, during the last year of the war, that -is, from March, 1782, to March, 1783, -was not quite one in twenty<a id="FNanchor_29" href="#Footnote_29" class="fnanchor">29</a>. This difference -was partly owing to the general increase -of health in fleets as a war advances, -partly to some improvements in victualling, -and partly to better accommodations as well -as regulations in what related to the care of -the sick. -<span class="pagenum" id="Page_207">207</span></p> - -<p>Though the mortality in fleets in the -West Indies is, upon the whole, greater than -in Europe, yet it has so happened, that, in -the late war, the fleet at home has, at particular -periods, been considerably more sickly -than that in the West Indies was at any one -time. I was informed by Dr. Lind, that, -when the grand fleet arrived at Portsmouth -in November, 1779, a tenth part of all the -men were sent to the hospital. It appears<a id="FNanchor_30" href="#Footnote_30" class="fnanchor">30</a>, -<span class="pagenum" id="Page_208">208</span> -that in the years 1780 and 1781, a period at -which the fleet in the West Indies was most -sickly, the medium of the numbers on the -sick list was one in fifteen, and many of -these were very slight complaints; whereas, -in the fleet alluded to in England, the diseases -were mostly fevers, and so ill as actually -to be sent to the hospital. It appears -likewise, that there was the greatest proportion -of sick in our fleet when it was on the -coast of America in September, 1780<a id="FNanchor_31" href="#Footnote_31" class="fnanchor">31</a>. -This difference is owing to the greater prevalence -of the ship fever, and of the scurvy, -in a cold than in a hot climate.</p> - -<p>With regard to the mortality at hospitals, -the comparison is greatly in favour of those -in England. This is owing to the greater -regularity, and the better accommodation -and diet, which an hospital at home admits -of, as well as to the difference of climate. It -has also been mentioned, that, on most occasions, -the hospitals I attended abroad were so -limited as to contain only the worst cases, in -consequence of which there would of course -<span class="pagenum" id="Page_209">209</span> -be a greater proportional mortality than in -the great hospitals of England.</p> - -<p>The following is an account of the whole -loss of lives from disease, and by the enemy<a id="FNanchor_32" href="#Footnote_32" class="fnanchor">32</a>, -in three years and three months, in -the fleets and hospitals with which I was -connected:</p> - -<table> - <tr> - <td>Died of disease<a id="FNanchor_33" href="#Footnote_33" class="fnanchor">33</a></td> - <td class="tdr">3200</td> - </tr> - <tr> - <td>Killed in battle</td> - <td class="tdr">648</td> - </tr> - <tr> - <td>Died of wounds</td> - <td class="tdr">500</td> - </tr> - <tr> - <td class="tdc">Total<a id="FNanchor_34" href="#Footnote_34" class="fnanchor">34</a></td> - <td class="bt tdr">4348</td> - </tr> -</table> -<p><span class="pagenum" id="Page_210">210</span></p> - -<p><span class="pagenum" id="Page_211">211</span></p> - -<p class="ph1" id="PART_II">PART II.<br /> - -<span class="small smcap">of the</span><br /> -<span class="x-large">CAUSES of SICKNESS in FLEETS,</span><br /> -<span class="small">and the</span><br /> -<span class="large">MEANS of PREVENTION.</span></p> - -<h2 id="PART_II_INTRODUCTION">INTRODUCTION.</h2> - -<p>In the year 1780 I printed a small treatise -for the use of the fleet, containing general -rules for the prevention of sickness; -and this part of the work is chiefly taken -from it.</p> - -<p>My own opportunities of experience, as -exhibited in the preceding Part, have been -sufficiently extensive to suggest many observations -on this subject; but as my object is -utility, rather than the praise of originality, -I shall not confine myself to these. Great -<span class="pagenum" id="Page_212">212</span> -part of what is to be advanced is taken from -books<a id="FNanchor_35" href="#Footnote_35" class="fnanchor">35</a> and conversation, as well as my own -experience, my design being to exhibit a -concise view of all the discoveries on this -subject that have come to my knowledge. -I have assumed nothing, however, from -mere report or testimony, having had opportunities, -from my own observations, of -verifying or disproving the assertions of -others.</p> - -<p>More may be done towards the preservation -of the health and lives of seamen than -is commonly imagined; and it is a matter -not only of humanity and duty, but of interest -and policy.</p> - -<p>Towards the forming of a seaman a sort -of education is necessary, consisting in an -habitual practice in the exercise of his profession -from an early period of life; so that -<span class="pagenum" id="Page_213">213</span> -if our stock of mariners should come to be -exhausted or diminished, this would be a -loss that could not be repaired by the most -flourishing state of the public finances; for -money would avail nothing to the public -defence without a sufficient number of able -and healthy men, which are the real resources -of a state, and the true sinews of -war.</p> - -<p>In this view, as well as from the peculiar -dependence of Britain on her navy, this order -of men is truly inestimable; and even -considering men merely as a commodity, it -could be made evident, in an œconomical and -political view, independent of moral considerations, -that the lives and health of men -might be preserved at much less expence -and trouble than what are necessary to repair -the ravages of disease. -<span class="pagenum" id="Page_214">214</span></p> - -<p>It would be endless to enumerate the accounts -furnished by history of the losses and -disappointments to the public service from -the prevalence of disease in fleets. Sir -Richard Hawkins, who lived in the beginning -of the last century, mentions, that in -twenty years he had known of ten thousand -men who had perished by the scurvy. -Commodore Anson, in the course of his -voyage of circumnavigation, lost more than -four fifths of his men chiefly by that disease. -History supplies us with many instances -of naval expeditions that have been -entirely frustrated by the force of disease -alone: that under Count Mansfeldt in 1624; -that under the Duke of Buckingham the -year after; that under Sir Francis Wheeler -in 1693; that to Carthagena in 1741; -that of the French under D’Anville in 1746; -and that of the same nation to Louisbourg -in 1757<a id="FNanchor_36" href="#Footnote_36" class="fnanchor">36</a>. -<span class="pagenum" id="Page_215">215</span></p> - -<p>That the health of a ship’s company depends -in a great measure upon means within -our power, is strongly evinced by this, that -different ships in the same situation of service -enjoy very different degrees of health. -Every one who has served in a great fleet -must have remarked, that out of ships with -the same complement of men, who have -been the same length of time at sea, and -have been victualled and watered in the same -manner, some are extremely sickly, while -others are free from disease. Is it not naturally -to be inferred from hence, that the -health of men at sea depends in a great -measure upon circumstances within the -<span class="pagenum" id="Page_216">216</span> -power of officers, and, indeed, upon their -exertions, much more than medical care<a id="FNanchor_37" href="#Footnote_37" class="fnanchor">37</a>?</p> - -<p>It has appeared in the preceding part of -this work, that the diseases most prevalent -among seamen are fevers, fluxes, and the -scurvy. These are indeed some of the most -fatal that can attack the human body; but -there is a numerous tribe of complaints, -which are also some of the most severe -scourges of human nature, from which -they are in a manner entirely exempt.—These -are the diseases to which the indolent -and luxurious are subject, and which so far -embitter their life as to render their portion -of worldly enjoyment nearly on a level with -that of the poor and laborious. The diseases -alluded to are chiefly the gout, stomach -complaints, hypochondriac and other nervous -<span class="pagenum" id="Page_217">217</span> -disorders. In all countries it is the better -sort of people that are most subject to -these; for they are owing to the want of -bodily exercise, to the great indulgence of -the senses, and a greater keenness and delicacy -in the passions and sentiments of the -mind. Man being formed by nature for -active life, it is necessary to his enjoying -health that his muscular powers should be -exercised, and that his senses should be habituated -to a certain strength of impression. -Animal and vegetable nature may be aptly -enough compared to each other in this respect; -for a tree or plant brought up in a -greater degree of shelter and shade than what -is suitable to its nature, will be puny and -sickly; it will neither attain its natural -growth nor strength of fibre, nor will it be -able to bear the influence of the weather, -nor the natural vicissitudes of heat and cold -to which it may be exposed.</p> - -<p>It is to be remarked, however, that exercise -and temperance may be carried to excess, -and that in these there is a certain salutary -medium; for when labour and abstinence -<span class="pagenum" id="Page_218">218</span> - -amount to hardship, they are equally -pernicious as indulgence and indolence. -This is strongly exemplified in seamen; for, -in consequence of what they undergo, they -are in general short lived, and have their -constitutions worn out ten years before the -rest of the laborious part of mankind. A -seaman, at the age of forty-five, if shewn to -a person not accustomed to be among them, -would be taken by his looks to be fifty-five, -or even on the borders of sixty<a id="FNanchor_38" href="#Footnote_38" class="fnanchor">38</a>.</p> - -<p>The most common chronic complaints -which a long course of fatigue, exposure to -the weather, and other hardships, tend to -bring on, are pulmonary consumptions, -rheumatisms, and dropsies. It is also to be -considered, that these complaints, particularly -the last, are farther fomented by hard -drinking, which is a common vice among -<span class="pagenum" id="Page_219">219</span> -this class of men, and they are led to indulge -in it by the rigorous and irregular -course of duty incident to their mode of life.</p> - -<p>With regard to gout, indigestion, hypochondriac -complaints, and low spirits, there -is something in hard labour of every kind -that tends to avert them, and particularly in -that rough mode of it peculiar to a sea life. -There is also something in the harsh sensations -from the objects which seamen are in -use to see, hear, and handle, which so modifies -their constitutions and hardens their -nerves as to make them little liable to what -may be called the diseases of excessive refinement, -such as those above mentioned. I -have, indeed, met with such diseases at -naval hospitals; but I always remarked that -they were in landsmen who had been pressed, -and who had been bred to sedentary and indolent -occupations.</p> - -<p>The diseases above enumerated, as well as -most other chronic complaints, being the -offspring of indolence and luxury, while -fevers and feverish complaints fall equally -<span class="pagenum" id="Page_220">220</span> -on all ranks and descriptions of men, it -was a saying of some of the ancients, that -acute diseases were sent from heaven<a id="FNanchor_39" href="#Footnote_39" class="fnanchor">39</a>; -whereas chronic diseases were of man’s own -creation. But I shall endeavour in the -course of this work to evince, that, with regard -to seamen at least, acute diseases are as -much artificial as any others, being the offspring -of mismanagement and neglect; with -this difference, that they are imputable not -<span class="pagenum" id="Page_221">221</span> -so much to the misconduct of the sufferers -themselves, as of those under whose protection -they are placed.</p> - -<p>If I were to add any other complaint to -the three already mentioned, as most prevalent, -and peculiar to a sea life, it would be -those foul and incurable ulcers which are so -apt to arise at sea, particularly in a hot climate. -The slightest scratch, or the smallest -pimple, more especially on the lower extremities, -is apt to spread, and to become an -incurable ulcer, so as to end in the loss of a -limb. The nature of the diet, and the malignant -influence of the climate, both conspire -in producing them.</p> - -<p>The diseases most frequent and prevalent -at sea have this advantage, that they are -more the subjects of prevention than most -others, because they depend upon remote -causes that are assignable, and which increase -and diminish according to certain circumstances, -which are in a great measure within -our power. -<span class="pagenum" id="Page_222">222</span></p> - -<p>The prevention of diseases is an object -as much deserving our attention as their -cure; for the art of physic is at best but -fallible, and sickness, under the best medical -management, is productive of great inconvenience, -and is attended with more or -less mortality. The means of prevention -are also more within our power than those -of cure; for it is more in human art to remove -contagion, to alter a man’s food and -cloathing, to command what exercise he is -to use and what air he is to breathe, than it -is to produce any given change in the internal -operations of the body. What we know -concerning prevention is also more certain -and satisfactory, in as much as it is easier to -investigate the external causes that affect -health than to develope the secret springs of -the animal œconomy.</p> - -<p>This part of the work, therefore, is -chiefly addressed to those who direct the -navy either in a civil or military capacity; -for the general health of ships depends so -much upon the victualling and manning in -<span class="pagenum" id="Page_223">223</span> -the first instance, and, afterwards, on the -degree of discipline and order which are -kept up, that I am persuaded that a certain -degree of attention on their part would -almost entirely eradicate disease from our -fleets.</p> - -<p>Several remarks in this part of the work -will be found so obvious, that it might -seem superfluous to mention them. But it -has been my intention to omit nothing that -I have heard of or observed as a matter of -ascertained utility, and, I believe, the most -experienced will find either something new, -or what they had not before sufficiently attended -to. Though the design of it is that -of being extensively useful, yet my trouble -would be compensated, should it prove the -means of health and comfort to a single -ship’s company; nay, I should not repent -my labour, could I enjoy the conscious certainty -of its being the means of saving the -life of one brave and good man.</p> - -<p>The prevention of disease has relation -only to the external causes that affect health, -<span class="pagenum" id="Page_224">224</span> -and I shall consider these under the four -heads of</p> - -<p> -I. AIR,<br /> -II. ALIMENT,<br /> -III. EXERCISE,<br /> -IV. CLOATHING.<br /> -</p> - -<p><span class="pagenum" id="Page_225">225</span></p> - -<h2 id="PART_II_CHAP_I">CHAP. I.<br /> - -<span id="AIR" class="large">AIR.</span></h2> - -<p>Under this head I shall not only consider -the natural state of the air of the atmosphere -in point of heat and cold, moisture -and dryness, purity and corruption, -but also the different artificial impregnations -of it from the holds or other parts of a -ship, or from the persons of men who have -been neglected in point of cleanliness.</p> - -<p>The common air of the atmosphere at sea -is purer than on shore, which gives to a sea -life a very great advantage over a life at -land. This advantage is still greater in the -tropical regions, where the land air, especially -such as proceeds from woods and -marshes, is so fatal, and where the heat is -also considerably less at sea than on shore. -But this superior purity of the air at sea is -<span class="pagenum" id="Page_226">226</span> -more than counterbalanced by the artificial -means of propagating diseases on board of -a ship. Since a sea life, however, has this -great natural advantage to health, the causes -of disease peculiar to it are chargeable rather -to the mismanagement of men than to -any thing unavoidable in nature; and we -are from this encouraged to exert our endeavours -in removing them.</p> - -<p>The effects of land air, however, are not -to be neglected by those who are studious of -preserving the health of a ship’s company, -for seamen are exposed to it in various ways -while they are in harbour; and this is what -we shall first treat of. -<span class="pagenum" id="Page_227">227</span></p> - -<h3 id="CHAP_I_SECT_I">SECT. I.<br /> - -<span class="medium">Of the noxious Effects of <span class="smcap">Land Air</span> in -particular Situations.</span></h3> - -<p>All the diseases incident to a fleet, except -the scurvy, are more apt to arise in a -harbour than at sea, and particularly the violent -fevers peculiar to hot climates. There -are generally woods and marshes adjacent to -the anchoring places in the West Indies, -and the men are exposed to the bad air proceeding -from thence, either in consequence -of the ship’s riding to leeward of them, or -of people’s going on shore on the duties of -wooding and watering. Instances of this, -without number, might be adduced from the -accounts of voyages to all the tropical countries. -Our fatal expeditions to the Bastimentos, -and to Carthagena, in former wars, -are striking proofs of it; and we have seen -the same effects, though in a much less degree, -while the fleet was at Jamaica in 1782. -<span class="pagenum" id="Page_228">228</span></p> - -<p>I have known a hundred yards in a road -make a difference in the health of a ship at -anchor, by her being under the lee of -marshes in one situation, and not in the -other<a id="FNanchor_40" href="#Footnote_40" class="fnanchor">40</a>. Where people at land are so situated, -as not to be exposed to the air of woods -and marshes, but only to the sea air, they -are equally healthy as at sea. There was a -remarkable instance of this on a small island, -called Pidgeon Island, formerly described, -where forty men were employed in making -a battery, and they were there from June -<span class="pagenum" id="Page_229">229</span> -to December, which includes the most unhealthy -time of the year, without a man -dying, and with very little sickness among -them, though they worked hard, lived on -salt provisions, and had their habitations entirely -destroyed by the hurricane. During -this time near one half of the garrison of -St. Lucia died, though in circumstances -similar in every respect, except the air of -the place, which blew from woods and -marshes. -<span class="pagenum" id="Page_230">230</span></p> - -<p>The duties of wooding and watering are -so unwholesome, that negroes, if possible, -should be hired to perform them. In general, -however, the employing of seamen in -filling water and cutting wood is unavoidable, -but it should be so managed as not to -allow them, on any account, to stay on shore -all night; for, besides that the air is then -more unwholesome, men, when asleep, are -more susceptible of any harm, either from -the cold or the impurity of air, than when -awake and employed.</p> - -<p>As the service necessarily requires that men -should be on shore more or less, however -unwholesome the air may be, means are to -be used to prevent its pernicious impressions -on the body. Certain internal medicines, -such as bitters, aromatics, and small quantities -of spirituous liquors, tend to preserve -the body from its bad effects. Of the bitters, -Peruvian bark is, perhaps, the best; -and there is a well-affected instance of its -efficacy in the account given by Mr. Robertson -of a voyage in the Rainbow to the -coast of Africa; and by the same means -<span class="pagenum" id="Page_231">231</span> -Count Bonneval and his suite escaped sickness -in the camps in Hungary, while half -of the army were cut off by fevers. In -consequence of Mr. Robertson’s representation -of the effects of bark in curing and preventing -the fevers of that climate, the ships -of war fitted out for the coast of Guinea have -been supplied with it gratuitously, and Government -would find its account in extending -this bounty to all the tropical stations.</p> - -<p>We have seen, in the former part of this -work, that the fever produced by the impure -air of marshes may not appear for many -days after the noxious principle, whatever it -is, has been imbibed; men having been -sometimes seized with it more than a week -after they had been at sea. It naturally occurs, -therefore, that something may be done -in the intermediate time to prevent the effects -of this bad air; and nothing is more -adviseable than to take some doses of Peruvian -bark, after clearing the bowels by a -purgative. Some facts, related in the first -part of this work, show that an interval of -ten days or a fortnight may elapse between -<span class="pagenum" id="Page_232">232</span> -the imbibing of the poison and its taking -effect. And, in order to guard against the -diseases of this climate in general, it would -be more proper to take some large doses of -bark once in either of these periods, than to -make a constant practice of taking a little, -as I have known some people do, by which -they may also render their body in some -measure insensible to its good effects. I -knew a physician of some eminence in the -West Indies, who always enjoyed uninterrupted -health, and he imputed it to his taking -from half an ounce to an ounce of -bark every change and full of the moon, as -he thought that fevers of the intermitting -and remitting kind, were more apt to occur -at these periods. Whether this idea be well -founded or not, the practice is proper, upon -the other principle that has been mentioned, -and the phases of the moon will at least -serve as an aid to the memory.</p> - -<p>The spices of the country, such as capsicum -and ginger, for which nature has given -the inhabitants of the torrid zone an appetite, -have also been found powerful in fortifying -<span class="pagenum" id="Page_233">233</span> -the body against the influence of noxious -air. Either these, or the bark, or similar -substances, of a bitter and aromatic nature, -given in a glass of spirits to men going -upon unwholesome duty, have been found -to have a powerful effect in preventing them -from catching the fevers of the climate. -The practice may be thought too troublesome -in the hurry of service in a great fleet; -and I in general avoid mentioning any thing -but what is easily practicable, and highly -important to the body of seamen at large; -but such a precaution may be of service at -least to officers, or to a ship’s company, -when service is easy, or on a small scale.</p> - -<p>But besides the poisonous effluvia of woods -and marshes, the sensible qualities of the air -are also to be attended to. If I were required -to fix on the circumstances most -pernicious to Europeans, particularly those -newly arrived in the West Indies, I would -say, that they are too much bodily exercise -in the sun, and sleeping in the open air; and -the practices most hurtful next to these are, -intemperance in drinking, and bad hours. -<span class="pagenum" id="Page_234">234</span> -The sickness and mortality among new -comers may, in general, be imputed to some -one of these causes. It is in favour of this -opinion that women are not subject to the -same violent fevers as the other sex, which -is probably owing to their not giving into -the above-mentioned irregularities.</p> - -<p>The last direction I shall mention with -regard to the preservation of health in a -harbour is, that the ship should be made to -ride with a spring on the cable, that the -side may be turned to the wind, whereby -a free ventilation will be produced, and the -foul air from the head, which is the most -offensive part, will not be carried all over -the decks, as it must be when the ship rides -head to wind.</p> - -<p>Having little experience of my own with -regard to diseases at sea in cold climates, I -cannot recommend any particular precautions; -but Dr. Lind thinks that garlick infused -in spirits is one of the best preservatives -against the bad effects of cold and wet. -The French ships of war are furnished with -<span class="pagenum" id="Page_235">235</span> -great quantities of garlick as an article of -victualling, and its effects seem to be very -salutary. It would appear, that substances -of this kind are very conducive to health in -hot climates also. I was informed by Capt. -Caldwell, that, when he commanded a sloop -of war on the coast of Guinea, he was supplied -with a large quantity of shalots by a -Portuguese about the time he left the coast, -and his men were remarkably healthy on the -passage to the West Indies, while the other -ships in company, who wanted this supply, -were very sickly.</p> - -<p>But besides the obvious and sensible qualities -of the air above mentioned, there are -certain obscure properties which we do not -understand, and which we find difficult to -investigate; for there are diseases prevailing -in certain places which seem to depend on -some latent state of the air. Of this kind is -the complaint of the liver, so common in -the East Indies, yet almost entirely unknown -in the West Indies; and in the West Indies -there are certain diseases which prevail in -one island and not in another; such as the -<span class="pagenum" id="Page_236">236</span> -<i>elephantiasis</i><a id="FNanchor_41" href="#Footnote_41" class="fnanchor">41</a> of Barbadoes, which is an affection -of the lymphatics peculiar to that -island. In the climates of Europe there are -also certain obscure conditions of the air -that favour one epidemic more than another, -and in some years more than others<a id="FNanchor_42" href="#Footnote_42" class="fnanchor">42</a>. All -this is very mysterious to us; and although -we could detect these properties of the air, -we probably could not prevent their bad effects, -since man must every where breathe -the air, whatever its qualities may be. -<span class="pagenum" id="Page_237">237</span></p> - -<h3 id="CHAP_I_SECT_II">SECT. II.<br /> - -<span class="medium">Of <span class="smcap">Foul Air</span> from the Neglect of Cleanliness -in Men’s Persons—<span class="smcap">Infection</span>.</span></h3> - -<p>Nature has wisely so contrived our -senses and instincts, that the neglect of -cleanliness renders a person loathsome and -offensive to himself and others, thereby -guarding against those fatal diseases that -arise from bodily filth. The noxious air we -speak of is generated by men keeping the -same clothes too long in contact with the -body, while they are at the same time confined -and crowded in small and ill-ventilated -apartments. Such is the origin of the jail -fever, otherwise called the ship and hospital -fever; and it seems to be with reason that -Dr. Cullen ascribes the low, nervous fever of -Britain to a similar origin, being caused, as -he thinks, by an infection of a milder kind, -arising in the clothes and houses of the -poor, who, from slovenliness or indigence, -<span class="pagenum" id="Page_238">238</span> -neglect to change their linen, and air their -houses.</p> - -<p>Man is evidently more subject to disease -than any other species of the animal creation, -owing partly to the natural feebleness -of his frame, but still more perhaps to the -artificial modes of life which his reason -leads him to adopt. There is no circumstance -of this kind by which health is more -affected than by clothing. Some of the -most fatal and pestilential diseases are produced -and communicated by it; for we see -that the greater number of fevers, particularly -those of the low and malignant sort, -may be traced to the want of personal -cleanliness.</p> - -<p>There are few subjects more mysterious -and difficult of investigation than this of infection. -The origin of specific contagions, -such as the small pox and the venereal disease, -seems to be almost beyond the reach -of a conjecture; and why all the contagions -we know, excepting that of the bite of a -mad dog, should be confined to one species -<span class="pagenum" id="Page_239">239</span> -of animal, their effects not being communicable -to any other, is equally unaccountable. -Why is the body incapable of being affected -more than once by certain morbid poisons; -and whence comes the striking and curious -differences of susceptibility to infection in -different individuals at the same time, and -of the same individual at different times?</p> - -<p>It would appear that the infection of -fever, which we are chiefly to consider here, -does not, like some of the diseases above -mentioned, depend on the continued propagation -of a certain poison, but that it may -spontaneously arise from a concurrence of -circumstances, producing a long stagnation -of the effluvia of the body on the clothes, -for want of clean linen, while people are -excluded from the free air, as in jails, hospitals, -or ships.</p> - -<p>In order, therefore, to preserve the crews -of ships from such diseases, means should -be taken not only to prevent the introduction -of infection already existing, but to prevent -the generation of it on board. -<span class="pagenum" id="Page_240">240</span></p> - -<h3 id="MEANS_OF_PREVENTING_THE_INTRODUCTION_OF_INFECTION">1. Means of preventing the Introduction of -Infection.</h3> - -<p>War being a state of violence and -confusion, in which the hurry and emergency -of service may be such as to render it -impossible to put in practice all the rules -which might be laid down concerning the -preservation of health, yet it is necessary -that those who direct the navy, either in a -civil or military capacity, should be aware -of the causes of sickness and mortality, in -order to guard against them as far as is -practicable. From an indolent acquiescence -in this idea of the hardships and inconveniences -of war being unavoidable, I have -known neglect to arise in the conduct of officers -with regard to those under their command, -as if it was not the duty of a commander -to employ his utmost attention to -alleviate the misfortunes and mitigate the -sufferings of his fellow creatures; and we -have seen that much more of the calamities -of war arise from disease than from the -<span class="pagenum" id="Page_241">241</span> -sword. The like excuse might be framed -for the neglect of stores and arms, which, -the hurry of service might equally expose -to injury. We see, indeed, infinite pains -taken to prevent cordage from rotting, and -arms from rusting; but however precious -these may be as the necessary resources of -war, it will not be disputed that the lives of -men are still more so; yet, though there is -the additional inducement of humanity to -watch over the health of men, I do not -think that this, in general, is studied with -a degree of attention equal to what is bestowed -on some inanimate objects.</p> - -<p>Ships of war are exposed to infection -chiefly by receiving such men as have been -raised by pressing, who are frequently confined -in guardships, under such circumstances -of bad air and bodily filth as tend to -generate the most virulent infection. The -service also requires sometimes that men be -received from jails, and they are either criminals -delivered over by the civil jurisdiction -of the country, or captives who have -been restored by the enemy after a course of -<span class="pagenum" id="Page_242">242</span> -confinement in their prisons. It may happen -too, as we have seen<a id="FNanchor_43" href="#Footnote_43" class="fnanchor">43</a>, that the enemy, -who are made prisoners at sea, may have infection -about them, and will communicate -it the more readily that they are strangers.</p> - -<p>There are few fevers but what are infectious -at some stage or other of the disease; -but it is not necessary that fever should actually -exist in order to create infection. In -the most violent and pestilential fevers, such -as have sometimes originated in the jails of -England, the persons who communicated -them were not affected with it themselves<a id="FNanchor_44" href="#Footnote_44" class="fnanchor">44</a>. -Infection, like some other poisons, does not -affect those who are accustomed to it, and -therefore those who are in the habit of being -exposed to it frequently escape its bad effects, -especially if it is gradually applied, as must -be the case with those about whose persons -it is generated. For the like reason, physicians -<span class="pagenum" id="Page_243">243</span> -and nurses are less susceptible than -others; and strangers, who are accustomed -to a pure air, are the most susceptible of -any. It is observed by Dr. Short, that contagious -epidemics are more frequent and -fatal in the country than in London, and -this may probably be accounted for on the -same principle; for every person in a great -town is exposed to the breath and effluvia -of others, and to a variety of putrid exhalations, -which are unavoidable where multitudes -inhabit together; but they are so used -to them, that they are not affected by them; -whereas in the country, where people are -less accustomed to each other’s company, -and less used to impure air in general, they -are the more readily affected when infection -is introduced among them. It may even -admit of a doubt if any society of men, -living together, are entirely free from morbid -contagion. It certainly sometimes happens, -that a ship, with a long-established -crew, shall be very healthy; yet, if strangers -are introduced among them, who are -also healthy, sickness will be mutually produced. -This principle in the human constitution, -<span class="pagenum" id="Page_244">244</span> -by which the presence of strangers -affects it, is well illustrated by a fact<a id="FNanchor_45" href="#Footnote_45" class="fnanchor">45</a>, -founded on the best testimony, that, in one -of the small western islands of Scotland, -which is so remote, that the inhabitants -are frequently without any communication -with strangers for several months together; -they become so susceptible, in consequence -of this long interruption of intercourse, -that they are seized with a catarrh when -strangers of any description come among -them. It was said before, that cleanliness -was founded on a natural aversion to what -is unseemly and offensive in the persons of -others; and there seems also to be implanted -in human nature, for the same purpose, -an instinctive horror at strangers, as is visible -in young children and uncultivated people. -In the early ages of Rome, one word -signified both a stranger and an enemy<a id="FNanchor_46" href="#Footnote_46" class="fnanchor">46</a>. -<span class="pagenum" id="Page_245">245</span></p> - -<p>These observations naturally suggest several -useful and practical remarks. It would appear -<span class="pagenum" id="Page_246">246</span> -that the utmost attention is necessary -not only to guard against the actual presence of -<span class="pagenum" id="Page_247">247</span> -of disease, but to be jealous of all new -draughts of men, especially if they should -<span class="pagenum" id="Page_248">248</span> -come from guardships, jails, or tenders, and -have been turned over from ships where -<span class="pagenum" id="Page_249">249</span> -disease is known to have prevailed; nay, -that it is best to avoid mixtures of any kind.</p> - -<p>The infection of fevers seems different -from most others in this, that it is very -various in its degrees of virulence. There -is reason to think that the poison of the -small pox, and that of the venereal disease, -are in their own nature invariable, and that -the difference of these diseases, in point of -malignancy, depends on the constitution and -<span class="pagenum" id="Page_250">250</span> -other circumstances of those affected; whereas -that of fevers being of different degrees -of activity, and being frequently obscure -and latent, is, on that account, the more -treacherous, and ought to be watched with -the greater circumspection.</p> - -<p>The mode of manning the navy by pressing, -I take it for granted, is unavoidable; at -any rate, it would not become me to arraign -a practice which has had the public sanction -for ages. It is, however, one of the principal -<span class="pagenum" id="Page_251">251</span> -means both of generating and spreading -the seeds of disease, in consequence of the -indiscriminate seizure of men for the public -service, and the confinement that is necessary -to secure them. And as the exigences -of the service make it necessary to admit -persons of every description, there is no -other remedy for this evil but to annihilate, -if possible, the contagion that may thus be -conveyed into ships of war. This is done -by stripping and washing the new recruits -who may be suspected of importing infection; -also by cutting off their hair, clothing -them with new clothes, and destroying -the old, before they are allowed to mix with -the ship’s company in which they are to -enter.</p> - -<p>Those who have put these methods strictly -in practice, have been sensible of their -great utility; and the most exact attention -is necessary, as a single infected man, or -even any part of his clothing, may spread -sickness through a whole ship’s company. -When we reflect what havock an infectious -fever sometimes makes in a ship, it will appear -<span class="pagenum" id="Page_252">252</span> -how very important this fort of attention -is; and when the cause of the sickliness -of particular ships is traced to its -source, it will generally be found to have -originated from taking on board infected -men at Spithead, or wherever else the ship’s -company may have been completed.</p> - -<p>After the first edition of this part of the -work was printed, an excellent institution -was established at Portsmouth for the prevention -of infection. A ship was appointed -for the reception of the recruits of the fleet -to which they were carried, to be stripped, -washed, and provided with new apparel, -before they joined their respective ships. -This had a visible good effect on the health -of the fleet; and it was planned and executed -by Sir Charles Middleton, Comptroller -of the Navy, whole unwearied assiduity, -as well as integrity and ability in that important -post, claim the highest praise and -gratitude from his country.</p> - -<p>It follows farther, from the preceding observations, -that there is a sort of risque in -<span class="pagenum" id="Page_253">253</span> -mixing two different sorts of men, even -when there is no actual disease or suspicion -of infection; for, whether it is from dormant -infection, or merely from the circumstance -of change of air, such mixtures are -known from experience to be sometimes -productive of sickness. The late Admiral -Boscawen was so sensible of this, that he -avoided it, unless when some evident utility -or necessity of service made it proper; and -upon this principle he used to resist the solicitation -of captains when they requested to -carry men from one ship to another upon -changing their commands.</p> - -<p>One probable reason, among others, for -ships of the line being more sickly than frigates -or smaller ships is, that in greater -numbers there is a greater chance of men -of various descriptions and modes of life -being mixed together. -<span class="pagenum" id="Page_254">254</span></p> - -<h3 id="MEANS_OF_PREVENTING_THE_PRODUCTION_OF_INFECTION"> -2. Means of preventing the Production of Infection.</h3> - -<p>The infection of fever is not always imported -from without, but may be originally -and spontaneously generated on board. The -causes of this, as mentioned before, are want -of personal cleanliness, and also confinement -and crowding in close apartments.</p> - -<p>In order to promote cleanliness, care should -be taken that every man, on his first entering -into the service, be provided with a proper -change of linen, and that a frequent -muster and review be made, in order to inspect -their persons, and to examine their -stock of apparel. A true seaman is in general -cleanly, but the greater part of men -in a ship of war require a degree of compulsion -to make them so; and such is the depravity -of many, that it is common enough -for them to dispose of their clothes for money -to purchase spirituous liquors. A muster -and review, therefore, wherein men -<span class="pagenum" id="Page_255">255</span> -should be obliged once in the week to present -themselves clean before their officers, -and to produce a certain necessary quantity -of clean apparel, would conduce both to -sobriety and cleanliness. The exertion of -authority, and the infliction of punishment, -is so far from being considered by the men -as a hardship, that they expect it; and it is -the duty of an officer, as it is of a parent to -a child, to constrain those entrusted to his -care to perform what is for their good. It -is common also for men to lay up their -clothes in a wet and unwashed state, which -in time is productive of the most offensive -and unwholesome vapours; and this can be -prevented only by their chests and bags -being frequently inspected by their superiors.</p> - -<p>It must be evident to any one who reflects -on this subject, that a regulation of this -kind is as necessary as any other part of -duty; and it deserves to be made an article -in the public instructions, instead of being -left to the discretion of officers. This sort -of discipline is particularly necessary in ships -<span class="pagenum" id="Page_256">256</span> -of the line, in which one cause of the greater -unhealthiness is the difficulty of taking cognizance -of so great a number; for, unless -some regular method, as by muster, is established, -there will be men who will escape -notice, and skulk below, indulging in laziness -and filth.</p> - -<p>The good sense and humanity of many -captains in the late war, led them to adopt -certain methodical regulations for the preservation -of cleanliness and order. The only -public sanction given to this sort of discipline, -was that of Lord Howe, who gave -it in orders to those under his command, -that each ship’s company should be divided -into as many divisions as there were lieutenants, -and that these should be divided into -squads, with a midshipman appointed to -each; and that the officers should be respectively -responsible for the good order and discipline -of the men assigned to them.</p> - -<p>It is an excellent custom, and pretty general -in the navy, to allow the men one day -in the week for washing, when the weather -<span class="pagenum" id="Page_257">257</span> -and other circumstances will admit of it. It -would be a farther improvement in the rules -of the service to supply sope in the same -manner as tobacco and slops are supplied, -that is, to let the men have what quantity -they want from the purser, who is allowed -to charge it against their wages<a id="FNanchor_49" href="#Footnote_49" class="fnanchor">49</a>.</p> - -<p>Next to want of cleanliness, the circumstances -most apt to give rise to infection are, -close air and crowding. A certain length of -time is necessary, in order that these should -have this effect, and the longer they take -<span class="pagenum" id="Page_258">258</span> -place, the more certainly will infection be -produced, and it will be the more virulent<a id="FNanchor_50" href="#Footnote_50" class="fnanchor">50</a>. -<span class="pagenum" id="Page_259">259</span></p> - -<p>In order to admit air freely, the ports -should be kept open whenever the weather -will permit this to be done. The great objection -to free ventilation is the danger of -exposing men to the air in cold climates. -But it fortunately happens, that fire, while -it is the most effectual means of counteracting -the cold air, is also the best means of -promoting ventilation; for wherever there -is fire, there is a constant change of air taking -place by means of the draught to -which it gives occasion. This cannot be -done with safety and convenience in all parts -<span class="pagenum" id="Page_260">260</span> -of the ship; but frequent fires in the lower -parts of a ship will prove extremely salutary -by drying up the moisture, and producing a -change of air, and also in a cold climate by -the warmth it produces.</p> - -<p>The hammocks and bedding should also -be aired by exposing them upon deck, especially -after the ports have been long shut in -consequence of bad weather. They cannot -be thoroughly aired unless they are unlashed; -and as this could not be conveniently done -daily in men of war, it might be done from -time to time by the different divisions in rotation<a id="FNanchor_51" href="#Footnote_51" class="fnanchor">51</a>. -When the men come to sleep upon -them after these operations, they experience -the same agreeable sensations as from a -change of linen; and this must conduce to -health as well as pleasure, like all other natural -and moderate gratifications. It may -be farther remarked in favour of cleanliness, -<span class="pagenum" id="Page_261">261</span> -that it is not only directly conducive to -health, but is naturally connected with habits -of good order, sobriety, and other virtues. -The most cleanly men are always the -most decent and honest, and the most slovenly -and dirty are the most vicious and irregular.</p> - -<p>A ship of war must have a much greater -number of men on board than what are necessary -to navigate her; for, besides the marines, -a great many hands are necessary to -man the great guns in time of action. For -this reason, there is a greater risque of the -inconveniences of overcrowding than in ships -intended for commerce, and therefore much -greater attention is necessary with regard to -ventilation and cleanliness. There is a piece -of management which tends also in some -measure to obviate the necessity of crowding. -This is to berth the watches alternately, -by which it is meant, that one half -of each watch should lie on different sides, -whereby they do not sleep so close, and are -not so much exposed to each other’s breath -and to the heat and effluvia of each other’s -<span class="pagenum" id="Page_262">262</span> -bodies. This has the farther advantage of -preserving the trim of the ship.</p> - -<p>What has been said of the ship and men -in general, applies still more strongly to the -sick, and the berth<a id="FNanchor_52" href="#Footnote_52" class="fnanchor">52</a> assigned to them; for -there is nothing so apt to increase, and even -generate, contagion, as a number of sick -together, unless uncommon attention is -paid to cleanliness and ventilation. This is -so true, that, unless where the complaint is -very catching, it is best not to separate the -sick; for if they are a good set of men on -board, those who are confined by sickness -will be better nursed and tended by their -messmates than in a sick berth. But if the -state of infection renders separation necessary, -the best part for the accommodation -of the sick, in a ship of the line, is under -the forecastle in a warm climate, and on the -fore part of the main deck in a cold one. -<span class="pagenum" id="Page_263">263</span> -When they are under the forecastle, however, -they ought to occupy only one side, -as they would otherwise be disturbed by the -men who must pass to and from the head, -and the men in health would, in this case, -be exposed also to contagion. As infection -is most likely to arise among the sick, attention -to cleanliness and air is doubly requisite -where they lie; and it has a good effect to -sprinkle hot vinegar and diffuse its steams -among them once or twice a day.</p> - -<p>Thus we see that cleanliness and discipline -are the indispensable and fundamental -means of health, without which every other -advantage and precaution is thrown away. -Government never bestowed more attention -and expence upon the victualling of the -navy than during the late war; but it would -be to little purpose to provide the most -nourishing and antiscorbutic diet, the most -wholesome and cordial wines, the most efficacious -remedies, and the most skilful physicians -and surgeons, if the men are not -constrained to keep their persons sweet, -their clothing and bedding clean, and their -<span class="pagenum" id="Page_264">264</span> -berths airy and dry. It is, therefore, upon -officers more than any others that the health -of the fleet depends; and I should be excused -in the frequent mention I make of -this, were it known how often I have been -the witness of the fatal effects of the neglect -of these rules.</p> - -<h3 id="MEANS_OF_ERADICATING_INFECTION">3. Means of eradicating Infection.</h3> - -<p>When, from a neglect of the means -above mentioned, an infectious fever comes -actually to prevail, and the infection, perhaps, -adheres obstinately to the ship in spite -of cleanliness, good air, and diet, and all the -other means, which, if employed in due -time, would have prevented it, then some -measures are to be taken for eradicating this -subtile poison.</p> - -<p>The first step towards this is, to prevent -the disease from spreading, and this is done -by separating the sick from the healthy, -and cutting off all intercourse as much as -possible. For this end, it is necessary to -appropriate a particular berth to contagious -<span class="pagenum" id="Page_265">265</span> -complaints, and not only to prevent the -idle visits of men in health, but to discover -and separate the persons affected with -such complaints as soon as possible, both -to prevent them from being caught by -others, and because recent complaints are -most manageable and curable. Officers -might be very useful in making an early -discovery of complaints, by observing those -who droop and look ill in the course of -duty; for seamen think it unmanly to -complain, and have an aversion to be put on -the sick list. I have heard of a method -practised in some ships, of keeping a book -on the quarter deck for the officer to mark -the names of such men as might look ill, -or might be missed from duty upon calling -the roll, in order to afford the surgeon a -means of finding out those who should be -the objects of his care.</p> - -<p>Those whose profession it is to superintend -the health of the ship, would find it for -their ease and interest, and should consider -it as their duty, to walk over the different -decks once a day, or every other day, in -<span class="pagenum" id="Page_266">266</span> -order to make an early discovery of those -who may be taken ill. Though I have laid -great stress on the duty of the commander, -as the proper guardian of health, yet his -assiduity will not avail unless the surgeon -also does his part, by such acts of attention -as I have mentioned, joined to skill in his -profession.</p> - -<p>Surgeons are, perhaps, more regarded in -our service than in that of other nations; -but it would be for the public benefit if they -were still more respected and encouraged. -To men of liberal education and sentiments, -as surgeons ought to be, and generally are, -the most effectual inducements for them to -do their duty are flattering attentions, and a -certain degree of estimation in the eyes of -their officers. Liberality of manners, on -the part of superiors, is the most likely -means of encouraging a conscientious performance -of duty in this profession; for -though strict and distant behaviour may operate -upon the minds of those whose functions -are merely mechanical, how can it infuse -that tender attention to human sufferings, -<span class="pagenum" id="Page_267">267</span> -and that sense of duty, which may -induce a man entrusted with the health and -lives of his fellow creatures to act his part -with propriety and effect?</p> - -<p>In order to prevent sickness from spreading, -it is not sufficient to cut off all personal -intercourse. The clothes of men are -as dangerous a vehicle of infection as their -persons; and it should be a strict and invariable -rule in case of death from fever, flux, -or small pox, to throw overboard with the -body every article of clothing and bedding -belonging to it.</p> - -<p>Upon the same principle, in case of recovery -from any contagious disease, as it -would be too great a waste to destroy the -clothes and beds, they should be smoked, -and then scrubbed or washed before the -men join their messes and return to duty. -This precaution is the more necessary, as -infection in a ship is extremely apt to be -communicated by bedding, from the custom -of stowing the hammocks in the netting, -by which they are brought in contact with -<span class="pagenum" id="Page_268">268</span> -each other. This, however, is an excellent -custom, as it not only clears the ship below, -and serves to form a barricade on the gunwale, -but tends to air the bedding; and -this salutary effect should not be prevented, -except in case of rain, by the coverings, -called hammock-cloths, by the use of which -utility is evidently sacrificed to an excess of -neatness.</p> - -<p>It sometimes happens that the number of -sick in a ship is so great, that it is not possible -to take proper and effectual measures on -board for stopping the progress of disease. -But when she can be cleared of the sick by -sending them to an hospital, no pains should -be spared to extirpate the remaining seeds of -infection.</p> - -<p>For this purpose, let their clothing and -bedding be sent along with them; let their -hammocks, utensils, and whatever else they -leave behind, be smoked, and either scrubbed -or washed before they are used by other -men, or mixed with the ship’s stores; let -the decks, sides, and beams of their berths, -<span class="pagenum" id="Page_269">269</span> -be well washed, scraped, smoked, and dried -by fire; then let them be sprinkled with -hot vinegar, and, finally, white-washed all -over with quick lime.</p> - -<p>Should any officer object to the trouble -and inconvenience of all this, let him reflect -for a moment how much more troublesome -and inconvenient, as well as noisome -and disagreeable, sickness itself proves -to be; let him reflect that the efficiency of -the ship, considered as a bulwark of defence, -or an engine of annoyance, depends on the -number of healthy hands, and that his own -character is to depend on the exertions to be -made by them in the day of battle, not to -mention the attention due from him as a man -to the sufferings of the objects themselves.</p> - -<p>But besides these recent infections, it -sometimes happens that the seeds of disease -adhere to the timbers of a ship for -months and years together, and can be -eradicated only by a thorough cleansing and -fumigation. Sweeping, washing, scraping, -and airing, are not sufficient entirely to -<span class="pagenum" id="Page_270">270</span> -remove the subtile infectious matter; but -they will assist and will prepare it to be -acted upon by heat and smoke, which are -the only means to be depended upon. A -complete fumigation can only be performed -when the ship is in dock; and I shall here -transcribe a method recommended by Dr. -Lind.</p> - -<p>“It will be proper to remove every -thing out of the ship, so that the hold -may be swept, and, when the men have -withdrawn, to light a number of charcoal -fires in different parts, and to throw -a handful or two of brimstone on each. -The steam of these should be closely confined -by shutting the ports and hatchways -from morning till evening, no person -in the mean time being allowed to -go below, nor for some time after opening -the ports and hatchways, that the -steam may be dispersed.</p> - -<p>“In order to purify the men’s clothes, -it would farther be proper to fumigate -the hulk into which they are removed -<span class="pagenum" id="Page_271">271</span> -with tobacco once or twice a week while -their ship is in dock, the men remaining -below as long as they can bear it.</p> - -<p>“The clothes and hammocks of the men -should be exposed in the hulk to the -smoke of the tobacco, and those which -are more particularly suspected may be -hung up the ship, and exposed to the -steam of the charcoal and brimstone.</p> - -<p>“The ship having been already fumigated -with tobacco, it will be sufficient -to use the fumigation of charcoal and -brimstone above described for three days, -and, after the last day’s fumigation, the -inside of the ship should be well washed -with boiling vinegar, and, before the men -return on board, all the decks should be -scraped and washed.”</p> - -<p>When a ship is at sea, these precautions -cannot be taken so completely; but if infection -is present, or is suspected, then -cleansing and fumigating may be practised -in a less degree. I have known a ship at -<span class="pagenum" id="Page_272">272</span> -sea fumigated with gunpowder kneaded with -vinegar, so as to prevent it from exploding, -and to make it burn slowly with a spattering -flame. Flowers of sulphur<a id="FNanchor_53" href="#Footnote_53" class="fnanchor">53</a>, with -<span class="pagenum" id="Page_273">273</span> -about an eighth part of nitre, will answer -still better. A quantity of these is placed -in each interval of the guns between decks, -every person being turned up, and the ports -<span class="pagenum" id="Page_274">274</span> -and hatches shut till they are consumed, -and till the smoke has dispersed. It has also -been recommended to burn resinous bodies, -such as the woods of fir, spruce, and juniper, -as the smoke of these is more salutary. -Upon the same principle, the effluvium of -tar is thought wholesome; and the cables -that are coiled in the lower parts of a -ship being soaked with tar, like most of the -other ropes of a ship, probably conduce to -the health of a place otherwise dank and -unwholesome. Fumigation may also be -performed by means of tar, either by throwing -it on red-hot irons, or a wood fire, -which may be carried about between decks -in a pot or moveable grate, or over some -cannon balls in a tub, or by immersing a -red-hot loggerhead<a id="FNanchor_54" href="#Footnote_54" class="fnanchor">54</a> in a bucket of tar. If -this is done in the place occupied by the -sick, it will have a still better effect; and it -will be of service to them to be removed for -a short time under the half deck or forecastle -till this or other means of purification -<span class="pagenum" id="Page_275">275</span> -are put in practice. In whatever manner -fumigation is performed, it will be of service -to spread out the clothes and bedding -of the men, or to hang them upon lines, -that they may be exposed to the heat and -smoke.</p> - -<p>It will also be of great service to make -the men expose their frowsy clothes to the -sun and wind. If a strong infection is suspected, -and it cannot be afforded to destroy -the clothes, the best means of eradicating -the poison is to hang them for a length of -time over pots of burning brimstone in a -large cask standing endways, with small -apertures to admit air enough for the brimstone -to burn.</p> - -<p>Fire in every shape is to be considered as -the principal agent of purification, by its -heat and the ventilation it occasions, perhaps, -still more than its smoke. It has already -been repeatedly inculcated, that the -great enemies of infection are ventilation -and heat. I have mentioned smoke and the -effluvia of balsamic bodies, but these are not -<span class="pagenum" id="Page_276">276</span> -to be depended on; and it is the more necessary -to mention this, as the attention bestowed -on more trifling means may divert the -mind from a proper regard to what is more -essential. It is mentioned by the benevolent -Mr Howard, that it is the custom in some parts -abroad to scatter fresh branches of pine or -spruce in the hospitals, in order to purify the -air; but, trusting to this, they neglect the -admission of fresh air, which is the only effectual -method of sweetening the air.</p> - -<p>There is reason to think that the open -air very soon dissipates and renders inert all -infections of the volatile kind, and of course -the warmer the air is the more readily it -will have this effect. It is accordingly observed, -that infection is much less apt to be -generated about the persons of men, and that -it adheres to them for a much less space of -time in a hot climate than in a cold or temperate -one. This is a remark, which, so far -as I know, has not been made by any author; -and, till observation suggested it to -me, I fancied the reverse to be the truth. -I have seen so many instances of filth and -<span class="pagenum" id="Page_277">277</span> -crowding in ships and hospitals in the West -Indies, without contagion being produced, -and which in Europe could hardly have -failed to produce it, or to render it more -malignant, that I am convinced there is -something in tropical climates unfavourable -to the production and continuance of infectious -fevers<a id="FNanchor_55" href="#Footnote_55" class="fnanchor">55</a>. The ships which bring this -fever from Europe in general get rid of it -soon after arriving in a warm climate; and -nothing but the highest degree of neglect -can continue or revive it.</p> - -<p>The facts above mentioned brought into -my mind what is related of the plague at -Smyrna and other places, that it disappears -at the hottest part of the year. It is also -curious and important to remark, that the -<span class="pagenum" id="Page_278">278</span> -true pestilence never has been heard of between -the tropics. It is not easy to assign -the cause of this effect of heat upon infection, -as every thing relating to this subject -is very obscure. We can conceive it to be -owing to the greater degree of airiness which -the heat of the climate makes necessary, or -to the use of fewer woollen clothes. There -may be something in the state of the body, -particularly in the pores of the skin, which -disposes them less to imbibe or produce the -poisonous effluvia, or, when imbibed, it -may more readily be thrown out by perspiration -with the other acrimony of the blood; -or more probably, as has been hinted above, -the virulent matter is of such a degree of volatility -as to be readily dissipated in a certain -degree of heat<a id="FNanchor_56" href="#Footnote_56" class="fnanchor">56</a>. -<span class="pagenum" id="Page_279">279</span></p> - -<p>There is a fact, which, though seemingly -of a contrary tendency, yet is in reality in -proof of the same opinion. It is, that these -same diseases disappear in circumstances of -great cold. When England was last visited -by the plague, it disappeared in winter; and -the same is observed at Moscow and other -places. In this case the infectious matter is -rendered <i>inert</i>, but not <i>extinct</i>, and the return -of heat sets it afloat in the atmosphere, -so as to expose it to human respiration. -Dr. Guthrie informs us, that infection is -entangled and fixed by the cold of winter -on the doors and walls of the houses of the -Russian peasants, and that upon the return -of the warm season it is set loose by the -thaw, and then becoming active, produces -diseases.</p> - -<p>With regard to the West Indies, the precautions -that have been laid down are chiefly -necessary when a ship newly arrives in the -climate; for it is during the first three or -four months that sickness is apt to prevail. -<span class="pagenum" id="Page_280">280</span></p> - -<p>This does not depend upon any thing peculiar -to the climate; for I have known -ships arrive without being visited with any -sickness. It seems to be owing, for the -most part, to that flock of infection and -disease imported from Europe exerting its -effects, and when this has spent itself, the -men remain in good health, unless exposed -to the land air or other accidents; for the -air at sea in those climates, as well as every -where else, is extremely pure and wholesome, -and there is no where that seamen are -more healthy or comfortable. -<span class="pagenum" id="Page_281">281</span></p> - -<h3 id="CHAP_I_SECT_III">SECT. III.<br /> - -<span class="medium">Of the <span class="smcap">Foul Air</span> generated in a Ship.</span></h3> - -<p>I mean here to distinguish the unwholesome -vapour produced by the contents of -the ship from the infection produced by the -effluvia of men’s persons, which was treated -of in the last section.</p> - -<p>The means of preventing this foul air -from being generated are, cleanliness, dryness, -and ventilation.</p> - -<p>All parts of a ship may, if neglected, become -dirty, and emit an offensive vapour; -but the parts under water consisting of the -orlop and hold, are more particularly so -from the materials they contain, and from -the want of free access to the fresh air; accordingly, -there is always more or less -stench in those parts, even in the best-regulated -ships. -<span class="pagenum" id="Page_282">282</span></p> - -<p>It was mentioned in the first part of this -work, that an opinion was entertained by -some that no foul air was productive of fevers -but such as proceeds from the living -human body. I alledged that this was -otherwise, at least in hot climates; and -some proofs of this opinion were adduced, -particularly from the French prizes. Though -the neglect of personal cleanliness is the -principal source of disease, yet cleanliness of -every kind, and purity of the air in every -respect, is to be anxiously studied.</p> - -<p>With regard to general cleanliness, it is -hardly necessary to mention sweeping, washing, -and scrubbing of the decks; for the -natural propensity of the English<a id="FNanchor_57" href="#Footnote_57" class="fnanchor">57</a> nation -<span class="pagenum" id="Page_283">283</span> -to neatness seldom allows any neglect of -these. Lord Howe, to whose virtues as a -man, and abilities as an officer, his country -<span class="pagenum" id="Page_284">284</span> -is so much indebted, gave it in general orders -to wash the upper decks every day, the -lower decks twice a week, and the orlop -<span class="pagenum" id="Page_285">285</span> -once a week at least. He also ordered that, -every washing, smoking, mustering, and review -of clothes, or any other means taken -for the health of the ship, should be marked -in the logbook, and the reason to be assigned -there if omitted at the stated times. -These rules are a good specimen of the order -that ought to prevail in every branch of -public duty; for it is well known to every -experienced officer that it is a methodical -proceeding of this kind which can alone -render service either easy or effective.</p> - -<p>The loss of men’s lives from the foul air -of the well is a common accident in ships, -and I have been myself witness to several -instances of it. Where there is the least -suspicion of this, a candle should previously -be let down, and if it should be extinguished, -it may be concluded that the air is -deadly. It becomes safe for men to breathe -in it by leaving it open for some time, or, -more expeditiously, by letting down fire in -a pot or grate, which soon changes the air, -by producing a draught of it upwards. -<span class="pagenum" id="Page_286">286</span></p> - -<p>It is a very salutary practice to let down -fires frequently into the well, both in order -to purify the air and to dry the surrounding -parts. It was formerly mentioned that this -was daily done in the Intrepid, and the effect -of it was to remove the wetness of the -ballast and the mouldiness which had overspread -the sides and beams; and having had -the effect of sweetening and purifying the -air, it seemed to be the principal circumstance -that tended to make this ship extremely -healthy from being the most sickly of all -the fleet. This precaution, as well as every -other point of cleanliness, is more necessary -in large ships, because the mass of foul air, -as well as the quantity of corrupting materials, -is greater<a id="FNanchor_58" href="#Footnote_58" class="fnanchor">58</a>. -<span class="pagenum" id="Page_287">287</span></p> - -<p>The following fact strongly evinces the -good effect of fire and smoke:—When it -was the custom for frigates to have their -kitchens between decks, they were much -more healthy than in the present construction, -in which they have them under the -forecastle, where the heat and smoke are -dissipated without being diffused through the -ship, and causing a draught of air upwards, -as formerly. The men derived then also -great benefit and comfort from having a -large fire, round which they might assemble -to warm and dry themselves in a sheltered -place. I leave it to those who preside -in the construction of the navy to determine -how far it would be advisable to return -to the old manner of construction. -The French ships of the line have their -kitchens and ovens between decks, and this -must tend to counteract the effects of their -want of cleanliness. The Dutch ships of -the line have their kitchens on the orlop -deck, which must be still more conducive -to the general purity of the air. -<span class="pagenum" id="Page_288">288</span></p> - -<p>Moisture is pernicious both in itself and -as the instrument of putrefaction. All the -complaints, called colds, are more owing to -wet than cold; and moisture may be the -means of producing, or at least of exciting -dangerous fevers, when they would not -otherwise appear. It besides contributes -greatly to the production of scurvy. Ships -built of ill-seasoned wood are found to be -very unhealthy on account of the moisture -contained in it. The moisture of timber -arises not only from being used too soon -after being felled, but also, as I am informed, -from being stripped of its bark and -outer surface when piled and exposed to the -weather in dock yards. This method of -smoothing and piling the wood is only a -late practice; and the advantage in point -of convenience and neatness seems to be -more than overbalanced by the detriment it -thereby receives.</p> - -<p>A wet hold diffuses moist vapour all over -the ship; and it was a rule with some of -those commanders whom I observed to be -<span class="pagenum" id="Page_289">289</span> -most successful in preserving the health of -their men, not only to have daily fires in -the well, but to bail out the water when -the pumps could not exhaust it all, and never -to allow it to collect to more than the -depth of a few inches. It is, therefore, -very doubtful whether it is a good practice -to let in water, as is very commonly done -in order to sweeten the hold, for the same -sweetness will be preserved if it is kept -strictly dry. If it should happen, indeed, that -there should be a great deal of putrid matter -in the lower parts of the ship, from previous -neglect or unavoidable leakage, it may be adviseable -to let in a quantity of water in -order to loosen and wash off what is offensive, -and then to pump it out.</p> - -<p>There is a circumstance in the first fitting -out of a ship well worth attention, as highly -conducive to the dryness and cleanness of -the hold. I mean the choice of the ballast; -for that which is called <i>shingle</i>, consisting all -of pebbles, is far preferable to that which is -sandy and earthy, as it does not so readily -<span class="pagenum" id="Page_290">290</span> -soak and retain the moisture and filth. Water -or fluid of any kind readily subsides in it, -and should any putrid matter be entangled -in it, there will be less difficulty in washing -it out.</p> - -<p>The decks should not be washed so often -when the weather is moist as when it is -fine, as it will be more difficult to dry them, -and more harm may arise from the moisture -than benefit from the cleanness. Washing -should also be performed very early in the -morning, even in the best weather, in order -that there may be time for the decks to become -dry in the course of the day. It is -after a general washing that the moveable -fires, formerly described, are most proper -and useful.</p> - -<p>Every contrivance should be fallen upon -to change the air in the orlop and hold. -Ventilators and windsails<a id="FNanchor_59" href="#Footnote_59" class="fnanchor">59</a> are well adapted -<span class="pagenum" id="Page_291">291</span> -for this purpose, and should be used as frequently -and for as long a time as possible. -It has also a good effect in cooling the air in -the lower parts of a ship in the West Indies, -to lift the gratings of the hatches, raising -them on their edges, and lashing them to -the staunchions. It contributes likewise to -cleanliness and coolness to keep the decks as -clear as possible from<a id="FNanchor_60" href="#Footnote_60" class="fnanchor">60</a> chests and other lumber, -which are in the way of sweeping and -washing, and prevent also the free course -of the air.</p> - -<p>Particular attention to ventilation is necessary -in frigates, for almost all that part in -which the men sleep is excluded from the -air, and they are therefore very uncomfortable -in the West Indies unless small scuttles -are cut in the sides. But if this should be -objected to as weakening or endangering the -ship, there is a good contrivance for the same -purpose, which I met with on board of the -<span class="pagenum" id="Page_292">292</span> -Nymphe frigate. It consists of a square -wooden pipe, of about nine inches in the -side coming from between decks, running -along the side of the ship, and opening over -the gunwale of the forecastle. There was -one on each side. -<span class="pagenum" id="Page_293">293</span></p> - -<h3 id="CHAP_I_SECT_IV">SECT. IV.<br /> - -<span class="medium">Means of guarding against <span class="smcap">Infection</span> and -<span class="smcap">Bad Air</span>.</span></h3> - -<p>Infection never prevails to such a degree, -as to affect every person indiscriminately -who is exposed to it. Even where the -plague and small-pox prevail to the greatest -degree, there are some persons who, though -susceptible of these diseases, yet escape them. -There are certain other infections of a weaker -nature, as was before observed, and these -will remain entirely inactive, till they find -constitutions so disposed as to be fit subjects -of their action. The seeds of disease may -be compared to those of vegetables, which -lye dormant, unless they happen to fall into -a situation peculiarly adapted for exciting -their activity. It is very difficult to account for -this uncertainty in the operation of infection, -but it is extremely providential, that under -the most calamitous state of sickness, there -<span class="pagenum" id="Page_294">294</span> -are always some who are in health and who -survive, for the necessary purposes of life. -If this were not the case, it might happen -that every person on board of a ship might -perish from sickness in the course of a voyage, -a circumstance which I believe has -never been known to happen.</p> - -<p>There is an endless variety in the constitution -of the human frame, both in mind and -body, as well as in the features of the face. -There are, perhaps, no two individuals in -the world in whom the same effect precisely -is produced by the same food, air, medicine, -poison, or passions of the mind. The different -effects of infection, therefore, upon different -people, seem to depend, in many cases, -on peculiarities of constitution too obscure -to be explained; but there are also known -circumstances which resist or encourage its -effects.</p> - -<p>The great power of habit<a id="FNanchor_61" href="#Footnote_61" class="fnanchor">61</a> in taking off the -effect of infection, has already been mentioned, -<span class="pagenum" id="Page_295">295</span> -and it would appear that novelty gives -an increased energy and activity to all impressions, -as well as those on the senses. If -a person, therefore, escapes the first attack of -infection, he will be more likely to continue -exposed to it with safety in future.</p> - -<p>There are certain precautions necessary -to be attended to by those who are unavoidably -exposed to contagion, particularly -in the first instance. Those who can afford -a full diet, and a liberal use of wine, have -been observed to resist infection better than -those who use food and drink that is meagre -and watery. It is also a good rule not to go -among the sick, nor otherwise to expose -one’s self to infectious air, with an empty -stomach; for whether it is that the body is -then more susceptible, or that the pores of -the skin and lungs are in a more highly absorbing -state, so as with greater readiness to -inhale the poison of disease, it is certain that -<span class="pagenum" id="Page_296">296</span> -a person in that situation is more apt to catch -harm from foul air of any kind. Whatever -else weakens and exhausts the body, renders -it also more susceptible of noxious impressions. -Under the head of weakening powers, I comprehend -not only what empties the body of -its fluids, such as loss of blood, or a diarrhœa, -but intoxication, fatigue, fasting, watching, -and certain affections of the mind, such as -care and grief.</p> - -<p>Cold and moisture may also be enumerated -among the causes that invite the attack of -infectious diseases. They are of themselves -simply productive of catarrhs, rheumatisms, -and the like disorders; but if an infection -should be accidentally present when the body -is exposed to them, then instead of these -complaints, the disease peculiar to that infection -will be produced<a id="FNanchor_62" href="#Footnote_62" class="fnanchor">62</a>. This was illustrated -<span class="pagenum" id="Page_297">297</span> -in the last reinforcement we had from -England; for while bad fevers were breaking -out in most of the other ships, the <a id="FNanchor_63" href="#Footnote_63" class="fnanchor">63</a>Union -was affected with those complaints only -which are simply the effects of cold and -moisture. It would be more proper, perhaps, -to say, <i>exposure to the air</i>, than to -call it <i>cold</i>; for exposing the naked body to -the open air, even in the warmest climate, -is prejudicial to health. This holds at least -with regard to Europeans who are accustomed -to clothing, however the natives of hot -climates who are naked, may expose themselves -with impunity.</p> - -<p>It is of the greatest consequence to ascertain -the extent of the influence of infection, -for the means of avoiding and preventing it -will very much depend upon this. It is -now known, that infection extends itself to -a very small distance. There are, indeed, -some morbid poisons, such as that of the -bite of a mad dog, and that of the venereal -disease, which require actual contact to -<span class="pagenum" id="Page_298">298</span> -make them take effect. Others are more -volatile, and seem to he inhaled by the -breath, or absorbed by the skin, but these -do not extend far. That of the plague<a id="FNanchor_64" href="#Footnote_64" class="fnanchor">64</a> -does not reach above a few yards, and that -of the small-pox and of fevers is probably -equally limited. This discovery is very valuable, -by ascertaining the limits of danger; -for when a person imagines he runs the same -risk when at a considerable distance from the -seat of disease, as if he were in contact with -the person affected, he will be apt to expose -himself wantonly and unnecessarily to the -infection.</p> - -<p>It seems to be owing to the ignorance of -the extent of its influence, that the plague -has in general been so fatal; for in consequence -of the opinion that the whole surrounding -atmosphere was affected, it was -<span class="pagenum" id="Page_299">299</span> -vainly attempted to purify it by large fires -in the open air, or by <a id="FNanchor_65" href="#Footnote_65" class="fnanchor">65</a>firing off artillery, instead -of trusting to the separation of the sick -so as to avoid their near approach, and to -the confinement of those in health to their -own houses, which are all the precautions -necessary to prevent its progress. -<span class="pagenum" id="Page_300">300</span></p> - -<h2 id="CHAP_II">CHAP. II.</h2> - -<h3 id="OF_ALIMENT" class="large">Of <span class="smcap">Aliment</span>.</h3> - -<h3 id="SECT_I_of_Solid_Food">SECT. I. Of <span class="smcap">Solid Food</span>.</h3> - -<p>The most unnatural circumstance in a -sea life is the food which men use, and the -disease most peculiar to it is one which is -owing chiefly to the nature of the aliment; -for though other causes conspire in aggravating -the scurvy, the depraved state of the -<small>INGESTA</small> is the main and fundamental cause -of it.</p> - -<p>It is this disease that is most fatal to seamen -next to fevers. It was formerly as fatal, -if not more so; but some modern improvements -have rendered it less frequent -and violent. The habitual use of salt provisions, -besides producing evident symptoms -of scurvy, begets such a state of the constitution, -that, upon the least scratch being received, -particularly on the lower extremities, -a large and incurable ulcer ensues; and -<span class="pagenum" id="Page_301">301</span> -this circumstance, trifling as it appears, is -the cause of losing an incredible number of -men to the service, especially in the West -Indies. The greater part of the food of a -ship’s company is necessarily salted meat. -Biscuit and pease, though of a vegetable -nature, are hard of digestion; and though -they qualify the animal food, they do not -answer the purpose of fresh vegetables. -Though officers have a supply of live stock -even for the longest voyages, it would be -impracticable to carry a quantity sufficient -to preserve a whole crew from the scurvy. -But certain articles have of late been introduced -into use, of a durable and portable nature, -which so qualify the salt provisions, -that they can be used without inducing this -disease. These are either such as are articles -of common diet, viz. melasses and sour -krout, or those which are intended only for -the sick and recovering, such as portable -soup and the preserved juice of lemons and -oranges.</p> - -<p>It is one of the most ancient and real -grievances in the service, that there has not -<span class="pagenum" id="Page_302">302</span> -been a sufficiently ample supply of nourishment -and cordials for the weak and recovering. -This complaint is made by <a id="FNanchor_66" href="#Footnote_66" class="fnanchor">66</a>Dr. Cockburn, -who was physician to the fleet in the -end of the last century; and it is a complaint -that has not yet been entirely redressed, nor -has the subject been considered with the attention -it deserves. The only improvement in -the sea victualling that I know of from that -time till of late, has been the use of raisins -for puddings, and the occasional use of vinegar, -which is an article extremely salutary, -and was looked upon as the great preservative -of health in the Roman armies.</p> - -<p>After the force of disease has been subdued -at sea, men are frequently lost by relapses, -or pine away in dropsies and other -chronic complaints, for want of being supported -by some cordial and nourishing diet. -It is mentioned in my memorial to the Admiralty, -how insufficient the small quantity -of surgeon’s necessaries are; and it is recommended -that a large quantity of certain species -<span class="pagenum" id="Page_303">303</span> -of refreshment should be put in the -purser’s charge, which, being substituted for -the common sea victualling while men are -ill or recovering, would cost Government -little or nothing. Besides the articles already -mentioned, it was recommended to -set apart a quantity of the best wines, and -to be provided with brown sugar, dried -fruits, barley, rice, sago, and salep. To -these might be added eggs, which, if greased -and put in salt, may be preserved fresh for a -great length of time. Carrots and other roots -might also be preserved for the longest voyages -by means of sugar; and green vegetables -might in like manner be preserved by -means of salt. But of all the articles, either -of medicine or diet, for the cure of the -scurvy, lemons and oranges<a id="FNanchor_67" href="#Footnote_67" class="fnanchor">67</a> are of much -the greatest efficacy. They are real specifics -in that disease, if any thing deserves that -name. This was first ascertained and set in -a clear light by Dr. Lind. Upon what -principle their superior efficacy depends, and -<span class="pagenum" id="Page_304">304</span> -in what manner they produce their effect, I -am at a loss to determine, never having been -able to satisfy my mind with any theory -concerning the nature and cure of this disease, -nor hardly indeed of any other. An -ingenious treatise has been published on this -subject by Dr. Milman, to which I refer the -reader, meaning to confine myself in this -work chiefly to what is practical.</p> - -<p>Every person who has beheld with attention -and feeling the tedious and languishing -series of suffering which the sick and recovering -endure for want of the means of supporting -and recruiting their strength and -spirits, must wish that those who preside -in the civil department of the navy would -seriously consider this subject, and complete -the reform that has already been begun.</p> - -<p>With regard to the victualling of men in -health, a most commendable attention has -been paid to the improvement of it. The -ordinary articles of victualling have not only -been of excellent quality, but some new articles -have been added, from which the -<span class="pagenum" id="Page_305">305</span> -greatest benefit has been derived. The -chief of these are sour krout and melasses. -The latter was first brought into use by -Captain Ferguson in the beginning of the -late war. He ordered it to be served with -rice to the men who were affected, or threatened -with the scurvy, in the ship under his -command. The benefit experienced from it -in this and other instances was so great, -that during the last two years of the war it -was made a regular article of sea victualling, -and substituted in place of a certain proportion -of oatmeal<a id="FNanchor_68" href="#Footnote_68" class="fnanchor">68</a>. -<span class="pagenum" id="Page_306">306</span></p> - -<p>As bread is one of the principal articles -of diet, the utmost care should be taken in -preserving it, and great advantage would -arise from stowing it in casks that are water -<span class="pagenum" id="Page_307">307</span> -tight, instead of keeping it in bags, or letting -it lie loose in the bread room. Captain -Cook, by this method, and by giving it a -cast in the oven in the course of the voyage, -preserved his biscuit found in every respect -for more than three years. But the greatest -improvement in this article of diet would be -to have, in the form of flour, a greater proportion -of what is now allowed in bread. -The flour might be made into puddings, -and seems, in this form, to be more nutritious -and antiscorbutic than biscuit which -has undergone a strong force of fire. This -sort of mess would be still more proper and -agreeable now that melasses is a stated article -of diet. Flour, by being well pressed -and rammed, will keep as long as biscuit, -and it can be stowed in one fifth part of the -space; it will, therefore, cost much less in -freight than the same quantity of it in that -form, and it may be baked abroad if necessary<a id="FNanchor_69" href="#Footnote_69" class="fnanchor">69</a>. -Malt, by being well rammed, may -also be preserved for a great length of time. -<span class="pagenum" id="Page_308">308</span></p> - -<p>Of all the former articles of sea victualling, -there was none more abused than oatmeal. -The quantity allowed to each man -was twice as much as he could consume, -and the overplus went to the purser’s profits, -or was wasted by being given to the hogs, -or even wantonly thrown overboard. Melasses -have, with great advantage, been substituted -for part of it, in the proportion of -<span class="pagenum" id="Page_309">309</span> -eleven pounds for two gallons of oatmeal. -The first trial of melasses was in the<a id="FNanchor_70" href="#Footnote_70" class="fnanchor">70</a> Foudroyant, -and it answered so well, that, in a -cruise under Admiral Geary in 1780, this -was the only ship free from the scurvy, and -out of two thousand four hundred men that -were landed at the hospital with this disease, -there were none from this ship. It -appears to be so similar in its nature and effects -to essence of malt, that it seems hardly -worth while for Government to be at the -expence of providing the latter.</p> - -<p>A certain proportion of barley has also of -late been substituted for part of the oatmeal, -which being more light and palatable, makes -a pleasing variety, particularly to the sick -and recovering. Captain Cook carried wheat -with him, and found it to answer equally -well. Might not potatoes also be a proper -and salutary substitute, as they will keep a -<span class="pagenum" id="Page_310">310</span> -considerable length of time in a warm climate, -and they have been successfully employed -in their raw state for the cure of -scurvy? It would not be right, however, to -abolish oatmeal entirely; for there is a certain -preparation of it which is an antiscorbutic -of equal efficacy with any whatever, except -the juice of lemons and oranges. This -is flummery, or sowins, which is prepared by -letting oatmeal and water stand together till -they grow acidulous, and then boiling them -into a jelly. I know of some well-attested -instances of the crews of ships being saved -from the scurvy by this alone.</p> - -<p>Butter is a good article of victualling in -so far as it renders that part of the diet -which consists of grain and vegetables more -palatable, and thereby induces men to eat -more. But as it is extremely corruptible in -a warm climate, hardly any being used by -the seamen but what is more or less rancid, -it should never be sent to a tropical station. -Greater quantities of it are condemned than -of any other article of victualling, and it is -therefore the most expensive to Government. -<span class="pagenum" id="Page_311">311</span> -There are certain articles that are the natural -produce of the West-India islands, which -may be substituted for it with the greatest -advantage. These are sugar and cocoa<a id="FNanchor_71" href="#Footnote_71" class="fnanchor">71</a>, -which, during the last year of the war, were -served in place of butter with great success, -and this proved an alteration in diet not -only salutary, but agreeable to the seamen, -whose inclinations are always to be consulted -in such changes<a id="FNanchor_72" href="#Footnote_72" class="fnanchor">72</a>. -<span class="pagenum" id="Page_312">312</span></p> - -<p>When a ship is in port, encouragement -should be given to the sale of roots, greens, -fruits, and sugar. The men have a good -custom of exchanging part of their bread, -beef, and pork, for what they can get from -the shore; but as they in general prefer spirituous -liquors to the above-mentioned articles, -the greatest care and vigilance should -be used to preclude men from such opportunities -of injuring themselves<a id="FNanchor_73" href="#Footnote_73" class="fnanchor">73</a>. Every -ship should be furnished with a seine, and -other implements for fishing, when in harbour. -<span class="pagenum" id="Page_313">313</span></p> - -<p>When captures are made, in which there -are such articles as sugar, wine, rice, or -fruits, it would be much better in many -cases to allow the immediate use of them at -sea, where the men may be disposed to -scurvy or other diseases, than to wait for -the conversion of them into money.</p> - -<p>Though it has been my object to introduce -as many articles of diet as possible, independent -of salt provisions, it does not follow -that these are in themselves unwholesome. -They are pernicious by being made -almost the sole and exclusive article; but if -used in moderate quantity, they are even in -some respects well adapted for the food of -<span class="pagenum" id="Page_314">314</span> -seamen. The nature of their life gives them -a strong digestion: in their duties they not -only employ violent exercise, but use more -muscles and a greater variety of postures -and motions than men of any other profession. -To such constitutions may not food -of a refractory nature and hard of digestion -have even an advantage over what is more -delicate and digestible?</p> - -<p>It does not appear that it is the salt quality -of the provisions used at sea that makes -them productive of scurvy, but the want of -their native juices and of the nutritious -principle. A small quantity of salt is necessary -to make all food palatable and wholesome, -in so much that it is reckoned one of -the necessaries of life. All animals have a -craving for sea salt, and nature has kindly -made it the most abundant and universal of -all saline bodies. Food, without this seasoning, -not only comes to be loathed, but -the want of it renders the animal weak and -flabby. As it not only assists digestion, -but invigorates all the bodily functions by -<span class="pagenum" id="Page_315">315</span> -stimulating and bracing the fibres, it is in -some cases a valuable medicine. It is remarkable -that men are very apt to tire of a -long continuance of fresh provisions<a id="FNanchor_74" href="#Footnote_74" class="fnanchor">74</a>, but -never of what is salt; and even under the -scurvy the latter will be relished, and sometimes -preferred to most other kinds of food. -It has been a practice with some to make -the scorbutic men drink sea water; but -though it is not attended with any manifest -benefit, I never heard that it aggravated the -disease.</p> - -<p>I was told by the gentlemen of the army -at New York in 1780, that the soldiers in -cantonments were not near so subject to -agues as the people of the country; and the -only difference in their mode of life was, that -the former had in their allowance a certain, -proportion of salt provisions. -<span class="pagenum" id="Page_316">316</span></p> - -<p>In an unhealthy country I should think a -free use of salt, as well as spice<a id="FNanchor_75" href="#Footnote_75" class="fnanchor">75</a>, would be -salutary; and when ships are in port it would -perhaps be better to allow a certain proportion -of salt provisions, because it would not -only be wholesome and agreeable, but the -men’s constitutions would probably be more -reconciled to an entire salt diet when necessary: -but I would except from this the -crews of such ships as have newly arrived -from a long cruise or voyage, in which it -may be necessary to alter the constitution as -quickly as possible by a diet entirely fresh.</p> - -<p>Nothing that I have collected from my -own observation, or that of others, has been -<span class="pagenum" id="Page_317">317</span> -neglected under this head, except one particular -caution with regard to the preparation -of the victuals. The large utensils employed -to boil the provisions are made of -copper, and it sometimes happens from neglect -that these are allowed to contract a rust, -which is one of the most active poisons we -know. The neglect consists chiefly in allowing -any thing acid, or what is liable to -become acid, such as gruel or burgoo, to remain -for a length of time without being -washed out; for when victuals have been -prepared in the boilers thus uncleaned, they -produce the most violent effects, even to the -loss of life, as once happened in a ship belonging -to our fleet<a id="FNanchor_76" href="#Footnote_76" class="fnanchor">76</a>. -<span class="pagenum" id="Page_318">318</span> -<span class="pagenum" id="Page_319">319</span></p> - -<h3 id="SECT_II_of_Drink">SECT. II. Of <span class="smcap">Drink</span>.</h3> - -<p>As the solid part of sea diet is very dry -and hard, and as the salt it contains is apt -to excite thirst, a freer use of liquids than -at land is necessary, particularly in a hot -climate.</p> - -<p>It has been the custom, as far back as we -know, to allow seamen the use of some sort -of fermented liquor. We need hardly inquire -if this is salutary or not; for it would -be impossible at any rate to withhold it, -since it is an article of luxury, and a gratification -which the men would claim as their -right. There is a great propensity in seamen -to intoxicating liquors, which is probably -owing to the hardships they undergo, -and to the variety and irregularity of a sea -life. But there is reason to think that all -sorts of fermented liquors, except distilled -spirits, are conducive to health at sea. -<span class="pagenum" id="Page_320">320</span></p> - -<p>There is no doubt that malt liquor is extremely -wholesome and antiscorbutic. The -common quantity of small beer allowed -daily is so liberal, that few men make use of -their whole allowance; and there is no objection -to the constant use of it, except that -it is apt to spoil in the course of a few weeks, -and that upon foreign stations the stock can -seldom be renewed. One of the greatest -improvements that could be made in the -victualling of the navy would be the introduction -of porter<a id="FNanchor_77" href="#Footnote_77" class="fnanchor">77</a>, which can be preserved -in any climate for any length of time that -may be necessary.</p> - -<p>Spruce beer seems to possess similar and -equal virtues with malt liquor and it has -<span class="pagenum" id="Page_321">321</span> -this advantage, that the materials of it can -at all times be carried about and used occasionally. -It agrees with malt liquor in being -a fermented vegetable sweet, the principal -ingredient of it being melasses. The other -ingredient, from which it takes its name, -being a balsamic substance, seems to be more -medicinal and antiscorbutic than hops, and -is therefore, perhaps, preferable to malt liquor. -There have been sufficient proofs of -its virtues in single ships; and all the men -of war that go to America and the West -Indies might be conveniently supplied with -it. Admiral Pigot provided a sufficient -quantity for the whole fleet; but the peace -coming on prevented the trial of it.</p> - -<p>The most salutary kind of drink next to -malt liquor, and spruce beer, is wine. The -<span class="pagenum" id="Page_322">322</span> -benefit which the fleet derived from it at different -times, and the advantage it has over -spirits has been often taken notice of in -the former part of this work. It seems to -be owing to this that the French fleet sometimes -enjoys superior health to ours, and is -less subject to the scurvy<a id="FNanchor_78" href="#Footnote_78" class="fnanchor">78</a>. Wine is also -preferable to every other medicine in that -low fever with which ships are so much infested; -and there is no cordial equal to good -wine in recruiting men who are recovering.</p> - -<p>Spirits differ from wine in this respect, -that they are a mere chemical liquor, incapable -of assimilation with our fluids, having -lost in distillation the native vegetable -principle in which the whole of its nutritious -quality and great part of its medical -virtue resides. -<span class="pagenum" id="Page_323">323</span></p> - -<p>The abuse of spirituous liquors is extremely -pernicious every where, both as an -interruption to duty, and as it is injurious to -health. It is particularly so in the West -Indies, both because the rum is of a bad -and unwholesome quality, and because this -species of debauchery is more hurtful in a -hot than in a cold climate.</p> - -<p>It is with reason that the new rum is accused -of being more unwholesome than -what is old; for, being long kept, it not -only becomes weaker and more mellow by -part of the spirit exhaling, but time is allowed -for the evaporation of a certain nauseous -empyreumatic principle which comes -over in the distillation, and which is very -offensive to the stomach; therefore, though -this is the produce of the West-India islands, -yet what is supplied there is inferior to that -which is brought from England.</p> - -<p>It was originally the custom to serve seamen -with their allowance of spirits undiluted. -The method now in use, of adding -water to it, was first introduced by Admiral -<span class="pagenum" id="Page_324">324</span> -Vernon in the year 1740, and got the name -of <i>grog</i>. This was a great improvement; -for the quantity of half a pint, which is -the daily legal allowance to each man, will -intoxicate most people to a considerable degree, -if taken at once in a pure state.</p> - -<p>The superiority of wine over spirits in -any shape was so conspicuous, that towards -the end of the war the fleets in the West -Indies and North America were supplied -with nothing but wine, and with a success -sufficient to encourage the continuance of -the same practice in future.</p> - -<h4 id="OF_WATER">Of <span class="smcap">Water</span>.</h4> - -<p>As water is a necessary of life, and as the -health and comfort of men at sea depend -upon its quality, it deserves particular attention.</p> - -<p>Spring water is to be preferred to running -or stagnated water; for, unless it is taken -at the source, or near it, it is apt to be -<span class="pagenum" id="Page_325">325</span> -impregnated with decayed vegetable and -animal substances, such as leaves, grass, -wood, and dead insects. This inconvenience -is greatest in a hot climate, where every -thing teems with life, and where the materials -of putrefaction are both more abundant -and more prone to corruption. This is the -most pernicious kind of impurity; for the -mineral impregnations common in springs -are seldom, in any degree, unwholesome, and -do not tend, like the other, to make the water -corrupt. At many of the West-India -watering places the water is found stagnated -just above high-water mark; and care should -be taken to go higher up to take it where it -is running.</p> - -<p>The purest water is apt to spoil by producing -a putrid glare upon the inner surface -of the cask which contains it. There is a -great difference in this respect between a -new cask, especially if made of moist wood, -and that cask which has been hardened and -seasoned by age and use. Several contrivances -have been proposed for preparing the -vessels that hold the water; but none have -<span class="pagenum" id="Page_326">326</span> -been found by experience so effectual as letting -them stand for some time full of sea -water; and it is a great advantage of this -method, that it is so easily practicable.</p> - -<p>It is in few places we meet with water -such as that of Bristol, which, in clean vessels, -may be kept for any length of time. -We may consider all water kept in wooden -vessels as more or less liable to putrefaction; -but there is a substance, which is neither -rare nor costly, that effectually preserves it -sweet. This is <i>quick lime</i>, with which every -ship should be provided, in order to put a -pint of it into each butt when it is filled. -It has the advantage of not being injurious -to health; but, on the contrary, is rather -friendly to the bowels, tending to prevent -and check fluxes. In the year 1779 several -ships of the line arrived in the West Indies -from England, and they were all afflicted -with the flux, except the Stirling Castle, -which was the only ship in which quick -lime was put into the water. Nor does it -spoil the water for any culinary purpose. -Its action in preventing putrefaction consists, -<span class="pagenum" id="Page_327">327</span> -in part at least, in destroying vegetable -and animal life. An addition of putrescent -matter is produced in water by the generation -of small insects; and the glare that -collects on the sides of casks, and also what -collects on the surface of the water, is a -species of vegetation of the order called by -naturalists <i>algæ</i><a id="FNanchor_79" href="#Footnote_79" class="fnanchor">79</a>. Quick lime is a poison -to this species of vegetable life as well as to -insects: but upon whatever principle it depends, -the property of it in preserving water -sweet is so well ascertained, that it is inexcusable -ever to neglect the use of it.</p> - -<p>Quick lime is equally efficacious for this -purpose, whether slacked or unslacked; and -though the latter form is more convenient -for stowage, by having less weight and -bulk, yet the other is to be preferred for the -sake of safety; for if water should by chance -reach the unslacked lime, a great degree of -heat is thereby produced, which has been -known to give occasion to the most formidable -accidents. -<span class="pagenum" id="Page_328">328</span></p> - -<p>The only other objection I know of to -the use of quick lime is, that it converts -the water into a lime water, rendering it -thereby disagreeable to the palate and stomach: -but the quantity necessary to preserve -it makes but a very weak lime water; -for part of the lime is precipitated by the -mephitic air, or the aerial acid, as it is -otherwise called, of which there is some -contained in the water. The accidental exposure -to the atmosphere, which also abounds -with this sort of air, tends farther to lessen -the acrimony of the quick lime<a id="FNanchor_80" href="#Footnote_80" class="fnanchor">80</a>.</p> - -<p>There are other substances which have -been found useful in correcting bad water. -Alum and cream of tartar, as antiseptic bodies, -have been employed for this purpose. -<span class="pagenum" id="Page_329">329</span> -Vinegar and the vegetable acid juices and -fruits, such as tamarinds, may be used occasionally -to take off the putrid offensive -taste which may have arisen in case the use -of quick lime has been neglected. In the -fleet under Sir Charles Saunders, the water -of the river St. Lawrence having been found -to produce fluxes, this quality was removed -by throwing four pounds of burnt biscuit -into each cask before it was used. But there -is nothing so effectual, and subject to so few -inconveniences, as quick lime.</p> - -<p>The next method to be mentioned of purifying -water is filtration, which not only -separates the gross impurities, but removes -the putrid smell and taste. It is performed -with a dripping stone, which is a convenient -<span class="pagenum" id="Page_330">330</span> -contrivance for officers, but cannot furnish -a supply for a whole ship’s company.</p> - -<p>When the water of wells or brooks is -found loaded with mud, the following expeditious -method of filtration, described by -Dr. Lind, has been practised with success:—Let -a quantity of clean sand or gravel be -put into a barrel placed on one end, without -the head, so as to fill one half or more of -it, and let another barrel, with both ends -knocked out, of a much smaller size, (or -let it be an open cylinder of any kind) be -placed erect in the middle of it, and almost -filled with sand or gravel. If the impure -water be poured into the small barrel or -cylinder, it will rise up through the sand -of both barrels, and appear pure above the -sand of the large one in the interval between -it and the small one.</p> - -<p>But when water is offensive in consequence -of being long kept, the most effectual and -expeditious method of sweetening it is by -exposing it to the air in as divided a state as -possible. Boiling will not expel the putrid -<span class="pagenum" id="Page_331">331</span> -effluvia contained in water; but such is the -attraction of air for this offensive matter, -that the water need only be thoroughly exposed -to it to be rendered quite sweet. This -is best done by a machine invented by Mr. -Osbridge, a lieutenant of the navy. It consists -of a hand pump, which is inserted in a -scuttle made at the top of a cask, and by -means of it the water, being raised a few -feet, falls through several sheets of tin -pierced like cullenders, and placed horizontally -in a half cylinder of the same metal. -The purpose of it is to reduce the water -into numberless drops, which being exposed -in this form to the open air, is deprived of -its offensive quality. The same method will -serve to separate the superfluous quick lime -in the water. It is a machine very deservedly -in common use, and the working of it is -a moderate and salutary exercise to men in -fair weather.</p> - -<p>The following contrivance will be found -to afford a sufficient supply of sweet water -to particular messes, and may be considered -as an artificial and more expeditious sort of -<span class="pagenum" id="Page_332">332</span> -dripping stone.—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<a id="FNanchor_81" href="#Footnote_81" class="fnanchor">81</a>.</p> - -<p>There should be in every ship an apparatus -for distilling water in case of distress. -This consists merely of a head and worm -adapted to the common boiler, and distillation -may go on while the victuals are boiling. -More than eight gallons of excellent -fresh water may be drawn off in an hour -from the copper of the smallest ship of -war<a id="FNanchor_82" href="#Footnote_82" class="fnanchor">82</a>. I refer for a more particular account -<span class="pagenum" id="Page_333">333</span> -of all this to the works of Dr. Lind, who -was the original inventor and recommender -of this method.</p> - -<p>This invention seems to have escaped -others so long, from the idea that the <i>desideratum</i> -in freshening sea water was some -substance to be added to it while under distillation. -No such substance is necessary, -and, the more simple the mode of distillation, -the fresher the water will prove.</p> - -<p>Rain water at sea is always pure and -wholesome, and may be saved occasionally -by means of a sail or awning. -<span class="pagenum" id="Page_334">334</span></p> - -<h2 id="PART_II_CHAP_III">CHAP. III.</h2> - -<h3 id="OF_CLOTHING">Of <span class="smcap">Clothing</span>.</h3> - -<p>Nature has made man so defenceless, -that even the rudest nations, in the hottest -climates, in general, adopt some sort of covering -to guard themselves from the weather. -We may affirm, that clothing is the -most artificial circumstance in the life of -man; and there is none, of which the -errors subject him to more inconvenience -and hardship. Insensible perspiration is performed -by the pores of the skin, and being -one of the most important functions of the -body, the suppression of it seems to be one -of the principal causes, or at least one of -the most frequent attendants on feverish and -inflammatory complaints; and one of the -most common causes of this suppression is -the application of cold to the skin.</p> - -<p>In order to keep up perspiration, it is necessary -that the orifices of the pores of the -<span class="pagenum" id="Page_335">335</span> -skin should be bathed, as it were, in the vapour -already secreted from them; and clothing -seems to act in confining this, as well -as in preventing the escape of the natural -heat and the access of the external air. -Though the air should not be cold, it will -check perspiration by carrying off this vapour -and drying the skin. In the warmest -climates exposure of the skin to the external -air is unsafe; for it not only produces a -feverish and uneasy sensation at the time, -but occasions the most dangerous internal -disorders. In consequence of the great sensibility -and sympathy of the body, and from -the pores of the skin being open in a warm -climate, exposure is in some respects even -more dangerous than in a cold one. Nothing -is more apt to bring on the locked -jaw and tetanus than sleeping in the open -air; and it was observed in Jamaica, that -when it was the custom to wear cotton and -linen clothes, the dry belly-ache was much -more common than now that it is the custom -to wear woollen cloth. -<span class="pagenum" id="Page_336">336</span></p> - -<p>We know besides, that the pores of the -skin can absorb not only the moisture that -floats in the atmosphere, but a variety of -foreign bodies, whether noxious or medicinal, -which may be applied to their orifices; -and as the air is in certain places loaded -with noxious matter, may not clothing be -considered as a filter, as it were, to separate -the impurities of the air before it comes in -contact with the surface of the body?</p> - -<p>It is therefore every where of the utmost -consequence that sufficient and suitable clothing -should be provided.</p> - -<p>It would certainly be for the benefit of -the service that an uniform should be established -for the common men as well as for -the officers. This would oblige them at all -times to have in their possession a quantity -of decent apparel, subject to the inspection -of their superiors. It would also be less easy -to dispose of their clothes for money without -detection, and desertion would also -thereby be rendered more difficult. -<span class="pagenum" id="Page_337">337</span></p> - -<p>It is of great consequence that the purser -should lay in a sufficient stock of clothing -and bedding suited to the climate for which -the ship is destined, in order that there may -be a sufficient supply after having been on a -distant station for a certain length of time. -I have known men suffer the greatest inconvenience -and hardship, and infectious diseases -kept up, from the neglect of this.</p> - -<p>The greatest evil connected with clothing -is the infection generated by wearing it too -long without shifting; for to this cause we -have attributed the jail, hospital, or ship fever. -The great importance of cleanliness appeared -when we were treating of infection, from -whence we may judge of what consequence -it is that men should be provided with a -shift of linen, as that part of the clothing -which is in contact with the skin is most -likely to harbour infection<a id="FNanchor_83" href="#Footnote_83" class="fnanchor">83</a>. -<span class="pagenum" id="Page_338">338</span></p> - -<p>As clothing is not the gift of nature, being -left to man’s own reason, it is subject to -caprice, and thereby productive of inconvenience -and disease. The necessity of it depends -very much upon habit, like every -thing else relating to the human body, and -therefore sudden and unseasonable changes -of apparel are very unsafe to health. It is -also found that a partial exposure of the -body is more pernicious than a general exposure. -If I were writing for the more delicate -part of the world, I should illustrate -this by the danger of exposing the feet alone -to cold or wet. It is seldom that seamen -are susceptible to so great a degree, for their -hardy and exposed life steels them against -<span class="pagenum" id="Page_339">339</span> -such impressions. But there is another circumstance -which renders it of the utmost -consequence to defend the feet against external -injury. It frequently happens, that, without -any visible symptoms of scurvy, the constitutions -of seamen are such, that, upon the -least scratch being received on the feet or -legs, a large spreading incurable ulcer arises; -which sometimes ends in the loss of a limb; -but at any rate disables them from duty till -a cure can be effected by the use of a fresh -and vegetable diet, or a change of climate. -Next to acute diseases and scurvy, this is the -most destructive complaint incident to a sea -life, particularly in a hot climate; and I -have known great numbers of good men -thereby lost to the service. It is, therefore, -of the utmost consequence that men should -not only be supplied with shoes, but be -obliged to wear them, which is found to -require a degree of compulsion; for in the -West Indies it is observed that seamen always -wish to go barefooted.</p> - -<p>Since the first edition of this work was -published, I have been favoured with several -<span class="pagenum" id="Page_340">340</span> -valuable remarks on this subject, by Captain -Caldwell, an officer of great humanity and -experience. Among other remarks, he observes, -that the different articles of clothing -supplied to sailors are, in general, too slight, -and of too small a size, which renders them -expensive and inconvenient to large men. -The trowsers, he observes, should be much -thicker, and larger, as the least shower goes -through them; and, in a cold climate, -those made of <i>fear-nought</i><a id="FNanchor_84" href="#Footnote_84" class="fnanchor">84</a>, which do not -cost more than the others, should also be -allowed. What a situation are men in -when topsails are reefing in the winter -season while it rains, when cold and wet, -with their trowsers sticking to them, (which -would not be the case if they were of -flannel) and it is not practicable that they -should have change of clothing for every -time they are obliged to be wet? Thick, -double-milled caps are much wanted in bad -weather to cover the head and ears. Dutch -caps do not keep out the weather, and will -not stay on the head. It is commonly remarked -<span class="pagenum" id="Page_341">341</span> -that the men who wear the thickest -linen shirts are the most healthy.</p> - -<p>Men, upon first entering into the service, -are allowed the advance of two months -wages, in order to provide necessaries: but -this, inadequate as it is for a long voyage, -is not extended to pressed men. It is also -argued against making large stoppages in -seamen’s wages; that, by diminishing what -they have to receive when paid off, a discouragement -is thereby given to the service. -But as we see men deserting from men of -war when several years wages are due to -them, the most reasonable and effectual encouragement -seems to be to render their -lives as comfortable and healthy as possible.</p> - -<p>But why might not most of the articles -mentioned be supplied gratuitously? In favour -of which Captain Caldwell makes use -of an argument frequently inculcated in -this work, viz. that so much advantage -would accrue to Government by preserving -the health and lives of men, and so much -would be saved in hospitals, as would much -<span class="pagenum" id="Page_342">342</span> -more than reimburse the extraordinary expence<a id="FNanchor_85" href="#Footnote_85" class="fnanchor">85</a>. -<span class="pagenum" id="Page_343">343</span></p> - -<h2 id="PART_II_CHAP_IV">CHAP. IV.</h2> - -<h3 id="OF_EXERCISE">Of <span class="smcap">Exercise</span>.</h3> - -<p>It commonly happens in a ship of war -that a great proportion of the hands is -landsmen; for, besides the men required to -navigate the ship, a great number is necessary -to fight the guns, as well as for other -duties, and their health may be affected by -the want of exercise.</p> - -<p>It has been observed before, that one use -of frequent reviews and musters in a numerous -crew is, to call forth men that would -otherwise be overlooked, to oblige them to -come into the open air, to keep themselves -clean, and to prevent them from indulging -in filth and laziness. It is observed, that -seamen are in general less subject to scurvy -than marines and landsmen, which seems to -be owing to the greater activity of their life -and alacrity of their minds. -<span class="pagenum" id="Page_344">344</span></p> - -<p>There is an essay on the causes of the pestilence, -by an anonymous author, published -at Edinburgh in 1759, in which this disease -is said to be entirely the offspring of idleness, -and he illustrates this by its being more apt to -arise in besieged towns than any other situation; -and he alledges that a false alarm of -the plague will actually produce it by throwing -people idle, as was the case, he affirms, -when the plague was last at Messina.</p> - -<p>There are always numbers who have been -pressed into the service, to whom a sea life -is new, and who are therefore prone to indolence, -low spirits, and self-neglect. Men -of this description are by far the most apt to -fall into the scurvy; and next to the quality -of the food, there is nothing contributes -more to promote the scurvy than such a disposition. -It is indeed both a cause and a -symptom of this disease, and therefore idleness -and <i>skulking</i> should be rigidly discouraged, -unless the complaint is so far advanced -as to render it cruel and even impossible -to force men to take exercise. -<span class="pagenum" id="Page_345">345</span></p> - -<p>The Conqueror, of 74 guns, one of our -squadron in the last year of the war, was -an instance of a ship in which only the -prime seamen were attacked with the scurvy, -and this is to be accounted for upon the -same principle, for it proceeded from their -having been exempted from the duty of -pumping, in which the inferior classes of -men were constantly employed, owing to -the leaky state of the ship.</p> - -<p>As low spirits and indolence have such an -unfavourable effect upon health, it would be -wise, as well as benevolent, to promote whatever -produces jollity, contentment, and good -humour, so far as is consistent with sobriety -and regularity. There are certain rough -sports which are now almost in disuse; and -whoever would revive and encourage them, -would perform a useful office to the service.</p> - -<p>A sea life frequently demands violent -temporary exertions, from the uncertainty -of the weather, and other incidents; so that -men are more exposed to extreme fatigue -<span class="pagenum" id="Page_346">346</span> -and sudden calls of duty in this than in any -other situation of life. Nothing tends more -to shorten life than excessive bodily labour -and watching; and it is for this reason that -seamen in general are short lived, and that -their countenance and general appearance -make them appear older than they really -are by several years. This is remarkably -the case when a seaman comes to be upwards -of forty and it has been mentioned -before, that a person not acquainted with -this circumstance will make a mistake of -ten years in guessing at the age of a seaman -from his looks.</p> - -<p>Fatigue being therefore frequently the -means of bringing on disease and breaking -the constitution, as much tenderness is due -to men as is consistent with the necessary -duties of service. This is a circumstance -in which young officers are apt to forget -themselves; and they should take care how -they <i>call all hands</i> wantonly, and oblige men -to make exertions beyond their strength, -especially as this will be submitted to more -<span class="pagenum" id="Page_347">347</span> -readily by sailors than any other set of men, -from the generous alacrity of their nature.</p> - -<p>It would be well if it could be rendered -convenient at all times, except in cases of -danger or emergency, to put the men at -three watches instead of watch and watch. -By the former arrangement they have eight -hours sleep and rest; by the latter only four -hours are allowed, which is not sufficient -for refreshment, nor is there time for them -to get dry, in case they have been exposed -to wet.</p> - -<p>It would be a good rule to have as few -men as possible out of bed in the night-time, -unless where active service renders it -necessary; for, if unoccupied, they lie about -the decks, fall asleep, and catch cold. In -such situations, might not all the topmen -but one remain on the forecastle, where they -might take exercise, which they could not -do aloft? I am indebted for this remark to -the Rev. Mr. Ramsay, who joins to a great -knowledge of the sea service a warm and -disinterested zeal for its prosperity, and has -<span class="pagenum" id="Page_348">348</span> -been so good in several other instances as to -communicate to me the results of his experience -and observation.</p> - -<p>The good effects resulting from the indulgent -treatment of men are, that it encourages -them to enter into the service, and to -do their duty with cheerfulness and resolution. -There is something more daunting -to the mind of man to see his companions -suffering under oppression and languishing -in disease, or perishing miserably from sores -or sickness, than in the terrors of fire and -sword, which, as we have seen, make the -least part of the calamities of war. The -good treatment of seamen, in so far as it -regards their health, is by no means incompatible -with strict discipline. Indeed strictness -and even severity is necessary with seamen; -for it is observed with regard to men -who are used to arbitrary government, that -they cannot bear indulgence and relaxation. -But the steady enforcement of discipline and -regularity is so far from being akin to cruelty, -that it tends to prevent both sickness -and the commission of crimes, consequently -<span class="pagenum" id="Page_349">349</span> -rendering the infliction of punishment less -frequent and necessary. The chief excellence -in the character of an officer seems to -consist in uniting strict discipline with indulgence -and humanity.</p> - -<h3 id="CONCLUSION">CONCLUSION.</h3> - -<p>The subject of the preceding remarks -has been the prevention of diseases and it -has appeared that the means of this are not -so much in the province of the medical profession -as of those who are entrusted with -the direction of the navy in a civil or military -capacity; and that with regard to cure -and recovery also, a great deal depends upon -them, by their having it in their power to -make a suitable provision of proper diet and -cordials. The great importance of the subject -will plead my excuse for again calling to -mind, that such attentions are not only dictated -by humanity, but would be the greatest -wisdom in an œconomical and national light, -<span class="pagenum" id="Page_350">350</span> -considering how expensive it is to <i>replace</i> -men and to support invalids, not to mention -that it is upon the health and lives of men -that every public exertion essentially depends, -and upon which may depend not only -the character of officers, but the national -character in the day of battle.</p> - -<p>It must be confessed, that though there is -still room for improvement, the navy is now -on a better footing with regard to the health -and comfort of seamen than it appears to -have been in former times. The victuals -were in general in the late war of excellent -quality; the civil branch has shewn in many -instances a readiness to adopt the means and -to furnish the articles that were recommended -for the health of the men<a id="FNanchor_86" href="#Footnote_86" class="fnanchor">86</a>; and most -of the commanders whom I have the honour -to know are humane, attentive, and -intelligent.</p> - -<p>To conclude; there is no situation of life -in which there is room for more virtues, -<span class="pagenum" id="Page_351">351</span> -more conduct and address, than that of a -sea officer. The men are thrown upon his -humanity and attention in more views than -one: they are subject to a more arbitrary -exertion of power than the constitution of -the date authorities in civil life, Englishmen -giving up into his hands, from considerations -of public expediency, that which they -hold most dear, and of which they are most -jealous, their <small>LIBERTY</small>. It is the character -of seamen to be thoughtless and neglectful -of their own interest and welfare, requiring -to be tended like children; but from their -bravery, utility, and other good qualities, -they seem entitled to a degree of <i>parental</i> -tenderness and attention from the state they -protect and the officers they obey. -<span class="pagenum" id="Page_352">352</span></p> - -<h3 id="APPENDIX_TO_PART_II">APPENDIX <small>TO</small> PART II.</h3> - -<blockquote> - -<p>In order to exhibit a concise view of the -most material observations contained in -this part of the Work, a Memorial, delivered -to the Board of Admiralty in -October, 1781, is here subjoined.</p></blockquote> - -<h4 id="MEMORIAL_TO_THE_ADMIRALTY">MEMORIAL,</h4> - -<blockquote> - -<p>Proposing Means for preventing the Sickness -and Mortality prevailing among His Majesty’s -Seamen in the West Indies.</p></blockquote> - -<p>I have for the two last years attended a -squadron, consisting seldom of less than -twenty ships of the line, in quality of physician -to the fleet at Barbadoes and the Leeward -Islands. I received, by the order of -the Commander in Chief, a monthly return -from the surgeon of each ship, setting forth -the diseases, deaths, and other circumstances -of the respective ships companies. -<span class="pagenum" id="Page_353">353</span> -I also superintended the hospital of the place -where the fleet happened to lie when in port. -These advantages have afforded me an intimate -knowledge of the nature and causes of -the sickness and mortality among the seamen, -both on board of their ships and in -hospitals.</p> - -<p>It appears by my returns, that there died -in the course of the twelve months preceding -July last, on board of ships, seven hundred -and fifteen seamen and marines, of -whom only fifty-nine died in battle and of -wounds. There died in the same time in -hospitals eight hundred and sixty-two: so -that out of twelve thousand one hundred and -nine men, which is the sum total of the complement -of twenty ships of the line, there -have perished in one year one thousand five -hundred and seventy-seven, that is nearly -every seventh man.</p> - -<p>There were also sent to England in the -same year, three hundred and fifty men, -disabled by lameness and chronic complaints, -<span class="pagenum" id="Page_354">354</span> -the greater part of whom will be for ever -lost to the service.</p> - -<p>The degree of sickness is very different at -different times; but it appears by the returns, -that, at a medium, there has been -one man in fifteen on the sick list.</p> - -<p>Having employed all the attention of -which I was capable to find out the causes -of this sickness and mortality, in order, if -possible, to point out the means of prevention, -I flatter myself with being able to -assign the most general causes, and to propose -some effectual remedies.</p> - -<p>When it is considered that sickness is almost -entirely confined to ships of two and -three decks, and that some of these are as -healthy as frigates and merchant ships, -though in the same circumstances of service -with others that are extremely sickly, we -are led from hence to infer, that sickness is -not in its own nature unavoidable, and we -are encouraged to hope, that the attainment -<span class="pagenum" id="Page_355">355</span> -of general health is within the compass of -human management.</p> - -<p>I humbly and earnestly solicit attention -to some of the most material observations -and conclusions which have occurred in the -course of a service, which, though short, -has been extensive; and whatever is here -proposed has this recommendation, that it is -easily practicable, and is no addition to the -public charges.</p> - -<p>First, I hardly ever knew a ship’s company -become sickly which was well regulated -in point of cleanliness and dryness. It -is the custom in some ships to divide the -crew into squads or divisions under the inspection -of respective officers, who make a -weekly review of their persons and clothing, -and are answerable for the cleanliness and -regularity of their several allotments. This -ought to be an indispensable duty in ships of -two or three decks; and when it has been -practised, and at the same time ventilation, -cleanliness, and dryness below and between -decks, have been attended to, I have never -<span class="pagenum" id="Page_356">356</span> -known seamen more unhealthy than other -men. The neglect of such attentions is a -never-failing cause of sickness.</p> - -<p>I would, therefore, with all becoming deference, -suggest, that such a regulation, instead -of being left to the discretion of officers, -should be made a part of the public -instructions. From some commanders, who -already practise these rules, the advantage -of them comes to be known; and would -not a public sanction not only render them -general and permanent, but facilitate the -duty of the officer, by making such a regulation -appear a matter of legal necessity, -instead of his own arbitrary act?</p> - -<p>Secondly, Scurvy is one of the principal -diseases with which seamen are afflicted, and -this may be infallibly prevented, or cured, -by vegetables and fruit, particularly oranges, -lemons, or limes. These might be supplied -by employing one or more small vessels to -collect them at different islands, and such an -expedient would prevent much sickness, and -save many lives. I am well convinced that -<span class="pagenum" id="Page_357">357</span> -more men would be saved by such a purveyance -of fruit and vegetables, than could be -raised by double the expence and trouble employed -on the imprest service; so that policy, -as well as humanity, concur in recommending -it. Every fifty oranges or lemons might -be considered as a hand to the fleet, inasmuch -as the health, and perhaps the life, of a man -would thereby be saved.</p> - -<p>Thirdly, The use of wine, in place of -rum, has been found extremely conducive -to health. In the course of my observation -I have met with the most unquestionable -proofs of the benefit that would arise from -this substitution. It is a farther reason for -such a change, that good rum is seldom or -never supplied in the West Indies.</p> - -<p>Fourthly, The necessaries provided for the -sick by the present establishment are not at -all adequate, especially on a distant station, -where the supply is not regular, and the -quantity at best is such as can contribute but -little to their comfort and recovery. An -ample provision might be made for the sick, -<span class="pagenum" id="Page_358">358</span> -without any additional expence, in the following -manner:</p> - -<p>It is a rule in the service, that though -men are sick, their ordinary allowance of -salt meat and other victuals is nevertheless -served out, and is either used by the other -seamen, who stand in no need of it, or is -wasted. Now, if the pursers were instructed -to provide themselves with certain species -of necessaries, such as Madeira wine, -sugar, rice, and dried fruits, to serve to the -sick, in place of rum, and the common provisions -of the ship, such a regulation would -be productive of the very best effects, in recovering -the health, and preserving the lives -of those men who have the misfortune to be -taken ill in a situation necessarily destitute -of most of the comforts that can alleviate -their sufferings. I cannot help here applauding -a late regulation, by which melasses are -substituted for part of the oatmeal; for the -quantity of the latter heretofore legally allowed -was so much greater than what was -necessary, that one half of it has commonly -been wasted. -<span class="pagenum" id="Page_359">359</span></p> - -<p>It is to be observed, in general, with regard -to the West Indies, that ships on service -are to be considered, in a great measure, -in the light of ships constantly at sea; for, -excepting the island of Barbadoes, there is -no other port in which fresh meat and vegetables -can be procured in any quantity, and -therefore sour krout, melasses, and such -other articles of antiscorbutic diet as can be -supplied on board, are absolutely necessary. -Fleets could hardly exist here, were it not -that a warm climate is naturally more unfavourable -to the scurvy than a cold one.</p> - -<p>Fifthly, Though the health of a ship’s -company depends chiefly on diet, and that -discipline and order which is the business of -officers, yet much depends also on the medical -art, particularly in the West Indies; -and as surgeons frequently cannot do justice -to the men without wronging themselves, -in a country where the price of every thing -is exorbitant, and medicines often unsound, -Government would find its account in supplying -gratuitously some of the most costly -<span class="pagenum" id="Page_360">360</span> -articles, particularly Peruvian bark in a fresh -state, from time to time, from England.</p> - -<p>Sixthly, It is now the general custom to -send every sick person on shore to an hospital, -where there is frequently worse air and -worse accommodation than on board, from -overcrowding the apartments. Contagious -diseases, though not so common as in Europe, -are here often mixed with those that -are not so, whereby numbers are infected and -carried off; and, besides this, the land air is -infinitely more unwholesome in the West -Indies than the air at sea or in a road. The -scurvy is perhaps not at all contagious, nor -is it very difficult of cure; but a number of -cases of it terminate fatally from the flux or -fever, caught either by contagion in hospitals, -by the noxious influence of land vapours, -or by intemperance. I beg leave, therefore, -humbly to suggest, that as few sick -as possible of any disease, but what is contagious, -be sent to hospitals, and that some -method be established for the supply of vegetables -and other refreshments to the sick -on board of their ships. -<span class="pagenum" id="Page_361">361</span></p> - -<p>Seventhly, Crowding, filth, and the mixture -of diseases, are the great causes of mortality -in hospitals. There should be a space -of five hundred cubic feet allowed for each -man; and in general the sick had better remain -on board than be crowded beyond that -degree; or relief should be provided to the -hospital by an hospital ship, which, for reasons -already given, is preferable to any accommodation -on shore; and such an institution -would be more particularly proper for -the reception of convalescent men.</p> - -<p>I would beg leave, therefore, earnestly -to recommend that cleanliness, the separation -of diseases, and a competent space, be -regularly enjoined and strictly enforced in -hospitals; and in order to make this more -practicable in the great scale of service now -going on, I would farther propose that hospital -ships be established for the reception of -the sick or recovering. I know from extensive -experience and close observation, that -these circumstances are more essential than -even medicine and diet. -<span class="pagenum" id="Page_362">362</span></p> - -<p>These are a few remarks extracted from a -series of observations, and derived from -great opportunities of experience. Many -other remarks would suggest themselves; but -I purposely confine myself to what is highly -important, and easily practicable, with little -or no addition to the public expence. -Some of the improvements recommended -are indeed an immediate, and all of them -will be an eventual, saving to the public.</p> - -<p>The alterations that have been proposed -are,</p> - -<p>1st, The establishment of a certain method -and discipline, in order to secure regularity -and cleanliness among the men, and -to render the ships clean and dry.</p> - -<p>2dly, The supply of fruit and other vegetables -for the cure of the scurvy.</p> - -<p>3dly, The substitution of wine<a id="FNanchor_87" href="#Footnote_87" class="fnanchor">87</a> for rum. -<span class="pagenum" id="Page_363">363</span></p> - -<p>4thly, The provision of an adequate quantity -of necessaries for the sick.</p> - -<p>5thly, The gratuitous supply of certain -medicines.</p> - -<p>6thly, The curing of certain diseases on -board instead of sending them to hospitals; -and,</p> - -<p>Lastly, The preventing of filth, crowding, -and the mixture of diseases in hospitals, -by proper regulations, and by establishing -hospital ships.</p> - -<p>I beg leave again to call to mind, that -1518 deaths from disease, besides 350 invalids, -in 12,109 men, in the course of one -year, is an alarming waste of British seamen, -being a number that would man three of -His Majesty’s ships of the line; and what I -advance is from a real conviction that a due -attention to the above-mentioned propositions -would save more than two thirds of -the seamen that would otherwise die in that -climate. It was to set this in a proper light -<span class="pagenum" id="Page_364">364</span> -that I requested leave to quit my duty during -the absence of the greater part of the squadron -in the hurricane months; and should -any thing I propose meet with public approbation, -and be carried into effect, I should -esteem it a recompence far above any other -gratification I can derive from the service.</p> - -<p> -<span class="smcap">London</span>,<br /> -October 13, 1781.<br /> -<br /> -To the Right Hon. the Lords Commissioners<br /> -of the Admiralty.<br /> -</p> - -<hr class="tb" /> - -<p>Next year the following Supplement to -the preceding Memorial was sent to the -Board of Admiralty:</p> - -<h4 id="SUPPLEMENT_TO_THE_MEMORIAL"><span class="smcap">Supplement</span> to the <span class="smcap">Memorial</span> delivered -last Year to the Board of Admiralty.</h4> - -<p>Since my return to my duty on this -station, additional experience has afforded -me farther practical confirmation of the -utility of the former proposals. -<span class="pagenum" id="Page_365">365</span></p> - -<p>The great squadron employed on this station -has, by the attention of the Commissioners -of Victualling, and also of the Commander -in Chief, been supplied with most of the -articles recommended, in such quantities as -to prove their efficacy; and indeed the small -degree of mortality in comparison of former -times, is a sufficient demonstration of this.</p> - -<p>I beg leave to give an instance in the Formidable -of the great and salutary effects of -the proposed improvements. This ship left -England, furnished not only with sour krout -and melasses, in common with most others -in the squadron, but what was peculiar to -herself was, an entire supply of good wine -in place of spirits; and an experiment has -been made in this instance, under my own -eye, to ascertain what degree of health it -was possible to attain in a great ship in this -climate. With the above advantages, together -with good discipline and medical care, -no man<a id="FNanchor_88" href="#Footnote_88" class="fnanchor">88</a> died of disease from December, -<span class="pagenum" id="Page_366">366</span> -1781, to May, 1782, and only thirteen -were sent to hospitals, whose complaints -were small pox and ulcers. In the months -of May and June last, when at Jamaica, -there died of disease in this ship, three men, -and seventeen were sent to the hospital, -most of whom had contracted their sickness -on board of French prizes.</p> - -<p>In the rest of the fleet the health was in -proportion to the wine and other refreshments, -and the cleanliness, good order, and -discipline observed.</p> - -<p>In the squadron I attended the last five -months, which seldom consisted, during the -last three months of that time, of less than -forty ships of the line, there have died of -disease about 350 men, and about 1000 have -been sent to hospitals; a degree of sickness -and mortality which, though not greater -than what frequently prevails in Europe, I -am persuaded would have been still less, -<span class="pagenum" id="Page_367">367</span> -had the improvements proposed been complied -with in a manner more extensive and -complete, and had the general rules of discipline -and cleanliness been kept up with -due and equal strictness throughout the fleet.</p> - -<p>This last article, which, being the most -important, I have placed first in the preceding -memorial, it is only in the power of -supreme authority to enforce; and my additional -experience and observation have so far -confirmed me in the opinion of the utility -of this, as well as the other articles, that I -hope to be again pardoned for repeating my -humble and earnest solicitations that these -regulations may be farther extended and enforced.</p> - -<p> -<span class="smcap">Formidable</span>,<br /> -At Port Royal, Jamaica,<br /> -July 16, 1782.<br /> -</p> - -<p><span class="pagenum" id="Page_368">368</span></p> - -<p class="ph1" id="PART_III">PART III.</p> - -<h3 id="DESCRIPTION_AND_TREATMENT">DESCRIPTION AND TREATMENT<br /> - -<span class="x-small">OF THE</span><br /> - -<span class="x-large">DISEASES</span><br /> - -<span class="x-small">MOST COMMONLY OCCURRING IN</span><br /> - -<span class="large">FLEETS IN HOT CLIMATES.</span></h3> - -<p>It was mentioned in the Introduction to -this work, that though my opportunities of -experience were extensive, several obstacles -had prevented me from making observations -so accurately as could have been wished. -These were chiefly the bad accommodation -of the sick at some of the hospitals, and -the shortness of our stay at any one place, -which seldom exceeded six weeks or two -months, and prevented me from completing -such observations as I have happened to be -engaged in. But having practised among -great numbers, observations necessarily arose -<span class="pagenum" id="Page_369">369</span> -from the comparison of so many cases; and -amidst the variety of situations connected -with the emergencies and hardships of war, -nature is seen in certain portions and under -certain trials which are not met with in -common life. I shall therefore describe the -diseases such as they occurred, and shall add -such remarks on practice as I could ascertain.</p> - -<p>The following observations shall be confined -chiefly to what I have called the sea -epidemics, viz. Fevers, Fluxes, and the -Scurvy. -<span class="pagenum" id="Page_370">370</span></p> - -<h2 id="PART_III_CHAP_I">CHAP. I.</h2> - -<h3 id="OF_FEVERS">Of <span class="smcap">Fevers</span>.</h3> - -<p>Though it is impossible to refer every -particular case of fever to a distinct class, on -account of the mixed and anomalous symptoms -that arise, yet there are certain distinguishing -features which afford sufficient -ground for dividing them into different -kinds, and such a division will at least serve -to facilitate description, and to afford room -for laying down the outlines of practice.</p> - -<p>The fevers which occurred most frequently -on board of ships, and at naval hospitals -belonging to the fleet in which I was employed, -were the infectious ship fever, -(which is the same with the jail and hospital -fever) the bilious remitting fever, and -the malignant yellow fever. -<span class="pagenum" id="Page_371">371</span></p> - -<h4 id="OF_THE_INFECTIOUS_SHIP_FEVER">1. Of the infectious <span class="smcap">Ship Fever</span>.</h4> - -<p>This does not occur so frequently in hot -as in cold climates, both because it is the -disease of ships newly fitted out, which they -seldom are in the West Indies, and because -there is something in the warmth of a climate -which prevents the production of contagion, -as has been formerly remarked. But -as great fleets arrived from time to time in -the West Indies from Europe, with numbers -of men labouring under this fever, -there were sufficient opportunities of making -observations upon it.</p> - -<p>It has been so well described by Sir John -Pringle, Dr. Lind, and other writers, that -it is unnecessary to enter into a minute detail -of all its different appearances in its -several stages; and I shall content myself -with recounting some of the most distinguishing -symptoms, and with marking the -peculiarities that arose from the influence of -the climate. -<span class="pagenum" id="Page_372">372</span></p> - -<p>This fever is extremely various in its -symptoms and in its degree of malignity -and fatality. We are told in some of the -histories of the jail distemper, that, upon -its first attack, few escaped that were seized -with it; but that afterwards it grew more -mild; and it has been already observed, that -the contagious poison of fever differs from -that of small pox and other specific infections, -by varying in its degrees of virulence.</p> - -<p>There are, however, certain characteristic -symptoms pretty constant in this fever in all -its forms.</p> - -<p>One of the most remarkable of these is a -greater degree of muscular debility than what -takes place in other fevers, and it deserves to -be mentioned first, as being one of the most -constant. It is also a tolerably true index of -the degree of malignity, the danger being -in proportion to this symptom. In the more -advanced stages of the fever, a tremor of the -hands, and of the tongue when put out, is -a constant symptom, and seems to be connected -with this weak state of the muscular -<span class="pagenum" id="Page_373">373</span> -fibres. I have seen, however, extreme debility -without tremor in cases too of the -greatest danger, and it was observable in -these that there was little or no delirium.</p> - -<p>Another striking character of this fever is -the delirium of a particular kind which usually -attends it. Sensation and reason are here -in a state uncommonly depraved; and it is -in this sort of fever oftener than any other -that we find a total deprivation of them in -the symptom called <i>coma</i>. The delirium is -seldom of a wild, ungovernable kind, such -as occurs in inflammatory continued fevers, -in the violent paroxysms of intermitting and -remitting fevers, or in inflammations of -the brain. It is, however, connected with -great suffering; and this consists in anguish -rather than pain, shewing itself by outward -tremor, agitation, and what is called the -<i>floccorum collectio</i>; also by sighing, mumbling, -and moaning, symptoms always indicating -danger.</p> - -<p>Delirium is a symptom, to the nature and -appearances of which I have been particularly -<span class="pagenum" id="Page_374">374</span> -attentive, in consequence of a painful -and diligent attendance upon some cases in -which I was particularly interested from -friendship and affection, and in which this -was a remarkable symptom. It seems chiefly -to consist in a false reference of our sensations, -whether external or internal; and -this is in no sort of fever more evident -than in this. When any painful impression, for instance, -is made by an external -body, the patient, if in a state of delirium, -does not refer it justly to the part affected; -but the general agitation and incoherence of -sentiments will be aggravated for the time. -I have known a degree of heat applied to -the extremities sufficient to blister them, -yet the part did not shrink, though the raving -and general uneasiness were increased. -In like manner, with regard to internal sensations, -when an irritation is excited to expel -the urine or <i>feces</i>, the mind does not recognize -it as such, but from a sense of uneasiness, -probably mistaken for something else, -an effort is made to relieve nature, which -is done without a proper consciousness, and -certain symptoms are produced which are -<span class="pagenum" id="Page_375">375</span> -well-known marks of danger in this fever. -In watching those who have been under the -influence of delirium, I have observed it increase -when any particular want of nature -urged, and this would continue for some -time, the patient being incapable of procuring -himself immediate relief on account of -the false reference of sensation that has been -mentioned; but he would become calm after -voiding the urine or <i>feces</i>, or after receiving -something to drink, according to the -particular want that was present at the time. -So great is the disorder in the common -course of sensation in this fever, that a person -ill of it has been even unconscious of inflammations -of vital parts, which, in the natural -state of the nerves, would have excited -the most acute pain, and would have been -distinctly referred to the part affected, but -were not discovered nor suspected till inspection -after death<a id="FNanchor_89" href="#Footnote_89" class="fnanchor">89</a>. I remember one case in -<span class="pagenum" id="Page_376">376</span> -which there were found large erosions, and -even holes in the intestines, without any -preceding complaint that could have led to -suspect such an appearance. It would appear -that the motions excited in the brain -and nerves in such cases, instead of producing -the sensations naturally belonging to -them, serve to excite disagreeable emotions -of a different kind, in which delirium consists. -It seems to be from the same depraved -state of sensation, that when a phthisical -person is seized with this sort of fever, his -cough is for the time suspended. I have -seen the same circumstance occur in a maniacal -case. From a like cause it sometimes -happens in dangerous cases of fever, that -in the height of delirium the <i>epiglottis</i> loses -its natural irritability, so that liquids in the -act of swallowing are apt to get into the -<span class="pagenum" id="Page_377">377</span> -windpipe, so as to excite coughing and -threaten suffocation, as I have observed in -some cases that came under my care.</p> - -<p>All these different forms of delirium are -signs of a body extremely disordered in its -functions, and forbode great danger.</p> - -<p>The next symptom I shall mention as -most characteristic of this sort of fever is, -the spots known by the name of <i>petechiæ</i> -and <i>vibices</i>, which, though far from being -constant, are, perhaps, more peculiar to it -than any other symptom. They occur only -in the latter stages of the disease, and in -cases of considerable danger. The common -opinion concerning their cause is, that the -blood is in such a dissolved state, that the -red part of it is effused into the cellular -membrane. The appearance in such bodies -as I have inspected, seems to favour this -opinion; for there was hardly any coagulation -of the blood in the great vessels, and -instead of those firm substances, called <i>polypi</i>, -in the heart, there were only soft grumous -bodies, which were so tender in their -<span class="pagenum" id="Page_378">378</span> -consistence, that, upon being handled, they, -as it were, dissolved. Since the improved -method of treating these fevers has been -generally adopted, this symptom seldom -occurs; for in most cases it may be called -an artificial symptom, chiefly arising from -close apartments and the heat of bed clothes.</p> - -<p>It may be considered as a peculiarity of -this fever, that it is more indefinite in its -crisis than most others. In continued fevers -of the inflammatory kind, there are frequent -attempts at remission, there are certain periodical -exacerbations, and there is generally -a distinct crisis marked by a freedom of the -secretions and turbid urine: but in the fever -of which we are treating, though the patient -is generally somewhat worse towards -the evening and during the night, its course -is more equable, and the transition from -sickness to health is insensible and gradual, -being seldom marked with any perceptible -crisis.</p> - -<p>The symptom next to be taken notice of, -though a minute one, is very constant and -<span class="pagenum" id="Page_379">379</span> -characteristic in this sort of fever. It is a -peculiar heat in the skin, communicated to -the hand of another person. It is usual to -grasp the wrist of the patient after feeling -his pulse, in order to examine the state of -the skin in point of heat and moisture; and -in doing this a glow of heat is impressed on -the palm of the hand, which lasts for some -hours, if one should neglect so long to wash -the hands. I have never met with this -symptom in any of the sporadic fevers of -England, though I am informed it sometimes -occurs in these.</p> - -<p>The fever we are treating of differs also -from the sporadic nervous fever of England, -and from most others of the continued -kind, in being attended with a more copious -secretion of bile, which, when thrown up, -is generally green, or, as it is otherwise -called, of a porraceous colour. This symptom -takes place in all climates; but is more -remarkable in a hot climate, as might be -expected. -<span class="pagenum" id="Page_380">380</span></p> - -<p>These are the chief characteristic symptoms -of this fever. I shall next point out -such modifications of it as occurred in the -West Indies from the influence of climate.</p> - -<p>In the first place, when this fever prevailed -on board of any ship that arrived from a -northern climate, it was soon after succeeded -by, or, as it were, converted into, a dysentery; -for those ships that arrived either -from England or North America with the -greatest stock of feverish infection, were the -most subject to fluxes, after being two or -three months in the West Indies. This -was formerly made use of as an argument, -to prove that the dysentery proceeds from -the same cause with fever, taking a different -determination, from circumstances of -climate and constitution.</p> - -<p>Secondly, It sometimes happens that men, -under the influence of this infection, are -more apt than others to be affected with -symptoms peculiar to the climate upon their -first arrival. A very striking instance of this -has been mentioned in the case of men that -<span class="pagenum" id="Page_381">381</span> -were pressed into the Formidable at New -York, some of whom had the common ship -fever on the passage; others, upon our arrival -at Barbadoes, were seized with the yellow -fever, and were the only men in the -fleet who had it at that time. There was -another instance in the recruits brought -from England by the Anson, who were -seized with a fever on board of the Royal -Oak; and in this fever the skin and eyes -were yellow, though without any symptoms -of malignancy<a id="FNanchor_90" href="#Footnote_90" class="fnanchor">90</a>.</p> - -<p>Thirdly, It happened in some ships<a id="FNanchor_91" href="#Footnote_91" class="fnanchor">91</a> -that the infection was kept up for several -months after arriving in the climate, from a -neglect of cleanliness, or the want of an opportunity -of removing those who were infected -to an hospital. It did not in these -take a dysenteric turn, as in most of the -other ships, but differed from the ship fever -of colder climates, as above described, in -some particulars, which I shall here enumerate. -<span class="pagenum" id="Page_382">382</span> -All the symptoms were milder: -it was more protracted, and less dangerous. -In the beginning there was but little difference, -only the symptoms were less violent; -but in the succeeding period of the disease -the pulse deviated very little from the natural -standard, and the skin felt cold and clammy. -The tongue was white; and this did not -seem so much owing to any fur covering it, -as to its being itself of a pale, lifeless colour, -as well as the face, and it appeared larger in -size than natural. The teeth were clogged -with a white fur. Those affected with this -fever were subject to faintings, and had a -constant uncomfortable languor and listlessness. -Most of them had a deep-seated pain -in the occiput, and an oppression at the -stomach, but without any inclination to -vomit. The unfavourable symptoms were -<i>coma</i>, <i>delirium</i> and a yellowness of the skin. -I never remember to have seen <i>petechiæ</i> in -any of them. The favourable symptoms -were a warm moisture, or a miliary eruption -on the skin, and a gentle <i>diarrhœa</i>, -which, however, if neglected, was in danger -of degenerating into an incurable flux. -<span class="pagenum" id="Page_383">383</span> -A great number were seized with this fever -in the Alcide, in July, 1783, and what is -remarkable, most of them had the tape -worm, as I was informed by Mr. Telford, -the surgeon of that ship, who frequently -obliged me with valuable remarks; and he -observed also, that it was evidently infectious, -and that the skin communicated the -same disagreeable feeling to the hand as was -mentioned above.</p> - -<p>Though the inflammatory fever does not -often occur in hot climates, yet, as it is of -great consequence to distinguish it in all -cases from the infectious fever of which we -are treating, it may not be improper, nor -uninstructive, here to point out the most -remarkable differences. There is more resemblance -in their symptoms, especially towards -the beginning, than might at first be -supposed; and as it is very material to avoid -error with regard to the practice, which, in -these two sorts of fevers, ought to be very -different, and even opposite, I have taken -particular pains to discriminate them. -<span class="pagenum" id="Page_384">384</span></p> - -<p>The continued inflammatory fever is very -uncommon in the West Indies; but in the -form in which I have met with it in North -America and England, there are cases in -which the blood is sizy during the whole -course of the disease, even without local -affection, though, in general, there is more -or less rheumatism, or pulmonic inflammation. -The symptoms which chiefly distinguish -such cases from the fever before described -are, a greater degree of muscular -strength, a more violent delirium, pale -urine, a more parched tongue and skin, -greater heat and thirst, and a pulse more -frequent and strong, with a particular sharpness. -There is another symptom sometimes -occurring, which I consider as strongly characteristic -of a fever of an inflammatory nature. -This is a watery diarrhœa, without -<i>fæces</i> and without gripes, the stools consisting -chiefly of the drink as it was taken in. -There seems here to be a suspension of the -power of absorption as well as secretion in -the bowels, in consequence of a general -spasm on the extreme vessels; for there -is hardly even bile or mucus in the stools. -<span class="pagenum" id="Page_385">385</span> -There is also a particular appearance of the -mouth connected with this type of fever, -which is better learned by the eye than by -description. It consists chiefly in a want -of moisture on the lips, and a dryness and -shining appearance of the teeth. With -these symptoms, it will be found that the -patient will bear the lancet in very advanced -stages of the disease. These fevers seldom -occur but in a sporadic way, unless when -there is some peculiarity of season, as at -New York in autumn, 1782. They are -also more frequent among the better than -the lower sort of people.</p> - -<p>By comparing these symptoms with those -of the infectious fever above described, there -will appear an obvious difference in their nature, -and evident reasons for varying their -treatment. -<span class="pagenum" id="Page_386">386</span></p> - -<h4><span class="smcap">Treatment</span> of the <span class="smcap">Ship Fever</span>.</h4> - -<p>When the body is thrown into disorder -by an attack of fever, the first step to be -taken is to clear the stomach and bowels of -their crude and acrid contents, consisting -either of the food imperfectly digested, or -the depraved natural secretions. So great -is the disturbance produced by such offending -matter, that, when nature is freed from -this embarrassment, the functions of the -body are frequently by this alone restored to -their proper exercise, and a remission produced. -It seems probable also, that this -evacuation proves salutary not only by removing -the morbid stimulus, but by preventing -the absorption of corrupted or ill-concocted -juices into the mass of blood, -which would tend still farther to derange -the functions of life. But perhaps the circumstance -that first suggested the utility of -evacuating the stomach, as the first step in -the cure of fevers, was the nausea so common -<span class="pagenum" id="Page_387">387</span> -in the beginning of them, which may -be considered as a natural indication of this -practice. It farther appears rational, that, -as acute diseases generally come on suddenly, -and find the body in a state of repletion -from the recent <i>ingesta</i>, the most obvious -means of relief should be to free the bowels, -and particularly the stomach, from what is -foreign and oppressive to it. It seems also -probable, that the <i>nausea</i> and the act of vomiting -have a salutary effect independent of -evacuation; for I have seen relief produced -from these when nothing was evacuated. -Such, indeed, is the great and universal influence -and sympathy of the stomach, that -the operation of vomiting affects every fibre -of the body, and has been known to resolve -tumours in the most distant parts. An early -administration of an emetic is therefore the -first step to be taken in the treatment of -this as well as most other fevers.</p> - -<p>If it is given in small divided doses, it will -most probably evacuate the bowels downwards; -and the most convenient form for -this purpose is a solution of emetic tartar. If -<span class="pagenum" id="Page_388">388</span> -it should not have this effect, some brisk -purgative medicine should be given soon after -the operation of it.</p> - -<p>I mention these evacuations before blood -letting; for though this ought to be first in -those cases in which it is proper, it is here -seldom necessary, and we may pronounce it -to be a remedy very ill adapted to this sort -of fever, particularly in a hot climate. It -sometimes happens, however, that there is -violent head-ach, pain of the back and limbs, -with a throbbing pulse; and these symptoms -may in the very beginning not only -justify, but require the losing some blood -before the administration of the emetic or -purgative.</p> - -<p>The next means of relief I shall mention, -and also the most probable means of cutting -short the disease, is to excite universal -sweat. This being an imitation of nature, -is founded on reason as well as experience; -for it is by sweating that the fit of an intermittent -is relieved and terminated; and continued -fevers in general, if not always, begin -<span class="pagenum" id="Page_389">389</span> -with a fit of the same kind. A dry skin, -accompanied with heat, is one of the most -constant as well as troublesome and uneasy -symptoms in all fevers; and it would appear -from the peculiar heat of the skin in this -sort of fever, that there is either a more -than common acrimony of the matter of -perspiration, or something peculiar in the -mode of circulation on the surface of the -body. Sweating does not seem to operate -entirely by the evacuation of acrimony, for -no relief is procured by it if it is partial; -and it is evident from a number of facts -that the state of the brain and <i>viscera</i> depends -on that of the external surface of the -body; for a free state of the pores of the -skin, provided it is general, tends more than -any other circumstance to relieve internal -pain, and also to take off delirium. The -good effect of sweating seems, therefore, -chiefly to depend on a general relaxed state -of the small vessels on the surface of the -body; and it ought to be effected, if possible, -by gentle, soothing means, and not by -such regimen and medicines as heat the body -and accelerate the circulation. This intention -<span class="pagenum" id="Page_390">390</span> -is best answered in the beginning by moderate -doses of antimonial medicines, and -either James’s powder or tartar emetic may -be employed. The first is a more certain -sudorific, being less apt than the other to -run off by the bowels; and its effect will -be still more certain, if accompanied with a -mild opiate, rendered diaphoretic by <i>Spiritus -Mindereri</i>, which will both prevent the antimonial -from acting roughly, and will determine -its operation to the skin. A sweat -kept up by these means, together with plentiful -warm dilution, from twelve to twenty-four -hours, is the most probable means -of bringing about a complete remission of -the fever; and in this case a fresh accession -is to be prevented by the immediate administration -of the bark.</p> - -<p>These are the means proper for stopping -the fever in the beginning, or tending to -render its future progress more safe; and -though, with this view, free evacuations -have been recommended, yet, if the fever -should go on, great caution is necessary in -this respect in the future treatment, debility -<span class="pagenum" id="Page_391">391</span> -being the symptom chiefly to be guarded -against. Purgatives may, indeed, be occasionally -necessary, in consequence of accumulations -of bile taking place; but, in general, -the evacuations by stool should not -be more frequent than in health; and some -of the cases which were most unmanageable -and fatal, were those in which there was a -spontaneous <i>diarrhœa</i>. With regard to blood -letting, it is always hurtful after the first -two days, unless some inflammatory affection -of a vital part should arise.</p> - -<p>The natural evacuation, which may with -most safety and advantage be solicited and -encouraged in this disease, is, that by perspiration; -and it is observable, that in those -cases for which nature does most, there is a -universal warm sweat, which has generally -a very offensive smell, and seems to be a salutary -effort of the constitution to cure the -disease. Where this takes place, little medical -assistance is necessary, except to keep -it up chiefly by warm dilution; and there -is no circumstance in which the judgement -of a physician is shewn more than in discerning -<span class="pagenum" id="Page_392">392</span> -those cases in which his chief business -is to look on, where nature, being -equal to the task, ought not to be disturbed -by the active and officious interposition of -art. We should not, however, aim at producing -a profuse sweat, except with a view -to effect a remission immediately after the -first evacuations. In the course of the disease, -it is only necessary to keep up a gentle -moisture or softness of the skin.</p> - -<p>The head being particularly affected in -this sort of fever, the patient is extremely -restless and delirious, especially at night; -and there is a medicine which has a most -pleasing effect in procuring both rest and -perspiration. This is a combination of an -opiate with an antimonial medicine, which -was administered in the evening with great -success; and the sudorific effect is rendered -more certain by the addition of some saline -neutral, especially <i>Spiritus Mindereri</i><a id="FNanchor_92" href="#Footnote_92" class="fnanchor">92</a>. I -<span class="pagenum" id="Page_393">393</span> -tried pure opiates in the early stage of this, -fever, but found them not to answer; -though in the low<a id="FNanchor_93" href="#Footnote_93" class="fnanchor">93</a> fevers of England, and -<span class="pagenum" id="Page_394">394</span> -in the advanced stages and convalescent state -of this fever, they are extremely safe and -useful. Pure laudanum is also given by Dr. -Lind, at Haslar, with great success in the -height of the disease; but in the West Indies -there is a greater tendency to acrid excretions, -and the effect of pure opium in -causing a retention of these, seems to be -the cause of its disagreeing in that climate -in the first stage of this fever.</p> - -<p>It may here be observed, that the addition -of a little neutral salt alone will sometimes -so qualify the operation of opium, as -to prevent its bad effects, such as the increase -of febrile heat and delirium, and the -stupor and head-ach which, when given -alone, it frequently induces the following -day. I have generally employed nitre with -this intention; but this does not seem so -well adapted to this disease as some other -neutral salts, as it tends too much to lower -the powers of life.</p> - -<p>But with a view to perspiration, the <i>Spiritus -Mindereri</i> is the most effectual neutral -<span class="pagenum" id="Page_395">395</span> -medicine when conjoined with an opiate, -and there is not, perhaps, a more safe and -pleasing diaphoretic known than a combination -of it with syrup of poppies<a id="FNanchor_94" href="#Footnote_94" class="fnanchor">94</a>. There -is some neutral salt in Dover’s powder, and -this has more effect than could be expected -from so small a quantity of an inert medicine; -for I know from trials of my own, -as well as those of others, that ipecacuanha -and opium given together, in the proportions -prescribed in that powder, will not -have the same effect as when joined with the -neutral salt. This is an instance of those -useful combinations of medicines which can -be discovered only by experience, but which -every physician ought gladly to adopt in -practice upon good testimony and fair trial, -though he may not be able to account for -their effects, nor to explain their mode of -operation. -<span class="pagenum" id="Page_396">396</span></p> - -<p>There is nothing more important than -plentiful warm dilution; and the infusion of -sauge, or any such light aromatic, is rather -more proper than farinaceous decoctions, or -any compositions in which there is wine or -spirits. Success in this, as well as other -diseases, depends on attention to nursing as -much as upon medicine; for what would it -avail here to administer medicines for promoting -perspiration, unless they were assisted -with fluids to allay thirst, to dilute the -acrimony in the first passages and in the -vessels, and to furnish the materials of free -perspiration?</p> - -<p>But however desirable it may be to procure -sweat, this is not to be attempted by close -rooms and bed clothes, nor by hot medicines, -such as volatile salts, serpentary, spirituous -tinctures, or aromatics. These, according -to the testimony of Sydenham, tend -to increase the heat and delirium, and to -produce <i>petechiæ</i>, miliary eruptions, or local -inflammations. In the intervals of the anodyne -diaphoretic above described, <i>Spiritus -Mindereri</i> and small doses of camphor, with -<span class="pagenum" id="Page_397">397</span> -proper dilution, may be safely employed to -procure a soft skin.</p> - -<p>The only other means I shall mention -with this view is, the application of warm -moisture to the surface of the body, which -may be done by soaking the feet and hands -in warm water, or by fomenting the feet -and legs with stupes<a id="FNanchor_95" href="#Footnote_95" class="fnanchor">95</a>. These operations -have the effect of bringing on a general relaxation -on the skin, thereby taking off febrile -agitation and delirium, and inducing -sleep. I sometimes, with seeming benefit, -ordered cataplasms to be applied to the feet, -merely of the emollient kind, without mustard -or any other acrid substance, being intended -to relax, and not to stimulate.</p> - -<p>In the use of pediluvia and fomentations, -there is a difference worth attending to between -the practice in this fever, and that in -the inflammatory fever before described, for -they are as hurtful in the latter as they are -<span class="pagenum" id="Page_398">398</span> -beneficial in the former. I have observed, -in general, that they have a bad effect in all -cases where there is sizy blood, particularly -where the breast is affected.</p> - -<p>Delirium is one of the most constant and -alarming symptoms in this disease, and the -removing of it depends much upon the attendants -as well as the physician. It has -been said before, that it depended on a false -apprehension of the impressions or natural -sensations. When a person, for example, -labours under delirium, and is affected with -thirst, the minds is either so agitated with -other objects, that this sensation is overlooked, -or, instead of producing a craving -for drink, it excites some other disagreeable -emotion in consequence of the disordered -state of <i>sensorium</i>. This last seems to -be probable from the cessation of delirium, -which will take place upon any natural want -being satisfied; I have seen a temporary -stop put to the patients raving by making -him drink, or upon his discharging his -urine or <i>feces</i>; for he is then unconscious -of thirst and other natural wants, is therefore -<span class="pagenum" id="Page_399">399</span> -ignorant of the means of satisfying -them; and when he does so, he fancies he is -about something else which is the subject -of his delirious thoughts. This observation -leads to a material practical purpose; for it -follows from it, that unremitting attention -should be given to the patient’s feelings and -all his possible wants, as those natural notices -and instinctive cravings which occur in -health are now wanting, in consequence of -the depraved state of sensation.</p> - -<p>Most of the remarks that have hitherto -been made apply to the earlier stages of the -disease. The principal remedies applicable -in the more advanced stages are, blisters, -Peruvian bark, opium, and wine.</p> - -<p>I have found what Dr. Lind says concerning -the efficacy of blisters confirmed by my -own experience, especially in those fevers in -which there was great delirium, <i>coma</i>, and -head-ach; but I have not experience enough -to say whether they were as useful in the -beginning of the disease in the West Indies -as he found them to be in England. -<span class="pagenum" id="Page_400">400</span></p> - -<p>The men that were brought from the -ships to the hospitals were affected with the -disease in various stages; but as we had in -general a very inaccurate history of the several -cases, the method of treatment upon -their first admission was pretty nearly the -same in all; and it consisted, in the first -place, in washing their face, hands, feet, -and legs, with warm water and vinegar, -from which they derived the greatest comfort, -being commonly very dirty. There -ought to be a <a id="FNanchor_96" href="#Footnote_96" class="fnanchor">96</a>warm bath at every naval hospital -kept in constant readiness; for there -are so few conveniences on board of a ship -for preserving bodily cleanliness among the -sick, that the surface of the body becomes -loaded with filth, so that the operation of -<span class="pagenum" id="Page_401">401</span> -the warm bath could not fail to be highly -comfortable and salutary as the first step to -their cure when brought on shore. We had -generally very indistinct information about -the state of their bowels, as well as other -circumstances, on account of their delirium; -but it was at any rate useful, or at least -safe, to give them a clyster. They were -enjoined plentiful dilution; and if they -were low, some wine and water was allowed. -In the evening, the anodyne diaphoretic -medicine was administered, and a -blister applied to some part of the body. In -consequence of this method, we seldom failed -to find the patients better next morning; -and it was tried in such numbers, that the -efficacy of it was sufficiently ascertained. It -happened in some cases, that these means -were omitted, and a comparison of these -with the others served to ascertain the true -efficacy of the medicines; the stationary -state of the symptoms, when the disease -was thus left to itself, sufficiently proving -the propriety of the treatment above described. -<span class="pagenum" id="Page_402">402</span></p> - -<p>It is an important question to what circumstances -of this fever the Peruvian bark -is adapted. An early and indiscriminate use -of it is recommended in some late publications, -upon the authority of which I tried -it without regard to the stages or symptoms, -and without any prejudice either for or -against the practice; but I found that this -powerful remedy was in danger of doing -much harm, unless great attention was paid -to circumstances, in order to ascertain the -proper seasons for giving it. The symptoms -that forbid the use of bark are chiefly -foul bowels, hard pulse, sizy blood, great -delirium, dry tongue, a hot and dry skin, -and inflammatory affections of the viscera. -It was found extremely pernicious in an -early stage of the disease previous to evacuations; -and the object of practice at this time -should be to relieve the habit by means of -these, in order to produce a general relaxation -of the secretions, and to render the skin -cool and soft, thereby paving the way for -the bark. -<span class="pagenum" id="Page_403">403</span></p> - -<p>It is not necessary, however, especially in -the advanced stages of the disease in this -climate, to wait for an absolute remission, -in order to administer the bark. In a cold -or temperate climate it will seldom be found -advisable to give it in any period of this -fever; but in a hot climate it is sometimes -admissible where there are symptoms -of general debility, such as a small pulse -and muscular weakness, even though the -frequency of the pulse, delirium, and a dry -skin and tongue, should indicate some degree -of fever. It may be remarked, by the -bye, that a dry tongue is a fallacious symptom, -for it may happen in consequence of -the patient’s breathing through the mouth -instead of the nose, without any fault in the -secretions of the <i>fauces</i>. The symptom -which forbids the use of the bark more absolutely -than any other is an inflammatory -or dysenteric state of the bowels, in which -cases it seems to be invariably pernicious.</p> - -<p>Where it happens that we are extremely -anxious to throw in the bark, as we usually -are in the West Indies, where fevers are -<span class="pagenum" id="Page_404">404</span> -very rapid and dangerous, and yet the -symptoms seem hardly to admit its use, it -was very commonly tried either in conjunction -with some antimonial medicine or neutral -salt, or these were given alternately -with it, in order to soften and qualify its -effects by preventing it from heating or -otherwise aggravating the symptoms. Antimonial -wine or <i>Spiritus Mindereri</i> were conveniently -employed with this intention.</p> - -<p>With regard to the quantity of bark to be -given, it may be proper in doubtful cases of -this kind to begin with small doses, in order -to feel how far it agrees or not; but in general -it may be laid down as a rule with regard -to this medicine, that, where it is -really proper, and the medicine to be depended -on, it is to be given in as large doses -and as frequently as the stomach will easily -bear it.</p> - -<p>The next remedy mentioned was opium. -It is a medicine more admissible and useful -in this than any other kind of fever. The -same cautions nearly apply in the administration -<span class="pagenum" id="Page_405">405</span> -of it as have been given with regard -to the Peruvian bark. The caution with -regard to foul bowels is particularly necessary -in a hot climate, where an over secretion -of bile is so apt to take place. When, -the Boreas frigate arrived from England in -March, 1783, there was a very bad fever of -the infectious kind on board, some cases of -which being sent to the hospital at St. Lucia, -were treated unsuccessfully with bark -and opium, which I had been induced to -try upon the authority of the authors above -alluded to. I attributed this want of success -to the neglect of previous evacuation; -for, upon inspecting the bodies, the intestines -were found full of bilious <i>feces</i>. I profited -from this, and was more successful in the -other cases. It were to be wished that physicians -could oftener bring themselves to confess -their errors in practice, and their writings -would be more instructive; for it is of -consequence to know what we are to avoid -as well as what we are to follow.</p> - -<p>It has been mentioned that the best effects -arise from the conjunction of an antimonial -<span class="pagenum" id="Page_406">406</span> -with an opiate; but, in this sort of fever, -antimonials, and even most of the neutral -salts, are hurtful after the first stage, and -opiates may after this be given alone or -combined with camphor. With regard to -the precise period of leaving off antimonials, -it must be left to discretion, and the constitution -of the patient is the best guide. -There is so great a difference in patients in -this respect, that all practical precepts should -be qualified by a due discrimination of constitutions. -Absolute and dogmatical rules -are so far from applying in the practice of -physic, that there are some cases of the -same disease that require a treatment even -opposite to what is in general most adviseable. -This may be very aptly illustrated -by the small pox, of which there are cases -that ought to be treated very differently from -the general method laid down by Sydenham, -and in which cordial medicines are highly -proper and necessary. This difference in -diseases themselves seems to be one great -cause of the difference of opinion among -physicians on practical points, each party -finding some countenance in experience for -<span class="pagenum" id="Page_407">407</span> -their general doctrine, do not make allowance -for the varieties that exist in nature; -so that, in one sense, both may be said to be -in the right. If the patient is not very -much sunk, and if there are bilious symptoms, -or an obstinate dryness in the skin, a -few grains of James’s powder may be given -with advantage even in an advanced period -of the disease. If a hot and dry skin should -at this period be the only troublesome symptom, -it will be more safely and effectually -removed by camphor combined with something -opiate and the <i>Spiritus Mindereri</i>, which -is the only neutral now admissible, than by -antimonials, which, at this time, would be -in danger either of ruffling the patient by -their operation on his stomach and bowels, -or of weakening him too much either in -this way, or by exciting profuse sweats. -Evacuant medicines of every kind being -then improper, clysters are the only laxatives -to be employed in case the state of the -bowels require them.</p> - -<p>Having mentioned camphor, it may be -proper here to remark, that it is a medicine -<span class="pagenum" id="Page_408">408</span> -of which I have found it extremely difficult -to ascertain the virtues and effects; and in -consequence of this ambiguity, I believe -there are few articles of the materia medica -more abused in practice. In all inflammatory -affections, and in the beginning of all -fevers where there is much heat and thirst, -I think I have observed it to aggravate the -symptoms. It seems in no case to be more -proper than at certain periods of this fever, -and especially when there happens to be -spasmodic pains of the stomach, or tremors -and cramps in the extremities.</p> - -<p>In this advanced stage of the fever, in -which the most common symptoms are weakness, -restlessness, tremors, and low delirium, -no medicine was found so much to be trusted -to as opium, which here acts as a cordial as -well as an anodyne and antispasmodic. It -may be given, in the camphorated julep, in -the form of tincture, from five to ten drops -every six or eight hours, or some of the officinal -compounds, such as the theriaca or -mithridate, may be employed with advantage. -I have thought also, that, at this period, -<span class="pagenum" id="Page_409">409</span> -castor conjoined with opium seemed to -improve its virtue. This was first suggested -to me by Mr. Crudie, an ingenious German -surgeon, whom I employed as an assistant at -the hospital at St. Lucia; and since I have -been physician to St. Thomas’s hospital, I -have found the most pleasing effects, in similar -cases, from a composition used there, -the principal ingredients of which are opium -and castor<a id="FNanchor_97" href="#Footnote_97" class="fnanchor">97</a>.</p> - -<p>In this state of the fever I have also used -with advantage the decoction of Peruvian -bark and serpentary, as recommended by -Sir John Pringle; and when the skin is cold -and the circulation is very languid, as is -sometimes the case, volatile salts and powder -of serpentary may very properly be employed. -<span class="pagenum" id="Page_410">410</span></p> - -<p>But in the advanced state, and in the -worst forms of this disease, there is perhaps -no medicine superior to wine. This was -given either pure, or diluted with water for -common drink, and sometimes to the quantity -of a quart in twenty-four hours. In -delicate people, such as we meet with in -private practice, the quantity ought to be -less.</p> - -<p>There is this caution necessary with regard -to the use of wine, that when the fever -is gone off, and only extreme debility remains, -the free use of it is not safe nor proper; -for, in a weak and exhausted state, a -person is more apt to be <a id="FNanchor_98" href="#Footnote_98" class="fnanchor">98</a>heated and intoxicated -by any fermented liquor, than in -health, or even in the preternatural and disturbed -<span class="pagenum" id="Page_411">411</span> -state of actual disease, such as occurs -in this fever.</p> - -<p>After the disease is removed, a long state -of weakness is apt to succeed, especially in -a warm climate. The most proper remedies, -then, are bitters, such as decoctions of Peruvian -bark, infusions of quassia bark, gentian, -or camomile flowers. These answer -better than the bark in substance, which is -now apt to nauseate and load the stomach, -and the patient is apt to take an aversion to -this and whatever else he took in a state of -sickness. The best strengthening medicines -are such as comfort the stomach and create -appetite; and we may mention Huxham’s -tincture of bark, in small doses, and a moderate -use of wine, as the most proper for -these purposes. Where colliquative sweats -take place, elixir of vitriol is serviceable, -<span class="pagenum" id="Page_412">412</span> -and with this intention I have joined it, -with evident advantage, to the evening anodyne, -which, without such a corrector, tends -rather to aggravate this symptom. I have -known assafœtida prove a useful stimulus to -the stomach at this time, and it may even -be used while the fever subsists, especially -where the secretions of the fauces are scanty. -This medicine is recommended by Sir John -Pringle in the same circumstances. But I -consider the prudent use of opiates, particularly -at bedtime, as the most effectual cordial -and strengthening medicine in this convalescent -state.</p> - -<p>But with regard to the management of -the sick at this time, as much depends on -diet as medicine. Nothing has been said -concerning this in the acute state of fever, -because no nourishment is then necessary. -In that state there is a loathing of all food, -and the powers of digestion and assimilation -seem to be then suspended, so that alimentary -substances become not only an useless -load, but offensive and hurtful by turning -acid or putrid. It is likewise evident from -<span class="pagenum" id="Page_413">413</span> -fact, as well as reason, that nature, in this -situation, does not require sustenance; for -we frequently see people labouring under -fevers who do well and recover, though -they have been entirely without nourishment -for a length of time in which the like abstinence -in a state of health would have -proved fatal. The friends and attendants -of the sick, from a prejudice not unnatural, -but not considering the difference between -health and that state of derangement which -takes place in fever, are for ever wishing to -supply the patient with nourishment, and -every physician meets with trouble in counteracting -this officiousness. Nevertheless, -when the fever draws out to a considerable -length, and the principal symptom is that -state of weakness which, in low fevers, runs -insensibly into that of convalescence, then -it is necessary to pay the utmost attention -to nourishment, and nothing tends more to -insure and hasten recovery than the assiduous -administration of light and nourishing -food, the same cautions being observed which -have just been mentioned with regard to -cordials. One of the greatest hardships of -<span class="pagenum" id="Page_414">414</span> -a sea life is the want of those articles of diet -that are suitable to a recovering state, and -many lives are lost from this circumstance, -after the force of the disease has been subdued<a id="FNanchor_99" href="#Footnote_99" class="fnanchor">99</a>.</p> - -<p>With regard to the peculiar form, before -described<a id="FNanchor_100" href="#Footnote_100" class="fnanchor">100</a>, which this fever assumes a few -months after ships have been in a hot climate, -we found camphor, volatile salts, and serpentary, -the best remedies. As there was a -remarkable coldness of the skin, I was induced -in one case to try the hot bath, and -with good effect, from which it seems probable -that a short stay in a bath, of a heat -from 96° to 100°, so as to have its warming -and stimulating, without its relaxing -effects, would answer well in fevers of this -kind. -<span class="pagenum" id="Page_415">415</span></p> - -<h4 id="OF_THE_BILIOUS_REMITTING_FEVER">2. Of the <span class="smcap">Bilious Remitting Fever</span>.</h4> - -<p>This is peculiar to tropical climates, -and arises in the same situations in which -intermitting fevers arise in temperate and -cold climates. It seldom arises at sea, unless -where there has been previous exposure -on shore, of which some examples have -been mentioned in the first part of the work. -It may generally be traced to the air of -woods or marshes; and in our fleet hardly -any men were attacked with it but those -who were employed in the duties of wooding -and watering.</p> - -<p>The most distinguishing symptom is a copious -secretion of bile which attends it. Its -course, in general, is shorter than that of -the fever before described; and though the -symptoms are more violent, they are not so -equal and steady, owing to the tendency -there is to remission. The symptoms are -particularly violent at the beginning, in so -<span class="pagenum" id="Page_416">416</span> -much that some of the men, after being exposed -upon duty to the heat of the sun and -the air of marshes and woods, would become -frantic, being seized almost instantaneously -with <i>delirium</i> resembling madness. -This fever, when it arises merely from the -effluvia of woods and marshes, has a natural -tendency to remit; nay, some fevers at St. -Lucia, proceeding from this cause, were of -the pure intermitting form from the beginning. -But in many of those that arose at -Jamaica little or no remission was to be perceived; -and it was distinguished from the -ship fever by the bilious vomits and stools, -more violent delirium, and head-ach, and -by being attended with less debility. The -greater tendency to the continued form at -this time was probably owing to this circumstance, -that the men who were exposed -to the land air in wooding and watering, -were then exposed also to such causes as -naturally produce continued fevers, such as -infection, the foul air of the French prizes, -intemperance, and hard labour. There was -in some cases a yellowness of the eye, and -even of the whole skin, but without the -<span class="pagenum" id="Page_417">417</span> -other symptoms that characterise the yellow -fever, properly so called.</p> - -<p>In cases that proved fatal, the symptoms, -for some time before death, resembled very -much those of the fever before described at -the same stage. There was either <i>coma</i> or -constant delirium, great seeming anguish, -the mouth and tongue very dry, or with -only a little ropy slime, a black crust on the -teeth, picking of the clothes, and involuntary -stools.</p> - -<h4><span class="smcap">Treatment of the Bilious Remitting -Fever.</span></h4> - -<p>The measures proper to be taken in the -beginning of all fevers are pretty nearly -the same. There is little difference in -the first treatment of this from that of the -ship fever, except that blood letting is here -more frequently proper, and that a more -free evacuation of the bowels is necessary -on account of the more copious secretion of -bile. -<span class="pagenum" id="Page_418">418</span></p> - -<p>In full and athletic habits the disease very -commonly begins with pains in the limbs, -back, and head, with a strong throbbing -pulse; in which case it is proper first of all -to let blood at the arm. This is also highly -proper and necessary in those cases mentioned -above, in which the patient becomes suddenly -frantic. But though the cases requiring -blood-letting are more frequent in this -sort of fever than that already treated of, -yet great caution and nice discernment are -necessary with regard to it, in all cases, in a -hot climate. As fevers in such a climate -run their course faster, the symptoms succeeding -each other in a more close and hurried -manner, greater expedition, as well as -discernment, are required in timing the different -remedies than what are necessary in a -cold climate. Blood letting unseasonably -and injudiciously employed either endangers -life, or has a very remarkable effect in protracting -recovery, by the irrecoverable weakness -it induces.</p> - -<p>With regard to the evacuation by the -bowels, it has already been mentioned in -<span class="pagenum" id="Page_419">419</span> -another part of the work, when on the subject -of prevention, that, before the fever -comes on, there is a languor and general -feeling of indisposition, and that then an -emetic and a purgative, followed by some -doses of the bark, were the most likely -means of preventing the attack of the disease. -If the fever has properly begun, which -is announced by a <i>rigor</i> taking place, then -no time is to be lost in procuring evacuation; -and, after blood letting, if the symptoms -should require it, the best medicine is tartar -emetic, which, if given in small divided -doses, at short intervals, will most probably -evacuate the whole intestines by vomiting -and purging, and may even prove sudorific. -But it will nevertheless be proper to administer -a purgative medicine soon after; and -what we found to operate with most ease, -expedition, and effect, was, a solution of -purging salts and manna, either in an infusion -of sena, or in common water, or barley -water, with some tincture of sena added -to it. -<span class="pagenum" id="Page_420">420</span></p> - -<p>The next step towards procuring a remission -is, to open the pores of the skin, -which is best done by small doses of James’s -powder or emetic tartar, assisted by the common -saline draughts, which will be given -with most advantage in the act of effervescence, -or by <i>Spiritus Mindereri,</i> together -with plentiful warm dilution. I once, by -way of comparison, tried the two antimonial -preparations above mentioned in a number -of men ill of this fever, who were sent -to the hospital at one time, giving emetic -tartar to one half, and James’s powder to -the other, and their effects were so similar, -that I could perceive no reason for preferring -the one to the other. Antimonial medicines -seem better adapted to this than any -other sort of fever, and may be more freely -given in it.</p> - -<p>These are the most likely means of bringing -about a remission; and if this is effected, -nothing remains to be done but to throw in -as much Peruvian bark as the stomach will -bear. -<span class="pagenum" id="Page_421">421</span></p> - -<p>But whether from a fresh accumulation -of bile, or some other circumstance, it may -happen that the fever is kept up; and in -this case there is commonly a sense of weight -or uneasiness about the <i>hypochondria</i>, which -seems to indicate that the redundant bile is -in the gall bladder or ducts of the liver. In -this case a repetition of evacuants is necessary, -and calomel will be found to answer -remarkably well as a purgative, its stimulus -being so extensive as to loosen and bring -away bile when the saline purgatives, such -as that above mentioned, had failed of having -that effect. I have known these to -pass through the intestines without relieving -the uneasy sensation about the stomach as -calomel is found to do; and it will be still -more effectual for this purpose, if given alone -in a dose, from five to ten grains, and followed -some hours afterwards by some other -purgative. After this, antimonial medicines -are again to be had recourse to; and these, -as well as purgative and neutral medicines, -are safe and useful in a more advanced stage -of this fever than they are in the ship fever; -for the strength is not so apt to sink, and -<span class="pagenum" id="Page_422">422</span> -the state of the bowels requires them more. -Antimonials, however, are to be used sparingly -and cautiously as the fever advances; -for I have known them, when given only a -few days after the first attack, to have the -effect, in some constitutions, of making the -stomach swell, and of producing a general -sense of heat and uneasiness.</p> - -<p>After the evacuations of the bowels, the -anodyne diaphoretic may be very seasonably -given in the manner formerly mentioned; -for it will not only tend to sooth and procure -sleep after the commotion that has been -excited, but by its gentle sudorific effect will -assist in completing the remission.</p> - -<p>The principal point of management in -the fevers of this climate is, to throw in -the Peruvian bark in proper season. I formerly -took occasion to differ from the opinion -of those who alledge that little or no -discrimination is necessary with regard to -the circumstances in which bark is proper -in continued fevers. I made fair and unprejudiced -trials of this, but always found that -<span class="pagenum" id="Page_423">423</span> -some sort of remission, especially towards -the beginning of the disease, was necessary, -in order to make the use of this medicine -safe and proper. The greatest vigilance is -indeed required that the administration of it -be not omitted when it is at all adviseable, -as the course of fevers is very quick and -critical in this climate. I have watched -many nights with some friends in whose -health I was particularly interested, to catch -the hour when it might be allowable to give -it; and where the propriety of it was somewhat -ambiguous, it was usual to qualify it -either by conjoining some antimonial or neutral -salt with the first doses, or by giving -them alternately with it, as has been formerly -mentioned.</p> - -<p>Under the use of these means, the favourable -symptoms are, a warm moist skin, a -strong steady pulse, with the pulsations under -a hundred in a minute, a natural countenance, -and being free from delirium. But -if the fever should not yield during the first -week, but takes an unfavourable turn, the -pulse then becomes more small and frequent, -<span class="pagenum" id="Page_424">424</span> -there is a general agitation, the tongue is -tremulous when put out, there is great thirst -and delirium, with a dry and hot skin. In -these circumstances, besides the continuation -of the antimonials in smaller doses, -with the anodyne diaphoretic, and the occasional -use of purgatives, blisters now become -proper; and we found also camphor combined -with nitre an excellent medicine at -this period of the disease.</p> - -<p>Should the patient survive to the end of -the second week, the treatment then comes -to resemble more and more that of the infectious -fever already described. Bark may -be given, though there should be no proper -remission, and cordials and opiates may be -more freely used. Attention to the state of -the bowels will still be necessary, since repeated -accumulations of bile are apt to occur -even in the most advanced stage, and -gentle emetics of ipecacuana, as well as -laxatives, may be necessary. For the same -reason also, greater caution is requisite in -the use of pure opiates than in the infectious -ship fever before treated of. In order to -<span class="pagenum" id="Page_425">425</span> -keep the bowels soluble, it was a very usual -practice, and found very useful, to conjoin -a few grains of rhubarb with each dose of -the bark.</p> - -<h4 id="OF_THE_YELLOW_FEVER">3. Of the <span class="smcap">Yellow Fever</span>.</h4> - -<p>The fever last treated of may be said to -be peculiar to a hot climate; but the hot -seasons of temperate climates produce something -resembling it. That now to be described -never occurs, so far as I know, except -under the influence of tropical heats. -Such a fever is indeed known without the -tropics; for it is very common in Carolina -in the hot season; but there the heat is -even greater than that of the West Indies. -In order to produce it, there must be, for -some length of time, a heat seldom falling -below seventy-five degrees on Fahrenheit’s -thermometer.</p> - -<p>Though it differs from the fever last described, -both in its causes and symptoms, it -is not meant to say that it is so distinct as to -<span class="pagenum" id="Page_426">426</span> -form a separate species of disease, like the -measles and small pox. Unless the characters -of fevers are strongly marked, it is difficult, -and even impossible, to refer them to -any particular species; and the different concurrence -of causes and constitutions is so -various, that great numbers of ambiguous -cases occur.</p> - -<p>With regard to the cause of the yellow -fever, it differs from the bilious remittent -in this, that the air of woods and marshes -is not necessary to produce it; for it most -commonly arose from intemperance or too -much exercise in the heat of the sun. It -was observable, however, that it was more -apt to arise when, besides these causes, men -were exposed to unwholesome air, particularly -the foul air of ships, whether from infectious -effluvia, or proceeding merely from -the putrefaction that takes place in neglected -holds.</p> - -<p>It is also remarkable with regard to it, -that it is confined almost entirely to those -who are newly come from a cold or temperate -<span class="pagenum" id="Page_427">427</span> -climate. The same remark is made by -the French, who therefore call it <i>fievre de -matelot</i><a id="FNanchor_101" href="#Footnote_101" class="fnanchor">101</a>, considering it as peculiarly incident -to those who have newly arrived from a long -voyage. It would appear also, from what -has been formerly mentioned<a id="FNanchor_102" href="#Footnote_102" class="fnanchor">102</a> that those -men, who have been exposed to that sort of -infection that prevails in ships in cold climates -are more particularly the subjects of -the yellow fever when they arrive in a hot -climate. It is farther in proof of the same -opinion, that there are medical gentlemen, -natives of the West Indies, who have hardly -ever seen it, their practice lying at a distance -from any sea-port town where strangers -usually arrive. Of these strangers, those -who are young, fat, and plethoric, are most -apt to be attacked; and more of our officers -in proportion were seized with it than common -men.</p> - -<p>It has been said, that it never attacks either -the female sex or blacks. This is in -<span class="pagenum" id="Page_428">428</span> -general, though not absolutely, true; for I -knew a black woman, who acted as nurse to -some men ill of this fever at Barbadoes, -who died with every symptom of it.</p> - -<p>This fever assumes various forms, according -to the peculiar constitutions of different -men, and other circumstances; but in the -following description I shall enumerate the -most common appearances:—In general it -begins with short alternate chills and flushes -of heat, seldom with those rigors which -constitute the regular cold fit, and with -which most other fevers begin. These are -immediately succeeded by violent head-ach, -pain in the back, universal debility, sickness, -and anguish at the stomach. There is -commonly, in the beginning, a good deal of -bile on the stomach, which is thrown off -by vomiting, either natural or excited by -an emetic. Those men who were taken ill -of this fever in the Alcide, in the end of -the year 1781, had a sore throat in the beginning; -but this is not a common symptom. -<span class="pagenum" id="Page_429">429</span></p> - -<p>In the course of this disease there is by -no means a free secretion of bile, and least -of all in those cases that are most violent, -and prove the soonest fatal. In cases that -are more protracted, and less desperate, there -are frequent accumulations of it, as appears -by the vomits and stools<a id="FNanchor_103" href="#Footnote_103" class="fnanchor">103</a>. -<span class="pagenum" id="Page_430">430</span></p> - -<p>The eye in a few hours takes a yellow -tinge, which soon after extends more or less -<span class="pagenum" id="Page_431">431</span> -over the face and whole skin. This is a -symptom so striking and constant, that it -<span class="pagenum" id="Page_432">432</span> -gives name to the disease, though it is not -absolutely either peculiar or essential to it. -<span class="pagenum" id="Page_433">433</span> -There is something contagious in this symptom, -which seems somewhat singular, and -difficult to be accounted for. It was observed -<span class="pagenum" id="Page_434">434</span> -in the Royal Oak and Alcide to extend -to men who were but slightly indisposed; -and at the hospital it spread to men -<span class="pagenum" id="Page_435">435</span> -in the adjoining beds, without imparting -any malignity to their diseases.</p> - -<p>There is something very peculiar in the -countenances of those who are seized with -it, discernible from the beginning by those -who are accustomed to see it. This appearance -consists in a yellow or dingy flushing -or fullness of the face and neck, particularly -<span class="pagenum" id="Page_436">436</span> -about the parotid glands, where the -yellow colour of the skin is commonly first -perceived. There is also in the eye and -muscles of the countenance a remarkable -expression of dejection and distress.</p> - -<p>One of the most constant and distinguishing -symptoms of this fever is an obstinate, -unremitting, and painful <i>pervigilium</i>, which -is the more tormenting, as the patient is -extremely desirous of sleep. It is seldom -that even a <i>delirium</i> comes to his relief to -make him forget himself for a moment; -but he continues broad awake, night and -day, with his reason and senses sound, in a -state of the most uneasy agitation.</p> - -<p>But the most distinguishing symptom, and -that which is expressive of the greatest danger, -is, an unconquerable irritability in the -stomach, which can be brought to bear nothing. -An almost incessant retching takes -place, which commonly, on the third day, -ends in what is called the <i>black vomit</i>, the -most hopeless of all the symptoms attending -it. When this is examined, the colour is -<span class="pagenum" id="Page_437">437</span> -found to be owing to small dark flakes, resembling -the grounds of coffee, and seems -to be blood which had oozed from the surface -of the stomach, a little altered. Indeed -pure blood is sometimes thrown up, and we -know that the red globules enter the smaller -order of vessels, and issue by them; for -bleeding at the nose is a common symptom -about this time; and some relate that it also -escapes by the ears and pores of the skin, -which I never saw, but can readily believe -it. At the same time, the stools grow -black, and the urine is frequently of a very -dark colour, which seem to be owing to -the same cause. I never remember to have -seen any one recover after these symptoms -came on.</p> - -<p>There seems to be a general <i>error loci</i> of -the more tenacious and globular parts of the -blood into the smaller order of vessels, to -which the yellow colour is in a great measure -owing; and when any part of the skin -is ever so little pressed upon, a damask red -colour remains for some time, the small -vessels readily admitting the red globules. -<span class="pagenum" id="Page_438">438</span> -It is certain that a yellow colour of the skin -may be produced by such an <i>error loci</i>, without -any suspicion of the presence of bile. -We have an illustration of this in the ecchymosis -which follows upon an external -contusion. In this case the red part of the -blood is mechanically forced either into the -smaller order of vessels, or into the cellular -membrane, which occasions a livid appearance, -and in the course of the recovery the -same parts become yellow, probably in consequence -of some of the gluten of the blood -assuming this colour after the red parts have -been removed by absorption or otherwise.</p> - -<p>In the worst form of this disease there is -all along an uncommonly distressing sensation -of universal anguish, particularly about -the stomach, where there is a sense of -burning heat, which, as the miserable sufferers -themselves express it, becomes unspeakable -torture.</p> - -<p>A sense of weight at the breast, deep and -frequent sighing, and a great failure of muscular -<span class="pagenum" id="Page_439">439</span> -strength, are dangerous symptoms in -all stages of the disease.</p> - -<p>Upon the first attack the skin is extremely -hot and dry, and the pulse hard and frequent; -but the external heat soon becomes -very little different from the usual standard -of health, and the skin feels soft and moist. -There sometimes happens an eruption of -small pustules, with white heads, on the -trunk of the body, which is a favourable -sign; and I have seen a head-ach disappear -upon this breaking out. The pulse does not -serve as an index of danger; for, after the -hurry of the first attack, it becomes very -moderate in point of frequency, varying -from eighty to a hundred pulsations in a minute, -and is natural in point of regularity -and strength.</p> - -<p>In these circumstances this fever differs -from that which was last described; and it -also differs from it in being attended with -little delirium. I have seen cases in which -the senses were not affected from beginning -to end; and I never observed that violent -<span class="pagenum" id="Page_440">440</span> -and incessant delirium which attends other -dangerous fevers.</p> - -<p>The state of the <i>fauces</i> is also different -from that of most other fevers, for there -is no excessive thirst. The tongue is somewhat -white and foul; but I do not remember -ever to have seen it black and dry.</p> - -<p>A want of action in the bowels, and an -insensibility to purgative medicines, indicate -great danger; and, next to the black slimy -stools, one of the most unfavourable symptoms -is, when the <i>feces</i> are like white clay, -as I have seen in some cases that ran out to -the length of a week before they proved fatal. -When the black vomit and stools occur, -death commonly happens on the third -or fourth day. A bilious diarrhœa spontaneously -coming on, is a very favourable symptom.</p> - -<p>In more unpromising cases the urine is -scanty, and in the last stage of life it becomes -of a very dark colour, as was mentioned -before. A plentiful secretion of urine -<span class="pagenum" id="Page_441">441</span> -is a very favourable circumstance, and seems -to be one of nature’s methods of curing the -disease; for such cases are observed to terminate -well. I remember one case in particular -in which several quarts were made -daily for several days together, and it was of -a very dark saffron colour, but looked green -where the surface was in contact with the -side of the pot. I inspissated a small quantity -of it, and found a large residuum, -which was very deliquescent, and seemed -to be all saline. In a hot climate the urine -does not shew that separation and deposition -which denote the crisis of fevers in cold climates, -and this is perhaps owing to there -being less mucilage and more alkali in the -former, on account of the more putrescent -state of the fluids. Upon adding a little -vinegar to the urine in the case above mentioned, -it became turbid like the critical -urine of the fevers of Europe.</p> - -<p>At the approach of death, cold clammy -sweats come on; the pulse continues regular -and of a certain degree of strength, but -grows gradually slower. I have counted it -<span class="pagenum" id="Page_442">442</span> -at forty pulsations in a minute. The patient -is frequently sensible to the last moment; -nor does the countenance sink into what is -called the <i>Hippocratic</i> appearance. In other -cases I have seen, at this time, <i>coma</i>, and -not infrequently convulsions. Broad livid -spots sometimes also appear on the skin. -Extreme muscular debility, a great difficulty -of deglutition, and a dimness of the -eye-sight, are likewise common symptoms -in the last scene.</p> - -<p>The different stages which lead to dissolution -following each other thus rapidly, there -is not that gradual failure of the powers of -nature that usually give warning of approaching -death; but the springs of life run -down, as it were, at once, the wretched -sufferer expires, and is happily delivered -from the most extreme misery of which -human nature is capable.</p> - -<p>Such is the general train of symptoms in -this fever, taken entirely from my own observation; -but great varieties occur both in -the symptoms and duration, so great indeed, -<span class="pagenum" id="Page_443">443</span> -that it is hardly recognisable for the same -disease. I shall give specimens of such anomalous -cases in two that occurred at Port -Royal, on board of the Canada, in July, -1782.</p> - -<p>A lieutenant of that ship had been subject, -for four days, to fits of retching, without -any bilious discharge or pain in the stomach; -and, except a white tongue, he had no -symptom of fever in that time, nor any -thing to prevent him from doing his duty. -On the fourth day, when I first saw him, -he began to complain of a fixed pain in the -pit of the stomach, which was not very -violent, and about the same time a yellowness -began to appear on the white of the -eye. He took a laxative medicine, which -had the desired effect, and some volatile spirits, -with some drops of thebaic tincture in -simple mint water, for the pain in his stomach. -He had a good night. Next day -the complaint of the stomach was better; -but there was great muscular debility. He -had several natural stools; and as there seemed -little indication but debility, he took nothing -<span class="pagenum" id="Page_444">444</span> -that day except an infusion of some -bitters and aromatics in wine. As he did -not want for appetite, he eat some broth -and chicken; and nothing to give any alarm -happened this day, except a short qualm, -in which he was faint, with a sense of cold, -feeling to himself, as he said, as if he -should have expired. In the afternoon he -began to have black-coloured stools, which -was the first symptom that clearly betrayed -the nature of the disease. He was then ordered -as much Peruvian bark as he could -take with red wine, and these his stomach -bore. Decoction of bark was also given -him in clysters. He had a strong voice, -and was quite sensible, but grew weaker -and weaker with frequent returns of the -qualms, and he expired that evening before -ten o’clock.</p> - -<p>I have not the least hesitation in ranking -this case with the fevers last described, -though so many of the usual symptoms were -wanting. This gentleman, though of a -lively, active disposition, was of a slender -make, and of a dingy, doughy complection, -<span class="pagenum" id="Page_445">445</span> -and his case gave me the idea of a disease attacking -a constitution which, not having -powers to struggle with it, is overwhelmed -without making resistance<a id="FNanchor_105" href="#Footnote_105" class="fnanchor">105</a>. In those robust, -plethoric habits, which are most commonly -attacked, there is a sufficient degree -of strength to excite the violent symptoms -before enumerated.</p> - -<p>A few days after this gentleman’s death, -another officer of the same ship was taken ill -with the same sort of fever, and it was also -attended with several unusual symptoms. -Neither his skin nor eyes were yellow; the -skin was hot and dry throughout the disease, -and during the three first days there -<span class="pagenum" id="Page_446">446</span> -was a diarrhœa, which was neither bilious, -putrid, nor mucous, but consisted in watery -stools. There were no gripes, nor any -local pains whatever; but I never remember -to have seen more suffering from that -general anguish, particularly about the stomach, -which attends this sort of fever. On -the third night he began to vomit and purge -blood, which soon terminated in that dark-coloured -discharge which is a symptom so -characteristic and fatal in this disease. He -continued sensible till within eight hours of -his death, which happened on the fourth -night. The pulse was full and pretty -strong during the whole course of the disease; -but there was all along great debility -and frequent sighing, symptoms that ought -always to create alarm.</p> - -<h4><span class="smcap">Treatment of the Yellow Fever.</span></h4> - -<p>I feel this as the most painful and -discouraging part of this work, the yellow -fever being one of the most fatal diseases to -<span class="pagenum" id="Page_447">447</span> -which the human body is subject, and in -which human art is the most unavailing.</p> - -<p>It seems hardly to admit of a doubt that -there are particular instances of disease, in -their own nature, <i>determinedly fatal</i>, that is, -in which the animal functions are from the -beginning so deranged, that there are no -possible means in nature capable of controlling -that series of morbid motions which -lead to dissolution. Of this kind appear to -be the greatest number of cases of the -plague, many of the malignant small pox, -and some of fevers, particularly of that kind -now under consideration. It is extremely -difficult to ascertain such cases from observation; -and it may be said that the opinion -of the existence of them is favourable to -ignorance and indolence. But, on the other -hand, it may be questioned if more harm is -not likely to arise in medicine by being too -sanguine and officious, than by a diffidence -of art and trusting to the powers of unassisted -nature? Were we thoroughly acquainted -with the animal œconomy, we should perceive -<i>à priori</i> in what instances the seeds of -<span class="pagenum" id="Page_448">448</span> -disease would either operate so as necessarily -to terminate in death, or when they were -within the command of art. But we can -derive little or no information from this -source, on account of our great ignorance -of the secret operations of the living body; -so that the only grounds of judging are our -observation and experience concerning the -usual event of disease, and the effects of remedies. -Though these are circumstances -attended with great uncertainty and ambiguity, -yet I believe it will be admitted as -the opinion of the most chaste and experienced -observers, that there do really exist -diseases whose course cannot be diverted by -any means that can be employed. This -opinion, I have said, is, in one view, extremely -discouraging; yet, to the mind of -a feeling and conscientious practitioner, who -must often find his best endeavours baffled -in many diseases as well as this, and who -might be apt to look back and accuse himself -of some fault or omission, it affords -this satisfaction to his reflections, that the -want of success may have been owing to -<span class="pagenum" id="Page_449">449</span> -something in the nature of the disease, and -not to his want of skill and attention.</p> - -<p>But though the fatality of this disease is -discouraging, let us not despond, but rather -redouble our diligence in observing what assistance -and relief nature may admit of.</p> - -<p>It is proper in this as in every other fever -of this climate, to begin the cure by cleansing -the first passages. This does not produce -the same relief as in the common bilious -fever, probably because there is a less -free secretion of bile, and therefore less oppression -from the collection of it.</p> - -<p>With regard to blood-letting, the most -that can be said in its favour is, that if -there should be a hard throbbing pulse, with -violent pain in the head and back, it is <i>safe</i> -in the first twelve hours. This limitation -is necessary, at least with regard to common -seamen, who do not bear evacuations so well -as officers and others, who are used to a better -diet, and to whom the loss of blood has, -in some cases, been found useful in the -<span class="pagenum" id="Page_450">450</span> -early stage of this fever. It is, however, in -all cases extremely dangerous, except in the -circumstances mentioned above. The blood -is said to shew a buff in the beginning of the -disease, but in the second stage, it is mentioned -by a French author<a id="FNanchor_106" href="#Footnote_106" class="fnanchor">106</a>, that it hardly -coagulates or separates. But even the appearance -of a buff, without considering other -circumstances, does not always argue the -propriety of blood-letting<a id="FNanchor_107" href="#Footnote_107" class="fnanchor">107</a>.</p> - -<p>The great object in the cure of this fever -is, to bring the stomach to bear the bark. -<span class="pagenum" id="Page_451">451</span> -There are here wanting most of the circumstances -that in the other cases forbid the -use of it; for there is no preternatural -quantity of bile in the stomach and intestines, -nor is there a hot and dry skin, nor -violent delirium. The only obstacle to its -administration is the great irritability of the -stomach, which is the most fatal symptom -of the disease; and the principal part of the -management of the patient consists in the -prevention or removal of this. The stomach -is to be treated with the utmost tenderness -and attention. One gentle emetic -at the beginning is all that is allowable; -and as fresh collections of bile are less apt to -occur, the repetition of it is less necessary.</p> - -<p>It is best to abstain altogether from antimonial -medicines, and to render every thing, -whether food, drink, or medicine, as grateful -as possible. The liquid most apt to stay -upon the stomach is the juice of the acid -fruits of the climate, such as<a id="FNanchor_108" href="#Footnote_108" class="fnanchor">108</a> oranges and -<span class="pagenum" id="Page_452">452</span> -lemons. It happens frequently, however, -that acids come to be loathed extremely, so -as to nauseate the stomach and to encourage -retching. In this case I have found a composition -of wine and water with lemon juice -and nutmeg, sweetened with sugar, and given -warm, to be a very grateful and salutary -drink. The patient sometimes prefers the -decoction of farinaceous substances to every -other liquid; and in one case in particular, -which did well, the patient was led by taste -to prefer warm water gruel to every thing -else, and the great quantity he drank seemed -to have a considerable share in his recovery, -by keeping up a warm moist skin and producing -a great flow of urine.</p> - -<p>In order to check vomiting, the saline -draught, in the act of effervescence, has been -employed with evident advantage; but in -most cases this symptom is so obstinate as -to discourage all attempts to remove it. I -have known magnesia in mint water have a -visible effect in soothing the stomach, particularly -when given immediately after some -acid beverage. -<span class="pagenum" id="Page_453">453</span></p> - -<p>I was informed by Dr. Young, physician -to the army, that he found an infusion of -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<a id="FNanchor_109" href="#Footnote_109" class="fnanchor">109</a>.</p> - -<p>But nothing I have ever seen tried had so -great an effect in removing this irritability -<span class="pagenum" id="Page_454">454</span> -of stomach as a blister applied to it externally; -and it is a remedy which, so -far as I know, has not been hitherto recommended. -In other fevers, when the -head was not particularly affected, I preferred -this part for the application of a blister, -for it is in some respects more convenient -than between the shoulders, and the -stomach is the part more affected perhaps -than any other in all fevers. But in this -fever I was led to apply it to this part, both -from its being affected in an uncommon degree, -and from observing, upon inspecting -the bodies of those who died, that the only -morbid appearance that could be discovered -was an inflammatory suffusion on the inner -membranes of the stomach.</p> - -<p>I have employed opiates both externally -and internally to allay this symptom, but -without the effect that might have been expected -from so powerful a sedative.</p> - -<p>As the stomach will seldom, even in the -most favourable cases, bear such a quantity -of bark as to subdue the disease, it must be -<span class="pagenum" id="Page_455">455</span> -exhibited in every other way that can be -thought of, such as by clyster and by external -fomentation, both of which I have -employed with good effect. I used to order -a pint of decoction of bark to be injected -every three or four hours, and the fomentation -to be employed nearly as often. I have -heard of the decoction of bark being used as -a warm bath with success; but I cannot -decide concerning this practice from my -own experience.</p> - -<p>I have no other internal remedy to recommend; -for whatever power of retention the -stomach may have should be employed in -taking bark. If it should become tolerably -retentive, camphor will be found of service; -and if given in the evening with an -opiate, perspiration and sleep will probably -be procured, by which the patient will be -greatly relieved.</p> - -<p>Blisters to the thighs and legs seemed to -coincide with the general intention of cure, -and they appeared to be of advantage in the -cases in which they were tried. -<span class="pagenum" id="Page_456">456</span></p> - -<h4 id="INTERMITTENT_FEVERS">4. Of the Effects of Flowers of Zinc and -White Vitriol in the Cure of obstinate -<span class="smcap">Intermittent Fevers</span>.</h4> - -<p>It frequently happens in the West Indies -that intermittent fevers are so obstinate -as to resist the common means of cure by -the Peruvian bark; so that these complaints -become extremely distressing to the medical -practitioner as well as to the patient. Indeed -this was a difficulty that occurred so -often, that I was sometimes tempted to -think, either that the great reputation of -this medicine is not so well founded as is -commonly believed, or that the bark generally -in use in these times is not of so good -a quality as that employed by the physicians -who first established its character.</p> - -<p>But, in the first place, the experience upon -which its reputation was first built was in a -temperate climate, where very few agues -are found to resist it when properly administered. -In the next place, there is reason to -<span class="pagenum" id="Page_457">457</span> -believe that, in fact, the medicine itself now -commonly in use is not equally powerful -with what was first employed; and a species -of it, called the Red Peruvian Bark, -has lately been discovered, or rather, perhaps, -revived, which is certainly of a superior -quality, and has been found to cure intermittents -in which the common sort had -failed<a id="FNanchor_110" href="#Footnote_110" class="fnanchor">110</a>.</p> - -<p>However this may be, it is an undoubted -fact that obstinate agues are much more frequent -in the West Indies than in Europe; -and something to supply the insufficiency of -the bark seemed to be a <i>desideratum</i>.</p> - -<p>I was informed by Dr. Hendy, of Barbadoes, -that he had found the flowers of zinc -to answer in cases of intermittent fever, in -<span class="pagenum" id="Page_458">458</span> -which even the bark and every other remedy -and mode of treatment had failed. It was -found very successful in the like cases, both -in my own trials at the hospitals, and by -the surgeons of the men of war to whom I -recommended the use of it. In order to -judge what may be expected from it, I shall -give a specimen of its success in some cases, -at the hospital at St. Lucia, of which I kept -an accurate account, in the months of February -and March, 1783.</p> - -<p>About the time the fleet arrived there, -six cases of intermittent fevers were sent to -the hospital from different ships. One was -of six weeks continuance, and had been -some times of the tertian, sometimes of the -quartan type. Two were quartans; one of -which was of two months, the other of -eight months duration. Two were regular -tertians; of which one had only had two -fits, but was a relapse after a week’s exemption -from an attack of several weeks. The -other was of three months continuance, attended -with an eruption on the hands and -<span class="pagenum" id="Page_459">459</span> -arms. The sixth case was a quotidian of -three weeks, attended with a cough of the -same standing, and joined with sea scurvy.</p> - -<p>In all of them the bark had been given -at some period or other; and the flowers of -zinc were now tried in all, except the last. -In three out of the five this medicine had -the most visible good effects. In one the -disease was so speedily removed, that there -was only one fit after the first day of taking -this medicine, and the other two had recovered -perfectly after it had been used for seven -days.</p> - -<p>In these cases there can be little or no -ambiguity with regard to the real efficacy of -the medicine, as the disease had lasted from -two to six months, and there was no other -circumstance of change in the situation or -treatment of the patients that could account -for their recovery.</p> - -<p>Of the two cases in which it failed, one -was the tertian of three months, attended -<span class="pagenum" id="Page_460">460</span> -with the eruption; the other was the relapsed -tertian of three days.</p> - -<p>With regard to the dose, I began with -giving it in the quantity of two grains -thrice a day, which, in some, produced the -desired effect, and without the least sensible -operation on the stomach or bowels. If -this dose did not stop the fits after a few -days trial, it was increased to three grains, -which, in some, would produce a little sickness. -I found that four grains ruffled the -stomach a good deal; but if the patient is -gradually habituated to it, even more than -this may be given without inconvenience.</p> - -<p>In those cases in which it was successful -it was not found necessary to give more -than two grains at a dose, except in one of -them, in which three were given the day -before the fit ceased. In the two unsuccessful -cases the medicine had a fair trial for a -fortnight; but one of them getting no better, -and the other seeming to get worse, it -was left off. -<span class="pagenum" id="Page_461">461</span></p> - -<p>The cases to which this medicine is -adapted are those that have extremely distinct -remissions, with no symptoms of bile -nor any local affection. When agues come -to be long protracted, they are frequently -what may be called nervous; that is, consisting -of certain morbid motions that seem -to be induced by habit, after the original -cause is removed, and with a tolerable enjoyment -of appetite, sleep, and all the functions -of life, during the intermission.</p> - -<p>The two cases in which the zinc failed -recovered by the use of the bark. This -had been unsuccessfully tried before, and its -good effects now might either depend on its -having been left off for some time, whereby -the body recovered its sensibility to its virtues, -or it might be in consequence of administering -it in ardent spirits with a few -grains of capsicum and ginger, additions -which I found to improve its effects in other -cases, and is a mode of giving it well suited -to this climate. -<span class="pagenum" id="Page_462">462</span></p> - -<p>The zinc was not tried in the sixth case, -on account of the local affection and the remission -being short and imperfect.</p> - -<p>The white vitriol, being a salt of zinc, -might be supposed to possess the same virtues; -and it would appear to do so from -some facts<a id="FNanchor_111" href="#Footnote_111" class="fnanchor">111</a> that were reported to me in the -West Indies, and also from some trials made -by me at St. Thomas’s hospital since I came -to England. -<span class="pagenum" id="Page_463">463</span></p> - -<p>Though this is a medicine of very considerable -powers, I do not mean to put it in -competition with the bark, by proposing it -as a substitute for it, or by representing it -as superior to it in all circumstances; but -only to propose it as a valuable subsidiary in -particular cases. The account I have given -is faithfully extracted from a diary of my -practice; and were I to say more in its favour -than the future experience of others -may warrant, I should do more harm than -service to its reputation. Many good medicines -have had their characters hurt by being -over-rated by the first proposers of them, -who are naturally sanguine and partial, without, -perhaps, intending to deceive. But -when others find that their virtues do not -come up to what has been asserted, they are -apt to run into the other extreme, and explode -<span class="pagenum" id="Page_464">464</span> -them altogether; so that what was -given out as good for every thing, is now -found to be good for nothing<a id="FNanchor_112" href="#Footnote_112" class="fnanchor">112</a>. -<span class="pagenum" id="Page_465">465</span> -<span class="pagenum" id="Page_466">466</span></p> - -<h2 id="PART_III_CHAP_II">CHAP. II.</h2> - -<h3 id="OF_FLUXES" class="medium">Of <span class="smcap">Fluxes</span>.</h3> - -<p>These seem to arise in the same circumstances, -and to be owing to the same -general causes, as fevers. They may, in -some sense, be considered as fevers, attended -with peculiar symptoms in consequence of a -determination to the bowels, just as fevers -in cold climates are sometimes attended with -rheumatism and catarrh. We have seen, in -the first part of this work, that the dysentery -arose chiefly in those ships which had -been subject to fevers.</p> - -<p>This determination to the bowels is owing -to a variety of causes, but is chiefly connected -with external heat; for it is most common -in hot climates, and towards the end -of summer or in the autumns of cold climates, -owing probably to a greater acrimony -of the secretions of the intestines, and -<span class="pagenum" id="Page_467">467</span> -particularly of the bile. Dysenteries arise -in camps also at the same seasons, and in the -same circumstances as bilious fevers<a id="FNanchor_113" href="#Footnote_113" class="fnanchor">113</a>.</p> - -<p>Besides climate and season, the other circumstances -determining to the one disease -more than the other are, 1. A difference in -the constitutions of different men; for in -the same ship it sometimes happens that -both diseases prevail equally, though all the -men are using the same diet and breathing -the same air. 2. The nature of the occasional -cause. A dysentery, for instance, is -more likely to arise from an irregularity in -eating or drinking; a fever from being exposed -to the weather, particularly marsh effluvia. -3. The particular species of infection -that may happen to be introduced. -Suppose, for example, that a ship’s company -is predisposed to acute distempers, and one -man or more ill of the dysentery should be -brought on board, this will become the prevailing -disease, as happened in the Torbay -in August, 1780. If the like number of -<span class="pagenum" id="Page_468">468</span> -fevers should be introduced, then fevers will -be the prevailing disease.</p> - -<p>These two diseases may therefore be considered -as <i>vicarious</i>, the one substituting itself -for the other according to particular accidents, -and both proceeding from the same -general causes; and this is no new idea of -mine, but seems to have been Dr. Sydenham’s, -when he calls the dysentery a <i>febris -introversa</i>. It may be farther added, that -dysentery is the latest form in which this -cause, which is common to both, can exert -itself; for it is a disease more within the -reach of art; and some of the most dangerous -symptoms attending fevers, particularly -<i>delirium</i>, seldom occur in dysentery. -When it proves fatal, it is in consequence -of violent local affection, and that in general -after it has taken a chronic form. When -an incipient fever turns into a dysentery, all -the symptoms, and particularly the head-ach, -delirium, and <i>coma</i>, if there should be -any, are immediately relieved. And the -most favourable cases of the yellow fever are -those in which a bilious diarrhœa comes on, -<span class="pagenum" id="Page_469">469</span> -while the most fatal are those in which the -bowels are so torpid as to be insensible to -any stimulus either from their own contents -or from medicine.</p> - -<p>I shall not enter into a minute description -of this disease in all its stages, as this has -been so ably executed by Sir John Pringle, -Sir George Baker, and other authors, but -shall only give a sketch of some of the most -remarkable symptoms, particularly such as -are peculiar to the climate and manner of -life, so as to explain the varieties that may -be necessary in the mode of treatment.</p> - -<p>The fluxes that arose in the fleet were -either what may be called the acute idiopathic -dysenteries, or a dysenteric state of the -bowels from neglected diarrhœas, which was -most apt to occur in the convalescent state -of fevers, or in men labouring under the -scurvy. The body is more susceptible of -infection in a state of weakness from these -or any other causes; and in hot climates -the dysentery seems to be more infectious -than fevers; for at hospitals it was so frequently -<span class="pagenum" id="Page_470">470</span> -communicated to men who were ill -of other complaints, that it was in these -the principal cause of mortality. For this -reason, I was at more pains with regard to -this disease than any other, in keeping those -who were ill of it in a separate ward.</p> - -<p>I have met with some violent and untractable -cases which proved fatal in the acute -state; but, in general, this disease draws out -to a chronic form in this climate, and does -not prove mortal for many weeks. The -usual cause of death appears, from the inspection -of the bodies, to be an ulceration of -the great intestines, particularly of the descending -colon and the rectum. This part -of the intestinal tube is most affected from -its being the receptacle of all the acrid secretions -from the rest of the canal; and it -is naturally more subject to congestions of -the fluids and incurable ulcers, as appears -from the rectum being so liable to the hæmorrhoids -and the <i>fistula</i>. This ulceration -of the great intestines is so common, that, -out of eight cases which I inspected after -death, seven had this appearance. The case -<span class="pagenum" id="Page_471">471</span> -in which there was none was not so much -a case of dysentery as of inflamed bowels, -brought on by the man having drank to -excess of spirits while he was recovering -from a dysentery. The acute <i>tormina</i> which -always occur in the first days of the disease -seem owing to an inflammation, which terminates -in ulcers; and these being constantly -irritated by the sharp humours, produce the -<i>tenesmus</i>, which is the symptom most essential -to dysentery in the after part of the disease. -Any diarrhœa may in this manner -become dysenteric. During the acute griping -at the beginning, the stools are loose -and copious; but as soon as the tenesmus -takes place, they are scanty, which is most -probably owing to the spasmodic strictures -in the great intestines, in consequence of -irritation upon their excoriated surface. The -inflammatory state is more lasting and violent -in a cold than a hot climate, the gripings -are more severe, and the danger is -also greater in this stage of it.</p> - -<p>The state which the great intestines fall -into in old dysenteries seems to have something -<span class="pagenum" id="Page_472">472</span> -in it peculiar to itself: the several -coats become thick and spongy; their texture -is obliterated and destroyed; and they -become of a black or very dark purple colour. -This, however, cannot be called mortification; -for the fibres of the gut do not -lose their tenacity, nor is there that putrid -and dissolved state in which gangrene consists; -but it advances in time to such an extreme -state of disease as to be entirely incapable -of recovering its natural appearance -and functions, and proves therefore the cause -of death.</p> - -<p>The greater frequency and obstinacy of -these chronic fluxes in hot than in cold climates -seems to be owing to the same weakening -of the powers of life which make -recovery in general so tedious, and particularly -that of wounds and ulcers. The -greater quantity of acrid bile will also tend -to keep up the ulceration. Dysenteries have -this disadvantage, that the Peruvian bark, -which is the most powerful restorative in -other complaints of this climate, is here -found to be inadmissible on account of the -<span class="pagenum" id="Page_473">473</span> -heat, thirst, and other febrile symptoms, -which it seldom fails to induce in all stages -of this disease.</p> - -<h4><span class="smcap">Treatment</span> of <span class="smcap">Fluxes</span>.</h4> - -<p>There are few diseases in which a -prudent employment of art is more useful, -or in which early means of relief are more -requisite than in this<a id="FNanchor_114" href="#Footnote_114" class="fnanchor">114</a>.</p> - -<p>Where the dysentery is the original disease, -and when the patient is robust and -plethoric, with acute pain and a strong -pulse, blood-letting may be practised with -advantage in the beginning of the complaint. -But there is no part of the practice -<span class="pagenum" id="Page_474">474</span> -in this disease in which the climate and -manner of life makes a greater difference -than in this; for in a temperate climate it -frequently happens that repeated blood-letting -is necessary; but in a hot climate, where -the fibres are relaxed, and in the constitutions -of seamen, whom we seldom or never -find plethoric, the inflammatory symptoms -requiring this evacuation do not run so high, -nor continue so long.</p> - -<p>It is in all cases of the utmost consequence -to administer as early as possible a brisk saline -purgative. An ounce and a half or two -ounces of purging salts may be dissolved in -a quart of barley water or water gruel, and -given warm in cupfuls, at small intervals, -till a free and copious evacuation is produced. -If there should be much fever, or -sickness at stomach, two grains of emetic -tartar will be a great improvement of this -medicine; and there will be this farther -advantage from its use, that if the stomach -should be loaded with bile, in which state -it is more irritable, an evacuation upwards -<span class="pagenum" id="Page_475">475</span> -will also be excited to the great relief of the -patient.</p> - -<p>This early and seasonable measure will, -in many cases, put a stop to the disease, -especially if the patient is thrown into a -sweat immediately after the bowels have -been thus thoroughly evacuated. It is of -great service in this disease to promote free -perspiration, and even a plentiful sweat, -which may be effected with great advantage -by giving, at bed time, a medicine composed -of opium, ipecacuana, and a little -neutral salt, accompanying it with plentiful -warm dilution. Nothing tends more to relieve -griping and tenesmus than a general, -warm moisture on the skin. The ipecacuana, -which is an ingredient in this medicine, is -one of the best anti-dysenteric remedies we -know; the opium procures rest; and this, -joined to the sudorific effect of the whole, -not only gives a temporary relief, but tends -to carry off the disease. It is most properly -given in the evening; for there would be -this inconvenience in constantly encouraging -a sweat, that if the tenesmus should return, -<span class="pagenum" id="Page_476">476</span> -it would either be checked by the patient -getting frequently out of bed, or there would -be danger of his catching cold. I am well -aware that we cannot be too cautious with -regard to the use of opium in the beginning -of this disease; but it is admissible more -early in a hot climate than a cold one, as -the inflammatory symptoms are less violent -and can be sooner subdued; besides, it becomes -an entirely different medicine when -conjoined with the other ingredients that -have been mentioned.</p> - -<p>The best medicine in the day time we -found to be small doses of ipecacuana alone -twice or thrice a day; and if there should -be fresh collections of bile, small doses of -the saline purgative will be necessary. Ipecacuana -in this intention, may be given in -the dose of two grains in athletic constitutions, -such as those of seamen; but in the -more delicate constitutions, such as are commonly -met with in private practice, one -grain is a sufficient dose. I have found -manna and tamarinds a good addition to this -medicine in the earlier stages of the disease, -<span class="pagenum" id="Page_477">477</span> -where there was much bile; but in a more -advanced stage of it they are apt to produce -gripings and flatulence.</p> - -<p>The marks of a redundance of bile are, a -sickness at stomach, a sense of scalding at -the anus when the stools are passing, and -the yellow or green colour of the stools -themselves. It is apt also to excite symptoms -of fever, such as a foul tongue, a hot -and dry skin, with thirst. When collections -of it are suspected in this disease, it is best -to evacuate it by vomiting, for it is thereby -prevented from irritating the bowels, and -from arriving at the inflamed parts with, -perhaps, increased acrimony, acquired in -passing through the whole length of the -intestines.</p> - -<p>Some gentlemen of the fleet informed me -that they found oil of almonds a useful addition -to the purgative. Others as well as -myself made a practical comparison of the saline -purgative with that composed of rhubarb -and calomel, as recommended by Sir John -Pringle, and we gave the preference to the -<span class="pagenum" id="Page_478">478</span> -former, as more easy, speedy, and effectual in -its operation, especially in the first stage. Cases -may occur, however, in which the other may -be more advisable; for where there is a sense -of weight about the stomach, which most -probably arises from the biliary organs being -clogged with bile, and where emetics -have failed to remove it, or the weakness of -the patient may render them improper, then -calomel has the best effect: for it was formerly -observed, that it tends to loosen the -secretions, and to stimulate the more distant -excretories, such as the biliary ducts.</p> - -<p>It is very important to caution young -practitioners concerning the employment of -opium in all stages of this disease, but especially -in the beginning; for though it is an -excellent remedy when seasonably and judiciously -employed, it is very liable to abuse, -particularly in the hands of the inexperienced, -who may be tempted to give it improperly -from an anxiety to relieve; but as -more harm may arise from an unseasonable -administration of it than could be compensated -by the best-timed use of it, it is best -<span class="pagenum" id="Page_479">479</span> -to err on the side of caution and omission. -The principal caution to be observed with -regard to this remedy is, to premise suitable -evacuation, such as blood-letting, if necessary, -but more especially purging. It is -always pernicious to give it in its pure state -during the <i>tormina</i>, so common in the first -days. By these I mean the abdominal gripings, -which denote inflammation, and are -entirely different from the <i>tenesmus</i>, which -is a more constant and characteristic symptom -of the disease, and seems to arise from -irritation and spasms of the rectum and -colon.</p> - -<p>It was in this disease that I first observed -the good effects of a small quantity of neutral -salt in taking off the inconveniencies -attending opium, such as the feverish heat -and confusion of the head, which it is apt -to produce in many constitutions; and as -the administration of the anodyne coincided -with the evening dose of ipecacuana, I was -led to adopt a form similar to that of Dover’s -powder, but with only half the quantity -of opium; or, it was given in a liquid -<span class="pagenum" id="Page_480">480</span> -form, by combining twenty drops of thebaic -tincture and a drachm of ipecacuana -wine, with nitre from five to ten grains, in -any simple vehicle in form of a draught. -There is a very observable difference, in -some cases, between opium given in a liquid -and in a solid form; and the former is much -more certain in its effect when the intention -is to procure speedy and effectual ease.</p> - -<p>I have observed great benefit from the use -of external remedies in dysentery, and these -have, perhaps, been too much neglected by -authors and practitioners. The warm bath -is of great service, especially where the -gripes and tenesmus are severe, and where -the fever has been taken off by previous -evacuation. Fomentations or warm applications -of any kind to the abdomen give -temporary relief; and it will be found of -advantage to keep those parts, at all times, -well defended from the cold air. Blisters to -the abdomen were also found of use, and -likewise acrid liniments, composed of oil, -volatile spirits, and tincture of cantharides. -Where the stomach has been much affected, -<span class="pagenum" id="Page_481">481</span> -I have perceived relief from fomenting it -with stupes, upon which thebaic tincture -and camphorated spirits were sprinkled, as -recommended by Dr. Lind. I was once affected -with a bad dysentery in the West Indies, -and I thought myself much relieved -by the warm bath and a blister. Strangury -is not an uncommon symptom in this disease, -independent of cantharides, and the -most sensible and effectual relief is derived -from fomentations to the pubis and perinæum, -as I also experienced in my own case.</p> - -<p>What has been hitherto said regards -chiefly the acute dysentery; but the most -frequent and troublesome complaint that -occurred at the hospital, was the same disease -in what may be called its chronic state.</p> - -<p>There is a considerable variety of symptoms -in all the stages of this disease, but -particularly in the more advanced or chronic -state, so that a corresponding variety is -necessary in the modes of treatment, and -there are few diseases in which there is more -room for exercising the judgement. -<span class="pagenum" id="Page_482">482</span></p> - -<p>In all stages of it an accurate discernment -is necessary with regard to the use of opiates, -and great part of the practice here consists in -timing these well. They are least admissible -in the beginning, where evacuation is the -principal object; but as the disease advances -they become more and more allowable and -useful. The principal cautions necessary -in their administration are, 1. To premise -sufficient evacuation, so that the intestines -may not be loaded with bile, <i>scybala</i>, or -any other irritating matter at the time of -giving the opiate. 2. To obviate the effects -which an anodyne has of causing a -retention of the contents of the intestines. -This may be done, either by giving something -purgative along with it, or after it -has produced its quieting effect. The former -method seems preferable; for as soon as the -effect of the opiate is over, the purgative -is ready to act; and in this way it is so far -favourable to the operation of the purgative -that large feculent stools will be discharged: -whereas, had the purgative been given alone, -it would have been more apt to produce -<span class="pagenum" id="Page_483">483</span> -scanty griping stools, attended with tenesmus. -Rhubarb answers well in such cases, -and may be given in a dose from twelve to -twenty grains, according to the age and -constitution. 3. To prevent feverish heat -and delirium. This was proposed to be done -in the first stage of the disease, by combining -it with ipecacuana and a little neutral -salt. With the same intention, it may now -be joined with a few grains of Dr. James’s -powder, or <i>vitrum ceratum antimonii</i>, in which -form it would not be so strongly sudorific, -an effect not so much required in the chronic -as in the acute state.</p> - -<p>The principal causes that keep up the -flux, and render it so obstinate, are, 1. A -too great secretion of bile, either continual -or frequently recurring. 2. Ulcers in the -great intestines. 3. A lienteric state of the -bowels. 4. A retention of <i>scybala</i>.</p> - -<p>The first cause is much less frequent than -might be expected by those who fancy that -every disease of this climate proceeds from -<span class="pagenum" id="Page_484">484</span> -bile. When there does occur a redundancy -of bile, there is more occasion for the employment -of evacuant medicines, and more -need of caution in that of opiates. A medicine -that will dispose the liver, or the circulating -system in general, to form less bile, is a <i>desideratum</i> -in physic; but, in case of an excessive -flow of it, emetics and mercurial purgatives, -as has been already mentioned, are -the best means of evacuating it; and care -should be taken that it be discharged before -it accumulates too much, or becomes acrid -by too long retention.</p> - -<p>In order to obviate that irritation in which -tenesmus consists, some benefit was found -from the injection of emollient and anodyne -clysters, to wash off and dilute the acrimony, -and to sooth and heal the parts. A -strong infusion or decoction of linseed or -starch may first be given to the quantity of -near a pint, to be evacuated after a short retention, -and then a few ounces of the same, -with thirty or forty drops of laudanum, to -be retained for a length of time, in order to -procure rest. Instead of this last, I have -<span class="pagenum" id="Page_485">485</span> -known a small quantity of warm milk, with -syrup of poppies, used with advantage in -private practice.</p> - -<p>I was at first tempted to think that a very -frequent injection of such clysters would be -very useful, by washing and healing the colon -and rectum, and preventing farther exulceration. -But besides the objection arising -from the tenderness of the parts, which, in -some cases, renders the operation itself painful, -I found that if they were given oftener -than once a day, they rather increased the -uneasiness, and made the patient feel languid -and exhausted; so true it is that no -practical rule can be established from reason -alone without being brought to the test of -experience. The rectum seems to have a -peculiar sensibility, and a remarkable consent -with the whole system; for a stool will -induce syncope, or even death, in a state of -great debility. Clysters may be pernicious, -even though they produce no evacuation of -<i>feces</i>; and Sydenham has remarked, with respect -to other diseases, that their unseasonable -or too frequent use greatly debilitates -<span class="pagenum" id="Page_486">486</span> -and disturbs the patient. When not abused, -however, they are of the most eminent service -in this and other complaints.</p> - -<p>Certain medicines, which have been called -<i>sheathing</i>, have been recommended to be taken -by the mouth. Of this kind are mucilage, -oil, and wax. I have made trial of -mucilage, such as starch, without any sensible -effect, probably because it loses its qualities -by the powers of digestion before it -reaches the part upon which it is intended -to act. With regard to oil, I have hardly -enough of experience of my own to decide; -but some of the surgeons of the fleet informed -me that they found advantage from -combining it with the purgatives. I was -discouraged from using it by finding that it -was apt, in the West Indies, to become rancid -on the stomach, and, for this reason, I -seldom, in any case, employed the castor -oil, which, though produced in that climate, -seems to answer better as a medicine -in Europe. But since my return to England -I have used, with great benefit, at St. -Thomas’s hospital, a medicine, composed of -<span class="pagenum" id="Page_487">487</span> -tincture of rhubarb and oil, in old dysenteries, -attended with discharges of blood. I -took the hint of this from finding it of -great service in deep-seated piles, as recommended -by Dr. Griffith<a id="FNanchor_115" href="#Footnote_115" class="fnanchor">115</a>. It is necessary -to combine something purgative with the -oil, otherwise it might be altered by digestion, -or absorbed, or might become rancid -by too long retention in the first passages. -Wax is a body not changeable by digestion, -and seems therefore well suited for the purpose -of sheathing the bowels; and I have -found advantage from the preparation of it -recommended by Sir John Pringle<a id="FNanchor_116" href="#Footnote_116" class="fnanchor">116</a>, on -the authority of Dr. Huck. I have also -seen some advantage in old fluxes, in St. -<span class="pagenum" id="Page_488">488</span> -Thomas’s hospital, from the use of spermaceti, -given with an equal quantity of -conserve of roses and half as much absorbent -powder, agreeably to a form in use at -that hospital.</p> - -<p>The climate has a great influence in preventing -these ulcers from healing, upon the -same principle that it prevents the cure of -external sores and wounds, so that there are -cases that admit of no cure but from a -change of climate. I have seen in some -cases of old dysentery, small, round, ill-conditioned -ulcers break out on the surface -of the body, which seemed to proceed from -the same general habit that produced those -of the intestines. There was something -peculiar in the appearance of those external -sores, being like small round pits, as if a -part of the skin had been removed by caustic, -and with little or no discharge. In a -case of this kind, which proved fatal, I -found the whole surface of the great intestines -beset with small ulcers, not unlike -those on the skin. -<span class="pagenum" id="Page_489">489</span></p> - -<p>Since the first edition of this work was -published, I have met with a pamphlet, -written by Dr. Houlston, of Liverpool, in -which the friction of mercurial ointment -on the abdomen is recommended as a cure -for old fluxes; and I have tried this practice -in some very obstinate cases in St. Thomas’s -hospital with evident success. In these -cases it is probable the disease is kept up by -a vitiated state of some of the various secretions -belonging to the intestinal canal, which -the mercurial alternative tends to correct.</p> - -<p>The next cause that was mentioned of the -long continuation of fluxes, was a lienteric -state of the bowels. This consists in a great -irritability of the whole alimentary canal, -whereby all the <i>ingesta</i> are transmitted so -fast, that there is no time for assimilation. -Liquid aliment, such as broth, is particularly -subject to this inconvenience. There -are few cases of long-protracted fluxes in -the West Indies, without this symptom in -some degree. -<span class="pagenum" id="Page_490">490</span></p> - -<p>The remedies that are here found of most -service are such as counteract irritability or -relaxation. It is in cases where this is the -prevalent symptom that opium may be most -freely used. Frequent and small doses of -the compound officinals, such as theriaca, -pulvis e bolo compositus, or diascordium, -have been found of service. Though the -relaxation would seem here to indicate the -Peruvian bark, yet I have hardly ever known -it employed in any form in this or any other -stage of the disease, without being hurtful. -But there are other bitters not only safe but -useful in restoring the tone of the bowels; -of this kind are simaruba, quassia, and chamomile -flowers. The first has been reckoned -a specific in this sort of flux; but -though its powers are undeniable, it will be -found frequently to fail<a id="FNanchor_117" href="#Footnote_117" class="fnanchor">117</a>. I have also used, -with advantage, a tincture of gentian and -cinnamon in Port wine. Something aromatic -<span class="pagenum" id="Page_491">491</span> -has a good effect when added to the -bitter, being adapted to prevent or obviate -flatulence, which is a common and troublesome -symptom in this complaint.</p> - -<p>That class of remedies which may be -called pure astringents, might seem at first -sight well calculated for cases of this kind. -Of this sort are the <i>terra Japonica</i> and <i>extractum -campechense</i>; but though I have seen -evident benefit from this last, there are few -cases in which such medicines are found by -experience to be of material service. Where -the cause consists in simple relaxation, they -will effect a cure; but it more frequently -happens that the disease is kept up by a vitiated -state of the secretions, or a depraved -action of the bowels.</p> - -<p>The absorbent earths are a more useful -<span class="pagenum" id="Page_492">492</span> -remedy in this form of the disease. They -have, perhaps, a restringent effect independent -of their power of absorbing acid. It -is certain, however, that great part of their -use consists in the destruction of acid, which -is very apt to be generated in that depraved -state of digestion which takes place in advanced -fluxes, particularly in this lienteric -state of the bowels. In the early and acute -state the vegetable purgatives, such as cream -of tartar, tamarinds, and manna, are proper; -but in this advanced stage they are hurtful -by the acidity and flatulence which they -produce, and both the food and medicines -should be so calculated as to avert and correct -those inconveniencies. There is something -in vegetable acids extremely unfriendly -to a weak state of the bowels in general, -tending to bring on spasmodic gripings, and -preventing a healthy digestion and assimilation, -as we know in the case of heartburn, -and of those who make use of vinegar to -check corpulency, by preventing the formation -of blood. Vegetable acids, however, -are admissible where there is a redundancy -of bile, or where the excrements are -<span class="pagenum" id="Page_493">493</span> -putrid; and Dr. Zimmerman recommends -tamarinds as a useful medicine in what he -calls the putrid dysentery.</p> - -<p>Lime water has been recommended in old -flaxes, and I tried it in several cases; but, -except in one, I could not perceive any benefit -from it.</p> - -<p>Absorbents may very properly be combined -in prescription with some of the compound-officinal -opiates, and a medicine will -thereby be formed, which will have at once -the advantage of an anodyne, a bitter, an -astringent, a carminative, and absorbent. -As these earths have little or no taste, they -may also be added, with propriety, to the -common drink, as in the form of the chalk -julep, or <i>decoctum album</i>. It may be thought -that here and elsewhere I have not been so -particular as I ought to be concerning the -forms and doses of medicines; but circumstances, -such as age, constitution, and symptoms, -make these, in a great measure, discretionary; -and any one who is sufficiently -conversant with physic to be entrusted with -<span class="pagenum" id="Page_494">494</span> -the charge of the sick, will have sufficient -judgement to vary his practice accordingly. -It has, therefore been my object rather to -give the general principles of treatment than -the particular forms of medicines.</p> - -<p>A proper regulation of diet, as well as medicine, -is of the utmost consequence in this -disease. A free indulgence of animal food -is pernicious, particularly in the first stage -of it. In the chronic state, a moderate use -of it is allowable, and in the lienteric state -it answers better in a solid form than that of -broth, which is apt to gripe and to run -quickly through the bowels. The best general -articles of diet are farinaceous bodies; -and these are greatly improved by being -toasted brown before they are used. It was -observed, in a former part of this work, that -the flux was supposed to have been prevented, -in the fleet commanded by Sir Charles -Saunders, by throwing burnt biscuit into -the water used by the crews of the ships. -It is a good practice to put a well-burnt -toast into all that the patient drinks, and -toasted bread, or panada made of toasted -<span class="pagenum" id="Page_495">495</span> -bread or biscuit, is one of the best articles -of diet. Brackish water ought to be avoided, -as it ruffles the bowels when in so delicate -a state. Fermented liquors are improper, -except when the disease is advanced, and -where weakness and relaxation are the prevailing -symptoms. Malt liquor will hardly -ever agree, on account of its acidity and flatulence. -Of wines, Port is to be preferred -as the most strengthening; Madeira as the -least subject to acidity; and, for the common -men, no drink of the fermented kind -is safer than a moderate quantity of spirits -diluted with water.</p> - -<p>Warm clothing is of the utmost consequence -in this disease, and external warmth -of the abdomen tends greatly to sooth the -bowels. I have seen good effects from a -warm gum plaster constantly worn on that -part. Though cold is in general hurtful -and unsafe, I have nevertheless known the -sailors, who, by their habits of life, are commonly -heedless, bathe in the sea when labouring -under what they call the white flux, -without any bad effects. -<span class="pagenum" id="Page_496">496</span></p> - -<p>It sometimes happens that this disease -baffles every effort both of medicine and -diet, so that a change of climate becomes -the only resource.</p> - -<p>The last cause of habitual flux that was -mentioned was the retention of <i>scybala</i>, -which keep up the irritation and tenesmus. -It is very natural to neglect purgative medicines -when there seems already to be too -great a discharge by the bowels; but there -is this inconvenience from omitting them -for a length of time, that those hard lumps -of feces, called <i>scybala</i>, are apt to collect in -the 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 -<span class="pagenum" id="Page_497">497</span> -a good effect after a long neglect of purgative -medicines. It is probable, from the -durable effects produced, that these do not -operate merely by the expulsion of <i>scybala</i>; -and we can conceive that they may be of -service by the removal of certain depraved -fluid secretions, or that they may stimulate -the vessels to a more healthy action and a -more natural secretion. Be this as it will, -experience teaches that in all fluxes it is of -advantage to interpose from time to time -some purgative medicine.</p> - -<p>From the preceding view of the variety of -causes which tend to keep up this disease, it -will appear that great judgement and discrimination -are necessary in varying the practice -according to circumstances; and there is -no disease in which there is room for more -attention and nicety in adapting the different -remedies to the different symptoms. We -can hereby also account for the various characters -that different remedies have had, -some having been extolled by one practitioner -while they have been pronounced insignificant -by another; for no one remedy will -<span class="pagenum" id="Page_498">498</span> -suit all the various cases of this disease. As -it is of the greatest consequence to distinguish -these cases, I have been more particular -and diffuse on this article than any other; -and having laboured under this complaint -myself, I was naturally led to take a greater -interest in its treatment, and had also thereby -a better opportunity of making observations -on it. -<span class="pagenum" id="Page_499">499</span></p> - -<h2 id="PART_III_CHAP_III">CHAP. III.</h2> - -<h3 id="OF_SCURVY">Of the <span class="smcap">Scurvy</span>.</h3> - -<p>I shall not be so minute either in the -description or treatment of the scurvy, as of -the preceding diseases. A detail of this kind -would lead to unnecessary prolixity and repetition; -for the prevention and cure of it -consisting in diet rather than medicine, have -been fully handled in the former parts of -this work; and the subject, in the descriptive -as well as the practical part, has, in a -manner, been exhausted by Dr. Lind. With -regard to the theoretical part, I refer the -reader to the ingenious treatise lately published -by Dr. Milman.</p> - -<p>It has appeared that the principal source -of scurvy is a vitiated or scanty diet, and -that it is very much promoted by cold, -moisture, filth, sloth, and dejection of mind. -Hard labour has been assigned by some as a -cause; but this is not conformable to my -<span class="pagenum" id="Page_500">500</span> -observation in general, and what has been -related to have happened in the Conqueror<a id="FNanchor_118" href="#Footnote_118" class="fnanchor">118</a>, -more particularly led me to be of a contrary -opinion.</p> - -<p>The principal differences of the symptoms -of the scurvy in hot and cold climates, so far -as I have observed, are, that in the former -the livid hardness on the extremities is an -earlier symptom, and in the latter the gums -are sooner affected, and the difficulty of -breathing is a more frequent and more uneasy -symptom. This difficulty of breathing -is one of the most fatal symptoms, and is -most frequent in those cases in which -there are the fewest external marks of the -disease, and is probably that form of the -complaint which attacks a vital part by a -sort of translation from the extremities. -<span class="pagenum" id="Page_501">501</span></p> - -<p>There is a remarkable symptom sometimes -attendant on this disease which has escaped -authors, and is mentioned in Mr. Telford’s -Report, page 23. This is the <i>nyctalopia</i>, -or weakness of the eye-sight, which was -also common in the garrison of Gibraltar<a id="FNanchor_119" href="#Footnote_119" class="fnanchor">119</a>, -among those who were affected with the -scurvy, a disease that prevailed much during -the late siege of that place.</p> - -<p>With regard to the cure, enough has been -said in the preceding parts of this work to -prove that fresh vegetables are the most effectual -antiscorbutics. I shall here mention -a fact farther in proof of this, which has not -before been taken notice of. When the -fleet arrived at Barbadoes in May, 1781, -part of the soldiers, who served as marines, -were affected with the scurvy, and being sent -to the army hospital, where, at that time, -no fresh animal food was allowed, they recovered -much faster by being confined to vegetable -<span class="pagenum" id="Page_502">502</span> -articles, than the seamen who were -fed upon fresh animal food without any fresh -vegetables.</p> - -<p>It has farther appeared, that there is something -in a particular class of fruit of the -lemon and orange kind, which far surpasses -every other remedy, whether dietetic or medicinal. -Numberless instances have occurred, -in the preceding part of this work, of -men having recovered at sea from using the -juice of this fruit alone, even under all the -inconveniences of a sea diet. When the -juice is intended to be kept for a length of -time, it should be expressed and bottled, a -small quantity of spirits being added to preserve -it for if fire is used in preparing it, -as in the form of a rob, I know for certain -that its virtues will be thereby very much -impaired. It is very difficult to say upon -what principle these fruits act, for no sensible -effects are produced by them except a -small increase of some of the secretions.</p> - -<p>It ought to be mentioned here as a fact of -great consequence, though very little known, -<span class="pagenum" id="Page_503">503</span> -and never, I believe, published before, that -the juice of limes and lemons is the best detergent -of any external application that has -yet been tried in scorbutic ulcers. Nothing -was found so effectual in preventing these -from spreading, and in disposing them to -heal, as an emollient poultice with<a id="FNanchor_120" href="#Footnote_120" class="fnanchor">120</a> lemon -or lime juice sprinkled on its surface; or it -was applied by soaking in it the lint with -which the sore was dressed, and also as a -lotion, in which case it was used diluted -with two or three times its quantity of water; -for if used pure, it was found too irritating, -and was apt to bring on a fungous -disposition. This precaution is particularly -necessary with regard to limes, the juice of -which is a much more concentrated acid -than that of lemons. Mr. Lucas, surgeon -of the Conqueror, favoured me with several -valuable remarks in proof of this practice. -A poultice was always found a good application -<span class="pagenum" id="Page_504">504</span> -in these cases, by its power of absorbing -the acrimonious discharge, which would -otherwise irritate the neighbouring parts. -I have been informed by a navy surgeon, -who served in the former war, that he has -known the most obstinate ulcers cured by -applying a paste of oatmeal and water, the -surface of which was sprinkled with Goulard’s -preparation of lead.</p> - -<p>The fleet was furnished with essence of -malt; but its powers were so inconsiderable, -that some of the surgeons denied that it had -any. In trials, however, that were made in -an early state of the disease, it was found to -have a sensible effect in checking and removing -it. It was also found of evident use -in the bad ulcers so apt to arise in scorbutic -habits, and in this intention was superior to -the Peruvian bark as an internal alterative. -Indeed, in those ulcers that were truly scorbutic, -the bark was found to be of very little -use; and, next to what has been already -mentioned, joined to the advantages of diet, -opium was found of the greatest service in -<span class="pagenum" id="Page_505">505</span> -disposing these, as well as all other ill-conditioned -sores of hot climates, to heal.</p> - -<p>I have mentioned the scorbutic habit as -distinguished from the scurvy, but there -seems to be no difference except in degree; -for a person may be laid to labour under the -disease before it betrays itself by any obvious -symptom, and it must have gathered a certain -degree of force before visible symptoms -are produced. The chief mark of this latent -and incipient stage of the disease is that -incurable state of ulcers that has been mentioned, -whether they appear spontaneously -or in consequence of slight accidents. There -is another mark of this scorbutic habit which -is not mentioned in any description of the -disease I have ever seen. It is a soft, indolent -tumour which arises under the skin on -a part which has received a small blow, or -contusion, so slight as not to break the skin. -It most commonly appears about the elbow -or fore-arm, and generally disappears without -any inconvenience, what it contains being -absorbed. A surgeon, who opened one -of them, (a practice, however, not to be -<span class="pagenum" id="Page_506">506</span> -approved of) informed me that it consisted -of fluid blood. We may also reckon a languor, -or sense of weight, as one of those -marks of scurvy which occur before the -more obvious symptoms appear.</p> - -<p>In this state of the disease, the articles of -lesser powers, such as malt and melasses, -may be of service by preventing its farther -progress, or the appearance of actual symptoms, -and by restoring the constitution.</p> - -<p>In some of the early stages of this disease -the effervescing mixture of acids with fixed -alkali may probably also be of use. I never -could perceive any sensible benefit in those -cases in which I tried it, though some of -the gentlemen of the fleet reported to me -that they thought it of service.</p> - -<p>There is no article of the <i>Materia Medica</i> -yet known that possesses any considerable -power over this disease without the assistance -of proper diet. With this assistance, however, -it is found, that whatever tends to increase -the fluid secretions, hastens very much -<span class="pagenum" id="Page_507">507</span> -the recovery of the scorbutic patient. I -have observed a very striking instance of this -in the effects of a spontaneous diarrhoea; -for I have seen those hard livid swellings on -the legs, that form one of the most constant -symptoms of this disease, almost disappear, -and the hams, from being contracted, -become flexible in the course of twelve -hours after the purging came on. I have -endeavoured to imitate this with purgatives, -but never with the same effects as the natural -looseness. A free flow of urine is also -found to promote the recovery, and vinegar -of squills is one of the most effectual medicines -in this intention. It is likewise of -singular service to excite sweat; for an obstruction -of perspiration seems to be one of -the principal constituents of the disease. The -goose skin, which is an early and constant -symptom of this disease, seems to be owing -to a constriction of the exhaling vessels. -Dover’s powder has been employed with -advantage as a sudorific, with decoction of -the woods drank warm, and plentiful warm -dilution. Camphor, combined with nitre, -<span class="pagenum" id="Page_508">508</span> -has been found one of the best remedies, -and it acts both as a diaphoretic and diuretic.</p> - -<p>Such external applications as relax the -skin are found also to forward the cure. -The contraction of the hams and the livid -hardness of the calves of the legs are relieved -by emollient cataplasms. Burying the -legs in the earth, which has a sensible good -effect, seems to act on the same principle, -for it makes the parts sweat profusely.</p> - -<p>There can be no doubt that in the scurvy -there takes place in certain parts of the -body a stagnation of the humours in the -small vessels, particularly of the lower extremities, -and that it is to this circumstance -that the livid hardness of the fleshy parts of -the legs is owing. The effect of medicine -in removing this, must be to restore the action -of those torpid vessels, so as to bring -the stagnated fluids again into circulation<a id="FNanchor_121" href="#Footnote_121" class="fnanchor">121</a> -<span class="pagenum" id="Page_509">509</span> -Purgatives seem to act upon it as they do in -the dropsy, by exciting absorption. The irritation -of the bowels and their increased -secretion thus affecting the minute vessels in -all parts of the body, is the result of that -sympathy or balance established between -every part of the system, in order to support -the harmony and effect the purposes of -the animal œconomy.</p> - -<p>It has long appeared to me, that the scurvy -is owing rather to a defect of nourishment -than to a vitiated state of it. In fact, -that sort of food which is supposed most -commonly to induce the scurvy, is, in most -cases, not putrid, but is in an unnatural and -depraved state by being drained of its juices, -which run off in brine; and perhaps some -<span class="pagenum" id="Page_510">510</span> -of the more subtile and nutritious parts are -wasted by evaporation. It is not found that -salt of itself has any effect in inducing the -scurvy, and indeed it can be induced under -a state of diet in which there is no salt, as -we know from some instances quoted by Dr. -Lind; and some cases are related by Dr. -Monro and Dr. Milman, in the Medical -Transactions, which are in proof of the same -opinion. But the case most in point to prove -that it depends on a defect of aliment, is -that of Dr. Stark, who, by way of experiment -on himself, reduced his diet to the -least quantity he could subsist upon, and was -thereupon affected with the symptoms of the -sea scurvy. I have also known some symptoms -of it arise in old people in consequence -of long abstinence, owing to the want of -appetite.</p> - -<p>It would appear that the aliment we take -in acts in two ways in increasing the vigour -of the body. First, by assimilation, whereby -it affords the matter of which the solids -of the body are made, in order to carry on -growth in youth; and to repair the waste of -<span class="pagenum" id="Page_511">511</span> -parts in adult age. A very small quantity -of matter is necessary for these purposes; -and as a proof of it, we see people supported -equally well with very different quantities -and qualities of food. Secondly, Food is -necessary as a stimulus, either by a power it -has of soothing the nerves of the stomach, -and the other surfaces to which it is applied, -or by its volume in distending the intestines -and blood vessels. It is upon this principle -that luxury renders the great quantities of -food we take in necessary; and those species -of food which satisfy most by their stimulus -are by no means such as are the most nutritious. -It is also upon this principle, that -in cases of accidental hardship from want -of food, or in barren and inclement countries -where food is scarce, the body is supported, -in some measure, by what contains -little or no nutritious matter, such as pure -water, or the bark of trees powdered and -kneaded into a sort of bread, as we are told -of the inhabitants of Lapland.</p> - -<p>There are other familiar and well-established -facts, which prove, that either from -<span class="pagenum" id="Page_512">512</span> -the influence of disease, from habits of life, -or the nature of particular animals, life can -go on for a length of time with little or no -aliment. This is the case in fevers, in sea-sickness, -in certain singular cases that have -been recorded<a id="FNanchor_122" href="#Footnote_122" class="fnanchor">122</a>, in torpid animals, and in -animals of cold blood. Though a man in -health will die if deprived of food for a very -few days, it does not follow that this is owing -to the want of matter to repair the -waste of the body. The craving for food, -and the faintness from long abstinence, arise -from the want of the accustomed stimulus, -especially in those who are used to live well; -and a person feels himself most refreshed by -food and drink when newly taken in, and -before it can be applied to the purpose of -nutrition.</p> - -<p>As there is a continual waste and decay, -however, both of our fluids and solids, some -degree of reparation is absolutely necessary, -especially to animals of warm blood; and -<span class="pagenum" id="Page_513">513</span> -such <i>ingesta</i> as would give the stimulus of -food, without being possessed of any nutritious -principle, would indeed continue life -for a certain time; but disease would ensue. -The provision used at sea answers, in a great -measure, to this description; for unless the -powers of digestion and assimilation are remarkably -strong, salt beef and biscuit, which -have been long kept, do not contain much -more nourishment than saw-dust, or the bark -of a tree, and the disease induced by this -diet is the scurvy.</p> - -<p>The nature and symptoms of the scurvy -countenance this opinion: for as the means -of renewing the animal matter of our bodies -is withdrawn under this course of diet, nature, -in consequence of an accommodating -principle, observes a sort of frugality, and -the animal œconomy adopts such measures -as may be productive of the least possible -waste and corruption of the fluids. Accordingly -all the secretions become scanty; and, -in particular, one of the first symptoms of -this disease is a suppression of perspiration, -as appears by the goose-skin that attends it. -<span class="pagenum" id="Page_514">514</span> -There is a paucity of urine. There is also -a great languor in the circulation, which -may be considered either as a means adopted -by nature to prevent that vitiated and effete -state of the fluids which a brisker action -might induce; or it may happen from a -want of that due supply of nourishment necessary -to produce a vigorous action of all -the functions.</p> - -<p>We have a proof of this general languor -not only from the great aversion to motion, -and the great disposition to syncope, but -from the inspection of the dead body, from -which it appears that the whole circulating -system, being more flaccid and less elastic, -is subject to preternatural distention. The -heart is accordingly found enlarged in bulk, -the size of the cavities being increased; and -in the extremities, where the circulation is -naturally most languid, the small vessels -carrying the colourless part of the blood, are -so far enlarged as to admit the red part of it, -as appears by the livid colour; and where -this is the case, these vessels being unable to -carry on the circulation, a stagnation ensues, -<span class="pagenum" id="Page_515">515</span> -as is evident in those livid appearances most -common about the calves of the leg, which -feel like a hard cake. I have examined -those parts in the dead subject, and found a -want of fluidity in the contents of the vessels, -but could not discover any thing like -<i>eechymosis</i>; from which I concluded that the -colour was owing to an <i>error loci</i>, and the -hardness to stagnation and coagulation of -the fluids, and a want of action of the -vessels.</p> - -<p>The incurable state of ulcers, so common -in this disease, is also what we might expect -from the defect of fresh assimilated -juices; for where a breach is made, either -by nature or accident, in the solids, particularly -of the extremities, the proper suppuration -is prevented by the depraved state -both of the fluids and vessels; and we cannot -expect that renewal of solid parts in -which healing consists, where both the instruments -and materials of its formation are -so defective. -<span class="pagenum" id="Page_516">516</span></p> - -<p>I shall conclude what I have to say on -this subject, by shortly considering whether -or not this disease is ever contagious.</p> - -<p>There is something in the nature and -history of the scurvy that would lead us at -once to pronounce that it is not infectious; -for the external causes on which it depends -are so obvious, and seem so adequate to account -for its appearance and prevalence upon -certain occasions, as at first sight to exclude -every other external cause.</p> - -<p>But it seems extremely unphilosophical to -deny the reality or possibility of any thing -in Nature, from our supposed knowledge of -the means and causes she employs, particularly -in a branch of science so obscure as the -animal œconomy. Could we, therefore, -prove the point as a matter of fact, it would -be in vain to deny it, from our fancied acquaintance -with Nature’s modes of operation.</p> - -<p>The facts which give a suspicion of the -scurvy being infectious are, 1st, What is -<span class="pagenum" id="Page_517">517</span> -related by Dr. Lind, that the sea scurvy -spread at one time from the naval hospital to -the people of the adjacent country. 2dly, -There occurred several instances, in the first -part of this work, of this disease prevailing -to a much greater degree in some<a id="FNanchor_123" href="#Footnote_123" class="fnanchor">123</a> particular -ships than others, though upon the most -accurate inquiry there was found no difference -in the diet, or any other external or -predisposing cause adequate to account for -this. We can conceive, that those ships -having accidentally a few men, whose constitutions -were remarkably predisposed to -this disease, might catch it earlier than in -other ships, and communicate it to the rest -of the crew.</p> - -<p>The only practical inference that would lie -from the establishment of this fact would be, -that when the disease begins first to appear, -the men affected should be separated from the -rest; and this is a good practice, whether -this opinion is true or not; for such men -<span class="pagenum" id="Page_518">518</span> -ought to be put in one mess, in order that -they all may live upon the same antiscorbutic -articles of diet, and that they may more easily -be debarred from the use of their common -provisions, of which this disease does -not make them lose the relish. -<span class="pagenum" id="Page_519">519</span></p> - -<h2 id="PART_III_CHAP_IV">CHAP. IV.</h2> - -<h3 id="OF_THE_WOUNDS_RECEIVED_IN_THE_ACTIONS_OF_APRIL_1782">Of the <span class="smcap">Wounds</span> received in the Actions of -April, 1782.</h3> - -<blockquote> - -<p>Loss in the Battle and from Wounds—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.</p></blockquote> - -<p>Though surgery was not properly in -my department, yet, having had a fair opportunity -of collecting facts concerning this -branch of practice, I thought it my duty to -pay some attention to it.</p> - -<p>The whole number of men wounded in -the actions of April, 1782, amounted to eight -hundred and ten. -<span class="pagenum" id="Page_520">520</span></p> - -<p>Of these, sixty died on board before the -end of the month, five in the course of the -following month, and two in June.</p> - -<p>There were ninety-seven wounded men -sent to the hospital at Port Royal, of whom -there had died twenty-one when the fleet left -Jamaica on the 17th of July.</p> - -<p>So that the whole loss of men in the battles -of April, and their consequences, is as -follows:</p> - -<table> - <tr> - <td>Killed outright</td> - <td class="tdr">266</td> - </tr> - <tr> - <td>Died of their wounds on board</td> - <td class="tdr">67</td> - </tr> - <tr> - <td>Died of their wounds at the hospital</td> - <td class="tdr">21</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="bt tdr">354</td> - </tr> -</table> - -<p>Of those who died on board, fifteen<a id="FNanchor_124" href="#Footnote_124" class="fnanchor">124</a> were -carried off with the Symptoms of the locked -<span class="pagenum" id="Page_521">521</span> -jaw; but of those sent to the hospital, only -one. The reason that so few in proportion -were affected with it in the hospital may -have been, that none of the wounded were -landed till near the end of the third week -after the principal action. The danger of -this symptom was then, in a great measure, -past, though I have known it to take place -in every period from the second or third day -till the fourth week.</p> - -<p>Only three men in the whole fleet recovered -from this alarming complaint; and as -it is interesting to know every thing relating -to so desperate a symptom, I shall give a -short account of each.</p> - -<p>The first was a seaman of the Montagu, -<span class="pagenum" id="Page_522">522</span> -who had his thigh wounded by a splinter -which carried away part of the integuments -and <i>membrana adiposa</i>, and lacerated in a small -degree the <i>vastus externus</i> muscle. The -wound did extremely well till the 23d day, -when the jaw became almost entirely fixed, -and the whole muscles of the wounded side -were thrown into frequent spasms. Mr. -Young, the surgeon, who was always anxious -and assiduous in his duty, consulted with me, -and we had immediate recourse to the warm -bath, which gave a degree of instantaneous -relief, and was repeated twice a day for half -an hour. He was sensibly better every time; -in nine days was entirely free of the symptom, -and continued afterwards to do well. -The only other means taken for this man’s -recovery, besides what were used with the -other wounded men, were from three to five -grains of opium, which he took every day, -in divided doses.</p> - -<p>The next was a seaman of thirty years of -age, belonging to the Magnificent, who had -the <i>humerus</i> broken and shattered by a splinter -which entered the deltoid muscle. Several -<span class="pagenum" id="Page_523">523</span> -large portions of bone were extracted, -and the artery was laid bare on the inside. -On the fifth day there came on a large ichorous -discharge, with a low quick pulse and -depressed spirits, and the jaws began to close, -with pain and stricture on both sides about -the articulation of the lower jaw. He had -every day since the accident taken half an -ounce of Peruvian bark, combined with -opium or rhubarb, according as it made him -loose or costive. This was continued, and -the part externally was kept constantly moist -all round with volatile liniment, to which a -fourth part of <i>tinctura thebaica</i> was added. -Next day the jaw was almost entirely fixed, -so that it was with difficulty that a little -wine and water could be introduced with a -spoon. Mr. Harris, the surgeon, now wisely -determining to do something vigorous in -this unpromising situation, beat up twelve -ounces of opium moistened to the consistence -of a cataplasm with the thebaic tincture, -and applied one half to each side of -the jaw. The patient this day swallowed -a pint of the bark decoction with half an -ounce of nitre, and took a diaphoretic -<span class="pagenum" id="Page_524">524</span> -draught of twenty drops of thebaic tincture -and thirty of antimonial wine. He had -also the smoke of tobacco thrown up his -nostrils.</p> - -<p>On the third day after the attack he could -open his mouth half an inch. The cataplasms -were taken off, beat up afresh with -the tincture, and applied anew. The bark -and other medicines were continued. On -the fourth day the stricture and pain of the -jaw went entirely off, but the cataplasm and -volatile liniment were applied for three days -longer. The wound produced a laudable -discharge, every symptom became favourable, -and he continued to recover.</p> - -<p>The only other person who recovered from -this symptom was a man in the Bedford. -Several died of it on board of this ship; and -as the same means of relief were skilfully -employed in all the cases by Mr. Wickes, -the surgeon, the success seemed owing more -to something favourable in the man’s constitution, -than any thing peculiar in the treatment, -which consisted in the administration -<span class="pagenum" id="Page_525">525</span> -of the warm bath, opium and camphor, with -mercurial friction on the jaw.</p> - -<p>This accident affected some ships remarkably -more than others, particularly the Barfleur -and Bedford, though their wounds had -nothing peculiar, nor were in a greater proportion -than in the rest of the fleet. Four -were carried off by it in each of these ships. -It has formerly been observed, that great -ships acquire peculiar habits, or dispositions, -which incline the constitutions of the men to -one disease more than another. This complaint -took a run in some particular ships last -year also after the battle of the Chesapeak; -and I have known it prevail in some particular -hospitals more than others. In the -present instance, it may have been owing -either to something peculiar in the constitution, -or air of the ships; or we can conceive -it to be owing to some sort of nervous -sympathy, just as the <i>epilepsy</i><a id="FNanchor_125" href="#Footnote_125" class="fnanchor">125</a> has been -known to spread from one boy to another, -<span class="pagenum" id="Page_526">526</span> -at a school, in consequence of imitation, -dread, horror, or some such delicate nervous -or mental affection. We have in yawning -an example of a spasmodic affection spreading -from one person to another. If this is -the case in the locked jaw, those affected by -it should be removed from the presence of -the other wounded men, lest the idea of the -sufferings of others should be so fixed in -their mind, or so impress them with the -fear of the like, as to invite the attack of -the same complaint.</p> - -<p>Though the locked jaw, in consequence of -wounds, resembles frequently in its symptoms -the tetanus which arises without any -external accident, yet there are many cases -of the former which differ materially from -the violent symptoms of the other, as described -by authors. In most cases of the -locked jaw from wounds the spasms are not -<span class="pagenum" id="Page_527">527</span> -so general, so violent, nor attended with -such exquisite pain. It sometimes happens -that the convulsive twitchings are even accompanied -with a sort of pleasure, as in the -case of a lieutenant of the Montagu, whose -case was related to me by Mr. Young, the -surgeon of that ship, a man of skill and observation -in his profession, and upon whose fidelity -and accuracy I could perfectly rely. This -officer had been wounded in the elbow at the -battle of St. Christopher’s by a splinter, -whereby the capsular ligament of the joint -was injured. On the ninth day, symptoms -of the locked jaw came on, and soon after -the whole muscles of the wounded side were -affected with frequent convulsive twitchings, -which, as he himself said, afforded a pleasant -sensation, exciting laughing like an agreeable -titillation. He died on the fourth day after -it came on, and had no pain to the last.</p> - -<p>The locked jaw from accident differs also -from other cases of tetanus, in respect to its -cure; for the latter has been successfully -treated by cold bathing, as is related by -<span class="pagenum" id="Page_528">528</span> -Dr Wright<a id="FNanchor_126" href="#Footnote_126" class="fnanchor">126</a> and Dr. Cochrane<a id="FNanchor_127" href="#Footnote_127" class="fnanchor">127</a>; but it is -acknowledged by the latter that this treatment -did not answer when the complaint -proceeded from a wound.</p> - -<p>It is to be remarked, that the locked jaw -did not take place in those cases in which the -wounds had a foul and gangrenous appearance -more than others; for those that digested -and cicatrized favourably, were equally -apt to be affected by it; and though amputations -are most liable to this symptom, the -slightest injuries, even a scratch, will sometimes -bring it on.</p> - -<p>It would be difficult, therefore, to establish -any particular treatment that would -tend to prevent accidents of this kind; but -Mr. Bassan, surgeon of the Arrogant, one -of the line-of-battle ships engaged on the -12th of April, mixed laudanum with the -dressings of all the wounds, and no locked -jaw occurred. -<span class="pagenum" id="Page_529">529</span></p> - -<p>In the Bedford there occurred a curious -circumstance concerning this complaint. In -one of the cases that proved fatal, the symptoms -did not come on till the wound was so -far healed that all dressing had been laid -aside.</p> - -<p>Mr. Wood, surgeon of the hospital at Jamaica, -informed me, that in cases of the -locked jaw from injuries to small members, -such as fingers, he had tried the effect of -amputating the part after the symptoms had -come on, but without any effect in putting -a stop to them.</p> - -<p>Would it not appear, from the two last -mentioned facts, that this symptom is not -kept up, nor even takes place in the first instance, -from an immediate present irritation, -but that the constitution comes to be so modified, -or receives such an impulse, as it -were, that the complaint runs its course -independent of the presence of that <i>stimulus</i> -which excites it?</p> - -<p>It would be difficult to assign a satisfactory -reason why this accident is more frequent in -hot than in cold climates. The effect of -<span class="pagenum" id="Page_530">530</span> -external heat upon the living body is not to -raise its temperature even when the heat of -the air exceeds that of the body<a id="FNanchor_128" href="#Footnote_128" class="fnanchor">128</a>; so that we -are to seek for the effects of it in some of -those affections peculiar to animal life. And -as the outward temperature of the air does -not affect the general mass of the body, all -the effects produced by it must depend on -impressions made on the external surface of -the body and lungs; and the skin, which -may be considered as a large expanded tissue -of nervous fibres endowed with universal -sympathy and great sensibility, affects every -organ and every function of the body, according -to the state of the air in contact with -it, whether cold or hot, moist or dry, pure -or vitiated. This sympathetic sensibility of -the skin is chiefly affected by the state of -the perspiring pores on its surface; for it is -only when these are open that the impression -of the air on the skin produces catarrhs, -rheumatisms, and internal inflammations in -cold climates; and the external temperature -in hot climates being such as to keep the -<span class="pagenum" id="Page_531">531</span> -pores almost always open, this seems to be a -principal reason of that universal irritability -prevailing there, and of the general sympathy -that prevails between every part, particularly -as connected with the organs of perspiration<a id="FNanchor_129" href="#Footnote_129" class="fnanchor">129</a>. -This readiness of one part to -be affected by another in hot climates is well -illustrated by the sudden translation of certain -diseases. I have seen, for instance, a -catarrh cease, and be converted, as it were, -into a diarrhœa, and this as quickly disappearing, -a pain in the foot would arise, like -an attack of the gout. All this would happen -in the space of a few hours.</p> - -<p>But, in cold climates, wounds are by no -means exempt from the locked jaw; for it -sometimes occurs in England, where I have -seen it even in the winter season<a id="FNanchor_130" href="#Footnote_130" class="fnanchor">130</a>. -<span class="pagenum" id="Page_532">532</span></p> - -<p>Since my return to England I have received -some new and useful information on -this subject in conversing with Dr. Warren, -physician to the King; and as any observations -derived from so much acknowledged -skill and sagacity must be valuable, I shall -here relate what he was so kind as to communicate -to me.</p> - -<p>This eminent physician, in attending a -case in which he was nearly interested, and -in which his endeavours were rewarded with -success, found the greatest benefit from -opium and the warm bath. The opium was -given in the form of tincture, in moderate, -but pretty frequent, doses. The bath was -composed of milk and water, and the addition -of milk was, no doubt, an improvement; -for there is something in this as well -as oil extremely soothing to the human -nerves. Dr. Warren had intended to make -trial of a bath of oil in case this had failed. -He mentioned the following observation, -with regard to the external application of -oil, which could only have been suggested -by that anxious attention that was paid to -the case. It was found, that the uneasiness -<span class="pagenum" id="Page_533">533</span> -arising from the spasm was allayed by constantly -drawing a feather wetted with oil -over the temples, which had an evident effect -in lulling the pain and spasm; for when -this operation was left off, there was an immediate -recurrence of these symptoms<a id="FNanchor_131" href="#Footnote_131" class="fnanchor">131</a>.</p> - -<p>It would appear, therefore, from this as -well as the former cases, that opium and -the warm bath are the only remedies yet -known which are of service in this complaint, -and much will depend on the judicious management -of them. The method of administering -the opium, recommended by Dr. -Warren, seems to be the most judicious, -especially in constitutions not habituated to -this medicine. -<span class="pagenum" id="Page_534">534</span></p> - -<p>There is a certain medium in giving opium, -by which its best effects are obtained, for in -an under dose it will produce disturbance instead -of rest; and when it is given in large -quantities it frequently defeats the very end -for which it is given, by throwing the body -into convulsions which terminate in death. -The rule for judging of the proper limits of -this dose is, by its effect in inducing that -stupor or insensibility which renders the -senses incapable of irritation; for in this, -as well as in every other case of disease, the -cure seems ultimately to be the work of nature, -the effect of medicine being only a secondary -operation, by which it removes -some obstacle to the natural efforts of the -constitution. Though a dose of opium -greater than ordinary is required to produce -this insensibility in cases of spasm, and -though the constitution in that situation will -bear more, yet even here it may be given to -excess; and by beginning with small quantities, -and giving it in frequent rather than -large doses, the constitution will thereby be -better reconciled to it, and it will also with -more convenience admit of that gradual increase -which is peculiarly necessary with this -<span class="pagenum" id="Page_535">535</span> -medicine. These ideas were suggested to me -by Dr. Warren; and it may be farther added, -in recommendation of his method, that the -liquid form is preferable to the solid, as the -effects of it will sooner be seen, and a better -judgement can be formed how far it is proper -to push it.</p> - -<p>Great attention is also necessary in regulating -the heat of the bath; for if it is not -sufficiently warm, it will not have the effect -of producing a due relaxation; and if it -should be too hot, it will stimulate too -much, and will have the farther inconvenience -of making the patient very faint in a -short time. It cannot be well regulated -without a thermometer, and 93° upon Fahrenheit’s -scale is perhaps the best temperature. -I have kept a patient in a bath of -that heat for six hours, which he could not -have endured for half an hour had the heat -been three or four degrees higher.</p> - -<p>The circumstance next in consequence, in -the cure of this complaint, is the keeping -up a moisture on the skin, and guarding the -surface of the body from the access of the -<span class="pagenum" id="Page_536">536</span> -air. This is particularly necessary with regard -to the part itself, which should be constantly -enveloped in warm, anodyne, and -emollient applications. The good effects of -this is particularly exemplified in the case -which recovered under the care of Mr. Harris, -who gave the diaphoretic medicine, composed -of antimonial wine and laudanum, and -applied the anodyne cataplasm to the external -<i>fauces</i>. It was remarked, that the locked -jaw was most incident to those wounded -men who lay in parts of the hospital where -they were exposed to a current of air; and -the cases of tetanus that most usually occur -in the West Indies, independent of wounds, -are those of slaves who fall asleep in the -night-time in the open air.</p> - -<p>Since the first edition of this work, there -has appeared an Essay on the Locked Jaw -by Dr. Rush, physician to the American -army in the late war, in which he recommends, -from his own observation, Peruvian -bark, wine, and blisters, and to dress the -wounds with mercurial ointment, in the -cure of this complaint. From some trials I -have since made of the bark in St. Thomas’s -<span class="pagenum" id="Page_537">537</span> -hospital, I have reason to think well of it as -a remedy in this disease.</p> - -<p>There is a singular species of accident to -which engagements at sea are liable, the <small>WIND -OF A BALL</small>, as it is called. If a cannon ball -in its flight passes close to any part of the body, -it renders it livid and numb for some time<a id="FNanchor_132" href="#Footnote_132" class="fnanchor">132</a>. -It is most dangerous when it approaches the -stomach; and there was an instance of a -man in the last battle, who, upon a ball -passing close to his stomach, dropped down -dead instantaneously, without the least visible -marks of injury. Another, in consequence -<span class="pagenum" id="Page_538">538</span> -of a ball passing close to his belly, -remained without sense or motion for some -time, and a large livid tumor arose on the -part, but he recovered. I attended a man -at the hospital at Barbadoes, who had the -buttons of his trowsers carried off by a -cannon ball, without its having touched the -body. The <i>pubis</i> was livid and swelled for -some time after: he suffered exquisite pain -from strangury, which seemed to proceed -from a <i>paralysis</i> of the bladder, for he voided -no water without a catheter for near three -months, after which time he recovered. I -know a brave young officer<a id="FNanchor_133" href="#Footnote_133" class="fnanchor">133</a> in the army, -who had his epaulette carried off by a cannon -ball at Charlestown, in consequence of -which the shoulder and adjacent parts of the -<span class="pagenum" id="Page_539">539</span> -neck were affected for some time. A like -accident happened to a marine officer in one -of the late engagements; but in neither of -these was the head materially affected, nor -is it so apt to be affected in this way as the -stomach. I never knew death the consequence -of the wind of a ball on the head; -though an officer<a id="FNanchor_134" href="#Footnote_134" class="fnanchor">134</a> in the Sultan, at the battle -of Grenada, was so stunned by a shot -passing near his temple, as to be insensible -for some time, but he recovered entirely in a -few hours<a id="FNanchor_135" href="#Footnote_135" class="fnanchor">135</a>.</p> - -<p>The class of wounds most peculiar to a sea -engagement are scorches from the accidental -explosion of gunpowder; and in most of the -campaigns in which I have served they have -been very frequent and fatal. Few accidents, -however, of this kind happened in the late -engagements; so that we had but little experience -of this sort of wounds in April, 1782. -But on former occasions they were very frequent, -and the best application to the burnt -<span class="pagenum" id="Page_540">540</span> -parts was found to be linseed oil, which -some of the surgeons mixed with lime water, -others with cerusse, and both compositions -answered well. Opium was found of -great use in alleviating pain and procuring -rest, care being taken to guard against costiveness -by the use of clysters. In the battles -of 1780 and 1781, one-fourth part of -the whole killed and wounded was from this -sort of accident; but on the 9th and 12th of -April, 1782, only two accidental explosions -of gunpowder happened in the whole fleet, -by one of which one life was lost, by the -other, two. This difference was owing -partly to greater experience and habits of -caution acquired in the course of the war, -and partly to certain improved methods in -working the artillery introduced by Sir -Charles Douglas, which, like all his other -valuable improvements, tend to give facility -and expedition, as well as to save the lives of -men. The circumstances which tend to prevent -explosions are, 1st, The wetting of the -wads, which prevents their inflaming and -blowing back when they fight the weather -side of the ship; a circumstance which, without -this precaution, gives occasion to a number -<span class="pagenum" id="Page_541">541</span> -of accidents by the burning parts catching -the loose powder, or setting fire to the -cartridges. 2dly, The use of goose-quill -tubes and small priming boxes, made of tin, -instead of the large horns formerly in use, -whereby great quantities of powder were -scattered about and exposed to accidental fire. -3dly, The use of locks, which was practised -with great success in several ships, and -was found to make the operation both more -safe and more expeditious.</p> - -<p>It frequently happens that men bleed to -death before assistance can be procured, or -lose so much blood as not to be able to go -through an operation. In order to prevent -this, it has been proposed, and on some occasions -practised, to make each man carry -about him a garter, or piece of rope-yarn, in -order to bind up a limb in case of profuse -bleeding. If it should be objected, that this, -from its solemnity, may be apt to intimidate -common men, officers at least should make -use of some such precaution, especially as -many of them, and those of the highest rank, -are stationed on the quarter deck, which is -one of the most exposed situations, and far -<span class="pagenum" id="Page_542">542</span> -removed from the cockpit, where the surgeon -and his assistants are placed. This was -the cause of the death of Captain Bayne, of -the Alfred, who, having had his knee so -shattered with a round shot, that it was necessary -to amputate the limb, expired under -the operation, in consequence of the weakness -induced by loss of blood in carrying him -so far. As the Admiral, on these occasions, -allowed me the honour of being at his side, -I carried in my pocket several tourniquets of -a simple construction, in case accidents to -any person on the quarter deck should have -required their use.</p> - -<p>It sometimes happens, however, that no -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 -<span class="pagenum" id="Page_543">543</span> -saw off the jagged end of the bone. He -survived six days, still without bleeding, and -died of the locked jaw.</p> - -<p>I was informed by several of the surgeons, -that the method of taking up the vessels -by the <i>tenaculum</i> was found to answer extremely -well; and many of them imagined -that the locked jaw was not so apt to be -brought on by this mode of operation as by -that of the needle. But it is hardly to be -attempted in time of action, for want of -steadiness and a good light, and it was chiefly -at the hospitals that this practice was found -so successful.</p> - -<p>Mr. Alanson’s method of amputation by a -great retraction of the muscles, so that the -fleshy parts shall meet over the bone and unite -in the first intention, was attended with great -success in the West Indies, particularly at the -hospital at St. Lucia, under the care of Mr. -Bulcock.</p> - -<p>It may be remarked, that though all sores -and wounds in the foot and leg are difficult -<span class="pagenum" id="Page_544">544</span> -of cure in a hot climate, I have observed, -that, where the constitution is good, those -in the thighs, arms, trunk, and head, are -rather more easy of cure than in Europe, -and that parts divided by incision very readily -unite by the first intention. In reasoning -upon this, it may be said, that as healing -depends on a certain degree of vigour in -the powers of life, this should not err either -on the side of excess or defect. If it is too -great, as in the case of a hale, plethoric -constitution in a cold climate, too much inflammation -is apt to be excited; and if too -feeble, as happens in a hot climate, in the -lower extremities, which are far removed -from the source of life and circulation, the -salutary effort is not strong enough to generate -new organised parts. But in the trunk -of the body, in such a climate, the powers -of the animal œconomy are in that just medium -which is most favourable to this operation -of nature.</p> - -<h5>THE END. -<span class="pagenum" id="Page_545">545</span></h5> - -<p class="ph1" id="APPENDIX_TO_PART_III">APPENDIX<br /> - -<span class="x-small">TO</span><br /> - -<span class="x-large">PART III.</span></p> - -<p>It has been suggested to me, that it would -add to the utility of this Work to subjoin a -list of the remedies best suited to the practice -of physic at sea, with their quantities, -and to give a set of formulas for the direction -of young practitioners. I have accordingly -made out a gross computation of the -requisite quantities of the most useful and -necessary articles of the Materia Medica, and -also a few of the most commodious and simple -forms of administering some of the most -efficacious remedies for the most common -diseases.</p> - -<p>It is of consequence every where, but -especially on board of a ship, to simplify -practice, as much as possible, with regard to -the number, the preparation, and the administration -of medicines. Where a great -number of compound medicines are given, -it is extremely difficult to ascertain, by accurate -and satisfactory observations, what -<span class="pagenum" id="Page_546">546</span> -are their real effects; and as there are not -conveniences at sea for great pharmaceutical -nicety, the plainest forms should be adhered -to. And as all operations are rendered more -practicable and easy by being reduced to a -stated method, this is an additional inducement -for studying plainness and simplicity -in preparing and administering remedies. -This uniformity is more attainable in the -public service than in private practice; for -in the former all the patients are of one sex, -they are all adults, and they are generally -of robust constitutions.</p> - -<p>In the list hereto subjoined the articles -are distinguished into <small>PRINCIPAL</small> and <small>SECONDARY</small>; -and when a surgeon considers how -limited his funds are, I hope he will not -think that I have made a disproportionate -assortment in reducing the number and quantities -of the latter, my view in this having -been that he may better afford an ample -proportion of such medicines as are -really efficacious and indispensable in the -cure of diseases. It may be affirmed, without -vanity or arrogance, that the printed -list of articles with which the navy surgeons -are enjoined to supply themselves is -very injudicious considering the present improved -state of the medical art; and it is of -great importance that the due proportion of -each article should be ascertained as nearly as -<span class="pagenum" id="Page_547">547</span> -possible, that no unnecessary expence may -be incurred, and that the chest may not be -encumbered with unnecessary articles.</p> - -<p>There are no simple distilled waters in the -following list, as they are very corruptible, -and too bulky to carry to sea. Their place -is supplied by a small quantity of oil of mint, -which may be occasionally added to common -water, in the proportion of a drop to an -ounce. There are no tinctures inserted, except -laudanum, the traumatic balsam, and -compound spirit of lavender, as the surgeon, -having a proper supply of spirit of wine -or rum, may make them on board of the -ship.</p> - -<p>In the following list the surgical articles -are not enumerated. There is a new article -which I beg leave to recommend, as it has -lately been found extremely useful, and is -now used in large quantities in the hospitals -in London. This is linseed meal for poultices. -The surgeon should also be provided -with a sufficient quantity of linseed oil, as it -has been found to be one of the best ingredients -in dressings for scorches. <a href="#Page_540">See page -540.</a></p> - -<p>The quantity of each article is adapted to -an hundred men for one year, so that a calculation -can easily be made for any number -of men, and for any length of time. -<span class="pagenum" id="Page_548">548</span></p> - -<h4 class="ph1" id="ASSORTMENT_OF_MEDICINES_TO_BE_CARRIED_TO_SEA"> -<span class="large">ASSORTMENT <small>OF</small> MEDICINES</span><br /> - -<span class="x-small">TO BE</span><br /> - -<span class="medium">CARRIED TO SEA,</span><br /> - -<span class="x-small">FOR</span><br /> - -<span class="large">ONE HUNDRED MEN, FOR ONE YEAR.</span></h4> - -<h5>PRINCIPAL ARTICLES.</h5> - -<p>Peruvian bark, ten pounds, and if the ship is destined -for a hot climate, twenty pounds. This article should be provided -by the Public. <a href="#Page_359">See p. 359</a>.—Calomel, two ounces and a -half—<i>a</i> Emetic tartar, one ounce and a half—Ipecacoanha, -four ounces—Opium, one ounce—<i>b</i> Purging salts, ten pounds—Senna -leaves, two pounds.</p> - -<h5>SECONDARY ARTICLES.</h5> - -<p>Aloes, half an ounce—Ammoniacum, two ounces—Balsam -of copaiva, three ounces—<i>c</i> 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—<i>d</i> Cordial confection, two ounces—<i>e</i> 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—<i>f</i> Laudanum, -four ounces—Linseed, one pound—Magnesia, six -ounces—Manna, eight ounces—Whole mustard seed, half a -pound—Myrrh, four ounces—<i>g</i> Crude mercury, two ounces—</p> - -<h6><i>Names in the last Edition of the London Pharmacopœia.</i></h6> - -<p><i>a</i> Antimonium tartarisatum.—<i>b</i> Either Glauber’s salts, natron -vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s -salt answers better in a hot climate, being less deliquescent -from the heat and moisture of the climate.—<i>c</i> Balsamum benzoes -compositum.—<i>d</i> Confectio aromatica;—<i>e</i> Extractum colocynthidis -compositum.—<i>f</i> Tinctura opii.—<i>g</i> Hydrargyrus. -<span class="pagenum" id="Page_549">549</span></p> - -<p><i>a</i> Corrosive sublimate, an ounce—Nitre, eight ounces—Oil of -almonds, one pint—<i>b</i> Castor oil, half a pint—Linseed oil, -three pints—Essential oil of mint, one ounce—<i>c</i> Jamaica -pepper, four ounces—<i>d</i> Blistering plaster, ten pounds—Quaffia, -eight ounces—Salt of hartshorn, two ounces—<i>e</i> Salt of steel, -half an ounce—<i>f</i> 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—<i>g</i> Weak spirit of vitriol, half a pint—<i>h</i> Volatile -aromatic spirit, half a pint—<i>i</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—<i>j</i> White vitriol, six drachms—Wormwood, -one pound—<i>k</i> Flowers of zinc, two drachms.</p> - -<blockquote> - -<p><span class="smcap">Necessaries</span> <i>to be put in charge of the Purser, and served out -to the Sick in place of the common sea provisions. <a href="#Page_358">See page -358</a>.</i></p></blockquote> - -<p>BARLEY, three hundred pounds—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.</p> - -<h4><i>Names in the last Edition of the London Pharmacopœia.</i></h4> - -<p><i>a</i> Hydrargyrus muriatus.—<i>b</i> Oleum ricini.—<i>c</i> Pimento.—<i>d</i> -Emplastrum cantharidis.—<i>e</i> Ferrum vitriolatum.—<i>f</i> Kali præparatum.—<i>g</i> -Acidum vitriolicum dilutum.—<i>h</i> Spiritus ammoniæ -compositus.—<i>i</i> Aqua ammoniæ acetata.—<i>j</i> Zincum vitriolatum.—<i>k</i> -Zincum calcinatum. -<span class="pagenum" id="Page_550">550</span></p> - -<h4 id="FORMULAE_QUAEDAM"> -<span class="medium">FORMULÆ QUÆDAM</span><br /> - -MEDICAMENTORUM<br /> - -<span class="medium">IN MEDICINA FACIENDA APUD NAUTAS</span><br /> - -<span class="large">ACCOMMODATIORES.</span></h4> - -<h5>IN FEBRE CONTINUA.</h5> - -<h6>PULVIS EMETICUS COMMUNIS.</h6> - -<blockquote> - -<p>℞. Pulveris radicis ipecacoanhæ grana decem, antimonii -tartarisati grana duo, misce.</p></blockquote> - -<h6>MISTURA CATHARTICA COMMUNIS.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h6>ENEMA COMMUNE.</h6> - -<blockquote> - -<p>Aquæ marinæ tepidæ uncias duodecim.</p></blockquote> - -<h6>POTUS COMMUNIS.</h6> - -<blockquote> - -<p>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.</p></blockquote> - -<h6>VINUM EMETICUM.</h6> - -<blockquote> - -<p><a id="FNanchor_136" href="#Footnote_136" class="fnanchor">136</a>℞. 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.</p></blockquote> - -<h6>PILULA FEBRIFUGA.</h6> - -<blockquote> - -<p>℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi -Dris. James drachmam unam, conservæ rosæ quantum -<span class="pagenum" id="Page_551">551</span> -latis sit. Simul contunde & divide in pilulas duodecim. -Deglutiatur una quartâ vel sextâ quâque horâ.</p></blockquote> - -<h6>MISTURA SALINA ET ANTIEMETICA.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h6><a id="FNanchor_137" href="#Footnote_137" class="fnanchor">137</a>PILULA DIAPHORETICA.</h6> - -<blockquote> - -<p>℞. Opii purificati grana duodecim, antimonii tartarisati grana -sex, 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.</p></blockquote> - -<h6><a id="FNanchor_138" href="#Footnote_138" class="fnanchor">138</a>MISTURA SEDATIVA.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h4><a id="FNanchor_139" href="#Footnote_139" class="fnanchor">139</a>BOLUS SEDATIVUS.</h4> - -<blockquote> - -<p>℞. Confectionis aromaticæ scrupulum unum, opii purificati -grani quartam partem, castorei Russici grana decem, -tincturæ opii guttas quatuor. Misce. Assumatur sextâ -quâque horâ.</p></blockquote> - -<h6>BOLUS SERPENTARIÆ COMPOSITUS.</h6> - -<blockquote> - -<p>℞. Pulveris serpentariæ Virginianæ grana decem, camphoræ -grana quatuor, confectionis aromaticæ quantum satis sit. -<span class="pagenum" id="Page_552">552</span> -Assumatur ter die.—Interdum conducit addere pulveris -corticis Peruviani drachmam dimidiam, vel superbibere -decocti corticis Peruviani uncias duas.</p></blockquote> - -<h6>ELECTUARIUM AD CONVALESCENTES.</h6> - -<blockquote> - -<p>℞. Pulveris corticis Peruviani, florum 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.</p></blockquote> - -<h5>IN FEBRE INTERMITTENTE.</h5> - -<p>Adhibeantur in initio eadem medicamenta ac in initio febris -continuæ. Deinde</p> - -<p>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 -(<i>rum</i> dicti) unciâ unâ.</p> - -<p>Si cortex frustra adhibeatur fauste adhiberi possint medicamenta -infra præscripta.</p> - -<blockquote> - -<p><a id="FNanchor_140" href="#Footnote_140" class="fnanchor">140</a>℞. 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.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p>℞. Zinci vitriolati grana duodecim aquæ puræ uncias tres -Sumatur tertia pars ter die augendo dosim si opus fuerit -& si ferat ventriculus.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p><a id="FNanchor_141" href="#Footnote_141" class="fnanchor">141</a>℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas -sex. Misce. Sumatur paucas horas ante paroxysmum.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p><a id="FNanchor_142" href="#Footnote_142" class="fnanchor">142</a>Cortice Peruviano frustra dato, aliquando conferat dare ægro -quotidie, vel calomelanos, vel pilularum ex hydrargyro -quantum & quamdiu sufficiat ad levem ciendum ptyalismum, -& deinde instituere curam de integro cum cortice -Peruviano.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p><a id="FNanchor_143" href="#Footnote_143" class="fnanchor">143</a>Sumantur tincturæ opii guttæ viginti quinque, incipiente æstu. -febrili, ex poculo potûs communis.</p></blockquote> -<p><span class="pagenum" id="Page_553">553</span></p> - -<h5>IN DIARRHŒA SIMPLICI.</h5> - -<h6>BOLUS AD DIARRHOEAM.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h5>IN CHOLERA MORBO.</h5> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h5>IN DYSENTERIA ACUTA.</h5> - -<p>Sumat æger quamprimum emeticum commune.</p> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<blockquote> - -<p><a id="FNanchor_144" href="#Footnote_144" class="fnanchor">144</a>℞. Pulveris ipecacoanhæ grana duo, pulveris opii purificati -exsiccati granum unum, nitri grana octo. Misce. Sumatur -horâ somni.</p></blockquote> - -<h6>ENEMA EMOLLIENS.</h6> - -<blockquote> - -<p>℞. Amyli unciam dimidiam, aquæ puræ uncias decem. Coque -ad idoneam spissitudinem.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p>℞. Seminum lini drachmas sex, aquæ puræ uncias duodecim. -Coque per quadrantem horæ & cola liquorem pro enemate.</p></blockquote> -<p><span class="pagenum" id="Page_554">554</span></p> - -<h6>ENEMA ANODYNUM.</h6> - -<blockquote> - -<p>℞. Enematis emollientis uncias quatuor, tincturæ opii guttas -quadraginta. Misce.</p></blockquote> - -<h5>IN DYSENTERIA CHRONICA.</h5> - -<h6>BOLUS CATHARTICUS.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h6>SOLUTIO CAMPECHENSIS.</h6> - -<blockquote> - -<p>℞. Extracti ligni Campechensis drachmam unam cum semisse, -tincturæ cinamomi unciam unam. Tere simul & admisce -aquæ puræ uncias quinque. Sumatur uncia una -ter die.</p></blockquote> - -<h6>DECOCTUM AMARUM.</h6> - -<blockquote> - -<p>℞. 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.</p> - -<p><a id="FNanchor_145" href="#Footnote_145" class="fnanchor">145</a>In casibus rebellibus confert illinere quotidie hypogastrium -unguenti ex hydrargyro drachmâ dimidiâ.</p> - -<p>Sit pro potu communi in hoc morbo aqua pura, frusto -panis recens tosti adjecto, & pauxillo spiritus vini tenuis -(<i>rum</i> dicti) admixto. Sit pro victu communi salab, vel -farina tritici in pulmentum tenue ex aquâ purâ cocta.</p></blockquote> - -<h5>IN INTESTINIS INFLAMMATIS.</h5> - -<h6><a id="FNanchor_146" href="#Footnote_146" class="fnanchor">146</a>SOLUTIO SALIS CATHARTICI.</h6> - -<blockquote> - -<p>℞. Decocti hordei libram unam, magnesiæ vitriolatæ uncias -duas. Misce ut fiat solutio. Bibatur, post sanguinis -missionem, uncia una omni semihorâ donec alvus bis dejecerit.</p> - -<p>Adhibeantur hypogastrio cucurbitulæ cruentæ, vel hirudines -plures. Applicetur ibidem epispasticum satis amplum. -Injiciatur enema cum oleo & pauxillo sale cathartico.</p></blockquote> -<p><span class="pagenum" id="Page_555">555</span></p> - -<p>IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus -æstuosis <i>DRY BELLY ACHE</i> dicto.</p> - -<h6><a id="FNanchor_147" href="#Footnote_147" class="fnanchor">147</a>PILULÆ CATHARTICO-ANODYNÆ.</h6> - -<blockquote> - -<p>℞. 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<a id="FNanchor_148" href="#Footnote_148" class="fnanchor">148</a> -olei ricini uncia una, & repetantur ut opus fuerit.—Interdum -in hoc malo divexat vomitus cui auxilio est, mistura -antiemetica. Vide page 551.</p> - -<p>Perfricetur hypogastrium oleo tepido.</p> - -<p>Ineat æger in balneum tepefactum ad 93° therm. -Fahren. per horam unam vel etiam diutius.</p> - -<p>Denique suffletur in anum fumus nicotianæ.</p></blockquote> - -<h5>Vel,</h5> - -<blockquote> - -<p>℞. Nicotianæ drachmas duas aquæ puræ ferventis libram -unam.—Fiat infusum & cola pro enemate.</p></blockquote> - -<h5>IN HÆMORRHÖIDE.</h5> - -<h6>BOLUS HÆMORRHOIDALIS.</h6> - -<blockquote> - -<p>℞. Florum sulphuris drachmam dimidiam, conservaæ rosæ, vel -pulpæ tamarindorum quantum satis fit. Assumatur bis -die.</p> - -<p>Si sanguinis ex ano profluentis magna fuerit vis, & præcipue -si ex alto fonte effluxerit, valde proderit medicamentum -infra præscriptum.</p></blockquote> - -<blockquote> - -<p><a id="FNanchor_149" href="#Footnote_149" class="fnanchor">149</a>℞. 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.</p></blockquote> - -<h5>IN ALVO ASTRICTA.</h5> - -<h6>PILULÆ LAXANTES.</h6> - -<blockquote> - -<p>℞. Aloes socotrinæ drachmam unam, syrupi quantum satis sit. -Contunde & divide in pilulas viginti. Sumantur duæ pro -re natâ.—Aliquando conducit adjicere vel pulveris zinzberis -<span class="pagenum" id="Page_556">556</span> -vel pulveris capsici grana quindecim, vel olei menthæ -guttas decem.—Vice aloes licet adhibere extractum -colocynthidis compositum.</p></blockquote> - -<h5>ELECTUARIUM ECCOPROTICUM.</h5> - -<blockquote> - -<p>℞. Pulveris jalapii unciam dimidiam, pulpæ tamarindorum -unciam unam, pulveris zinziberis semi-drachmam, syrupi -<i>melasses</i> dicti quantum satis sit. Sumatur circiter drachma -pro re natâ.—Interdum prosit adjicere crystallorum -tartari drachmas duas.</p></blockquote> - -<h5>IN CATARRHO.</h5> - -<h6>LINCTUS.</h6> - -<blockquote> - -<p>℞. 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.</p> - -<p>Sit pro potu communi decoctum hordei in quo coquatur -uvarum passarum uncia una, & sub finem cocturæ -seminum lini drachmas duas pro singulis libris -decocti.</p> - -<p>Si febricitârit æger, sumantur mistura salina & pilula -febrifuga ter die.</p></blockquote> - -<h5>IN PLEURITIDE ET PERIPNEUMONIA.</h5> - -<blockquote> - -<p>℞. 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 <i>melasses</i> dictus.</p> - -<p>Sumatur mistura salina & pilula febrifuga sextâ vel -quartâ quâque horâ.</p></blockquote> - -<h5>IN HÆMOPTÖE.</h5> - -<p>Hauriat æger infusi rosæ uncias tres quater die. Interdum adjiciatur -vel tincturæ opii guttæ quatuor, vel nitri grana decem.</p> - -<h6>HAUSTUS OLEOSUS.</h6> - -<blockquote> - -<p><a id="FNanchor_150" href="#Footnote_150" class="fnanchor">150</a>℞. Olei amygdalini, aquæ menthæ simplicis singulorum unciam -unam, manræ drachmas tres. Misce. Sumatur -ter die. Sæpe conducit adjicere singulis dosibus tincturæ -opii guttas quatuor vel quinque.</p></blockquote> -<p><span class="pagenum" id="Page_557">557</span></p> - -<h5>IN TUSSI ASTHMATICA.</h5> - -<h6>PILULÆ PECTORALES.</h6> - -<blockquote> - -<p><a id="FNanchor_151" href="#Footnote_151" class="fnanchor">151</a>℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis -drachmas duas, pulveris radicis scillæ grana sex opii purificati -grana tria, syrupi <i>melasses</i> dicti quantum satis sit. -Contunde simul & divide in pilulas quadraginta octo. -Sumantur quatuor bis die.</p></blockquote> - -<h5>IN ASTHMATE A DIATHESI HYDROPICA -PROVENIENTE.</h5> - -<h6>PILULÆ SCILLITICÆ.</h6> - -<blockquote> - -<p>℞. Radicis scillæ aridæ grana duodecim, conservæ rosæ quantum -satis sit. Contunde simul & divide in pilulas duodecim. -Sumatur una vel duæ bis vel ter die.</p></blockquote> - -<h5>Vel,</h5> - -<h6><a id="FNanchor_152" href="#Footnote_152" class="fnanchor">152</a>HAUSTUS DIURETICUS.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h5>Vel,</h5> - -<h6>BOLUS CÆRULEUS CUM SCILLA.</h6> - -<blockquote> - -<p><a id="FNanchor_153" href="#Footnote_153" class="fnanchor">153</a>℞. Pilularum ex hydrargyro grana quinque vel usque ad decem, -pulveris radicis scillæ grana duo. Misce. Sumatur -horâ decubitûs, per tres vel quatuor noctes consequentes.</p></blockquote> - -<h5>IN RHEUMATISMO ACUTO.</h5> - -<h6>MISTURA DIAPHORETICA.</h6> - -<blockquote> - -<p>℞. 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.</p> - -<p>Bibatur affatim decoctum hordei tepidum, cum nitri -scrupulis duobus in singulis libris.</p></blockquote> -<p><span class="pagenum" id="Page_558">558</span></p> - -<h6>HAUSTUS SUDORIFICUS.</h6> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<h5>IN RHEUMATISMO CHRONICO.</h5> - -<blockquote> - -<p>℞. 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.</p></blockquote> - -<blockquote> - -<p>℞. Pulveris ipecacoanhæ compositi (Pharm. Lond.) scrupulum -unum. Sumatur hora somni alternis noctibus.</p> - -<p>In casibus rebellibus pro remedio efficaci compertum -est dare quotidie calomelanos granum unum vel grana -duo.</p></blockquote> - -<h5>IN HYDROPE.</h5> - -<h6>PULVIS HYDRAGOGUS.</h6> - -<blockquote> - -<p>℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana -quindecim, pulveris zinziberis grana quinque. Misce -fiat pulvis, fumatur alternis diebus.</p></blockquote> - -<h6>MISTURA DIURETICA.</h6> - -<blockquote> - -<p>℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias -duas, kali præparati drachmam unam. Misce. Hauriamur -unciæ tres bis die.<a id="FNanchor_154" href="#Footnote_154" class="fnanchor">154</a>Vice infusi gentianæ licet adhibere -infusum absynthii.</p></blockquote> - -<h6>TINCTURA SCILLÆ. Pharm. Lond.</h6> - -<p>Sumatur drachma una bis die ex haustu potûs communis.</p> - -<h6>PILULA EX ELATERIO.</h6> - -<blockquote> - -<p>℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur -in pilulas sex. Sumatur una bis die.</p> - -<p><a id="FNanchor_155" href="#Footnote_155" class="fnanchor">155</a>Ægro licet, imo prodest hoc morbo laboranti bibere -ad libitum ex liquore aliquo siti extinguendæ accommodato, -veluti aquâ hordei cum crystallis tartari.</p></blockquote> - -<h5>IN ERYSIPELATE.</h5> - -<blockquote> - -<p><a id="FNanchor_156" href="#Footnote_156" class="fnanchor">156</a>℞. Pulveris corticis Peruviani drachmam unam. Sumatur -omni horâ vel interpositis duabus vel tribus horis.</p></blockquote> - -<p><span class="pagenum" id="Page_559">559</span></p> - -<h5>IN MORBO VENEREO.</h5> - -<h6>1. IN GONORRHOEA.</h6> - -<p>Hauriatur ad libitum infusum lini, vel decoctum hordei cum -gummi arabici drachmis sex in singulis libris.</p> - -<p>Sumantur calomelanos grana duo quotidie per viginti circiter -dies.</p> - -<blockquote> - -<p><a id="FNanchor_157" href="#Footnote_157" class="fnanchor">157</a>℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati -granum unum. Misce. Injiciatur pauxillum in urethram -bis vel ter die.</p></blockquote> - -<h6>IN GONORRHOEA BENIGNA.</h6> - -<blockquote> - -<p>℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ -guttas triginti. Misce. Sumatur bis die.</p></blockquote> - -<h6>2. IN ULCUSCULIS.</h6> - -<p>In initio feliciter adhibetur causticum.</p> - -<blockquote> - -<p>℞. Calomelanos drachmam dimidiam, 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.</p> - -<p>Pro medicamento topico, utile erit inspergere ulcusculum -cum pulvere hydrargyri nitrati.</p></blockquote> - -<h6>3. IN BUBONE.</h6> - -<p>Illinatur artus lateris affecti infra inguen cum unguenti ex -hydrargyro drachmâ dimidiâ quotidie.</p> - -<p>Si abierit bubo in ulcus mali moris omittatur pro tempore -usus hydrargyri & sumatur quotidie <a id="FNanchor_158" href="#Footnote_158" class="fnanchor">158</a>opii purificati granum -unum primo semel, dein bis, denique ter die vel etiam 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.</p> - -<h6>4. <small>IN VERA LUE</small>, anginâ scilicet osteocopiis, exostosibus & -defædatione cutis.</h6> - -<p>Illinantur membra quotidie cum unguenti ex hydrargyro -<span class="pagenum" id="Page_560">560</span> -drachmis duabus quotidie usque dum cieatur ptyalismus<a id="FNanchor_159" href="#Footnote_159" class="fnanchor">159</a> per dies -triginta ad minimum vel donec evanuerint symptomata.—Interdum -vice litûs adhibere conveniat vel calomelanos granum -unum ter die, vel pilularum ex hydrargyro grana quinque -bis die, vel</p> - -<blockquote> - -<p>℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram -unam. Fiat solutio, & sumatur uncia dimidia bis die. -In ulceribus tonsillarum pernotabili est auxilio suffitum -ex cinnabare in fauces inhalare semel vel bis quotidie.</p> - -<p>Si ulcera mali moris exorta fuerint in quavis corporis -parte, eadem, ut jam de bubone dictum est, fiant.</p></blockquote> - -<h5>IN SCORBUTO MARINO.</h5> - -<p>Sumat æger quotidie succi limonum unciam unam ter quaterve -die.</p> - -<blockquote> - -<p>℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi -<i>melasses</i> 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 <i>rum</i> 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.</p></blockquote> - -<blockquote> - -<p>℞. 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 <i>melasses</i> dicti quantum sufficiat ad gratum saporem -conciliandum.</p> - -<p>Ad alvum solvendam commode adhiberi potest electuarium -eccoproticum cum crystallis tartari. Vid. p. 556.</p></blockquote> - -<h5>THE END.</h5> -<p><span class="pagenum" id="Page_Ii">i</span></p> - -<h2 id="INDEX">INDEX.</h2> - -<ul class="index"><li class="ifrst">A.</li> - -<li class="indx"><span class="smcap">Absorbents</span> useful in fluxes, <a href="#Page_491">491</a>, <i>& seq.</i></li> - -<li class="indx"><i>Action</i>, close, the advantages of it, <a href="#Page_103">103</a>, <i>& seq.</i></li> - -<li class="indx"><i>Air</i>, superiority of that at sea, <a href="#Page_225">225</a>.</li> -<li class="isub1">—Noxious effects of it at land in a hot climate, <a href="#Page_227">227</a>.</li> -<li class="isub1">—Extent of its influence, <a href="#Page_228">228</a>.</li> - -<li class="indx"><i>Alcide</i>, sickly on the passage to America, <a href="#Page_36">36</a>.</li> -<li class="isub1">—Subject to various forms of fevers, <a href="#Page_39">39</a>.</li> - -<li class="indx"><i>Aliment</i>, want of proper, chief cause of scurvy, <a href="#Page_300">300</a>.</li> -<li class="isub1">—Increases the vigour of the body in two ways, <a href="#Page_510">510</a>.</li> - -<li class="indx"><i>America, North</i>, hotter in summer than the West Indies, <a href="#Page_30">30</a>.</li> -<li class="isub1">—Fleet goes there to avoid the hurricanes, <a href="#Page_35">35</a>, <a href="#Page_146">146</a>.</li> -<li class="isub1">—Uncommon season there, <a href="#Page_156">156</a>, <i>& seq.</i></li> - -<li class="indx"><i>Amputation</i>, the number that died of it at Barbadoes, <a href="#Page_190">190</a>.</li> - -<li class="indx"><i>Amputation</i>, Mr. Alanson’s method of performing it, <a href="#Page_543">543</a>.</li> - -<li class="indx"><i>Antimonials</i>, best adapted to bilious fevers, <a href="#Page_420">420</a>.</li> -<li class="isub1">—A caution with regard to them, <a href="#Page_422">422</a>. -<span class="pagenum" id="Page_Iii">ii</span></li> - -<li class="indx"><i>Army</i> at St. Lucia, diseases in it, <a href="#Page_127">127</a>.</li> -<li class="isub1">—Mortality in it, <a href="#Page_27">27</a>, <a href="#Page_228">228</a>, <i>& seq.</i></li> - -<li class="indx"><i>Asthma</i>, climate in the West Indies favourable to it, <a href="#Page_97">97</a>.</li> - -<li class="ifrst">B.</li> - -<li class="indx"><i>Barbadoes</i>, more refreshments at it than any other island, <a href="#Page_27">27</a>.</li> -<li class="isub1">—Ravaged by a hurricane, <a href="#Page_41">41</a>.</li> -<li class="isub1">—Composed of coral rock, <a href="#Page_89">89</a>.</li> -<li class="isub1">—Conjecture concerning its origin, <i>ibid.</i></li> - -<li class="indx"><i>Barfleur</i>, fevers on board in consequence of recruits from a French jail, <a href="#Page_142">142</a>.</li> - -<li class="indx"><i>Bark, Peruvian</i>, its effects in preventing fevers, <a href="#Page_230">230</a>, <i>& seq.</i></li> -<li class="isub1">—When useful in continued fevers, <a href="#Page_390">390</a>, <i>& seq.</i>, <a href="#Page_402">402</a>, <a href="#Page_422">422</a>, <i>& seq.</i></li> - -<li class="indx"><i>Bark, Peruvian, red</i>, some account of it, <a href="#Page_457">457</a>.</li> - -<li class="indx"><i>Barricading a ship</i>, what meant by it, <a href="#Page_21">21</a>.</li> - -<li class="indx"><i>Bath, warm</i>, of use in the dysentery, <a href="#Page_480">480</a>.</li> -<li class="isub1">—In the locked jaw, <a href="#Page_522">522</a>.</li> -<li class="isub1">—Its proper temperature, <a href="#Page_535">535</a>.</li> - -<li class="indx"><i>Battle</i>, the ardour of, favourable to health, <a href="#Page_22">22</a>, <a href="#Page_77">77</a>, <a href="#Page_101">101</a>.</li> -<li class="isub1">—Number killed in, <a href="#Page_209">209</a>.</li> -<li class="isub1">—Loss in those of April, 1782, <a href="#Page_520">520</a>.</li> - -<li class="indx"><i>Bedding</i>, utility of airing it, <a href="#Page_260">260</a>.</li> - -<li class="indx"><i>Bile</i>, a defect of it in the worst cases of yellow fever, <a href="#Page_429">429</a>,<i>& seq.</i></li> -<li class="isub1">—Theoretical disquisition on its influence in fevers, <i>ibid.</i></li> - -<li class="indx"><i>Bile</i>, the marks of a redundance of it in dysenteries, <a href="#Page_477">477</a>.</li> -<li class="isub1">—Its tendency to prolong fluxes, <a href="#Page_483">483</a>, <i>& seq.</i></li> - -<li class="indx"><i>Blindness</i> from the scurvy, <a href="#Page_24">24</a>, <a href="#Page_501">501</a>.</li> - -<li class="indx"><i>Blisters</i> of use in the ship fever, <a href="#Page_399">399</a>.</li> -<li class="isub1">—For removing irritability of stomach in the yellow fever, <a href="#Page_453">453</a>, <i>& seq.</i></li> -<li class="isub1">—Of service in dysentery, <a href="#Page_480">480</a>, <i>& seq.</i></li> - -<li class="indx"><i>Blood</i>, a remark concerning the buff upon it, <a href="#Page_450">450</a>. -<span class="pagenum" id="Page_Iiii">iii</span></li> - -<li class="indx"><i>Bloodletting</i>, cautions with regard to it in ship fevers, <a href="#Page_388">388</a>.</li> -<li class="isub1">—In bilious fevers, <a href="#Page_418">418</a>.</li> -<li class="isub1">—In the yellow fever, <a href="#Page_450">450</a>.</li> - -<li class="indx"><i>Butter</i>, objections to its use, <a href="#Page_310">310</a>.</li> - -<li class="ifrst">C.</li> - -<li class="indx"><i>Calomel</i>, in certain cases, the best purgative, <a href="#Page_421">421</a>.</li> - -<li class="indx"><i>Camphor</i>, estimate of its virtues, <a href="#Page_407">407</a>.</li> - -<li class="indx"><i>Catarrh, epidemic</i>, one in Europe affected men at sea, <a href="#Page_157">157</a>.</li> -<li class="isub1">—Communicated by strangers not affected with it themselves, in one of the Western Islands, <a href="#Page_244">244</a>.</li> - -<li class="indx"><i>Causes</i>, a combination of them necessary to produce diseases, <a href="#Page_126">126</a>, <i>& seq.</i></li> - -<li class="indx"><i>Chronic complaints</i> brought on by hardship, <a href="#Page_218">218</a>.</li> - -<li class="indx"><i>Cleanliness</i> the principal means of health, <a href="#Page_254">254</a>, <a href="#Page_337">337</a>.</li> - -<li class="indx"><i>Clothing</i>, its great influence upon health, <a href="#Page_238">238</a>.</li> -<li class="isub1">—Advantages and disadvantages of it, <a href="#Page_334">334</a>, <i>& seq.</i></li> - -<li class="indx"><i>Cocoa</i> substituted, with advantage, for butter, <a href="#Page_311">311</a>.</li> - -<li class="indx"><i>Cold</i> favourable to infection, <a href="#Page_258">258</a>.</li> - -<li class="indx"><i>Cold</i> hurtful in all climates, <a href="#Page_297">297</a>.</li> - -<li class="indx"><i>Colica pictonum</i>, forms of medicines adapted to it, <a href="#Page_555">555</a>.</li> - -<li class="indx"><i>Coma</i>, a symptom in the ship fever, <a href="#Page_373">373</a>.</li> - -<li class="indx"><i>Commission, Ships long in</i>, most healthy, <a href="#Page_54">54</a>, <a href="#Page_79">79</a>, <a href="#Page_93">93</a>, <a href="#Page_167">167</a>.</li> - -<li class="indx"><i>Constitution</i>, the great variety of it, <a href="#Page_294">294</a>.</li> -<li class="isub1">—Regard to be had to it in practice, <a href="#Page_406">406</a>.</li> - -<li class="indx"><i>Coppers</i>, cautions with regard to them, and instance of poison from neglect of them, <a href="#Page_317">317</a>, <i>& seq.</i></li> - -<li class="indx"><i>Cordials</i>, a caution with regard to them, <a href="#Page_410">410</a>.</li> - -<li class="indx"><i>Crowding</i>, bad effects of it, <a href="#Page_192">192</a>.</li> - -<li class="indx"><i>Cruises</i> to windward of Martinico, <a href="#Page_48">48</a>, <a href="#Page_180">180</a>.</li> -<li class="isub1">—Near Jamaica, <a href="#Page_120">120</a>.</li> -<li class="isub1">—How long they ought to be continued -<span class="pagenum" id="Page_Iiv">iv</span> -consistent with health, <a href="#Page_148">148</a>, <i>& seq.</i></li> -<li class="isub1">—A long one off St. Domingo, without the scurvy appearing, <a href="#Page_154">154</a>, <i>& seq.</i></li> - -<li class="indx"><i>Cullen, Dr.</i>, his opinion of the origin of nervous fevers, <a href="#Page_237">237</a>.</li> -<li class="isub1">—His great merit, <a href="#Page_445">445</a>.</li> - -<li class="ifrst">D.</li> - -<li class="indx"><i>Delirium</i>, a remarkable symptom in the ship fever, <a href="#Page_373">373</a>.</li> -<li class="isub1">—Explanation of it, <i>ibid.</i>, <i>& seq.</i></li> -<li class="isub1">—Means of removing it, <a href="#Page_398">398</a>, <i>& seq.</i></li> -<li class="isub1">—Sudden and violent in bilious fevers, <a href="#Page_416">416</a>.</li> - -<li class="indx"><i>Diaphoretic</i>, what safest and best, <a href="#Page_395">395</a>.</li> - -<li class="indx"><i>Diet</i>, a table of the daily allowance of it in the navy, <a href="#Page_311">311</a>.</li> -<li class="isub1">—A method of providing what is suitable to the sick, <a href="#Page_335">335</a>.</li> - -<li class="indx"><i>Diet</i>, a caution with regard to it in convalescent fevers, <a href="#Page_358">358</a>.</li> - -<li class="indx"><i>Diet</i>, what best in fluxes, <a href="#Page_494">494</a>, <i>& seq.</i></li> - -<li class="indx"><i>Dilution</i>, the great advantage of it, <a href="#Page_391">391</a>, <i>& seq.</i></li> - -<li class="indx"><i>Discipline</i>, advantage of, to health, <a href="#Page_348">348</a>, <a href="#Page_355">355</a>.</li> - -<li class="indx"><i>Diseases</i>, list of all those on board of the fleet, <a href="#Page_94">94</a>.</li> -<li class="isub1">—What sorts seamen are most subject to, and most exempt from, <a href="#Page_216">216</a>.</li> - -<li class="indx"><i>Diseases</i>, acute, tend naturally to wear themselves out, <a href="#Page_70">70</a>.</li> -<li class="isub1">—Imputed anciently to supernatural influence, <a href="#Page_220">220</a>.</li> -<li class="isub1">—Owing to neglect, <i>ibid.</i></li> - -<li class="indx"><i>Dropsy</i>, medicines adapted to it, <a href="#Page_558">558</a>.</li> - -<li class="indx"><i>Dysentery</i> depends on the same cause as fevers, <a href="#Page_36">36</a>.</li> -<li class="isub1">—Arises in the Prince George from cold weather, <a href="#Page_79">79</a>.</li> -<li class="isub1">—More fatal in its acute state in a cold than a hot climate, <a href="#Page_155">155</a>. -<span class="pagenum" id="Page_Iv">v</span></li> - -<li class="indx"><i>Dysentery</i>, appearances upon dissection, <a href="#Page_471">471</a>, <i>& seq.</i></li> - -<li class="indx"><i>Dysentery</i>, forms of medicines adapted to it, <a href="#Page_553">553</a>.</li> - -<li class="ifrst">E.</li> - -<li class="indx"><i>Earthquakes</i> frequent in the West Indies, <a href="#Page_88">88</a>.</li> - -<li class="indx"><i>Effluvia</i>, what kind of them produce diseases, <a href="#Page_134">134</a>, <i>& seq.</i></li> - -<li class="indx"><i>Elephantiasis</i>, peculiar to Barbadoes, <a href="#Page_235">235</a>, <i>& seq.</i></li> - -<li class="indx"><i>England</i>, health of the fleet there compared to that in the West Indies, <a href="#Page_67">67</a>, <i>& seq.</i></li> -<li class="isub1">—Fleet there more sickly at particular periods than in the West Indies, <a href="#Page_208">208</a>.</li> - -<li class="indx"><i>English</i>, their cleanliness only of modern date, <a href="#Page_282">282</a>.</li> - -<li class="indx"><i>Erasmus</i>, his account of the causes of pestilential diseases in England, <a href="#Page_282">282</a>.</li> - -<li class="indx"><i>Erysipelas</i>, Peruvian bark the best medicine in it, <a href="#Page_558">558</a>.</li> - -<li class="indx"><i>Exercise</i>, the advantage of it, <a href="#Page_343">343</a>.</li> - -<li class="indx"><i>Exercise</i> in the sun very pernicious, <a href="#Page_233">233</a>.</li> - -<li class="indx"><i>Expeditions</i>, list of, frustrated by disease alone, <a href="#Page_214">214</a>.</li> - -<li class="indx"><i>Explosions</i> of gunpowder, frequent and destructive, <a href="#Page_539">539</a>.</li> -<li class="isub1">—Means of preventing them, <a href="#Page_540">540</a>.</li> - -<li class="ifrst">F.</li> - -<li class="indx"><i>Fatigue</i> tends to shorten life, <a href="#Page_346">346</a>.</li> - -<li class="indx"><i>Fevers</i> depend on the same cause as fluxes, <a href="#Page_36">36</a>, <i>& seq.</i></li> -<li class="isub1">—More prevalent in port than fluxes, <a href="#Page_113">113</a>, <a href="#Page_127">127</a>.</li> -<li class="isub1">—Assume a different type upon the importation of infection, <a href="#Page_182">182</a>.</li> -<li class="isub1">—Difference of its infection from that of some other diseases, <a href="#Page_244">244</a>, <a href="#Page_249">249</a>.</li> - -<li class="indx"><i>Fever, ship</i>, description of it, <a href="#Page_371">371</a>.</li> -<li class="isub1">—Treatment of it, <a href="#Page_386">386</a>.</li> - -<li class="indx"><i>Fever, inflammatory</i>, principal symptoms of it, <a href="#Page_384">384</a>. -<span class="pagenum" id="Page_Ivi">vi</span></li> - -<li class="indx"><i>Fevers, intermittent</i>, some unusual remedies for them, <a href="#Page_456">456</a>, <i>& seq.</i></li> -<li class="isub1">—Forms of medicines adapted to them, <a href="#Page_552">552</a>.</li> - -<li class="indx">Fires, the most effectual means of sweetening the air of a ship, <a href="#Page_117">117</a>.</li> -<li class="isub1">—The most powerful means of destroying infection, <a href="#Page_276">276</a>, <i>& seq.</i></li> - -<li class="indx"><i>Flour</i> preferable to bread for exportation, <a href="#Page_307">307</a>.</li> - -<li class="indx"><i>Fluxes</i> depend on the same cause as fevers, <a href="#Page_36">36</a>, <i>& seq.</i></li> -<li class="isub1">—Prevail least when fevers most violent, <a href="#Page_44">44</a>, <a href="#Page_113">113</a>.</li> -<li class="isub1">—Apt to arise in ships soon after their arrival in the West Indies, <a href="#Page_19">19</a>, <a href="#Page_84">84</a>, <a href="#Page_183">183</a>.</li> -<li class="isub1">—More frequent at sea than in port, <a href="#Page_113">113</a>.</li> -<li class="isub1">—More frequent in ships that have been subject to fevers, <a href="#Page_183">183</a>.</li> -<li class="isub1">—Why so frequent and fatal at West India hospitals, <a href="#Page_192">192</a>, <i>& seq.</i></li> -<li class="isub1">—Observations on them, <a href="#Page_466">466</a>.</li> -<li class="isub1">—Treatment of them, <a href="#Page_473">473</a>.</li> - -<li class="indx"><i>Formidable</i>, extraordinary degree of health on board of her, <a href="#Page_107">107</a>, <a href="#Page_128">128</a>, <a href="#Page_365">365</a>.</li> -<li class="isub1">—Causes of it, <a href="#Page_72">72</a>, <a href="#Page_108">108</a>.</li> -<li class="isub1">—Fever arises in her from men lent to another ship, <a href="#Page_128">128</a>.</li> -<li class="isub1">—From pressed men, <a href="#Page_161">161</a>.</li> - -<li class="indx"><i>French ships</i>, their discipline and œconomy inferior to British, <a href="#Page_114">114</a>.</li> - -<li class="indx"><i>Frigates</i> more healthy than ships of the line, causes of this, <a href="#Page_54">54</a>, <i>& seq.</i></li> -<li class="isub1">—More healthy when their fire place was between decks, <a href="#Page_287">287</a>.</li> -<li class="isub1">—A contrivance for ventilating them, <a href="#Page_292">292</a>.</li> - -<li class="indx"><i>Fumigation</i>, method of performing it, <a href="#Page_270">270</a>, <i>& seq.</i></li> - -<li class="ifrst">G.</li> - -<li class="indx"><i>Gibraltar</i> relieved by Lord Rodney, <a href="#Page_19">19</a>.</li> -<li class="isub1">—Admissions and deaths at the hospital there, <a href="#Page_187">187</a>, <a href="#Page_205">205</a>. -<span class="pagenum" id="Page_Ivii">vii</span></li> - -<li class="indx"><i>Gibraltar</i> man of war, account of her, <a href="#Page_53">53</a>.</li> - -<li class="indx"><i>Grosislet Bay</i>, description of it, <a href="#Page_28">28</a>.</li> - -<li class="indx"><i>Gunpowder</i>, accidents from it, <a href="#Page_190">190</a>, <a href="#Page_539">539</a>, <i>& seq.</i></li> - -<li class="indx"><i>Guthrie, Dr.</i>, his observations on infection in Russia, <a href="#Page_279">279</a>.</li> - -<li class="ifrst">H.</li> - -<li class="indx"><i>Habit</i>, effect of it in resisting infection, <a href="#Page_294">294</a>.</li> - -<li class="indx"><i>Hæmorrhages, internal</i>, oil and tincture of rhubarb of eminent service in them, <a href="#Page_486">486</a>, <i>& seq.</i></li> - -<li class="indx"><i>Hæmorrhage</i>, a limb sometimes carried off without any ensuing, <a href="#Page_542">542</a>.</li> - -<li class="indx"><i>Hæmorrhoids</i>, medicines adapted to them, <a href="#Page_555">555</a>.</li> - -<li class="indx"><i>Hardship</i> impairs health and shortens life, <a href="#Page_218">218</a>.</li> - -<li class="indx"><i>Heat</i> communicated to the hand, a symptom of the ship fever, <a href="#Page_378">378</a>, <i>& seq.</i></li> - -<li class="indx"><i>Hemisphere, Northern</i>, a cold summer general all over it, <a href="#Page_157">157</a>.</li> - -<li class="indx"><i>Herodotus</i>, his account of the clothing and health of the ancient Ægyptians, <a href="#Page_284">284</a>.</li> - -<li class="indx"><i>Hospitals</i> not so proper for the sick as their own ships, <a href="#Page_60">60</a>.</li> -<li class="isub1">—Account of diseases sent to them, <a href="#Page_185">185</a>.</li> -<li class="isub1">—At Gibraltar, <a href="#Page_187">187</a>.</li> -<li class="isub1">—At Barbadoes, <a href="#Page_189">189</a>, <a href="#Page_197">197</a>.</li> -<li class="isub1">—At St. Christopher’s, <a href="#Page_195">195</a>.</li> -<li class="isub1">—At St Lucia, <i>ibid.</i></li> -<li class="isub1">—At Jamaica, <a href="#Page_198">198</a>.</li> -<li class="isub1">—At New York, <a href="#Page_201">201</a>, <i>& seq.</i></li> -<li class="isub1">—General view of them all, <a href="#Page_205">205</a>.</li> -<li class="isub1">—Proportion of deaths in them no criterion of the success of practice, <a href="#Page_195">195</a>, <a href="#Page_200">200</a>.</li> - -<li class="indx"><i>Hurricane months</i>, <a href="#Page_28">28</a>.</li> - -<li class="indx"><i>Hurricane</i>, a violent one in the West Indies—its good effect on the health of the inhabitants, <a href="#Page_40">40</a>, <i>& seq.</i></li> - -<li class="indx"><i>Hypochondriac</i> complaints do not affect the laborious part of mankind, <a href="#Page_219">219</a>. -<span class="pagenum" id="Page_Iviii">viii</span></li> - -<li class="ifrst">I.</li> - -<li class="indx"><i>Jaw, locked</i>, account of those affected by it in the battles of April, 1782, <a href="#Page_520">520</a>, <i>& seq.</i></li> -<li class="isub1">—Its symptoms different from those of the tetanus, <a href="#Page_526">526</a>.</li> -<li class="isub1">—Wherefore most frequent in hot climates, <a href="#Page_529">529</a>, <i>& seq.</i></li> - -<li class="indx"><i>Indolence</i> a cause of scurvy, <a href="#Page_345">345</a>.</li> - -<li class="indx"><i>Infection</i>, the obscurity of and difficulty of investigating it, <a href="#Page_238">238</a>.</li> -<li class="isub1">—Various ways in which it is introduced into a ship, <a href="#Page_241">241</a>.</li> -<li class="isub1">—It may arise without the presence of fever, <a href="#Page_242">242</a>.</li> -<li class="isub1">—Habit renders people insensible to it, <i>ibid. & seq.</i></li> -<li class="isub1">—It never affects all indiscriminately who are exposed to it, <a href="#Page_245">245</a>.</li> -<li class="isub1">—It does not pass from one species of animal to another, <a href="#Page_249">249</a>.</li> -<li class="isub1">—How to prevent the production of it, <a href="#Page_254">254</a>.</li> -<li class="isub1">—Means of eradicating it, <a href="#Page_264">264</a>.</li> -<li class="isub1">—Method of guarding against it, <a href="#Page_293">293</a>.</li> -<li class="isub1">—Less frequent in hot climates than cold, <a href="#Page_276">276</a>.</li> - -<li class="indx"><i>Inflammatory</i> complaints most frequent in ships where no infection, <a href="#Page_172">172</a>.</li> - -<li class="indx"><i>Inoculation</i>, conjecture concerning the cause of its safety, <a href="#Page_247">247</a>.</li> - -<li class="indx"><i>Intermittent fevers</i> sometimes arise on board of a ship, <a href="#Page_32">32</a>.</li> -<li class="isub1">—Some unusual remedies for them, <a href="#Page_456">456</a>, & <i>seq.q.</i></li> - -<li class="indx"><i>Intestines</i>, great, the principal seat of the dysentery, <a href="#Page_470">470</a>.</li> - -<li class="ifrst">L.</li> - -<li class="indx"><i>Labour</i> necessary to health, <a href="#Page_217">217</a>.</li> -<li class="isub1">—Pernicious if in excess, <i>ibid.</i></li> -<li class="isub1">—What diseases it tends to avert, <a href="#Page_219">219</a>.</li> -<li class="isub1">—Scurvy prevented by it, <a href="#Page_344">344</a>. -<span class="pagenum" id="Page_Iix">ix</span></li> - -<li class="indx"><i>Land wind</i> at Jamaica, <a href="#Page_119">119</a>.</li> -<li class="isub1">—Not at the small islands, <i>ibid.</i></li> - -<li class="indx"><i>Lemon juice</i>, extraordinary instance of its efficacy in scurvy, <a href="#Page_86">86</a>.</li> -<li class="isub1">—The most effectual remedy in scurvy, <a href="#Page_303">303</a>.</li> - -<li class="indx"><i>Lemons and limes</i>, their juice the best detergent in scorbutic ulcers, <a href="#Page_502">502</a>, <i>& seq.</i></li> - -<li class="indx"><i>Lientery</i>, a symptom in obstinate fluxes, <a href="#Page_489">489</a>.</li> - -<li class="indx"><i>Limes</i>, instance of their great antiscorbutic effect, <a href="#Page_56">56</a>.</li> - -<li class="indx"><i>Liver</i>, inflammation of it seldom known in the West Indies, <a href="#Page_95">95</a>.</li> -<li class="isub1">—But appeared at New York in men belonging to the West-India fleet, <a href="#Page_156">156</a>.</li> - -<li class="ifrst">M.</li> - -<li class="indx"><i>Magnesia</i>, given with acids, removes sickness of the stomach, <a href="#Page_452">452</a>.</li> - -<li class="indx"><i>Malt liquor</i>, the utility of it, <a href="#Page_320">320</a>.</li> - -<li class="indx"><i>Malt, essence of</i>, a weak antiscorbutic, <a href="#Page_57">57</a>, <a href="#Page_504">504</a>.</li> -<li class="isub1">—Of service in the beginning of scurvy, <a href="#Page_146">146</a>, <a href="#Page_164">164</a>.</li> - -<li class="indx"><i>Manners, Lord Robert</i>, his death lamented, <a href="#Page_520">520</a>.</li> - -<li class="indx"><i>Marshes</i>, their exhalations cause fevers, <a href="#Page_43">43</a>.</li> - -<li class="indx"><i>Melasses</i>, method of using it, <a href="#Page_305">305</a>.</li> -<li class="isub1">—Great utility of it, <a href="#Page_308">308</a>.</li> - -<li class="indx"><i>Mixing of men</i>, bad consequences of, <a href="#Page_252">252</a>, <i>& seq.</i></li> - -<li class="indx"><i>Moisture</i>, the bad effects of it, <a href="#Page_288">288</a>.</li> - -<li class="indx"><i>Mortality</i>, method of calculating the proportion of it, <a href="#Page_88">88</a>.</li> -<li class="isub1">—Greater at sea from the want of an hospital and of proper diet, <a href="#Page_143">143</a>.</li> -<li class="isub1">—In the fleets and hospital at different periods, <a href="#Page_205">205</a>.</li> -<li class="isub1">—In the army in the West Indies, <a href="#Page_206">206</a>.</li> -<li class="isub1">—In England, <a href="#Page_207">207</a>.</li> -<li class="isub1">—Total in the fleet for three years and three months, <a href="#Page_209">209</a>. -<span class="pagenum" id="Page_Ix">x</span></li> - -<li class="indx"><i>Mortification</i>, an uncommon instance of it in the shoulder, <a href="#Page_83">83</a>.</li> - -<li class="ifrst">N.</li> - -<li class="indx"><i>Necessaries</i>, Surgeons, their quantity very inadequate, <a href="#Page_302">302</a>.</li> - -<li class="indx"><i>New York</i>, the fleet therein 1780, <a href="#Page_38">38</a>.</li> -<li class="isub1">—in 1782, <a href="#Page_150">150</a>.</li> - -<li class="indx"><i>Nyctalopia</i>, a symptom of the scurvy, <a href="#Page_24">24</a>, <a href="#Page_501">501</a>.</li> - -<li class="indx"><i>Nymph</i> frigate, account of her health, <a href="#Page_164">164</a>.</li> - -<li class="ifrst">O.</li> - -<li class="indx"><i>Oatmeal</i>, the abuse of it, <a href="#Page_308">308</a>.</li> - -<li class="indx"><i>Observations</i>, the difficulty of making them, <a href="#Page_9">9</a>.</li> - -<li class="indx"><i>Officers</i>, more affected by foul air than common men, <a href="#Page_116">116</a>, <a href="#Page_137">137</a>.</li> - -<li class="indx"><i>Opium</i>, advantage of combining with antimonials, <a href="#Page_392">392</a>.</li> -<li class="isub1">—With neutral salts, <a href="#Page_395">395</a>.</li> -<li class="isub1">—Its use in continued fevers, <a href="#Page_404">404</a>, <a href="#Page_408">408</a>.</li> -<li class="isub1">—Cautions and directions with regard to it in fluxes, <a href="#Page_476">476</a>, <a href="#Page_479">479</a>.</li> -<li class="isub1">—Its use in ulcers, <a href="#Page_504">504</a>.</li> -<li class="isub1">—The best method of giving it in the locked jaw, <a href="#Page_532">532</a>, <i>& seq.</i></li> - -<li class="indx"><i>Osbridge</i>, Lieut, his ingenious contrivance for sweetening water, <a href="#Page_331">331</a>.</li> - -<li class="ifrst">P.</li> - -<li class="indx"><i>Pediluvia</i> hurtful in inflammatory fevers, <a href="#Page_397">397</a>.</li> - -<li class="indx"><i>Petechiæ</i>, a symptom in the ship fever, <a href="#Page_377">377</a>.</li> - -<li class="indx"><i>Phthisis pulmonalis</i>, not so common in the West Indies as Europe, <a href="#Page_97">97</a>.</li> -<li class="isub1">—but more rapid, <i>ibid.</i> -<span class="pagenum" id="Page_Ixi">xi</span></li> - -<li class="indx"><i>Phœnix</i>, Spanish Admiral’s ship, her excellent materials and construction, <a href="#Page_53">53</a>.</li> - -<li class="indx"><i>Pigeon Island</i>, remarkable proof of its healthiness, <a href="#Page_228">228</a>, <i>& seq.</i></li> - -<li class="indx"><i>Plague</i>, its infection does not spread far, <a href="#Page_298">298</a>.</li> -<li class="isub1">—Means of preventing it from spreading, <i>ibid.</i> and <a href="#Page_299">299</a>.</li> -<li class="isub1">—Never known in tropical climates, <a href="#Page_277">277</a>, <i>& seq.</i></li> - -<li class="indx"><i>Porter</i>, its effect in preventing scurvy, <a href="#Page_320">320</a>.</li> - -<li class="indx"><i>Potatoes, raw</i>, a remedy for scurvy, <a href="#Page_60">60</a>.</li> -<li class="isub1">—Proposed as an article of victualling, <a href="#Page_309">309</a>, <i>& seq.</i></li> - -<li class="indx"><i>Prudent</i>, effects of soaking her timbers in pickle, <a href="#Page_81">81</a>.</li> - -<li class="indx"><i>Pulmonic</i> complaints, medicines adapted to them, <a href="#Page_556">556</a>.</li> - -<li class="indx"><i>Putrefaction</i>, simple, effluvia of it may produce fevers, <a href="#Page_134">134</a>, <i>& seq.</i></li> - -<li class="ifrst">Q.</li> - -<li class="indx"><i>Quick lime</i>, the best preservative of water, <a href="#Page_326">326</a>, <i>& seq.</i></li> - -<li class="ifrst">R.</li> - -<li class="indx"><i>Recruits</i>, new raised, the cause of sickness, <a href="#Page_180">180</a>.</li> - -<li class="indx"><i>Returns</i>, intention of them, <a href="#Page_6">6</a>, <a href="#Page_7">7</a>.</li> -<li class="isub1">—Specimens of them, <a href="#Page_23">23</a>.</li> -<li class="isub1">—Method of forming them into tables, <a href="#Page_24">24</a>.</li> - -<li class="indx"><i>Rheumatism</i>, forms of medicines adapted to it, <a href="#Page_557">557</a>.</li> - -<li class="indx"><i>Royal Oak</i>, cause of her health, <a href="#Page_80">80</a>.</li> -<li class="isub1">—Method of curing the scurvy on board, <a href="#Page_81">81</a>.</li> - -<li class="indx"><i>Ruby</i>, remarkably healthy, <a href="#Page_167">167</a>. -<span class="pagenum" id="Page_Ixii">xii</span></li> - -<li class="ifrst">S.</li> - -<li class="indx"><i>St. Lucia</i>, woody, mountainous, and rainy, <a href="#Page_27">27</a>.</li> -<li class="isub1">—Proportion of deaths at the hospital there, <a href="#Page_195">195</a>.</li> - -<li class="indx"><i>Salt</i>, the good effects of it in diet, <a href="#Page_314">314</a>.</li> - -<li class="indx"><i>Sandwich</i>, health of, on her first arrival, <a href="#Page_19">19</a>.</li> - -<li class="indx"><i>Scorches</i>, great numbers killed and wounded in this manner, <a href="#Page_190">190</a>.</li> - -<li class="indx"><i>Scurvy</i>, in a cruise to windward of Martinico, <a href="#Page_49">49</a>.</li> -<li class="isub1">—In a cruise near Jamaica, <a href="#Page_121">121</a>.</li> -<li class="isub1">—High degree of it in the Nonsuch, <i>ibid.</i></li> -<li class="isub1">—On the passage to New York, <a href="#Page_148">148</a>.</li> -<li class="isub1">—Why less of it in the ships last from England, <a href="#Page_147">147</a>.</li> -<li class="isub1">—Its rapid progress in the latter part of a cruise, <a href="#Page_148">148</a>, <i>& seq.</i></li> -<li class="isub1">—Method of curing it on board of the fleet at New York, <a href="#Page_151">151</a>.</li> -<li class="isub1">—Numbers that died of it according to Sir Richard Hawkins, <a href="#Page_214">214</a>.</li> -<li class="isub1">—In Commodore Anson’s Squadron, <i>ibid.</i></li> - -<li class="indx"><i>Scurvy</i>, observations on it, <a href="#Page_499">499</a>.</li> -<li class="isub1">—What meant by the latent state of it, <a href="#Page_505">505</a>.</li> -<li class="isub1">—The best remedies for it, <a href="#Page_506">506</a>, <i>& seq.</i></li> -<li class="isub1">—In what manner the nature of the diet induces it, <a href="#Page_509">509</a>.</li> -<li class="isub1">—Whether it is infectious, <a href="#Page_516">516</a>.</li> - -<li class="indx"><i>Seasons</i> in the West Indies, account of them, <a href="#Page_28">28</a>, <i>& seq.</i></li> - -<li class="indx"><i>Ships</i>, new, not more unhealthy than others, <a href="#Page_19">19</a>, <a href="#Page_52">52</a>.</li> -<li class="isub1">—Disadvantage in changing their commanders, <a href="#Page_80">80</a>.</li> -<li class="isub1">—Why large ones most sickly, <a href="#Page_128">128</a>, <a href="#Page_133">133</a>, <a href="#Page_253">253</a>.</li> - -<li class="indx"><i>Shingle ballast</i>, the advantage of it, <a href="#Page_289">289</a>.</li> - -<li class="indx"><i>Shoes</i> of great use to seamen, <a href="#Page_339">339</a>.</li> - -<li class="indx"><i>Sick</i>, what the best place for them in a ship, <a href="#Page_262">262</a>.</li> - -<li class="indx"><i>Sickness</i>, method of calculating the proportion of it, <a href="#Page_90">90</a>.</li> - -<li class="indx"><i>Situation</i>, effects of the difference of it upon health, <a href="#Page_28">28</a>.</li> - -<li class="indx"><i>Small-pox</i> very prevalent in the fleet, <a href="#Page_85">85</a>. -<span class="pagenum" id="Page_Ixiii">xiii</span></li> - -<li class="indx"><i>Sope</i> supplied on board of the fleet, <a href="#Page_145">145</a>.</li> -<li class="isub1">—Its great utility, <a href="#Page_151">151</a>, <a href="#Page_257">257</a>.</li> - -<li class="indx"><i>Sour krout</i>, manner of using it, <a href="#Page_305">305</a>.</li> - -<li class="indx"><i>Splinters</i> more destructive than balls, <a href="#Page_103">103</a>.</li> - -<li class="indx"><i>Spices</i> good against noxious air, <a href="#Page_230">230</a>.</li> - -<li class="indx"><i>Spruce beer</i>, the great advantage of it, <a href="#Page_320">320</a>.</li> - -<li class="indx"><i>Strangers</i> communicate disease to each other without any apparent previous disease, <a href="#Page_243">243</a>.</li> - -<li class="indx"><i>Surf</i>, danger from it in watering at St. Lucia, <a href="#Page_88">88</a>.</li> - -<li class="indx"><i>Surgeons</i>, a greater proportion of mortality among them and their mates, <a href="#Page_134">134</a>.</li> -<li class="isub1">—Advantage of encouraging them, <a href="#Page_266">266</a>.</li> - -<li class="indx"><i>Sweating</i> of use in curing the ship fever, <a href="#Page_388">388</a>, <i>& seq.</i></li> -<li class="isub1">—In the dysentery, <a href="#Page_475">475</a>.</li> - -<li class="indx"><i>Sweet vegetables</i> more antiscorbutic and medicinal in their natural state, <a href="#Page_58">58</a>.</li> - -<li class="ifrst">T.</li> - -<li class="indx"><i>Tables</i>, method of forming them, <a href="#Page_90">90</a>.</li> - -<li class="indx"><i>Tenaculam</i> recommended in amputation, <a href="#Page_543">543</a>.</li> - -<li class="indx"><i>Thermometer</i>, general range of it in the West Indies, <a href="#Page_29">29</a>.</li> -<li class="isub1">—Observations on it at Port Royal, <a href="#Page_124">124</a>.</li> - -<li class="indx"><i>Thucydides</i>, his observations on the plague at Athens, <a href="#Page_296">296</a>.</li> - -<li class="ifrst">U.</li> - -<li class="indx"><i>Ulcers</i> keep pace with scorbutic and feverish complaints, <a href="#Page_132">132</a>.</li> -<li class="isub1">—Proportion of them, <a href="#Page_150">150</a>.</li> -<li class="isub1">—Very frequent in the Barfleur, <i>ibid.</i></li> -<li class="isub1">—Great effect of a cold climate in diminishing them, <a href="#Page_156">156</a>. -<span class="pagenum" id="Page_Ixiv">xiv</span></li> -<li class="isub1">—Form a considerable part of sea complaints, <a href="#Page_221">221</a>.</li> -<li class="isub1">—Apt to arise in scorbutic habits, <a href="#Page_339">339</a>, <a href="#Page_500">500</a>, <a href="#Page_505">505</a>.</li> - -<li class="indx"><i>Uniform</i> for common seamen recommended, <a href="#Page_336">336</a>.</li> - -<li class="indx"><i>Union</i> remarkably healthy, <a href="#Page_167">167</a>.</li> -<li class="isub1">—Subject only to inflammatory complaints, <a href="#Page_173">173</a>, <a href="#Page_297">297</a>.</li> - -<li class="indx"><i>Urine</i>, appearance of it in the yellow fever, <a href="#Page_437">437</a>, <a href="#Page_440">440</a>, <i>& seq.</i></li> - -<li class="ifrst">V.</li> - -<li class="indx"><i>Venereal disease</i>, the medicines best adapted to the various forms of it, <a href="#Page_559">559</a>.</li> - -<li class="indx"><i>Vernon</i>, Admiral, health of his fleet compared with Lord Rodney’s, <a href="#Page_131">131</a>, <a href="#Page_198">198</a>.</li> -<li class="isub1">—The first who caused the spirits allowed the seamen to be diluted, <a href="#Page_324">324</a>, <i>& seq.</i></li> - -<li class="indx"><i>Victory</i>, 12th of April, 1782, <a href="#Page_99">99</a>.</li> -<li class="isub1">—Its effects on the health of the men, <a href="#Page_101">101</a>, <i>& seq.</i></li> - -<li class="indx"><i>Ville de Paris</i>, sickness and mortality on board after being captured, <a href="#Page_115">115</a>.</li> -<li class="isub1">—Foundered, <a href="#Page_210">210</a>.</li> - -<li class="indx"><i>Vinegar</i>, use of it in the navy, <a href="#Page_302">302</a>.</li> -<li class="isub1">—In the Roman armies, <i>ibid.</i></li> - -<li class="indx"><i>Vitriol, white</i>, used as a remedy in intermittent fevers, <a href="#Page_462">462</a>.</li> - -<li class="indx"><i>Vomit, black</i>, the most dangerous symptom in the yellow fever, <a href="#Page_436">436</a>.</li> - -<li class="ifrst">W.</li> - -<li class="indx"><i>Wall, Dr.</i> recommends opium in low fevers, <a href="#Page_393">393</a>.</li> - -<li class="indx"><i>War</i>, why fleets most sickly in the beginning of it, <a href="#Page_69">69</a>. -<span class="pagenum" id="Page_Ixv">xv</span></li> - -<li class="indx"><i>Warren, Dr.</i>, his successful treatment of a case of the locked jaw, <a href="#Page_532">532</a>.</li> - -<li class="indx"><i>Water</i> of springs preferable to running water, <a href="#Page_324">324</a>.</li> -<li class="isub1">—Quick lime the best preservative of it, <a href="#Page_326">326</a>.</li> -<li class="isub1">—Various other means of correcting it, <a href="#Page_329">329</a>.</li> -<li class="isub1">—Distillation from sea water recommended, <a href="#Page_332">332</a>.</li> - -<li class="indx"><i>Watering duty</i> dangerous and unwholesome, <a href="#Page_88">88</a>, <a href="#Page_118">118</a>.</li> - -<li class="indx"><i>Well</i> of a ship, great danger of foul air in it, <a href="#Page_285">285</a>.</li> -<li class="isub1">—Method of preventing it, <i>ibid.</i></li> - -<li class="indx"><i>Wind of a ball</i>, the effects of it, <a href="#Page_537">537</a>.</li> - -<li class="indx"><i>Wine</i>, the great advantage of it in the French fleet, <a href="#Page_322">322</a>.</li> -<li class="isub1">—Superior to spirits, <a href="#Page_324">324</a>.</li> -<li class="isub1">—Its utility in continued fevers, <a href="#Page_410">410</a>.</li> - -<li class="indx"><i>Women</i>, why not so subject to acute diseases in the West Indies as men, <a href="#Page_234">234</a>.</li> - -<li class="indx"><i>Wounds</i>, number that died of, <a href="#Page_209">209</a>.</li> -<li class="isub1">—Account of those received in April, 1782, <a href="#Page_520">520</a>.</li> - -<li class="ifrst">Y.</li> - -<li class="indx"><i>Yams</i> used in place of bread, <a href="#Page_76">76</a>.</li> - -<li class="indx"><i>Yellow fever</i>, <a href="#Page_425">425</a>.</li> - -<li class="indx"><i>Yellowness</i> of the skin not always a symptom of malignity, <a href="#Page_181">181</a>.</li> - -<li class="ifrst">Z.</li> - -<li class="indx"><i>Zinc</i>, effects of it in obstinate intermittent fevers, <a href="#Page_456">456</a>.</li> -<li class="isub1">—Cases in which it is proper, <a href="#Page_461">461</a>.</li></ul> - -<div class="footnotes"> - -<h2 id="FOOTNOTES">FOOTNOTES:</h2> - -<div class="footnote"> - -<p><a id="Footnote_1" href="#FNanchor_1" class="label">1</a> - These were the Conqueror, the Cornwall, and the -Boyne, which were so damaged in the battles, that they -were obliged to bear away for St. Lucia.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_2" href="#FNanchor_2" class="label">2</a> - The following may serve as a specimen of these -returns:</p> - -<h3><span class="smcap">State</span> of <span class="smcap">Health</span> of His Majesty’s Ship <span class="smcap">Alcide</span>. -Carlisle Bay, Barbadoes, 1st June, 1781.</h3> - -<table class="bbox"> - <tr> - <th colspan="2">Sick now on Board.</th> - <th colspan="2">Died in the course<br />of last Month.</th> - <th colspan="2">Sent to the Hospital<br />in the course of<br />last Month.</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">4</td> - <td rowspan="5" style="vertical-align: top">Of Fever</td> - <td rowspan="5" class="tdr" style="vertical-align: top">1</td> - <td rowspan="5" style="vertical-align: top"> Ill of Scurvy</td> - <td rowspan="5" class="tdr" style="vertical-align: top">35</td> - </tr> - <tr> - <td>Flux</td> - <td class="tdr">5</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">26</td> - </tr> - <tr> - <td>Catarrh and Rheumatism</td> - <td class="tdr">7</td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">42</td> - </tr> -</table> - -<h4>REMARKS.</h4> - -<p>During the course of last month we had one hundred -and fourteen of the men, who contracted the scurvy in -the late long cruise, recovered by the use of limes, which -were procured at Montserrat. A pint of wine, with an -equal quantity of water, made agreeable with sugar and -tamarinds, is served to each patient daily. The regimen -is exactly the same as mentioned last month.</p> - -<p>Since we came into port, very few have been seized -with scurvy, but several complain daily of fluxes and -feverish complaints, none of which seem at present to be -of any consequence.</p> - -<p>Four patients have last month complained of an almost -total blindness towards evening, accompanied with -head-ach, vertigo, nausea, and a sense of weight about -the precordia. The pupil is then extremely dilated, but -contracts readily when a strong light is presented to it. -Two of them had the scurvy in a high degree, one of -them slightly, and the other seemed entirely free from it. -I am not well acquainted with the nature or cure of this -disease, which I believe is called Nyctalopia by some -systematic writers.</p> - -<p>I gave those who were affected with it an emetic, -which brought up a great deal of bile, and relieved the -symptoms both of the head and stomach. This encouraged -me to a repetition of it, which seemed also to be -attended with benefit. I likewise applied blisters behind -the ears, and gave bark and elixir of vitriol, with the -antiscorbutic course, to those that required it.</p> - -<p>I can form no probable conjecture concerning the -cause of this disease. I have observed a dilation of the -pupil in scorbutic patients, and they complained of a -cloud before their eyes, with imperfect vision, which -disappeared as the scurvy went off.</p> - -<p class="author">WILLIAM TELFORD.</p> - -<p> -To Dr. <span class="smcap">Blane</span>,<br /> -Physician to the Fleet. -</p></div> - -<div class="footnote"> - -<p><a id="Footnote_3" href="#FNanchor_3" class="label">3</a> - Although this hurricane, in itself and its consequences, -was so destructive to the lives and health of -men, yet, with regard to the inhabitants on shore, it -had a surprising and unexpected effect in mending their -health. I wrote an account of this hurricane to the -late Dr. Hunter, who communicated it to the Royal -Society, and the following passage is extracted from it:</p> - -<p>“The consequences of this general tumult of nature, -on the health of man, was none of the least curious of -its effects. I made much inquiry on this head, not -only of the medical gentlemen who had the charge of -hospitals, and of the physicians of the country, but of -the inhabitants, and every one had some cure to relate -either of themselves or their neighbours, in a variety of -diseases. Nor could I find that either those who were -in health, or those who were ill of any disease whatever -suffered from it, otherwise than by its mechanical -violence; but, on the contrary, that there was a general -amendment of health. This is a fact, which I could -neither credit, nor would venture to relate, were it not -supported by so many concurring testimonies. It had -a visible good effect on the acute diseases of the climate. -The chronic fluxes, of which there were then some at -the naval hospital, were cured or much relieved by it. -But the diseases upon which it had most evident and -sensible effects, were pulmonic consumptions. Some -recent cases of phthisis, and even the acute state of -pleurisy, was cured by it; and in the advanced and incurable -state of it, the hectic fever was removed, and -remarkable temporary relief afforded. A delicate lady -of my acquaintance, who was ill of a pleurisy at the -time, and passed more than ten hours in the open air, -sitting generally several inches deep in water, found -herself free of complaint next day; had no return of it; -and when I saw her a few weeks after, was in much -better health and looks then usual. The people observed -that they had remarkably keen appetites for -some time after, and the surviving part of them became -uncommonly healthy; some of both sexes, whom I -had left fallow and thin a few months before, looking -now fresh and plump.</p> - -<p>It is very difficult to account for this, as well as every -thing else in the animal œconomy; but it was probably -owing in part, at least, to the very great coldness and -purity of the air from the upper regions of the atmosphere. -Great agitation of mind sometimes also produces -a revolution in health; and we know that the -effect of external impressions in general is very different -when the mind is vacant, from what it is when occupied -and interested by objects, whether of pleasure and satisfaction, -or of danger and suffering.”</p></div> - -<div class="footnote"> - -<p><a id="Footnote_4" href="#FNanchor_4" class="label">4</a> - In order to ascertain more exactly the degree of -sickness in each month, a column was afterwards added -to the form of the returns, expressing the number taken -ill of the several diseases in the course of the month.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_5" href="#FNanchor_5" class="label">5</a> - I was informed by Captain Caldwell, that when he -commanded the Hannibal, of 50 guns, his crew was so -much afflicted with the scurvy, in a passage of nine -weeks from St. Helena to Crookhaven, in Ireland, that -ninety-two men were confined to their hammocks in the -last stage of that disease, though they had been supplied -with sugar at St. Helena, and served with it on the passage. -They remained three weeks at Crookhaven; at -the end of which time every man was fit for duty: and -though they had fresh provision, they had no fresh vegetables, -so that their cure is to be ascribed to the use of -lemons and oranges, which the Captain very humanely -ordered to be purchased for them from on board of a -foreign ship that happened to put into the same harbour.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_6" href="#FNanchor_6" class="label">6</a> - <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_7" href="#FNanchor_7" class="label">7</a> - They were the Formidable and Namur, of 90 guns; -the Arrogant, Conqueror, Marlborough, Hercules, and -Fame, of 74 guns; the Yarmouth, Repulse, Prothée, -Anson, and Nonsuch, of 64 guns.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_8" href="#FNanchor_8" class="label">8</a> - These were the Prince George, of 90; the Bedford, -Canada, and Royal Oak, of 74; the America and Prudent, -of 64 guns.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_9" href="#FNanchor_9" class="label">9</a> - This is a term in use for the different articles of -seamen’s cloathing, particularly shirts and trowsers.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_10" href="#FNanchor_10" class="label">10</a> - The mortification in the shoulder, mentioned above, -was somewhat singular. It happened to a man in the -Yarmouth, who, after being for a week ill of a fever -and flux, was one day, early in the morning, seized -with a pain in the upper part of the right arm, which -immediately began to mortify. He soon after became -convulsed, and died the same day about two o’clock.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_11" href="#FNanchor_11" class="label">11</a> - Earthquakes are frequent in the West Indies, and -perhaps proceed from a weaker operation of the same -cause that originally produced the islands themselves, -which seem all to have been raised from the sea by subterraneous -fire. There are evident vestiges of volcanoes -in them all, except Barbadoes; but there are other unequivocal -marks of this island having been raised from -the bottom of the sea; for it is entirely formed of coral, -and other sub-marine productions, of which the strata -are broken, and the parts set at angles to each other, as -might be expected from such a cause. There is, perhaps, -at all times in the caverns of the earth, elastic -vapour struggling to vent itself, and when near the surface, -it may sometimes overcome the incumbent masses -of matter, and produce certain convulsions of nature. -In the account of the hurricane which I wrote to Dr. -Hunter, I gave reasons for believing, from the testimony -of the inhabitants, that hurricanes are attended with -earthquakes; and if a conjecture might be advanced concerning -the cause of this, it might be said, that as the -atmosphere is lighter at that time, by several inches of -the barometer, the elastic vapour, confined by the weight -of the incumbent earth and atmosphere, being less compressed, -may exert some sensible effects, producing a sort -of explosion.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_12" href="#FNanchor_12" class="label">12</a> - Since the publication of the first edition of this -work I have been informed that this complaint is not so -rare on shore as in the fleet, which may be partly owing -to the greater coolness of the air at sea, and partly from -the seamen not having been a sufficient length of time in -the climate to be affected with this disease, as few of -them had been more than two years from England. -But as this affection of the liver was very common in the -fleets and naval hospitals in the East Indies, it is evident -that there is a great difference of the climates in this respect. -It is worth remarking, that it sometimes breaks -out in the West-India Islands like an epidemic. The -complaint, for instance, was very little known in the -island of Grenada, till about the year 1785, when it -became very frequent in a particular quarter of the island; -and the gentleman who sent the description of it to England -alledged, that there were the most unequivocal -proofs of its being contagious. It was most successfully -treated by very copious bloodletting, and in exciting a -salivation by mercury. See Dr. Duncan’s Medical Commentaries, -Decad. 2, vol. I.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_13" href="#FNanchor_13" class="label">13</a> - Dr. Lind, on the authority of Mr. Ives, surgeon -to Admiral Matthews.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_14" href="#FNanchor_14" class="label">14</a> - London Gazette, <i>June</i>, 1781.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_15" href="#FNanchor_15" class="label">15</a> - This is well illustrated by the manner in which -Captain Nott, of the Centaur, was killed in Fort-Royal -Bay. This brave man, having carried his Ship nearer -the enemy than the rest of the line, but nevertheless at a -great distance, had his signal made to keep the line, and -having gone into his cabin, as it is said, to examine the -import of the signal, a cannon ball struck him in the groin, -and it was so far spent, that it stuck in his body. It tore -away a whole plank of the ship’s side, the splinters of -which killed a young gentleman, the only person near -him.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_16" href="#FNanchor_16" class="label">16</a> - I have seen an account of the diseases of the army -at St. Lucia for a whole year, kept by Mr. Everard -Home, an ingenious gentleman belonging to the army -hospital, and it appears, that, during ten months out of -the twelve, the dysentery was the predominant disease. -This seems to contradict the opinion, that the land air -is more apt to occasion fevers than fluxes; but it is to -be remarked, that the sickness of the soldiers on this -island was not so much owing to the malignant influence -of the air, the situation of the garrison being high and -airy, as to the bad accommodations and provisions, together -with hard labour.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_17" href="#FNanchor_17" class="label">17</a> - See Essay on the Yellow Fever, by Dr. Hume, in a -Collection of Essays published by Dr. D. Monro.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_18" href="#FNanchor_18" class="label">18</a> - Campbell’s Lives of the Admirals, Vol. IV.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_19" href="#FNanchor_19" class="label">19</a> - The late Dr. William Hunter.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_20" href="#FNanchor_20" class="label">20</a> - <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_21" href="#FNanchor_21" class="label">21</a> - Captain Samuel Thompson.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_22" href="#FNanchor_22" class="label">22</a> - As my own stay at different ports was short, and -as my own knowledge could not extend beyond that -period, Dr. Farquarson, First Commissioner of Sick and -Wounded Seamen, very politely gave me leave to inspect -the books of the different hospitals at his office, -and I collected from them the fate of all the men that -were landed.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_23" href="#FNanchor_23" class="label">23</a> - It is proper to mention, that the name of the disease -in the hospital books being taken from the ticket sent -on shore with each sick person, great accuracy is not to -be expected, as this is frequently done in a careless manner. -My returns were made with great exactness; and, -in the latter part of the war, the hospital books may also -be depended upon in this respect, the tickets, at my request, -having been made out with accuracy.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_24" href="#FNanchor_24" class="label">24</a> - In this, and the other tables, the smaller fractions -are neglected.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_25" href="#FNanchor_25" class="label">25</a> - <a href="#PART_III_CHAP_IV">See the last chapter of Part III</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_26" href="#FNanchor_26" class="label">26</a> - In the year 1741, the fleet under Admiral Vernon -was at Jamaica at the same time of the year; and the -following is the account of the men sent to the hospital -in May and June:</p> - -<table class="bbox"> - <tr> - <th>DISEASES.</th> - <th>Admitted.</th> - <th>Died.</th> - <th>Proportion.<br />NEARLY<br />ONE IN</th> - </tr> - <tr> - <td>Fevers</td> - <td class="tdr">957</td> - <td class="tdr">255</td> - <td class="tdr">3½</td> - </tr> - <tr> - <td>Fluxes</td> - <td class="tdr">267</td> - <td class="tdr">73</td> - <td class="tdr">3½</td> - </tr> - <tr> - <td>Scurvy</td> - <td class="tdr">314</td> - <td class="tdr">41</td> - <td class="tdr">7½</td> - </tr> - <tr> - <td>Other Complaints</td> - <td class="tdr">167</td> - <td class="tdr">26</td> - <td class="tdr">6 </td> - </tr> - <tr> - <td class="tdc">Total</td> - <td class="tdr">1703</td> - <td class="tdr">395</td> - <td class="tdr">4 </td> - </tr> -</table> - -<p>There was on board of this fleet about two thirds of -the number of men that was on board of the fleet in -1782. I cannot ascertain how many died on board of -the ships in Admiral Vernon’s fleet; but the deaths at -the hospital alone are somewhat more than what happened -to our fleet both on board and at the hospital.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_27" href="#FNanchor_27" class="label">27</a> - I was enabled, after coming to England, to ascertain -the deaths in that part of the squadron from which I -happened at any time to be absent, by having leave from -the Navy Board to inspect the ships’ books deposited at -their office.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_28" href="#FNanchor_28" class="label">28</a> - <a href="#APPENDIX_TO_PART_II">See Appendix to Part II</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_29" href="#FNanchor_29" class="label">29</a> - The mortality of the army in the West Indies is -much greater; for it appears by the returns of the War -Office, that there died in the year 1780, two thousand -and thirty-six soldiers, which being calculated by the -numbers on the station, and those who arrived in the convoy -in March and July, the annual mortality is found to -be one in four. The greatness of this mortality will appear -in a still stronger light, when it is considered that -those who serve in the army are the most healthy part of -the community. When I was at the encampment at -Coxheath in the year 1779, I was politely favoured with -a sight of the returns, both of the general officers and -physician, and it appeared that in an army of ten thousand -and eighty-nine men, there died, from the 10th of -June to the 2d of November, forty-three, exclusive of -twelve who died of small pox. This being calculated, -is equal to an annual mortality of one in a hundred and -nine; and it was not half so much in the encampment of -the former year. It appears by Mr. Simpson’s tables, -that the mortality of mankind in England, from the age -of twenty to forty-five, which includes the usual age of -those who serve in the navy and army, is one in fifty.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_30" href="#FNanchor_30" class="label">30</a> - See <a href="#TABLE_II">Table II</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_31" href="#FNanchor_31" class="label">31</a> - See <a href="#TABLE_II">Table II</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_32" href="#FNanchor_32" class="label">32</a> - None are comprehended but those who were killed -or wounded in battles in which the whole fleet was present, -this account not including those who fell in single -actions in frigates or other ships.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_33" href="#FNanchor_33" class="label">33</a> - It would appear, that, anciently, though the slaughter -in battle was greater than in modern times, yet that -disease was still more destructive than the sword. One -of the oldest testimonies to this purpose is in the History -of Alexander’s Expedition, by Arrian—τους μεν ἐν ταῖς -μαχαις ἀπολωλεκασιν, ὁι δε ἐκ των τραυματων ἀπομαχοι γεγενημενοι, -ὁι πλειοῦς δε νοσω ἀπολωλεσαν.—Arrian. Hist. Alex. Exped.</p> - -<p class="author">Lib. v. cap. 26.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_34" href="#FNanchor_34" class="label">34</a> - Upwards of three thousand were also lost at sea in -ships of war belonging to the same fleets in the hurricane -of October, 1780, and in the storm in September, 1782, -in which the Ville de Paris and the other French prizes -were lost on their passage to England.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_35" href="#FNanchor_35" class="label">35</a> - The authors from whom I have borrowed have been -chiefly Dr. Lind and Capt. Cook. To the former we -are indebted for the most accurate observations on the -health of seamen in hot climates; of the improvements -made by the latter, an excellent compendium may be -seen in Sir John Pringle’s Discourse before the Royal -Society, on the occasion of adjudging a prize medal to -Capt. Cook for his paper upon this subject.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_36" href="#FNanchor_36" class="label">36</a> - In the late war sickness alone was not the cause of -want of success in any instance, except in the last action -in the East Indies, in which so many men were ill of the -scurvy, that there were not hands enow to manage the -guns.</p> - -<p>There is another fact in history, which, though not -so applicable to this subject as those above recited, forcibly -evinces how important a study the health of men -ought to be in military affairs. When Henry V. was -about to invade France, he had an army of fifty thousand -men; but owing to a sickness which arose in the -army, in consequence of some delays in the embarkation, -their number was reduced to ten thousand at the -battle of Agincourt. The disease of which they chiefly -died was the dysentery.</p> - -<p class="author"><span class="smcap">Rapin.</span></p></div> - -<div class="footnote"> - -<p><a id="Footnote_37" href="#FNanchor_37" class="label">37</a> - It is not meant by this to insinuate that every -commander is absolutely accountable for the health of -his ship’s company, and censurable when they are sickly; -for this may depend on his predecessor in command, or a -stubborn infection may have prevailed from the original -fitting out or manning of the ship which he may not -have superintended.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_38" href="#FNanchor_38" class="label">38</a></p> - -<div class="poetry"> -<div class="poem"><div class="stanza"> -<span class="i0">Οὐ γαρ ἐγωγέ τι οῗδα κακώτερον ἄλλο θαλάσσης,<br /></span> -<span class="i0">Ανδεά τε συγχεῦαι, εἰ καὶ μάλα καρτερὸς εἴη.<br /></span> -</div> -<p class="author">ΟΜΗΡ. ΟΔΥΣ. Θ.</p> -</div></div> - -<div class="poetry"> -<div class="poem"><div class="stanza"> -<span class="i0">Dire is the ocean, dread in all its forms!<br /></span> -<span class="i0">Man must decay, when man contends with storms.<br /></span> -</div> -<p class="author smcap">Pope.</p> -</div></div></div> - -<div class="footnote"> - -<p><a id="Footnote_39" href="#FNanchor_39" class="label">39</a> - Wherever causes are obscure, superstition naturally -ascribes them to some preternatural influence; and what -seemed farther to have encouraged this, anciently, was, -that violent epidemics occurred most frequently in camps -and at sieges where great political conjunctures were -likely to arise, in which superior powers were supposed to -interest themselves. Thus we read in Homer of fatal -diseases being sent as punishments by the gods. But the -pestilential diseases so often mentioned by poets and historians -as prevailing in cities and armies, were probably -nothing else but fevers, produced partly perhaps by the -scarcity and bad quality of provisions, but probably still -more by corrupted human effluvia, which was very apt -to he produced by the want of personal cleanliness, to -which the mode of cloathing among the ancients would -more particularly subject them, especially in camps and -besieged towns.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_40" href="#FNanchor_40" class="label">40</a> - If the experiments of modern philosophy are to be -depended on, they go a certain way to account for the -unwholesomeness of air from woods in hot climates, and -in wet weather; for Dr. Ingenhousz found that the -effluvia of plants in the night time, and in the shade, are -more poisonous in hot than in cold weather; but though -there is a salubrity in the effluvia in sunshine, the heat of -the weather makes no difference with regard to this. -He found also that vegetables, when wet, yield an unwholesome -air.</p> - -<p>It is difficult to ascertain how far the influence of vapours -from woods and marshes extend; but there is reason -to think that it is to a very small distance. When -the ships watered at Rock Fort, they found that if they -anchored close to the shore, so as to smell the land air, -the health of the men was affected; but upon removing -two cables length, no inconvenience was perceived. I -was informed of the following fact, in proof of the same, -by the medical gentlemen who attended the army in Jamaica:—The -garrison of Fort Augusta, which stands -very near some marshes, to which it is to leeward when -the land wind blows, was yet remarkably healthy; but -it became at one time extremely sickly upon the breaking -in of the sea in consequence of a high tide, whereby the -water which was retained in the hollows of the fort produced -a putrid moisture in the soil, exhaling a vapour -offensive to the smell, and with all the noxious effects -upon health commonly arising from the effluvia of -marshes.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_41" href="#FNanchor_41" class="label">41</a> - Dr. Hendy has lately published an ingenious treatise -upon this disease.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_42" href="#FNanchor_42" class="label">42</a> - See Sydenham’s Works.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_43" href="#FNanchor_43" class="label">43</a> - <a href="#BOOK_II_CHAP_VI">See Part I. Book II. Chap. VI</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_44" href="#FNanchor_44" class="label">44</a> - We have a proof of this fact in particular, in the -account of the jail distemper, which broke out at the -Old Bailey in the year 1750.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_45" href="#FNanchor_45" class="label">45</a> - See Martin’s History of the Western Islands, and -Medical Communications, Vol. I. page 68.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_46" href="#FNanchor_46" class="label">46</a> - There are some contagious diseases which cannot be -propagated but by their own peculiar infections, as has -been before observed, just as the seeds of vegetables are -necessary to continue their several species; so that if the -infectious poison were lost, so would the disease. Of -this kind are the small pox, and the other diseases to -which man is subject but once during life. There are -other diseases which produce infection without having -themselves proceeded from it. Of this kind are fevers -and fluxes.</p> - -<p>But there is no infection of any kind, however virulent, -that affects indiscriminately all persons exposed to -it. If a number of persons, who never have had the -small pox, are equally exposed to it, some will be seized, -while others will escape, who will be affected at another -time, when they happen to be more susceptible. It is -doubtful how far the habit of being exposed to such specific -infections renders the body insensible to them, as -was said with regard to fevers; but there is another -principle of the animal œconomy laid down and illustrated -by Mr. Hunter, which goes at least a certain -length in explaining this variable state of the body with -respect to its susceptibility of infectious diseases. This -principle is, that the body cannot be affected by more -than one morbid action at the same time. If a person is -exposed to the small pox, for instance, while he labours -under a fever, or while he is under the influence of the -measles, he will not catch the first till the other has run -its course. It may happen, therefore, that people escape -the effect of contagion in consequence of being at the -time under the influence of some other indisposition, either -evident or latent: and supposing the body to be exposed -to a number of noxious powers at the same time, -one only could take effect. But it seems difficult to explain -why some of those who are actually seized, and -who have previously been to all appearance in equally -good health, shall have it in a very mild degree, while -in others it will be malignant and fatal. This is very remarkable -with regard to the small pox, which are in some -cases so slight, that they can hardly be called a disease, -while in others they are so malignant, as hardly to admit -of any alleviation from art. May not this, in some -measure, be explained from some of the principles above -mentioned, in the following manner:—The small pox, -in their mildest form, are attended with little or no fever, -which, therefore, is not essential to them; and -when we see them attended with various forms of fever, -and thereby prove fatal even in the most hale constitutions, -we ought not to attribute this to any thing in the -nature of the small pox, but rather to say, that they have -served as an agent in exciting a fever, for which there -happened to be some previous latent disposition, that -would not otherwise have exerted itself, and that this -disposition, or contamination, as it may be called, may -have been induced by some past exposure to morbid effluvia, -which either from habit, or some other circumstance, -may not have been sufficiently powerful to excite -the constitution to fever without some such stimulus. -Any other occasional circumstance producing disturbance -or irregularity in the functions of the body, may, -in like manner, excite any particular kind of fever to -which the body may at that time be disposed. Thus the -amputation of a limb will have this effect; also exposure -to cold or fatigue, and intemperance in eating or drinking.</p> - -<p>It would appear from these considerations, that there -are certain circumstances, or temporary situations of -constitution, which invite infection, and render its effect -more certain and violent in one case than another. -There are artificial methods, however, of obtruding it, -as it were, upon the constitution, though not particularly -disposed, or even though averse to receive it; and -may not this, in some measure, account for the greater -safety of some diseases when communicated by inoculation, -than when caught in the natural way?</p> - -<p>But these, as well as many other facts in animal nature, -do not admit of a satisfactory explanation upon any principle -as yet known. Even the most common operations -of the body, such as digestion and generation, when -considered in their causes and modes of action, are so obscure -and mysterious, as to be almost beyond the reach -of rational conjecture. A little reflection will teach us -the utmost modesty with regard to our knowledge of -such things; for nature seems to have innumerable ways -of working, particularly in the animal functions, to -which neither our senses can extend, nor perhaps could -our intellects comprehend them. Had we not, for instance, -been endowed with the sense of sight, nothing -could have led us even to suspect the existence of such a -body as light; and there may be numberless other subtile -and active principles pervading the universe, relative to -which we have no senses, and from the knowledge of -whose nature and exigence we must for ever be debarred. -We have, indeed, become acquainted with electricity by -an operation of reason; and animals have lately been -discovered to which the electric fluid serves as a medium -of sense through organs calculated to excite it, and to -receive and convey its impressions.</p> - -<p>But there are few subjects we can study that are more -subtle and obscure than the influence of one living body -on another. There is a familiar instance of the great -subtilety of animal effluvia, and also of the fineness of -sense in a dog’s being able to trace his master through -crowds, and at a great distance; and we can conceive -that infectious matter may adhere, and be communicated -in a similar manner. We have endeavoured to illustrate -the great obscurity of its operation by an allusion to generation, -digestion, and other animal functions, with -which it is equally obscure and inexplicable. It is similar -to generation in this, that its influence does not pass -from one species of animal to another; for the poison of -the plague, that of the small pox, that of fever, and the -venereal disease, do not affect brutes<a id="FNanchor_47" href="#Footnote_47" class="fnanchor">47</a>, nor do the infectious -diseases of brutes affect different species of them, -nor the human species. The only exception to this, that -we know of, is the bite of a mad dog.</p> - -<p>From these facts, and also from what was formerly -mentioned of contagion not affecting indiscrimately all -that may be exposed to it, it would appear that some nice -coincidence of circumstances is necessary to modify an -animal body, so as to receive its action. There must be -a sort of unison, as it were, or sympathy, betwixt different -living bodies, so as to render them susceptible of -each other’s influence.</p> - -<p>It is none of the least curious facts with regard to infection, -that there are some species of it by which the -body is liable to be affected only once in life. When -this is considered, it is indeed conformable to what happens -in the course of the disease itself; for, unless there -was in the body a power of resisting it, there could be no -such thing as recovery. Where the disease actually exists, -the continued presence of the poison, which is also infinitely -multiplied, would infallibly prove fatal in all -cases, unless the living powers were to become insensible -to it<a id="FNanchor_48" href="#Footnote_48" class="fnanchor">48</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_47" href="#FNanchor_47" class="label">47</a> - Hunter’s Experiments.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_48" href="#FNanchor_48" class="label">48</a> - Mr. Hunter’s Lectures.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_49" href="#FNanchor_49" class="label">49</a> - It is sincerely to be wished that this were adopted, -and it is surprising that an article so salutary and necessary, -and so difficult to be procured on foreign stations, -should not have been the object of public attention, rather -than a mere article of luxury, such as tobacco. -But in order that it might not be a matter of choice -with seamen, it would be worth while to supply them -with it at prime cost, or even as a gratuity, and then -they might be compelled to use it for the purpose of -cleanliness. There are other articles of less importance, -but being necessary to enable men upon foreign stations -to keep themselves neat and clean, deserve to be made -the object of public instruction. These are handkerchiefs -for the neck, thread, worsted, needles, buckles, -and knives.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_50" href="#FNanchor_50" class="label">50</a> - At the time I am writing this, (March 8th, 1785) -there has occurred a fact which proves the effect of time -in generating infection. There now prevails a contagious -fever in several of the hospitals in London, and, among -others, in that to which I am physician. In another hospital -it has been so violent, that there has been a vulgar -report that the plague had broke out in it. The same -fever also prevails among the poor at their own houses. -The cause of it seems to be, that the cold weather has -been uncommonly long and severe; for the frost began -early in December, and the cold has hitherto been more -like that of winter than spring. The thermometer all -this month has varied from 30° 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_51" href="#FNanchor_51" class="label">51</a> - It is of some consequence to attend to the materials -of the seamen’s beds; for, instead of flock, they are -frequently fluffed with chopped rags, which, consisting -of old clothes, emit a disagreeable smell, and may even -contain infection.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_52" href="#FNanchor_52" class="label">52</a> - By a <i>berth</i> is understood the interval between two -guns, or any space between decks, which is sometimes -formed into a sort of apartment by means of a partition -made of canvass.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_53" href="#FNanchor_53" class="label">53</a> - It is remarkable that this method of purifying was -practised in the most ancient times, as we learn from the -following passage in Homer, where Ulysses is represented -fumigating the apartments of his palace in which the -suitors had been slain:</p> - -<div class="poetry"> -<div class="poem"><div class="stanza"> -<span class="i0">Τὴν δ᾿ἀπαμειζόμενος προσεφη Πολυμητις Ὀδυσσευς<br /></span> -<span class="i0">Πυρ νυ̃ν μοι πρώτιστον ἐνὶ μεγάροισι γενέσθω.<br /></span> -<span class="i0">Ως ἔφαθ’. ουδ’ἀπιθησε φιλη τροφος Ἐυρυκλειος<br /></span> -<span class="i0">Ἠνεγκεν δ᾿ ἄρα πυρ και θηιον. αυταρ Ὀδυσσευς<br /></span> -<span class="i0">Ἒυ διεθέιωσεν μέγαρον και δῶμα και ἀυλήν.<br /></span> -</div> -<p class="author">ΟΜΗΡ. ΟΔΥΣ. Χ.</p> -</div></div> - -<div class="poetry"> -<div class="poem"><div class="stanza"> -<span class="i0">Bring sulphur straight, and fire, the Monarch cries;<br /></span> -<span class="i0">She heard, and at the word obedient flies.<br /></span> -<span class="i0">With fire and sulphur, cure of noxious fumes,<br /></span> -<span class="i0">He purg’d the walls and blood-polluted rooms.<br /></span> -</div> -<p class="author smcap">Pope.</p> -</div></div> - -<p>This practice was probably founded in superstition, -rather than the knowledge of nature. That some divine -influence should be ascribed to fire was very natural, as -the principal deities of the ancients were only personifications -of the elements; and it is worthy of remark, -that their name for sulphur signifies <i>something divine</i> -το θεῖον, which was probably owing to its being found in -those chasms of the earth, in Sicily and Italy, which -were supposed to communicate with the infernal regions; -for the whole Greek mythology relating to these was -taken from the 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 <i>ærugo æris</i>, which -has been found by the experience of modern surgery to be -one of the best detergents in ill-conditioned sores. It is -probably, from a false analogy, founded on some such incident, -that an idea prevails among the vulgar, which -has become proverbial, that some part taken from the -offending body is good in all external injuries. Thus -some part of a mad dog is said to have a virtue in curing -his bite. Herein may be seen the difference of that -knowledge which is suggested by superstition, and that -which is acquired by the observation of nature.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_54" href="#FNanchor_54" class="label">54</a> - A loggerhead is a large round mass of iron, with a -long handle to it.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_55" href="#FNanchor_55" class="label">55</a> - A fact, related in Anson’s Voyage, is also strongly -in proof of the same opinion. When the rich Spanish -prize was taken, it was necessary to crowd the prisoners -into the hold, for fear of an insurrection, which was to -be dreaded from their numbers; yet, when they arrived -in China, none of them had died, nor had any disease -broke out. They suffered only in their looks, being -wan and emaciated to a great degree.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_56" href="#FNanchor_56" class="label">56</a> - It may be brought as a farther proof of a warm -climate being unfavourable to every sort of infection, -that though the itch is very common in ships and hospitals -in Europe, I do not remember ever to have met -with it in the West Indies, except in ships newly arrived -from England.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_57" href="#FNanchor_57" class="label">57</a> - This circumstance, in the character of the English, -is only of modern date; for we learn from Erasmus, who -was in England about two hundred and fifty years ago, -that they were then extremely slovenly. The following -passage is extracted from a letter he wrote to a physician -in York, after his return to Holland:—“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.</p> - -<p>There are some passages in ancient history in confirmation -of the same opinion. Herodotus relates, that the -ancient Egyptians were the most healthy of all the nations, -except the Libyans, and he imputes this to the invariableness -of their weather, and the serenity of their -sky. But he mentions in another part of his works, that -they were also the most cleanly of all people, not only in -their household utensils, but in their persons, and that -their clothing was chiefly of linen, which it was one of -the principal studies of their life to wash and keep clean—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 <i>plague</i> in -a loose sense to signify any violent acute distemper; for -he relates that a great part of the army of Xerxes, in -their retreat from Greece, perished by the <i>plague</i> λοιμου and -dysentery, in consequence of famine. Herod. Lib. viii. -cap. 115.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_58" href="#FNanchor_58" class="label">58</a> - It is proper also to observe here, that those ships -which are built of winter-felled timber are much drier -than those built of what is summer felled; and this circumstance -should have been mentioned with regard to the -Montague, for the cause of her healthiness, notwithstanding -her being a new ship, was probably from being -built of winter-felled timber. It should, therefore, be -strictly enjoined to fell the wood in winter; for those -who are employed to do it have an interest in doing it -in summer, on account of the value of the bark.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_59" href="#FNanchor_59" class="label">59</a> - A windsail is a long cylinder of canvass, open at -both ends, kept extended with hoops, and long enough -to reach from the lowermost parts of the ship through all -the hatchways into the open air.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_60" href="#FNanchor_60" class="label">60</a> - It is not necessary that seamen should have chests, -for bags or wallets answer their purpose equally well, and -are much more convenient in respect of stowage.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_61" href="#FNanchor_61" class="label">61</a> - Since the first edition of this work, I have met with -a fact in confirmation of this principle, with regard to the -cutaneous complaint called the <i>ring-worm</i>. This had -prevailed in a private school in the neighbourhood of -London, which I visited, but it had to all appearance -become extinct; yet it nevertheless affected those boys -who were newly sent to the school.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_62" href="#FNanchor_62" class="label">62</a> - It is mentioned by Thucydides, that while the plague -raged at Athens, the people were affected with no other -disease; from which it would appear that those persons -who would otherwise have been attacked with some particular -indisposition, were seized with the plague in place -of it. Vide note p. 247.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_63" href="#FNanchor_63" class="label">63</a> - Part I. Book II. Chap. VI.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_64" href="#FNanchor_64" class="label">64</a> - It is related by the travellers into Turkey, that the -Christians save themselves from it, merely by shutting -themselves up in their houses, and the inhabitants, who -sleep on the open roofs of the houses, do not catch it -even from those of the adjacent buildings, though the wall -that separates them is of no great heighth.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_65" href="#FNanchor_65" class="label">65</a> - Vide Opera Ambrosii Parei.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_66" href="#FNanchor_66" class="label">66</a> - See Essay on Sea Diseases.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_67" href="#FNanchor_67" class="label">67</a> - Limes, shaddocks, and perhaps all the other fruits -of that class, possess the same virtues; but I have most -frequently observed good effects from lemons.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_68" href="#FNanchor_68" class="label">68</a> - In the course of the passage from England to the -West Indies in February, 1782, the following directions -for using the sour krout and melasses were given in public -orders by the Admiral to the different ships of the -squadron:</p> - -<p>“The allowance of sour krout made by the public -boards in England, is two pounds to each man every -week; and the Admiral orders that from a pound and -a half to two pounds (beginning with the lesser quantity, -and increasing as the men may find it palatable) -be boiled with every gallon of pease on a pease day. -The cooks are desired not to wash it, nor to put it -into the coppers till the pease are sufficiently broken. -“Half a pound is directed to be issued raw to each man -on beef days, and a quarter of a pound on pork days. -It is recommended that the allowance of vinegar be -saved, particularly on meat days. When sour krout -runs short, the pease and beef days to have the preference; -when shorter still, the pease days. Melasses -having been allowed in lieu of part of the oatmeal, in -the proportion of eleven pounds to two gallons, the -Admiral directs, that a pound of melasses be boiled -with every gallon of oatmeal on Mondays, Wednesdays, -and Fridays, mixing it and stirring it round -with the burgoo immediately after it is drawn off. -He directs that half a pound of melasses be issued -with every three pounds of flour over and above the -common proportion of raisins; and to prevent any -abuse, it is directed that the purser’s steward pour it -into the platter with the flour of which the pudding is -made. The Admiral forbids the use of pease in lieu of -oatmeal, as has sometimes been the practice.”</p> - -<p>These rules were suggested by Sir Charles Douglas, -captain of the fleet, whose benevolence is equal to his -known professional skill; and he had ascertained the utility -of the preceding directions when captain of the -Duke in the former part of the war.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_69" href="#FNanchor_69" class="label">69</a> - In the French ships of war there is an oven large -enough to supply not only all the officers and sick, but -part of the crew, with soft bread every day. The advantages -attending the use of flour in place of bread are -so great and obvious, that the former will probably, in -time, be substituted entirely for the latter. There is a -proof of its being practicable to use it in place of bread -in British ships of war, even with their present conveniences, -communicated to me by Captain Caldwell. -When he commanded the Agamemnon, of 64 guns, at -New York, in the end of 1782, there happened to be no -bread in store to supply that ship on her passage to the -West Indies, and flour was given in place of it. The -men, without any inconvenience, were able to bake it -into bread for themselves, and it proved so salutary, that -Captain Caldwell ascribed the uncommon degree of -health which his men enjoyed to the use of the flour. -The only objection that can be made to it is the greater -consumption of wood occasioned by baking; but this -may be obviated by adopting the grates invented by -Mr. Brodie, in which the ovens are heated by the same -fire with which the victuals are boiled.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_70" href="#FNanchor_70" class="label">70</a> - Mr. Napeane, afterwards Under Secretary of State, -was at that time purser of the Foudroyant, and acted a -very benevolent and disinterested part, by being instrumental -in introducing this reform in the navy victualling.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_71" href="#FNanchor_71" class="label">71</a> - Half a pound of cocoa, and as much sugar, was -allowed in place of a pound of butter.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_72" href="#FNanchor_72" class="label">72</a> - <span class="smcap">Table</span>, exhibiting the daily Allowance of Provisions -for each Man in the Navy.</p> - -<table class="bbox"> - <tr> - <th /> - <th>Biscuit.</th> - <th>Beer.</th> - <th>Beef.</th> - <th>Pork.</th> - <th>Pease.</th> - <th>Oatmeal.</th> - <th>Butter.</th> - <th>Cheese.</th> - </tr> - <tr> - <th /> - <th>lbs.</th> - <th>galls.</th> - <th>lbs.</th> - <th>lbs.</th> - <th>Pint.</th> - <th>Pint.</th> - <th>ozs.</th> - <th>ozs.</th> - </tr> - <tr> - <td>Sunday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc"></td> - <td class="tdc">1</td> - <td class="tdc">half</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - </tr> - <tr> - <td>Monday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc">1</td> - <td class="tdc">2</td> - <td class="tdc">4</td> - </tr> - <tr> - <td>Tuesday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc">2</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - </tr> - <tr> - <td>Wednesday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc">half</td> - <td class="tdc">1</td> - <td class="tdc">2</td> - <td class="tdc">4</td> - </tr> - <tr> - <td>Thursday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc"></td> - <td class="tdc">1</td> - <td class="tdc">half</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - </tr> - <tr> - <td>Friday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc">half</td> - <td class="tdc">1</td> - <td class="tdc">2</td> - <td class="tdc">4</td> - </tr> - <tr> - <td>Saturday</td> - <td class="tdc">1</td> - <td class="tdc">1</td> - <td class="tdc">2</td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - <td class="tdc"></td> - </tr> -</table> - -<p>This has continued from the last century till the alterations -above mentioned, all of which, except the introduction -of vinegar, have been made in the three last -years of this war. When the stock of small beer is exhausted, -half a pint of spirits is allowed daily, diluted -with four or five times its quantity of water. When -wine is supplied, the daily allowance of it to a man is -one pint.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_73" href="#FNanchor_73" class="label">73</a> - Instead of leaving this to the management of the -men themselves, it might be done with greater advantage -to them by instituting short allowance in the following -manner:—Let a certain proportion, suppose one -third, of the salt provisions, bread, and pease, particularly -the first, be stopped, and let the amount of this, -for the whole crew be thrown into one estimate. Let -the agent victualler pay into the purser’s hands the value -of these provisions in money, at the contract price, with -such a discount as will allow for the use of the money. -Let the purser, in return, give him a receipt, as if for -so much provisions checked. This money, being distributed -in the name of short allowance, will enable the -men to purchase vegetables, and the provisions will be -saved for a time of want, or for a cruise.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_74" href="#FNanchor_74" class="label">74</a> - The sailors in the squadron of Commodore Anson -never murmured more under any of their hardships than -when they were fed with fresh turtle for a length of -time in the South Sea.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_75" href="#FNanchor_75" class="label">75</a> - Since the first edition of this work was printed, I -have met with a book published by Mr. Fletcher, a -navy surgeon, in which he mentions that spices, being -antiseptic bodies, might be substituted for part of the -salt in curing provisions, and this would, no doubt, be -an improvement in the sea victualling. The quantity of -spice he proposes for every barrel of beef or pork is four -ounces of black pepper, and as much allspice, and also -eight ounces of nitre in powder. It may be farther alledged -as an advantage of spice over salt, that it would -be less apt to run into brine, which robs the meat of the -greater part of its nourishment.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_76" href="#FNanchor_76" class="label">76</a> - This accident happened in the Cyclops frigate in -September, 1780. Mr. Gordon, the surgeon, favoured -me with the following account of it:</p> - -<p>“Mr. Smith, an officer, John Barber and Anthony -Wright, seamen, having eat some victuals prepared in -a foul copper, complained soon after of violent gripes, -giddiness, and vomiting, and they had a few loose -stools. There was intense heat; the pulse was quick, -full, and hard; a tremor of the hands and tongue, -and wildness of the eyes. The looseness was soon -succeeded by obstinate costiveness, tension of the abdomen, -difficult breathing, and loss of deglutition. -In the night, towards the morning, there came on -insensibility, with an increase of all the symptoms, -except the heat. The body was violently convulsed, -with cold clammy sweats and coldness of the extremities. -The abdomen subsided a short time before -they died, and, before they expired, a small quantity -of greenish matter, mixed with phlegm, issued from -the mouths of two of them.</p> - -<p>Thirty three other men were put upon the sick list -with similar symptoms in a less degree, and some of -them continued on the list for five or six weeks before -they perfectly recovered.”</p> - -<p>It is not said what means were attempted for the recovery -of these men; but, besides emetics and milk, or -oil, a dilute solution of the fixed alkali in water has been -recommended against this poison.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_77" href="#FNanchor_77" class="label">77</a> - I was furnished by Dr. Clephane, physician to the -fleet at New York, with the following fact, as a strong -proof of the excellence of this liquor:</p> - -<p>In the beginning of the war two store ships, called the -Tortoise and Grampus, sailed for America under the convoy -of the 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_78" href="#FNanchor_78" class="label">78</a> - We have a remarkable proof of this in comparing -the fleet under the command of Admiral Byron with that -under the Count d’Estaing, when they both arrived -from Europe on the coast of America in the year 1778, -some of the British ships having been unserviceable from -the uncommon prevalence of scurvy, while the French -were not affected with it.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_79" href="#FNanchor_79" class="label">79</a> - See an article in Rozier’s Journal de Medicine for -July, 1784, by Dr. Ingenhousz.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_80" href="#FNanchor_80" class="label">80</a> - Since I came to England I have met with a pamphlet -published by Mr. Henry, of Manchester, in which -an ingenious method, founded on chemical principles, is -proposed for separating the quick lime from water; but I -fear it is too nice and complex to be brought into common -practice. It would certainly be worth the trouble; -but there are so many duties in a ship of war to call off -the attention of the men, and they are so little accustomed -to nice operations, that it would be difficult to -persuade officers to attend to it and enforce it. If a sufficient -quantity should not be precipitated by the air in -the water, and by the accidental exposure to the atmosphere, -it might be more effectually exposed to the air by -Osbridge’s machine, to be described hereafter, or by a -long-nozzled bellows, and if a small impregnation should -be left, this is rather to be desired than avoided.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_81" href="#FNanchor_81" class="label">81</a> - See Dr. Lind on the Health of Seamen.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_82" href="#FNanchor_82" class="label">82</a> - The want of this apparatus may be supplied, in case -of exigency, by a contrivance mentioned by Dr. Lind, -consisting of a tea-kettle with the handle taken off, and -inverted upon the boiler, with a gun barrel adapted to the -spout, passing through a barrel of water by way of refrigeratory, -or kept constantly moist with a mop.</p> - -<p>In this place I cannot help mentioning also, that in case -of great extremity it has been found that the blood may -be diluted, and thirst removed, by wetting the surface of -the body even with sea water, the vapour of which is always -fresh, and is inhaled by those pores of the skin -whose natural function it is to imbibe moisture, of which -there is always more or less in the common air of the -atmosphere.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_83" href="#FNanchor_83" class="label">83</a> - When we consider that linen was not in use among -the ancient Romans, we might be apt to wonder that -they were not more unhealthy; but their substitute for -this was frequent bathing, which not only served to remove -the <i>sordes</i> adhering to the surface of the body, but -to air that part of the clothing which was usually in contact -with the skin. The washing of the bodies of men -suspected of infection upon their first entrance into a -ship, has already been mentioned, and I have known -some commanders who made their men frequently bathe -themselves with great seeming advantage.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_84" href="#FNanchor_84" class="label">84</a> - A coarse woollen stuff so called.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_85" href="#FNanchor_85" class="label">85</a> - He makes the following computation of the additional -expence for each man in some of the articles that -have been mentioned:</p> - -<table> - <tr> - <th /> - <th>£.</th> - <th><i>s.</i></th> - <th><i>d.</i></th> - </tr> - <tr> - <td>For 3 handkerchiefs, at 1s. 6d.</td> - <td class="tdc">0</td> - <td class="tdc">4</td> - <td class="tdc">6</td> - </tr> - <tr> - <td>For 12 pounds of sope, at 6d.</td> - <td class="tdc">0</td> - <td class="tdc">6</td> - <td class="tdc">0</td> - </tr> - <tr> - <td>For 1 knife, at 1s.</td> - <td class="tdc">0</td> - <td class="tdc">1</td> - <td class="tdc">0</td> - </tr> - <tr> - <td>For 1 pair of buckles, at 9d.</td> - <td class="tdc">0</td> - <td class="tdc">0</td> - <td class="tdc">9</td> - </tr> - <tr> - <td></td> - <td class="bt tdc">0</td> - <td class="bt tdc">12</td> - <td class="bt tdc">3</td> - </tr> - <tr> - <td>Suppose 3 shirts a year, the difference</td> - <td class="tdc">0</td> - <td class="tdc">2</td> - <td class="tdc">3</td> - </tr> - <tr> - <td>Suppose 3 pair of trowsers, ditto</td> - <td class="tdc">0</td> - <td class="tdc">2</td> - <td class="tdc">3</td> - </tr> - <tr> - <td>Suppose 1 milled cap</td> - <td class="tdc">0</td> - <td class="tdc">2</td> - <td class="tdc">0</td> - </tr> - <tr> - <td class="tdr">Total £.</td> - <td class="bt tdc">0</td> - <td class="bt tdc">18</td> - <td class="bt tdc">9</td> - </tr> -</table> -</div> - -<div class="footnote"> - -<p><a id="Footnote_86" href="#FNanchor_86" class="label">86</a> - <a href="#PART_I">See Part I</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_87" href="#FNanchor_87" class="label">87</a> - Had I then known the salutary effects of porter -and spruce beer, of which I have since been convinced, -I should have proposed them as substitutes for rum.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_88" href="#FNanchor_88" class="label">88</a> - The authenticity of this fact, as well as every other -assertion in this work relating to the mortality in the -fleet, may be proved from the ship’s books, deposited at -the Navy Office.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_89" href="#FNanchor_89" class="label">89</a> - I fancied that my reasoning on this subject was in -a great measure new; but I lately met with the following -passages in Celsus and Hippocrates, which seem to -be illustrative of the same idea:—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.</p> - -<p>The same principle is ingeniously explained by Mr. -Hunter in his Lectures.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_90" href="#FNanchor_90" class="label">90</a> - <a href="#Page_181">See page 181</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_91" href="#FNanchor_91" class="label">91</a> - <a href="#Page_125">See pages 125 and 126</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_92" href="#FNanchor_92" class="label">92</a> - The form of administering this medicine was to add -twenty drops of thebaic tincture, from half a grain to a -grain of emetic tartar, and from five to ten grains of -nitre, to two ounces of water or camphorated julep, of -which one half was given about two hours before the -common hour of rest, and the remainder at that hour. -If spiritus Mindereri is preferred to the nitre, it may be -given from two drachms to half an ounce for a dose, and -it is better to administer it separately; for if it should not -be exactly neutralized, it may decompose the antimonial, -and render it inactive.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_93" href="#FNanchor_93" class="label">93</a> - Since the publication of the first edition of this -work, there has appeared a small tract on the treatment -of low fevers, by Dr. Wall, of Oxford, and as his ingenuity -and learning give him a just claim to the high -rank he holds in his profession, attention is due to what -he advances. The principal scope of the work is to recommend, -from his own observation, the early use of -opiates in those fevers, and the Doctor’s authority, as -well as my own experience, convince me of the propriety -of this practice in many cases occurring in this -country, particularly among the lower sort of people, -for whom spare diet and hard labour render evacuations -less necessary than among the better sort. The inferior -class of people are also more subject to this sort of fever -from their houses and persons being less clean, and their -apartments being worse ventilated; so that practice in -these, as well as other cases, is to be varied according to -the constitution and previous habits of life.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_94" href="#FNanchor_94" class="label">94</a> - I first learned this, as well as many other useful -and practical facts, from Mr. Farquhar, Surgeon in -London, who has laid me under the greatest obligations -by communicating many of his observations, derived -from the most extensive experience and a truly penetrating -sagacity.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_95" href="#FNanchor_95" class="label">95</a> - I owe this piece of instruction, as well as many -others, to Dr. Cullen’s Lectures.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_96" href="#FNanchor_96" class="label">96</a> - In a review of Haslar hospital made in person by -that excellent officer, Vice-admiral Barrington, in 1780, -it was very judiciously proposed, among other salutary -improvements, that there should be two apartments for -the reception of the sick upon their first landing; one -wherein they should be stripped of their dirty clothes, -and another in which they should go into the warm bath, -and put on the hospital dress, that they might not carry -infection into the wards.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_97" href="#FNanchor_97" class="label">97</a> - The following is the form of it, and it was first introduced -by Mr. Whitfield, apothecary to the hospital, -under the name of Bolus Sedativus:—℞. Confection. -Damorat. [dram]ss. Castor. Russic. pulv. [scruple]ss. Tinct. Thebaic. -g<sup>tt.</sup> iv. Syr. sim. q.s. Fiat bolus sexta quaque hora -sumendus.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_98" href="#FNanchor_98" class="label">98</a> - Great nicety is required in all cases with regard to -the times and doses of cordials; for it by no means follows -that these should be in proportion to the lowness -and loss of strength. This is well illustrated by Mr. -Hunter in his Lectures, where he explains the distinction -between the powers of the body and its <i>actions</i>. -There must be a certain degree of strength to bear the -excitement occasioned by stimulating and strengthening -medicines or diet; for nothing is more pernicious, or -even fatal, than that any part or function should make -exertions beyond its strength; and there is the more -danger in ill-timed remedies of this kind, as a state of -weakness is generally a state of irritability.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_99" href="#FNanchor_99" class="label">99</a> - See a method proposed for obviating this, <a href="#Page_358">page 358</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_100" href="#FNanchor_100" class="label">100</a> - <a href="#Page_381">Page 381</a> et seq.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_101" href="#FNanchor_101" class="label">101</a> - Sailor’s fever.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_102" href="#FNanchor_102" class="label">102</a> - See pages <a href="#Page_161">161</a>, <a href="#Page_181">181</a>, and <a href="#Page_380">380-1</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_103" href="#FNanchor_103" class="label">103</a> - I have in the whole of this work been extremely -cautious in reasoning concerning causes, from an opinion -that they are very obscure, and that the theoretical -part of physic is very imperfect and fallacious. This -is perhaps in no instance more remarkable than in those -opinions that prevail concerning the nature and influence -of bile in producing diseases. An increased secretion of -bile commonly attends the feverish complaints of hot -climates, and those of the hot seasons of temperate and -cold climates. It is not unnatural, therefore, to impute -the disease then prevailing to this redundancy of bile: -but, upon considering the matter more closely, it will -appear to be rather a concomitant symptom, or effect, -than a cause of those fevers; for, in the first place, in -those cases in which there is the greatest secretion of bile, -as in the <i>cholera morbus</i>, there is no fever. The only -danger in this disease arises from the violent irritation -produced in the bowels by such an extraordinary quantity -of this secretion which commonly passes downwards; -though I have seen it prove fatal when it flowed -into the stomach, and produced perpetual retching and -excoriation of the fauces; but in this case also without -any fever. Secondly, in the most fatal of all fevers, in -the West Indies, there are no marks of an increased secretion -of bile, but, on the contrary, a preternatural -defect of it, as appears by its not being evacuated either by -stool or vomiting, by the white stools which sometimes -attend the yellow fever, and by its not appearing in the -first passages, nor in its own receptacles after death. -Perhaps also that state of the bowels which renders it so -difficult to procure stools may be in part owing to the -want of this natural stimulus. It is nevertheless true, -that in the intermitting and remitting fevers of hot climates -and seasons there is perhaps always an accumulation -of bile at the beginning, and an increased secretion -of it during their course. It is farther true, that this -adds to the patient’s uneasiness, and aggravates the -symptoms, and that the cure consists partly in the evacuation -of the bile. But it is also true, that in the -very worst sort of fevers in hot climates it is a favourable -symptom where the secretion of the liver is restored -and increased, a bilious diarrhœa being one of the most -auspicious symptoms that can occur in a yellow fever; -and in those that are protracted and afford hopes of recovery, -there is generally a gush of bile from time to -time.—We may therefore lay down the following positions: -1. That in cases in which bile is most freely and -copiously secreted no fever exists, as in <i>cholera morbus</i>. -2. That in the worst sort of fevers there is no preternatural -secretion of bile, but, on the contrary, a defect of -it. 3. That nevertheless there is an uncommon quantity -of bile secreted in most of the fevers of hot climates, -and that part of the cure consists in evacuating -it.</p> - -<p>I am extremely diffident, as I have said, in all matters -depending on our supposed knowledge of the animal œconomy; -but the preceding circumstances seem to countenance -the following reasoning:—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 <i>feces</i>; -but external heat continued for any length of time tends -to augment this corruption of the fluids, and therefore -to increase the secretion of bile; and it has been observed -both by myself and others, that the bile found in -those bodies that have been inspected after death, in consequence -of fevers in hot climates, is less bitter, and not -so penetrating to the fingers, being therefore deficient in -the antiseptic principle. But since external heat makes -no alteration in the degree of temperature of the fluids -themselves, this effect must take place through the medium -of the solids, in consequence of that general languor -and want of energy which too much external heat -induces in the functions, particularly in that power -by which the living body preserves itself from putrefaction. -Now if this portion of the blood, thus altered -and depraved, is readily secreted and speedily thrown -out, as in <i>cholera morbus</i>, no harm befals the constitution, -nor any inconvenience but what arises from the -irritation of the <i>primæ viæ</i>. But this may not take -place if the body should be otherwise deranged; for the -removal of this noxious matter from the mass of blood -depends upon a due irritability of the blood vessels, the -liver, and the bowels, whereby they are stimulated to -contract, and thereby expel it. According to the principle -of Mr. John Hunter, (whose deep and industrious -researches into the animal œconomy place him high in -the list of those few on whom nature has bestowed real -genius, and who are capable of adding something new to -the stock of human knowledge,) there is in a state of -health a relative habitude or mutual harmony existing -between the solids and fluids, whereby they stimulate -and produce actions in each other, in which the healthy -state of the functions consists, whether employed in the -formation of what is found, or the expulsion of what is -noxious: so that where it happens that the solids have a -morbid insensibility to the impressions of corrupted and -acrimonious fluids, the retention of these adds still more -to the general derangement. To illustrate this, it may -be observed, that the stomach and bowels, when they are -endowed, as it were, with their natural perception, immediately -expel any preternatural accumulations of bile -that may take place; but when they are insensible to -this stimulus through disease, no effort is made to relieve -nature till it is excited by medicine. The same reasoning -may be applied to the various vessels and ducts. -Thus when we see the liver gorged with bile, without -any free excretion of it into the gall bladder, as I have -sometimes found to be the case upon inspecting the body -in some of the worst cases of fever, would it not appear -that the gall ducts have lost that natural irritability -whereby the bile is expelled? Or, in consequence of a -depraved state of action, connected with febrile affection, -may it not happen that the absorbents, which, in -their natural state, only absorb particular substances, and -in a given quantity, will suffer a change in this natural -action, and absorb whatever happens to be applied to -their orifices? In case of jaundice, the bile, which is -perhaps not at all absorbed in a state of health, is taken -up in large quantities, and mingled with the mass of -blood, which proves a seasonable relief in the state of accumulation -and distension occasioned by the obstruction. -This may happen in cases of fever, not indeed as a relief -to nature, but from a depraved state of irritability in the -lymphatics, induced by disease. Though no increased -quantity of bile, therefore, is found in the gall bladder, -there may have been an increased excretion of it, a preternatural -absorption having been excited. So that it -may admit of a question whether the colour of the skin, -in the yellow fever, is owing to this, or if the idea of it -given in the text<a id="FNanchor_104" href="#Footnote_104" class="fnanchor">104</a> is more just; but in either case -it seems probable that the extreme tendency to putrefaction -in the whole body is owing either to the presence -of bile, in consequence of absorption, or the retention of -something in the blood from a defect of its secretion.</p> - -<p>This reasoning concerning the bile in hot climates -may, in some sort, be illustrated by what happens to the -urine in cold climates. The urine is the vehicle of an -excrementitious part of the blood, of which an increased -proportion is generated in certain fevers, and if it is -thrown out in the form of high-coloured, turbid urine, -the fever will most probably be slight and short; but if -it becomes pellucid, or <i>crude</i>, as it is called, the general -derangement will be increased, the fever will be more -violent and dangerous, and the first sign of returning -health will be a turbid appearance and sediment.</p> - -<p>If the reasoning in the above discussion should appear -to some readers unsatisfactory, or ill connected, I can -only say that if it is deserving of this character, I am -willing to have it considered not only as an illustration, -but an example of the nicety and fallacy of theoretical -disquisitions.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_104" href="#FNanchor_104" class="label">104</a> - <a href="#Page_437">See page 437-8</a>.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_105" href="#FNanchor_105" class="label">105</a> - I have been very cautious of admitting any theory -into this work; but I cannot help adopting the doctrine of -my much-valued master, Dr. Cullen, on this point, viz. -that a great part of the symptoms of fever arise from reaction, -or that effort which nature makes to overcome -the morbid cause. I am happy in any opportunity of acknowledging -my obligations to this learned professor, to -whom the medical world in general is so much indebted, -as well for the rational views of the animal œconomy, -which he teaches, as for that spirit of study and inquiry -which he infuses into the minds of his pupils.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_106" href="#FNanchor_106" class="label">106</a> - M. Desportes, who wrote a treatise on the diseases -of St. Domingo.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_107" href="#FNanchor_107" class="label">107</a> - There is a difference in the appearance of the blood -when sizy, perhaps not sufficiently insisted on by practical -writers; for though there should even be a very -thick buff, yet, if the surface is flat, and the <i>crassamentum</i> -tender, no great inflammation is indicated, in comparison -of that state of the blood wherein the surface is -cupped, the <i>crassamentum</i> contracted so as to afford the -appearance of a large portion of <i>serum</i>, and where it -feels firm and tenacious, though perhaps but thinly covered -with buff. This is a distinction well worth attending -to in practice; for it is in these last circumstances -that blood-letting gives most relief, and where the patient -will bear the repetition of it with most advantage.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_108" href="#FNanchor_108" class="label">108</a> - See the same observation in Mr. Hume’s Essay on -this Disease, published by Dr. Donald Monro.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_109" href="#FNanchor_109" class="label">109</a> - The state of the stomach is very much affected by -that of the external surface of the body; and it is sagaciously -observed by Sydenham, that the stomach being -commonly very irritable in the plague, the most effectual -means of making it retain what was administered internally -was to excite a sweat.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_110" href="#FNanchor_110" class="label">110</a> - The red bark was brought to England in a Spanish -prize in the year 1781, and a very accurate account of -its medical and chemical properties was published the year -after by Dr. William Saunders, of Guy’s hospital. None -of it had been brought to the West Indies before the -peace, so that I had no opportunity of trying it in that -climate.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_111" href="#FNanchor_111" class="label">111</a> - Mr. Telford related to me, that he had cured several -intermittents that had baffled the bark, by means of -white vitriol, whilst he was surgeon of the Yarmouth -in 1779. He gave it in doses of five grains every four -hours in the intermission, and was successful in every -case except two, in which the patients were far advanced -in the dropsy.</p> - -<p>He met with several cases of the same kind in the Alcide, -in 1782, in which he was successful with the flowers -of zinc, after having given large quantities of bark to no -purpose. He preferred, however, the white vitriol, as -being milder in its operation, and less apt to disagree with -the patient’s stomach.</p> - -<p>He did not employ either of them in the recent state -of the disease, nor does he assert that they are universal or -infallible remedies; but only alledges, that he has experienced -the most evident good effects from them in an -advanced stage of the disease, and a reduced state of the -patient, where the common remedy had failed.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_112" href="#FNanchor_112" class="label">112</a> - Dr. Huck Saunders, whose recent loss the world has -reason to regret on account of his experience and sagacity -as a physician, as well as his virtues as a man, communicated -to me, in conversation, some observations on the -cure of obstinate intermittents, which deserve to be mentioned -here. When he was physician to the army at the -Havannah he cured a number of agues which had resisted -the bark, by giving two ounces of the vinous tincture of -rhubarb and six drams of the tincture of sena seven or -eight hours before the fit. This being repeated two or -three times, carried off the disease. He also informed -me, that he had met with agues in England which did -not yield to the bark; but, upon leaving it off, and putting -the patients on a course of mercury, they were cured -upon returning to the use of the bark.</p> - -<p>Arsenic has also been found to be an effectual remedy -in intermittent fevers. I was informed by Dr. Huck -Saunders, that when he was in North America, in the -war before the last, there was an expedition undertaken -against the Cherokee Indians, whose country is extremely -subject to agues; and as an adequate quantity of bark -would have been very cumbersome where light service -was necessary, Mr. Russel, who had the medical management -of the expedition, provided a great number of -pills, containing each one eighth part of a grain of arsenic, -by the proper use of which he was enabled to cure -the intermittent fevers with which the troops were seized.</p> - -<p>I shall here mention another unusual remedy in intermitting -fevers; and though I can bring only one instance -in proof of its efficacy, yet this is so strong as to make it -deserve farther trial. A man, on board of the Sandwich, -had an obstinate intermittent which had resisted the bark, -and was stopped by applying to the stomach a plaster, -composed of gum plaster, epispastic plaster, and opium, -in proportions which I do not now recollect.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_113" href="#FNanchor_113" class="label">113</a> - Sir John Pringle on the Diseases of the Army.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_114" href="#FNanchor_114" class="label">114</a> - This is elegantly expressed as follows, in Sir George -Baker’s learned Dissertation on this disease:—“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.”</p></div> - -<div class="footnote"> - -<p><a id="Footnote_115" href="#FNanchor_115" class="label">115</a> - In Dr. Griffith’s form of his medicine for the piles, -six drachms of fresh-drawn linseed oil are joined with -two drachms and a half of the vinous tincture of rhubarb, -and given twice a day in a draught. I commonly -used oil of almonds at the hospital. This may be considered -as another instance of those useful combinations of -medicines, which experience alone sometimes discovers. -I have found it of use also in other internal hæmorrahages.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_116" href="#FNanchor_116" class="label">116</a> - See Diseases of the Army, p. 273. 6th Edit.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_117" href="#FNanchor_117" class="label">117</a> - Since coming to England, I have been informed by -Dr. Garden, a learned and ingenious practitioner from -South Carolina, that this medicine, in order to produce -its proper effect, should be given in a very weak decoction; -for that after having almost abandoned it in consequence -of its failure when he gave it in strong decoctions, -and in substance, he was again convinced of its -efficacy by using it in a very weak decoction, a scruple -being boiled in a pint of water to half a pint.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_118" href="#FNanchor_118" class="label">118</a> - <a href="#Page_345">See page 345</a>. A fact mentioned in Capt. Cooke’s -Voyage to the North Pacific Ocean, may be also alledged -in favour of this opinion. He remarks, that the -Kamschadales, who were habituated to hard labour, -were free from scurvy, while the Russians and Cossacks, -who were in garrison in their country, and led indolent -lives, were subject to it.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_119" href="#FNanchor_119" class="label">119</a> - I was informed of this fact by Mr. Cairncross, an -ingenious surgeon belonging to one of the battalions that -served there during the siege.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_120" href="#FNanchor_120" class="label">120</a> - I imagined that this was a new practice; but I find, -since the first edition of this work was printed, that it -has been recommended by Pere Labat in his voyage to -the Antilles.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_121" href="#FNanchor_121" class="label">121</a> - There is a symptom which takes place when men are -beginning to recover from scurvy, (particularly when -the cure is rapidly effected by the use of lemon and -orange juice) upon which I have frequently reflected, -but for which I have never been able to account. This -consists in acute pains, which are felt in the breast and -limbs, resembling rheumatic pains. I once knew the -crew of a ship which was much affected with scurvy, -and had about ninety men under cure by lemons and -oranges, who were most of them affected with this -symptom in one night, and made such a noise by crying -out as to alarm the officers who were upon duty.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_122" href="#FNanchor_122" class="label">122</a> - See the Medical Essays of Edinburgh. Sennertus, -lib. iii. part i. sect. ii.—Haller Elem. Physiolog. lib. xix. -sect. ii.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_123" href="#FNanchor_123" class="label">123</a> - In the Princessa, 1781, and the Nonsuch, Prince -George, and Royal Oak, in 1782.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_124" href="#FNanchor_124" class="label">124</a> - Since this was first written, the melancholy tidings -have arrived of another case to be added to this fatal list. -It is that of the amiable and gallant Lord Robert Manners, -who commanded the Resolution on the 12th of -April, and having lost his leg, besides receiving a wound -in his arm and breast, died of this untractable symptom -on his passage to England; and though he shared a fate to -be envied by every lover of true glory, his loss can never -be enough deplored by his country and friends, being -formed by his great virtues and accomplishments, joined -to the lustre of his rank, to hold out an example of all -that was good and great as a man and an officer.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_125" href="#FNanchor_125" class="label">125</a> - See Kaau Boerhaave’s account of this epilepsy in a -school at Harlaem, in a book, entitled Impetum faciens -dictum Hippocrate per corpus consentiens (page 355.) -A fact of the same kind is also related in a pamphlet, -entitled Rapport des Commissaires chargés par le Roi de -l’examen du Magnetisme Animal.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_126" href="#FNanchor_126" class="label">126</a> - London Medical Observations and Inquiries, Vol. VI.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_127" href="#FNanchor_127" class="label">127</a> - Medical Commentaries, Vol. III., and a Thesis printed -at Edinburgh, 1784.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_128" href="#FNanchor_128" class="label">128</a> - See experiments on a heated room. Philosophical -Transactions, 1775, Vol. LXV.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_129" href="#FNanchor_129" class="label">129</a> - That species of locked jaw, called by authors the -<i>Trismus Infantium</i>, to which children are liable the first -week after birth, is probably owing to the contact of -the external air upon the skin, which is accustomed in -the womb to a moist and warm medium.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_130" href="#FNanchor_130" class="label">130</a> - 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_131" href="#FNanchor_131" class="label">131</a> - There are several valuable practical remarks on this -complaint in some of the ancient authors, especially -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 <i>hiera</i>, 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_132" href="#FNanchor_132" class="label">132</a> - This is a fact which does not admit of doubt; but -the manner in which the effect is here produced is a matter -of conjecture. It is most probably owing to the -compression and tremor of the air in consequence of its -resistance to the motion of the ball. We can also conceive, -that, with regard to an yielding part, such as the -stomach or abdomen, a body flying with great velocity -may even, for a moment, displace a portion of it by -passing through the same space, without any other mechanical -injury than contusion, in a manner similar to -what happens to two balls in the act of collision in philosophical -experiments made to illustrate the nature of -elasticity; or the compressed air may even, in this case, -act, as it were, like a cushion, preventing the sudden -impulse and contact of the ball. This explanation furnishes -a reason why the parts of the body above mentioned -should be more liable to be affected by accidents -of this kind than the head. Perhaps this difference may -also, in part, arise from the principle laid down by Mr. -Hunter, that the stomach is more essential to life, and -more immediately the seat of it, than the head or any -other member or organ of the body, and that an injury -to this part is more immediately destructive of life than -any other.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_133" href="#FNanchor_133" class="label">133</a> - The honourable Captain Fitzroy.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_134" href="#FNanchor_134" class="label">134</a> - Colonel Markham.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_135" href="#FNanchor_135" class="label">135</a> - Animals are affected by these accidents as well as -men. A cow in one of the ships was killed in one of -the actions in April, by a double-headed shot passing -close to the small of her back.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_136" href="#FNanchor_136" class="label">136</a> - Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ excerpta -est.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_137" href="#FNanchor_137" class="label">137</a> - Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta -est.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_138" href="#FNanchor_138" class="label">138</a> - Vide pag. 408.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_139" href="#FNanchor_139" class="label">139</a> - Vide pag. 409. 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_140" href="#FNanchor_140" class="label">140</a> - Vide pag. 456.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_141" href="#FNanchor_141" class="label">141</a> - Ex auctoritate Cl. Huck Saunders.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_142" href="#FNanchor_142" class="label">142</a> - Ex auctoritate Cl. Huck Saunders.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_143" href="#FNanchor_143" class="label">143</a> - Ex auctoritate Cl. Lind.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_144" href="#FNanchor_144" class="label">144</a> - Vide pag. 479.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_145" href="#FNanchor_145" class="label">145</a> - Vide pag. 489.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_146" href="#FNanchor_146" class="label">146</a> - Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo -de morbis castrensibus.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_147" href="#FNanchor_147" class="label">147</a> - Hæc formula ex Pharmacopœiâ Nosocomii Sti. Thomæ, excerpta -est.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_148" href="#FNanchor_148" class="label">148</a> - Vice olei ricini dare licet olei amygdalæ unciam unam cum -tincturæ sennæ unciâ dimidiâ. Vide Pharm. Nosoc. Sti.Thomæ.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_149" href="#FNanchor_149" class="label">149</a> - Hæc formula ex auctoritate Cl. Griffiths. In periculis a me -ipso factis felicissimum successum ex hoc medicamento percepi.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_150" href="#FNanchor_150" class="label">150</a> - Hoc medicamentum speciatim his 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_151" href="#FNanchor_151" class="label">151</a> - Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta -est.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_152" href="#FNanchor_152" class="label">152</a> - 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_153" href="#FNanchor_153" class="label">153</a> - 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_154" href="#FNanchor_154" class="label">154</a> - Vide Cl. Pringle in opere suo de morbis castrensibus.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_155" href="#FNanchor_155" class="label">155</a> - Hujus doctrinæ auctor est Hippocrates, quæ restaurata est -auctaque a Cl. Milman in opusculo suo de hydrope.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_156" href="#FNanchor_156" class="label">156</a> - 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.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_157" href="#FNanchor_157" class="label">157</a> - Vide opus Cl. Johannis Hunter de morbo venereo.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_158" href="#FNanchor_158" class="label">158</a> - Vires opii in isto morbo primo innotuerunt ex experientiâ -Cl. Nooth, dum præfuit nosocomiis militaribus in America, & -pro optimo remedio a peritissimis medicis & chirurgis jam habetur.</p></div> - -<div class="footnote"> - -<p><a id="Footnote_159" href="#FNanchor_159" class="label">159</a> - Non hic intelligitur ptyalismum veram esse causam 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.</p></div></div> - -<div class="transnote"> - -<h3>Transcriber's Note:</h3> - -<p>Inconsistent spelling and hyphenation are as in the original.</p> - -</div> - - - - - - - - -<pre> - - - - - -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-h.htm or 53007-h.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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