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  OBSERVATIONS

  ON THE

  DISEASES

  OF

  SEAMEN.

  BY

  GILBERT BLANE, M. D.

  F. R. S. S. LOND. AND EDIN.

  PHYSICIAN EXTRAORDINARY TO THE PRINCE OF WALES,
  PHYSICIAN TO THE DUKE OF CLARENCE,
  AND TO ST. THOMAS’S HOSPITAL.

  THE SECOND EDITION,

  WITH CORRECTIONS AND ADDITIONS.

  LONDON:

  Printed by JOSEPH COOPER;
  And sold by JOHN MURRAY, No. 32 Fleet Street;
  J. JOHNSON, St. Paul’s Church Yard;
  And by WILLIAM CREECH, in Edinburgh.

  M.DCC.LXXXIX.

 Nec Medici, nec Imperatores, nec Oratores, quamvis artis præcepta
 perceperint, quidquam magna laude dignum sine usu et excercitatione
 consequi possunt.

  CICERO.




CONTENTS.


  PART I.

  BOOK I.


  Comprehending the Medical History of the Fleet, from March 1780,
    till August 1781                                                  17


  CHAP. I.

  ACCOUNT of the Health of the Fleet from March 1780,
    till July following                                            _ib._


  CHAP. II.

  ACCOUNT of the Health of the Fleet from August 1780,
    till December following                                           35

  CHAP. III.

  ACCOUNT of the Health of the Fleet from January 1781,
    till July 1781, both Months included                              46


  BOOK II.

  Continuation of the Medical History of the Fleet, from August
    1781, till the Conclusion of the War in April 1783                63


  CHAP. I.

  Some ACCOUNT of the Interval between the Campaigns of
    1781, and the Junction of the Reinforcement from England in
    April 1782                                                     _ib._


  CHAP. II.

  ACCOUNT of the Health of the Fleet from the Junction
    of the Squadron from England, till the general Rendezvous at
    St. Lucia, in the beginning of April                              75


  CHAP. III.

  STATE of HEALTH of the Fleet in April 1782                          98

  CHAP. IV.

  ACCOUNT of the Health of the Fleet while it lay at
    Jamaica, during May, June, and part of July, 1782                109


  CHAP. V.

  ACCOUNT of the Health of the Fleet from its leaving Jamaica
    on the 17th of July 1782, till its Departure from New York
    on the 25th of October following                                 139


  CHAP. VI.

  ACCOUNT of the Health of the Fleet from its Departure from
    New York till the Conclusion of the War                          158


  BOOK III.

  Of the NUMBERS and MORTALITY of different DISEASES sent to
    Hospitals, with a general View of the whole Mortality during
    the War                                                          185




  PART II.


  Of the CAUSES of Sickness in Fleets, and the Means of PREVENTION   211

  Introduction                                                     _ib._


  CHAP. I.

  Of Air      225

  Sect. I. Of the noxious Effects of Land Air in particular
    Situations                                                       227

  Sect. II. Of the Effects of foul Air from the Neglect of
    Cleanliness in Men’s Persons--INFECTION      237

    1. Means of preventing the Introduction of Infection             240

    2. Means of preventing the Production of Infection               254

    3. Means of eradicating Infection                                264

  Sect. III. Of the foul Air generated in a Ship                     281

  ---- IV. Means of guarding against Infection and bad Air           293


  CHAP. II.

  Of Aliment                                                         300

  Sect. I. Of solid Food                                           _ib._

  ---- II. Of Drink                                                  319

  Of Water                                                           324


  CHAP. III.

  Of Clothing                                                        334


  CHAP. IV.

  Of Exercise                                                        343

  CONCLUSION                                                         349

  APPENDIX to PART II.                                               352

  Memorial to the Admiralty                                        _ib._

  Supplement to the Memorial                                         364


  PART III.

  DESCRIPTION and TREATMENT of the Diseases most frequently
    occurring in Fleets in hot Climates                              368


  CHAP. I.

  Of Fevers                                                          370

    1. Of the infectious Ship Fever                                  371

    2. Of the bilious Remitting Fever                                415

    3. Of the Yellow Fever                                           425

    4. Of the Effects of some unusual Remedies in the Cure of
        obstinate Intermittent Fevers                                456


  CHAP. II.

  Of Fluxes                                                          466


  CHAP. III.

  Of Scurvy                                                          499


  CHAP. IV.

  Of the WOUNDS received in the Actions of April 1782                519

  APPENDIX TO PART III.                                              545

  Assortment of Medicines to be carried to Sea                       548

  Formulæ Medicamentorum                                             550




  DEDICATION.

  TO HIS

  ROYAL HIGHNESS

  PRINCE WILLIAM-HENRY.


  SIR,

The following Work is the fruit of several years labour employed in the
Public Service, chiefly under that great and successful Admiral, Lord
Rodney, in a series of Naval Operations, which have been productive
of events more glorious than any recorded in the Annals of Britain.
As your Royal Highness was present during some part of the service
which is the subject of these Observations, and as You have not only
honoured the Sea Service by embracing it as a profession, and enrolling
your illustrious Name among its officers, but in undergoing the dangers
and fatigues of actual service, which is so necessary to attain that
practical Skill which Your Royal Highness is well known to possess, I
have, upon these grounds, presumed to lay this Work at Your feet. I
should do this with greater satisfaction, were it more worthy of Your
acceptance; but however inadequate my abilities may have been to the
talk, it has been my sincere aim to produce a work of some utility to
that only Bulwark of our Country, the British Navy, of which your Royal
Highness is the Pride and the Hope.

Your Royal Highness’s Permission to inscribe this work to You, and
the personal Notice and Protection with which you have been pleased
to honour me, I consider as the first Distinctions of my life, and of
which I shall ever entertain a becoming sense, by cherishing those
indelible sentiments of Respect, Gratitude, and Attachment, which are
due to Your Royal Highness from

    Your Royal Highness’s
      Most faithful,
        Most obedient, and
          Most devoted Servant,
        GILBERT BLANE.

    LONDON,
    May 1, 1785.




PREFACE.


Having been appointed by Lord Rodney Physician to the Fleet under his
command, in the beginning of the year 1780, I determined to avail
myself, to the utmost of my abilities, of the advantages which this
field of observation afforded. This I was led to do, in order to
satisfy my own mind as a matter of duty, as well as to find out, if
possible, the means of bettering the condition of a class of men, who
are the bulwark of the state, but whose lot is hardship and disease,
above that of all others.

A fleet, consisting seldom of less than twenty ships of the line
of battle, and sometimes exceeding forty, which I attended in the
different scenes of active service in that distant and unhealthy
region, for more than three years, has afforded me opportunities of
making observations upon a large scale.

My object has been prevention as much as cure; and as the former must
more particularly depend on a knowledge of the external causes of
disease, I have collected and arranged all the facts upon this subject
that came within my reach, considering these as the only grounds from
whence the remote causes of health and sickness could be deduced.

When I entered upon my employment, the Commander in Chief gave an
order, that every surgeon in the fleet should send me a monthly
return, stating the degree of prevalence of different diseases, the
mortality, and whatever else related to the health of the respective
ships. This was done with a view to enable me to regulate the reception
of men into hospitals, so that each ship might have a due proportion of
relief, according to the degree of sickness on board, taking care at
the same time that the hospitals should not be overcrowded; and also
to acquaint the Commander in Chief, from time to time, of the state
of sickness, or the predominance of particular diseases, in order to
recommend such articles of diet, or other means, as might tend to cure
them, or to check their progress. These returns have served also in
this work as a method of collecting a multitude of well-established
facts, tending to ascertain the causes and course of disease.

While the fleet was in port, I also superintended and visited daily the
hospitals, of which there is one at almost every island on the station;
and having kept an account of the different kinds of disease that were
admitted, and of their mortality, I have in this way likewise been
furnished with a number of facts that may throw light on the history of
human maladies.

Nevertheless, I do not boast of having made great discoveries; and
every person of a correct judgement must be aware how difficult it
is to ascertain truths, and to draw fair and solid inferences, on
medical subjects. I have attempted little more than to amass, from my
own observation, and by the assistance of the surgeons of the fleet,
a number of well-established facts, and to arrange them in such a
methodical manner, as to prove a groundwork for investigation; and I am
persuaded that others, of more sagacity and enlarged knowledge than
myself, may be able to deduce from them, observations that may have
escaped me especially if these new, but imperfect, attempts should come
to be compared with similar ones that may be made by other observers in
other climates, and in other circumstances of service.

I met with several obstacles in instituting inquiries, purely medical,
to the extent I could have wished. There is, in the first place, from
the nature of the subject, a great difficulty attending all practical
inquiries in medicine; for, in order to ascertain truth, in a manner
that is satisfactory to a mind habituated to chaste investigation,
there must be a series of patient and attentive observations upon
a great number of cases, and the different trials must be varied,
weighed, and compared, in order to form a proper estimate of the real
efficacy of different remedies and modes of treatment.

But besides this difficulty belonging to the nature of the subject,
there were others connected with the nature of the service; for the
hospitals were at times so inadequate in point of size, and so ill
provided with necessary articles and accommodations, particularly
during the first part of my attendance, that my principal care was to
remedy these defects by proper superintendence and representation.

A due attention to air, diet, and cleanliness, is not only more
essential than mere medical treatment, but the sick cannot be
considered as fit subjects for evincing the powers of medicine till
they are properly provided for in these respects. These inconveniences
were owing, in a great measure, to the unusual extent of the service;
for there was a much greater naval force in those seas, at this period,
than was ever before known, and there was of course a proportional
want of accommodation for the sick. Towards the end of the war these
difficulties were much obviated, so that a fairer field of observation
presented itself.

Another obstacle to my practical inquiries was, that the fleets I
belonged to seldom remained more than six weeks or two months at any
one place, so that any series of observations that might have been
instituted was interrupted, and I was in a great degree deprived of the
fruits of them, by not seeing the event of cases under my management.

The peace in the spring of the year 1783 put an end to all my
inquiries, and particularly prevented me from following out some
practical researches. I have ventured, however, in one part of this
work, to give the result of my experience in some diseases, more
especially such as are peculiar to the climate and mode of life.

Upon the whole, I have, in the following work, humbly attempted to
follow what I conceive to be the only true method of cultivating any
practical art, that is, to collect and compare a great number of
facts. A few individual cases are not to be relied on as a foundation
of general reasoning, the deductions from them being inconclusive and
fallacious, and they are liable to be turned and glossed, according as
the mind of the observer may he biassed by a favourite prepossession or
hypothesis. It has been my study to exhibit a rigid transcript of truth
and nature upon a large scale, and to take the average of numberless
particular facts, to serve as a groundwork for observation; and I
have endeavoured to analyse and collate these facts, by throwing the
monthly returns that were made to me into the form of Tables, as the
most certain and compendious way for finding their general result. If
the materials are not sufficiently ample, or if the method should be
found faulty and imperfect, let it be remembered, that I had no example
to go by in this field of observation. It is to be regretted, that ages
have passed without any attempts being made to transmit regular records
of this kind to posterity. It would not only be extremely curious, as
a piece of natural knowledge, but would conduce greatly to medical
improvement and public utility, were we possessed of such information
concerning the causes and nature of the diseases prevailing at sea, in
various circumstances of weather, climate, and diet, in remote ages and
countries, or even in our own age and country, as might enable us to
compare them with present facts, and to ascertain more precisely the
means of preventing and removing such diseases.

The favourable reception which the first edition of this work has met
with, renders it necessary to offer another to the Public; and though
no new opportunities have occurred of making additional observations in
the naval service I have endeavoured, during the last two years, from
a pretty extensive experience in a large hospital, and from private
practice, to add some new information on some practical points; and I
hope this edition will be found throughout more full and correct than
the former.

The method I propose to follow in this work, is, First, to deliver the
history of the different voyages and expeditions, so far as relates to
health, giving an account of the prevalence and nature of the diseases
and mortality on board of ships and in hospitals.

Secondly, To deduce, from observations founded on these facts, and also
from the former experience of others, the causes of sickness in fleets,
and the means of prevention.

Thirdly, To deliver some practical observations on the cure of the most
common diseases incident to fleets, particularly in hot climates.




  OBSERVATIONS.

  PART I.

  BOOK I.

 Comprehending the MEDICAL HISTORY of the FLEET, from March, 1780, till
 August, 1781.




CHAP. I.

 Containing an Account of the HEALTH of the FLEET from March,
 1780, till July following.----Five Ships of the Line arrive at
 Barbadoes from Europe in March--Join a large Squadron then on that
 Station--Their Health compared--Engagements with the Enemy in April
 and May producing Hardship and Exposure, but little Increase of
 Sickness--Method of collecting the Returns of the Surgeons--Influence
 of Situation upon Health in Harbours--Course of the Seasons, and
 Temperature of the West Indies--The Fleet reinforced in June and July
 with Ships from England and North America--Their Health.


During the war, which broke out with France in 1778, and with Spain in
1779, the West Indies was the principal seat of naval operations, and
much greater fleets were then employed in that quarter of the world
than in any former period.

Though there had been a great squadron on the Caribbee station during
the greater part of 1779, no physician was appointed to it till the
beginning of the next year, when I arrived there in that character with
my friend and protector, Lord Rodney.

There were then sixteen ships of the line on that station, most of
which had been upwards of twelve months in the climate; and they were
reinforced at this time by five more from England.

The squadron which we found on the station was then extremely healthy,
and in several of the ships there was not a man unfit for duty. We were
told, however, that they had all been subject to sickness, particularly
to the dysentery, soon after their arrival in that climate. Of the five
with which the fleet was at this time reinforced, all but the Intrepid
left England at Christmas, making part of the squadron which effected
the first relief of Gibraltar, under the command of Lord Rodney, who
continued his route to the West Indies, in order to take the command
on the Windward station, where he arrived on the 16th of March. The
Intrepid had arrived with a convoy the day before. These five ships
were all pretty healthy on their passage, except the Sandwich and
Terrible, in which a fever prevailed; but they had almost recovered
from it before they arrived in the West Indies. A dysentery broke
out in April in all the ships newly arrived, and it prevailed to the
greatest degree in those which had been most affected with fevers in
Europe, namely, in the Terrible and Intrepid. The Sandwich and Ajax
were also affected, though in a less degree; but the Montagu, though
this was her first voyage, and though she was just off the stocks, had
been the most healthy of any of them from the time of leaving England,
and continued so during all this campaign. I have not observed that
new ships are more unhealthy than others, unless they are built of
ill-seasoned timber; and they have this advantage, that there is no
previous infection adhering to them. What may have contributed also
to the superior health of the Montagu, was the precaution that was
taken when this ship was first manned and fitted out, of stripping and
washing the men that were brought from the guardship to complete the
crew.

The Intrepid, while in England, had been afflicted with fevers to a
most uncommon degree; for, being one of the fleet in the Channel cruise
the year before, almost the whole crew either died at sea, or were
sent to the hospital upon arriving at Portsmouth. This ship, after
refitting, was pretty healthy for a little time; but, probably from the
operation of the old adhering infection, she became extremely sickly
immediately after joining our fleet, and sent two hundred men to the
hospital the first two months after arriving in the West Indies. Most
of these were ill of the dysentery.

The Pegasus frigate arrived with the ships from Gibraltar, and we have
here an instance of the superior health commonly enjoyed by this class
of ships over ships of the line; for when she was dispatched to England
in the end of April, there had not been a man taken ill from the time
of her arrival on the station.

This season was a very active one in the operations of war; for,
besides the general battle of the 17th of April, there were two partial
actions in May; and, from the 15th of the former month till the 20th of
the latter, our fleet was constantly in the face of the enemy’s, except
for a few days that it was refitting at St. Lucia after the first
battle. This was extremely harrassing to the men, not only from the
incessant labour necessary in the evolutions of the fleet, but by their
being constantly at quarters with the ships clear for action; for, in
that situation, they had nothing to sleep upon but the bare decks, the
hammocks and bedding being removed from between decks, where they might
embarrass the men in fighting, and they become useful on the quarter
deck, by serving to barricade the ship, which is done by placing them
in ranges on the gunwale, to cover the men from the enemy’s grape and
small shot. These hardships were productive of some sickness, though
much less than might have been expected; for the weather is at all
times warm, and it was at this time extremely moderate and dry. Besides
we shall see in other instances as well as this, that, in the ardour
inspired by the presence of an enemy, men are less exhausted by their
exertions than on ordinary and less interesting occasions.

Almost the whole of the sick and wounded, to the number of 750, were
put on shore at Barbadoes, where all the fleet, except three ships[1],
arrived on the 22d of May.

I now began to keep regular and methodical accounts of the sickness
and mortality in the fleet, though in a manner more imperfect and less
accurate than was afterwards adopted. I was embarked on board of the
Sandwich, where the Commander in Chief had his flag, so that I was
always present with the main body of the fleet, whether at sea or in
port.

A form of monthly returns[2] was adopted, which, as well as other
points of method, was afterwards improved.

After collecting the returns for each month, I made abstracts of them
in tables; in one column of which the complement of each ship is set
down, in order to form calculations of the comparative prevalence
and mortality of different diseases at different times. One of the
abstracts is here inserted, (Table I.) by way of specimen, and the
proportional result of them for fourteen months is set down in another
table, (Table II.)

Though this last exhibits a tolerably just view, yet it may be
remarked, as one imperfection, that there was no distinction made
at this time in my returns between the killed and those who died
of disease; so that in the month of May, which stands first, the
proportion is too high; for there were sixty-four killed, and two
hundred wounded, in the two actions of that month.


TABLE I.

  +--------------------------------------------+
  | ABSTRACT OF RETURNS,                       |
  | 1ST JUNE, 1781.                            |
  +--------------------------------------------+
  |   Transcriber’s keys:                      |
  |                                            |
  |   A Complement.                            |
  |   B Sick and Wounded on Board.             |
  |   C Sent to the Hospital in the            |
  |       course of last Month.                |
  |   D Dead on Board in the course            |
  |       of last Month.                       |
  +----------------+--------+------+------+----+
  | SHIPS’         |   A    |  B   |  C   | D  |
  | NAMES.         |        |      |      |    |
  +----------------+--------+------+------+----+
  | Sandwich       |   732  |  28  |  36  |  2 |
  +----------------+--------+------+------+----+
  | Barfleur       |   767  | 133  |  22  |  1 |
  +----------------+--------+------+------+----+
  | Gibraltar      |   650  |  67  |  88  | 10 |
  +----------------+--------+------+------+----+
  | Triumph        |   650  |   7  |   9  |  2 |
  +----------------+--------+------+------+----+
  | Centaur        |   650  |  45  |  26     5 |
  +----------------+--------+------+------+----+
  | Torbay         |   600     31  |  57  |  5 |
  +----------------+--------+------+------+----+
  | Monarch        |   600  |  62  |  14  |  2 |
  +----------------+--------+------+------+----+
  | Terrible       |   600  |  85  |  24  |  1 |
  +----------------+--------+------+------+----+
  | Alfred         |   600  |  57  |  38  |  1 |
  +----------------+--------+------+------+----+
  | Russel         |   600  |  44  | 134  |  7 |
  +----------------+--------+------+------+----+
  | Alcide         |   600  |  42  |  35  |  1 |
  +----------------+--------+------+------+----+
  | Shrewsbury     |   600  |  30  |  23  |  5 |
  +----------------+--------+------+------+----+
  | Invincible     |   600  |  50  |  63  |  9 |
  +----------------+--------+------+------+----+
  | Resolution     |   600  | 107  |  54  |  3 |
  +----------------+--------+------+------+----+
  | Ajax           |   550  |  20  |  10  |  2 |
  +----------------+--------+------+------+----+
  | Princessa      |   560  |  88  |  40  |  5 |
  +----------------+--------+------+------+----+
  | Belliqueux     |   500  |  19  |   0  |  1 |
  +----------------+--------+------+------+----+
  | Prince William |   500  |  25  |  14  |  2 |
  +----------------+--------+------+------+----+
  | Panther        |   420  |  16  |   6  |  0 |
  +----------------+--------+------+------+----+
  | Triton         |   200  |   5  |   1  |  0 |
  +----------------+--------+------+------+----+
  | Hyena          |   200  |  11  |   0  |  0 |
  +----------------+--------+------+------+----+
  | Cyclops        |   200  |   5  |   2  |  0 |
  +----------------+--------+------+------+----+
  |     Total      | 11979  | 977  | 696  | 64 |
  +----------------+--------+------+------+----+

The main body of the fleet lay at Barbadoes till the 6th of June, and
the men had recruited extremely by their stay there; for vegetables,
fruit, and other refreshments, can be procured at an easier rate, and
in much greater plenty, at this island, than any other on the station.

The fleet arrived at St. Lucia the next day after it sailed from
Barbadoes, and remained there till the 18th of June. The whole of this
month was showery at this island, though it is not accounted the common
rainy season; for more rain falls here than at any of the other islands
at that time in our possession, being the most mountainous, as well as
the most woody and uncultivated, of them all. These rains produced some
increase of sickness, but very little, when compared to what took place
at the same time in the army on shore, and in the ships refitting at
the Carenage. There died about this time from fifty to fifty-five men
every week in an army of not quite two thousand men.

The difference in point of health between the Carenage (which, as the
word implies, is the place where ships go to be hove down, or otherwise
repaired) and Gros-Islet Bay, where the main body of the fleet lay,
affords a striking proof of the effects of situation. The Carenage is
a land-locked creek, with a marsh adjacent to it, whereas the other is
a road open to the fine air of the sea, the only land sheltering it to
windward being a small, dry island, consisting of one hill, of half a
league in circumference, and some of the cliffs of the main island of
St. Lucia.

The increase of sickness here was farther prevented by the men
having little labour to perform on shore, nor any haunts to
encourage intemperance, a vice which the Admiral endeavoured still
more effectually to prevent, by ordering all the rum stills in the
neighbourhood to be destroyed.

It may be proper here to introduce a general account of the seasons
and temperature of the West Indies, as there will be frequent occasion
hereafter to make allusions to them. With regard to the heat, though
the range of the temperature is very small, in comparison of what it
is in Europe, the variations follow the same seasons; for July and
August are the hottest months, and December and January the coolest.
This we would naturally expect, as our plantations lie all in the
northern hemisphere, between the 10th and 20th degree of N. latitude,
and therefore bear the same relation as Europe does to the sun’s
annual course. The hurricanes happen in the same season in which the
periodical rains chiefly fall, that is, in the months of August,
September, and October, which are called the hurricane months, and
this is also the most unhealthy season. The time of the year which is
most apt to be rainy, next to this, is from the middle of May to the
middle or end of June, but this is not invariable. The lowest I ever
observed the thermometer was at 69°; it stands very commonly at 72° at
sunrise, in the cool season, rising to 78° or 79° in the middle of the
day. In the hot season, the common range is from 76° to 83°. It seldom
exceeds this in the shade at sea; and the greatest height at which I
ever observed it in the shade at land was 87°. This is far short of
the extremes of heat which they experience at certain seasons on the
continent of North America, even very far north. In Pennsylvania and
New York, the thermometer, I have been assured, rises frequently above
90°. It does so commonly enough in the East Indies; but I believe it
never was known to rise so high in the West Indies, so that the heat,
comparatively speaking, may be called moderate and steady.

The comparative mortality in June is small, owing to the fleet’s having
been cleared of all the bad cases at Barbadoes before it sailed from
thence. Though the proportion of sick in July is less, that of the
mortality is greater, (see Table II.) which seems to be owing to this
circumstance, that the cases taken ill during the rainy weather of June
did not terminate fatally till the succeeding month.

In the course of this summer the fleet was reinforced by several ships
of the line from England. The Triumph arrived in May, without any sick
on board; but a flux prevailed a few weeks afterwards, without any
evident cause, except the influence of the climate, and the exposure
and fatigues during the operations of May. The disease, however, soon
subsided, and the ship being kept in excellent order and discipline,
continued healthy during all the remaining time in which she served
with us.

In June, the Russel, of 74 guns, arrived from North America, and the
Shrewsbury, a ship of the same rate, from England. The former left
England in 1778, but was obliged to put back by stress of weather
and sickness, and upon arriving afterwards on the coast of America,
was extremely afflicted both with fevers and the scurvy. These were
removed to the hospital, and this ship had become free of all sickness
before sailing for the West Indies, except that a few of the men were
seized with fevers, and she remained healthy after arriving there, not
suffering from any regular attack of sickness, such as affected the
ships in general from Europe. The Shrewsbury left England healthy, but
was soon attacked with a fever and flux, which continued to prevail
till the end of the year.

The fever in these two ships resembled rather the low ship fever of
Europe than the bilious one peculiar to the climate. This last, indeed,
seldom or never prevails to a great degree on board of a ship, unless
it has been caught on the watering duty, or from some other exposure to
the air of the land. I have, however, known a few instances of bilious
fevers in men who never had been on shore from the time they left
England; I have even known men of the same description attacked with
intermittent fevers, which are supposed to depend still more on land
air. This is perhaps owing either to the quantity of water in a great
ship, part of which is always more or less putrid, or to the fresh-cut
wood of the country taken on board for fuel, the steam of all which
must resemble a good deal the effluvia of woods and marshes, which are
supposed to give rise to intermittents.

In the beginning of July our fleet was reinforced with the Culloden,
Egmont, and Centaur, all of 74 guns. In the end of the same month
we were joined by the Alcide and Torbay, of the same rate, and also
directly from England. The fleet was at this time at St. Christopher’s,
having arrived there on the 22d of the month, with a large convoy from
England, which had joined it at St. Lucia, under protection of the
Thunderer and Berwick, two ships of the line, which being bound to
Jamaica, I do not reckon as belonging to our fleet.


TABLE II.

 Shewing the proportional Sickness and Mortality, in relation to the
 whole Numbers on board, for fourteen Months.

  +------------------------------------------------------+
  | Transcriber’s keys:                                  |
  | A Proportion of Sick and                             |
  |     Wounded on board on                              |
  |     the First of the Month.                          |
  |                                                      |
  | B Proportion of Sick and                             |
  |     Wounded sent to the                              |
  |     Hospital in the Course                           |
  |     of the Month.                                    |
  |                                                      |
  | C Proportion of Deaths                               |
  |     on board in the Course                           |
  |     of the Month.                                    |
  +-----------------+-----------+----------+-------------+
  | Months.         |   A       |   B      |   C         |
  +-----------------+-----------+----------+-------------+
  |                 | ONE IN    | ONE IN   | ONE IN      |
  +-----------------+-----------+----------+-------------+
  | May, 1780       |  18½      |  20½     |  87         |
  | June            |  13       |  68½     | 418         |
  | July            |  17½      |  80      | 163         |
  | August          |  18       | 227      |  80         |
  | September       |   9       |   6      | 188         |
  | October         |  14       |  25      |   0         |
  | November        |  33½      | 192      | 265         |
  | December        |  16       |  67      | 185         |
  | January, 1781   |  14       |  60½     | 316         |
  | February        |  18       | 413      | 214         |
  | March           |  15½      |  30      | 201         |
  | April           |  11       |  59      | 169         |
  | May             |   9½      |  17      | 188         |
  | June            |  12       |  40      | 701         |
  +-----------------+-----------+----------+-------------+
  | Mean Proportion |  15½      |  93      | 227         |
  +-----------------+-----------+----------+-------------+




CHAP. II.

 Account of the HEALTH of the FLEET from August, 1780, till December
 following.----The Fleet divided--The principal Squadron goes to North
 America--Fluctuation between Fevers and Fluxes--The Alcide and Torbay
 the most sickly Ships--Health mended by the Climate and Diet in North
 America--Hurricane in the West Indies--Sufferings in consequence of
 it--Fevers the chief Disease.


The hurricane months approaching, the season for active operations in
the West Indies was now over. The whole force of the enemy, consisting
of thirty-fix French and Spanish ships of the line, having gone to St.
Domingo in the end of July, ten sail of the line were detached after
them from our station, for the protection of Jamaica. The Admiral
sailed for North America in August, with eleven ships of the line,
leaving six for the protection of the islands.

There was little alteration in the general state of the sick during the
voyage to America, and indeed we found no diminution of the West-India
heat, which at this season is at the greatest height, until we came to
the 33° of N. latitude.

The only material alteration in point of health was in the Alcide and
Torbay, which had arrived from England with a few men ill of fevers;
but in the course of this voyage these two ships became as unhealthy as
any that ever came under my observation. There was a greater number of
sick on board of them than all the fleet besides, and it increased to
such a degree, that upon their arrival at New York, which was in the
middle of September, after a passage of three weeks, near one half of
their men were unfit for duty. In the Alcide it was a fever that raged;
in the Torbay it was a dysentery; and the unusual degree of sickness
and mortality which appears in the Table for the month of September,
was owing to the very sickly state of these two ships.


TABLE III.

Shewing the Number of Fevers and Fluxes on board on
the First of each Month, and the Number sent to the Hospital in the
Course of the Month.

  [Key:
  B On board.
  H Sent to the Hospital.

  +---------------+-------------------+-------------------+-------------------+
  |               |     MAY, 1780.    |       JUNE.       |       JULY.       |
  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
  | 16th March    |  6 |  0 | 16 | 19 |  3 |  0 | 12 |  0 | 10 |  5 | 16 |  3 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Terrible,     |    |    |    |    |    |    |    |    |    |    |    |    |
  | 16th March    |  0 |  0 | 40 | 20 |  0 |  3 | 86 | 75 |  3 | 25 | 60 | 24 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 7th May       |    |  0 |    |  0 |  0 |  0 |  0 |  0 |  0 |  0 | 32 | 17 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 18th June     |    |    |    |    |    |    |    |    | 22 |  0 |  0 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Shrewsbury,   |    |    |    |    |    |    |    |    |    |    |    |    |
  | 26th June     |    |    |    |    |    |    |    |    |  5 |  0 |  0 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d Nov.      |    |    |    |    |  3 |  0 |  2 |  0 |  5 | 12 | 15 |  4 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d November  |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+

  +---------------+-------------------+-------------------+-------------------+
  |               |      AUGUST.      |     SEPTEMBER.    |      OCTOBER.     |
  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
  | 16th March    | 20 |  0 |  5 |  0 | 16 |  4 |  5 |  2 |  5 |  9 |  4 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Terrible,     |    |    |    |    |    |    |    |    |    |    |    |    |
  | 16th March    | 25 |  0 | 30 | 13 | 19 | 12 | 41 |  9 |  2 |  0 |  3 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 7th May       |  5 |  0 |  7 |  0 |  0 |  0 |  3 |  0 | continued healthy.|
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 18th June     |  5 |  0 |  7 |  0 |  0 |  0 |  3 |  0 | continued healthy.|
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Shrewsbury,   |    |    |    |    |    |    |    |    | No Return, the    |
  | 26th June     | 14 |  0 | 12 |  0 | 20 |  0 | 20 |  0 | Ship being absent.|
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     | 17 |  0 |  0 |  0 | 54 |  0 |  3 | 22 | 20 |  2 | 59 | 37 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     |  6 |  0 |  3 | 0  |  3 | 0  |169 |143 |  3 |  0 | 12 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d Nov.      |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d November  |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+

  +---------------+-------------------+-------------------+-------------------+
  |               |     NOVEMBER.     |     DECEMBER.     |   JANUARY, 1781.  |
  | SHIPS’ NAMES, +---------+---------+---------+---------+---------+---------+
  |     AND       | Fever.  |  Flux.  | Fever.  |  Flux.  | Fever.  |  Flux.  |
  | Date of their +----+----+----+----+----+----+----+----+----+----+----+----+
  |   Arrival.    | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  | B  | H  |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Sandwich,     |    |    |    |    |    |    |    |    |    |    |    |    |
  | 16th March    |  3 |  0 |  5 |  0 |  8 |  0 | 10 |  0 |  9 |  0 | 13 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Terrible,     |  continued quite  |    |    |    |    |    |    |    |    |
  | 16th March    |      healthy.     |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Triumph,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 7th May       |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Russell,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 18th June     |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Shrewsbury,   | No Return, the    |    |    |    |    |    |    |    |    |
  | 26th June     | Ship being absent.|  0 |  0 | 13 |  0 |  1 |  0 |  7 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alcide,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     |  0 |  0 | 23 | 10 |  0 |  0 | 14 |  0 |  6 |  5 | 17 |  0 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Torbay,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 30th July     |  6 |  0 | 5  |  0 |  0 |  1 | 22 | 30 |  5 |  0 | 10 |  1 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Monarch,      |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d Nov.      |    |    |    |    |    |    |    |    |    |    |    |    |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+
  | Alfred,       |    |    |    |    |    |    |    |    |    |    |    |    |
  | 22d November  |    |    |    |    |  6 |  0 |  5 |  0 | 15 | 16 | 11 |  8 |
  +---------------+----+----+----+----+----+----+----+----+----+----+----+----+

We shall hereafter see reason for supposing that fever and dysentery
proceed from the same cause; and as both these ships arrived
from England in a similar state with regard to health, fevers would
probably have been the prevailing disease in both; but a part of the
87th regiment, then serving as marines in the fleet, was put on board
of the Torbay at St. Christopher’s, and some of them being ill of the
dysentery, gave this turn to the disease which afterwards prevailed on
board. I have formed a Table to shew the fluctuating state of these
two diseases, and this was one of my first and most imperfect attempts
towards a medical history of the fleet in a methodical way. (Table III.)

There was but little sickness in the rest of this squadron, except in
the Terrible, where the dysentery prevailed a good deal. None of the
ships of the line which we found in the West Indies, upon our arrival
there, were now in company, except the Yarmouth, and this was the most
healthy of all the ships that went to North America.

The health of the fleet was very much recruited by its short stay in
America; for the men were supplied with fresh meat and spruce beer,
and they enjoyed the two finest months of the year in that temperate
climate. The squadron left New York in the middle of November, and
though dispersed by a violent storm, all the ships arrived safe in the
West Indies before the middle of December.

In October the fleet had attained such a degree of health, that though
the calculation in the Table is made from five of the most sickly
ships, no death happened in this month on board of any of them. In
November the mortality was also inconsiderable, though the ships left
in the West Indies are included in the calculation; which, had it been
made upon those only that went to North America, the deaths would have
been no more than one in seven hundred and eleven in this month, which
is rather less than that of any other month in the Table.

The amendment in health, in consequence of the change of climate, was
most remarkable in the Terrible, which, by the time she left America,
had entirely got rid of the violent dysentery that had prevailed for
some time on board. This sudden change in the health of this ship was
evidently owing to the great attention of the Captain to cleanliness
and discipline, and no less to the assiduity and abilities of the
Surgeon. The Alcide still continued sickly, though not so much so as
the Torbay. The former had sailed on a cruise in October, and having
met with very rough weather, the sick list was thereby increased. The
dysentery now prevailed in that ship, as well as fevers, and those
men chiefly were attacked with fevers who were ill of the scurvy, or
recovering from it. This was not very common; and there were several
other remarkable particulars with regard to the fevers in this ship;
for her men were not only uncommonly subject to this disease, both in
America and the West Indies, but to all the various forms of it; the
low, infectious, ship fever of Europe, the bilious remitting, and the
malignant yellow fever of hot climates. It would appear from this,
as well as other instances, that a ship may assume, as it were, a
particular constitution, or a tendency to some particular disease,
for a length of time, and this depending on some lurking and adhering
infection, or the manner in which she may have been victualled,
watered, disciplined, or manned.

The great benefit derived to the health of the fleet, from the change
of climate, as well as other reasons, justified the Admiral in going
to North America; and there was the more merit in this measure, as it
was undertaken without precedent, and without instruction. Upon our
return we found there was great good fortune in it, as well as wisdom;
for there had happened on the 10th of October a more violent hurricane
than any in the memory of man, and the ravage it made both by sea and
land is, perhaps, unparallelled in history. Several of the ships of the
line were exposed to it; but though they suffered extremely, and were
in the utmost danger, none were lost. Two of them happened to be at
Antigua, which was out of the track of this hurricane, as it extended
only from the 12th to the 15th degree of N. latitude; so that the only
islands that suffered by it were Barbadoes, St. Lucia, St. Vincent, and
Martinico.--Four frigates, and as many sloops of war, either foundered
or were wrecked, and about one thousand seamen perished in them. One
of the buildings of the hospital at Barbadoes was entirely demolished
by the impetuosity of the sea, which, having risen to a great height,
dashed a ship against it, and twenty-three seamen were buried in the
ruins[3].

The Montague suffered most on this occasion, and was also most
subject to sickness and mortality, brought on in consequence of the
great fatigue and hardships of the men in bringing her into port
and refitting her; for the ship was almost torn to pieces both in
the rigging and hull, and the bedding and other necessaries and
conveniencies were entirely destroyed. The fever that prevailed on
board at this time was of the most malignant kind known in this
climate; and the worst cases arose in watering, and the other
necessary duties on shore, from which the men would sometimes return
frantic, and die in a few hours. There was a party of soldiers on
board; and as they were not called upon to perform any duties on
shore, they had but little sickness in companion of the sailors.

The other ships having suffered less from the storm, were also less
sickly, as it was not necessary for them to remain so long in the
unhealthy Carenage to repair.

The only disease that prevailed at this time, in these two ships, was
fevers, there being few or no fluxes, though they had been so frequent
in the former part of the year. Though fevers and fluxes depend on the
same general causes, yet when these causes exist in a higher degree,
it would appear that they are more apt to produce fevers. Thus the
exhalations of the earth from marshes are more apt to produce fevers;
and mere excesses of heat and cold, or moisture, are more apt to
produce fluxes; just as in Europe a catarrh, which may be considered as
a local febrile affection, as well as a dysentery, will be excited by
exposure to cold or damp, without any specific bad quality in the air.

The Ajax and Montague are the only two ships of those left in the West
Indies, which are included in the estimate of sickness and mortality
in November and December, and they bear a very great proportion to the
whole; for out of forty-four that died in fourteen ships of the line in
November, twenty died in the Montague, and five in the Ajax; and out of
forty-three, the whole number of deaths in December in twenty-one ships
of the line, ten were of the Montague, and eleven of the Ajax.




CHAP. III.

 Account of the HEALTH of the FLEET from January, 1781, till July,
 1781, both Months included.----Arrival of seven Ships of the Line
 from England--Increase of Sickness in consequence of a Descent on St.
 Vincent’s--Long Cruise to windward of Martinico--Great Prevalence
 of Scurvy--Difference of Health in different Ships--New Ships not
 more unhealthy than others--Why Frigates are more healthy than Ships
 of the Line--Remarkable Cure of Scurvy in two Ships--Essence of
 Malt--Vegetables most antiscorbutic in their natural State--Advantage
 of supplying Refreshments on board of Ships in preference to Hospitals.


We are now come to that period in which our fleet was reinforced with
seven ships of the line, which arrived at Barbadoes from England on the
5th of January, 1781, under the command of Lord Hood. This addition,
with two which had arrived in November, made the force upon this
station again amount to twenty-one ships of the line.


TABLE IV.

Shewing the Number of each Disease on board on the First of each Month,
the Numbers sent to the Hospital, and Dead, in the Course of the Month.

  KEY:
  B  On board.
  H  Sent to the Hospital.
  D  Dead.

  +--------------+------------------------------------------------+
  |   SHIPS’     |                                                |
  |   NAMES.     |               FEBRUARY, 1781.                  |
  | N. B. Those  +---------------+---------------+----------------+
  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  | D  |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Sandwich     |   8 |  0 |  0 |   4 |  0 |  0 |   2 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Barfleur   |   8 |  0 |  1 |   4 |  0 |  1 |   3 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Gibraltar  |  25 |  0 |  2 |   4 |  0 |  0 |   4 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triumph      |   0 |  0 |  1 |   1 |  0 |  1 |  21 |   8 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Centaur      |   2 |  0 |  0 |   2 |  0 |  0 |  20 |   0 |  8 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Torbay       |   6 |  0 |  0 |  11 |  0 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Monarch      |  13 |  0 |  3 |  13 |  0 |  0 |   2 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Terrible     |   2 |  0 |  0 |  10 |  0 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Montagu      |  40 |  0 |  8 |  14 |  0 |  5 |   4 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alfred       |   4 |  0 |  0 |   4 |  0 |  0 |   4 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Russel       |   0 |  0 |  0 |   7 |  0 |  1 |   2 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alcide       |   1 |  0 |  2 |   9 |  0 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Invincible |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Resolution   |   1 |  0 |  0 |   7 |  0 |  1 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Shrewsbury   |   8 |  0 |  0 |   0 |  1 |  1 |   6 |   7 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Ajax         |   8 |  0 |  1 |   6 |  0 |  5 |   3 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Princessa  |   8 |  0 |  1 |   3 |  0 |  1 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Intrepid     |  18 |  1 |  1 |  10 |  4 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Belliqueux |  11 |  0 |  0 |  10 |  0 |  5 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Prince     |     |    |    |     |    |    |     |     |    |
  | William      |  21 |  0 |  0 |  17 |  0 |  0 |   4 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Panther    |   2 |  0 |  0 |   4 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triton       |   7 |  0 |  0 |  15 |  2 |  0 |  14 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   2 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Cyclops      |   4 |  1 |  0 |   3 |  0 |  0 |   0 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |     Total    | 197 |  2 | 19 | 158 |  7 | 21 |  93 |  19 | 10 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+

  +--------------+------------------------------------------------+
  |   SHIPS’     |                                                |
  |   NAMES.     |                    MARCH.                      |
  | N. B. Those  +---------------+---------------+----------------+
  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Sandwich     |   8 |  3 |  1 |   4 |  0 |  0 |   2 |   2 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Barfleur   |  28 |  4 |  0 |  35 |  0 |  0 |   5 |  27 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Gibraltar  |   8 |  1 |  0 |   0 |  0 |  0 |   6 |  22 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triumph      |   3 |  0 |  0 |   2 |  0 |  1 |  24 |  18 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Centaur      |   7 |  0 |  0 |   4 |  0 |  0 |  50 |   0 |  8 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Torbay       |   7 |  0 |  0 |   8 |  0 |  0 |   8 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Monarch      |   5 |  0 |  0 |   4 |  0 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Terrible     |   2 |  0 |  0 |   9 |  0 |  2 |   3 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Montagu      |   § |  § |  5 |   § |  § |  3 |   § |   § |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alfred       |  25 |  0 |  0 |   8 |  0 |  1 |  56 |  16 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Russel       |   7 |  0 |  0 |   8 |  2 |  0 |   0 |  61 |  5 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alcide       |   1 |  0 |  0 |   1 |  0 |  0 |  15 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Invincible |   6 |  1 |  0 |   1 |  0 |  0 |   5 |   6 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Resolution   |   6 |  0 |  0 |   5 |  0 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Shrewsbury   |   5 |  0 |  1 |   6 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Ajax         |   2 |  0 |  2 |  10 |  0 |  5 |   6 |   0 |  6 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Princessa  |   6 |  0 |  5 |   2 |  0 |  0 |   4 | 102 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Intrepid     |  10 |  0 |  0 |   9 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Belliqueux |   3 |  1 |  2 |  52 |  0 |  1 |   0 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Prince     |     |    |    |     |    |    |     |     |    |
  | William      |  23 | 12 |  0 |  47 | 62 |  5 |   6 |  10 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Panther    |   5 |  0 |  0 |   8 |  0 |  0 |   4 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triton       |   3 |  2 |  0 |  12 |  2 |  0 |   6 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Hyena        |   0 |  0 |  0 |   0 |  1 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Cyclops      |   4 |  0 |  0 |   3 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |     Total    | 174 | 24 | 16 | 238 | 67 | 18 | 202 | 265 | 27 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+

  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |   SHIPS’     |                                                |
  |   NAMES.     |                     APRIL.                     |
  | N. B. Those  +---------------+---------------+----------------+
  | marked *,    |    Fever.     |     Flux.     |    Scurvy.     |
  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Sandwich     |   6 |  0 |  2 |   9 |  1 |  1 |   2 |   4 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Barfleur   |  24 |  0 |  0 |  25 |  0 |  0 |  33 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Gibraltar  |   0 |  0 |  1 |   0 |  0 |  0 |  18 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triumph      |   0 |  0 |  1 |   3 |  0 |  2 |  12 |   0 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Centaur      |   1 |  0 |  0 |   3 |  1 |  0 |  55 |   1 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Torbay       |   6 |  0 |  0 |   8 |  0 |  0 |  23 |  27 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Monarch      |   8 |  0 |  4 |  17 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Terrible     |   0 |  0 |  0 |  10 |  0 |  0 |   4 |   3 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Montagu      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alfred       |  11 |  0 |  0 |  26 |  0 |  1 | 116 |  44 |  4 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Russel       |   0 |  0 |  0 |   4 |  0 |  1 |  44 |   0 |  3 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alcide       |   1 |  0 |  0 |   3 |  0 |  0 |   8 |  16 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Invincible |   4 |  0 |  0 |   4 |  0 |  0 |   2 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Resolution   |   5 |  0 |  0 |   8 |  0 |  2 |   7 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Shrewsbury   |   4 |  3 |  0 |   0 |  0 |  0 |   4 |   6 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Ajax         |   4 |  0 |  1 |  15 |  4 |  2 |  30 |   5 | 10 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Princessa  |   6 |  0 |  0 |   1 |  0 |  0 |  40 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Intrepid     |   9 |  § |  § |  13 |  § |  § |   1 |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Belliqueux |   0 |  0 |  0 |   3 |  0 |  0 |   2 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Prince     |     |    |    |     |    |    |     |     |    |
  | William      |  19 |  2 |  0 | 147 | 40 |  0 |  16 |   7 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Panther    |   2 |  0 |  0 |   4 |  3 |  0 |   9 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triton       |   2 |  0 |  0 |   2 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   2 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Cyclops      |   2 |  0 |  0 |   2 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |     Total    | 115 |  5 |  9 | 317 | 49 |  9 | 428 | 115 | 26 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+

  ----------------------------------------------------------------+
  |   SHIPS’     |                                                |
  |   NAMES.     |                      MAY.                      |
  | N. B. Those  +---------------+---------------+----------------+
  | marked *,    |     Fever.    |     Flux.     |    Scurvy.     |
  | arrived with +-----+----+----+-----+----+----+-----+-----+----+
  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  |  D |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Sandwich     |   2 |  2 |  1 |  10 |  5 |  0 |   5 |  18 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Barfleur   |  12 |  3 |  1 |  16 |  1 |  0 |  54 |  10 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Gibraltar  |   4 |  0 |  0 |   0 |  0 |  0 |  30 |  22 |  4 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triumph      |   0 |  1 |  1 |   0 |  0 |  0 |  13 |   8 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Centaur      |   0 |  0 |  0 |   2 |  0 |  2 |  15 |   4 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Torbay       |   6 |  0 |  0 |  13 |  7 |  0 |  44 |  31 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Monarch      |   5 |  2 |  2 |   3 |  0 |  0 |  57 |  11 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Terrible     |   0 |  0 |  1 |  10 |  4 |  0 |   5 |  20 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Montagu      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alfred       |  15 | 10 |  1 |  11 |  3 |  0 | 130 |  25 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Russel       |   0 |  1 |  0 |   8 |  0 |  0 | 132 | 102 |  4 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alcide       |   0 |  0 |  1 |   1 |  0 |  0 |  40 |  35 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Invincible |   7 |  0 |  1 |   6 |  8 |  4 |  31 |  54 |  4 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Resolution   |   5 |  2 |  0 |   9 |  0 |  0 |  15 |  45 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Shrewsbury   |   3 |  1 |  0 |   5 |  2 |  0 |  22 |   6 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Ajax         |   4 |  1 |  1 |   3 |  0 |  0 |   8 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Princessa  |   2 |  0 |  0 |   2 |  0 |  1 |  30 |  40 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Intrepid     |   § |  § |  § |   § |  § |  § |   § |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Belliqueux |   0 |  0 |  0 |   2 |  0 |  0 |   2 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Prince     |     |    |    |     |    |    |     |     |    |
  | William      |   5 |  5 |  2 |  53 |  5 |  0 |   7 |   4 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Panther    |   3 |  2 |  0 |   8 |  4 |  0 |   1 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triton       |   2 |  0 |  0 |   4 |  0 |  0 |   0 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Hyena        |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Cyclops      |   0 |  0 |  0 |   0 |  0 |  0 |   0 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |     Total    |  76 | 30 | 12 | 166 | 39 |  7 | 641 | 436 | 22 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+

  +--------------+------------------------------------------------+
  |   SHIPS’     |                                                |
  |   NAMES.     |                     JUNE.                      |
  | N. B. Those  +---------------+---------------+----------------+
  | marked *,    |     Fever.    |     Flux.     |    Scurvy.     |
  | arrived with +----+----+-----+-----+----+----+-----+--- -+----+
  | Lord Hood.   |  B  | H  | D  |  B  | H  | D  |  B  |  H  | D  |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Sandwich     |   2 |  0 |  0 |   3 |  0 |  0 |  10 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Barfleur   |  20 |  0 |  0 |  13 |  0 |  0 |  58 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Gibraltar  |   3 |  1 |  0 |   4 |  0 |  0 |  48 |  17 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triumph      |   1 |  0 |  0 |   0 |  0 |  0 |   6 |   5 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Centaur      |   4 |  0 |  0 |   9 |  0 |  1 |  15 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Torbay       |  16 |  0 |  0 |   6 |  0 |  0 |   9 |   0 |  1 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Monarch      |   4 |  3 |  1 |   4 |  0 |  0 |  36 |   5 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Terrible     |   3 |  1 |  0 |  12 |  0 |  0 |  20 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Montagu      |   § |  0 |  0 |   § |  0 |  2 |   § |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alfred       |  14 |  § |  § |  10 |  0 |  0 |  26 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Russel       |   0 |  1 |  0 |  19 |  1 |  0 |  14 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Alcide       |   4 |  2 |  0 |   5 |  0 |  0 |  26 |   5 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Invincible |   8 |  0 |  0 |  22 |  0 |  0 |  10 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Resolution   |   1 |  0 |  0 |   3 | 12 |  0 |  84 |   0 |  2 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Shrewsbury   |   3 |  § |  § |   4 |  § |  § |  20 |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Ajax         |   2 |  0 |  0 |   2 |  0 |  1 |   6 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Princessa  |   2 |  0 |  0 |   6 | 40 |  0 |  70 | 154 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Intrepid     |   § |  § |  § |   § |  § |  § |   § |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Belliqueux |   2 |  0 |  1 |   3 |  0 |  0 |   8 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Prince     |     |    |    |     |    |    |     |     |    |
  | William      |   4 |  4 |  2 |  13 |  3 |  1 |   8 |   7 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | * Panther    |   3 |  0 |  0 |   8 |  1 |  0 |   1 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Triton       |   2 |  0 |  1 |   1 |  0 |  0 |   0 |   1 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Hyena        |   3 |  0 |  1 |   2 |  0 |  0 |   5 |   0 |  0 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  | Cyclops      |   § |  § |  § |   § |  § |  § |   § |   § |  § |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+
  |     Total    | 101 | 12 |  6 | 149 | 57 |  5 | 480 | 198 |  4 |
  +--------------+-----+----+----+-----+----+----+-----+-----+----+

  N. B. Where the Spaces are marked thus, §, no Return was made.

The whole fleet was tolerably healthy during this month, the season
being dry and cool; there was, however, a small increase of sickness
at this time, and it was owing to a descent made on St. Vincent’s in
December. The soldiers, (of whom there was still a regiment on board of
the fleet) the marines, and some of the seamen, had been on shore for
one night only; but many of them having lain on the ground, some having
been intoxicated, or having eaten to excess of sugar-cane and fruit,
caught fevers and fluxes, which increased the proportion of diseases
and deaths the following months, as appears by the Table.

I have exhibited, in another Table, a view of the sickness and
mortality of this fleet for the five succeeding months. (Table IV.)
This account, as well as most of those that are to follow, is confined
to three diseases, that may be called the sea epidemics. These are,
fever, flux, and scurvy.

The whole fleet met at Barbadoes on the 13th of January, and no service
was undertaken till the accounts of the Dutch war arrived on the 30th
of that month. In consequence of this intelligence, the greater part of
the ships of war went against St. Eustatius, which was taken on the 3d
of February.

Ten days after this a squadron of seventeen ships of the line was sent
to cruise to windward of Martinico, with a view to intercept a French
squadron which was then said to be on its passage from Europe. The
cruise was there continued for six weeks; after which small divisions
of the ships were sent to water and refit, by turns, at St. Lucia, and
were relieved by the ships left for the protection of that island.

Soon after this, the whole squadron came to leeward of Martinico; and
though the former intelligence had proved false, the greater part
of our fleet still kept the sea, in order to block up the enemy in
Fort-Royal Bay. This they continued to do till the 29th of April, when
a French fleet of twenty-two ships of the line, from Europe, joined by
four from Martinico, forced their way into their own port, pushing to
leeward our fleet, consisting only of eighteen ships of the line; so
that the greater part of them did not get into port till they came to
an anchor at Barbadoes on the 23d of May.

It was in this season of cruising, and keeping the sea, that the fleet
contracted such a degree of scurvy as had never before been known in
the West Indies. This disease is not so apt to arise in a hot climate
as in a cold one; and the prevalence of it on this occasion was owing
to the men having been for a great length of time upon sea victualling;
for one part of the fleet had not had a fresh meal from the time of
leaving America, that is, for six months; and that part of it which
came last from England had been in the same circumstances for seven
months; nor had any of them been in a place capable of supplying
vegetable refreshments from the time they left Barbadoes in the end of
January. But though no fresh meat or vegetables could be procured at
St. Lucia or St. Eustatius, yet the scurvy did not make such progress
in the ships that lay at anchor there, as in those that were at sea;
and it appears that the time in which it prevailed most was, while the
greatest number of ships was at sea, that is, in the month of March.
It appears, indeed, by the Table, that there was a greater number ill
of this complaint on the 1st of May than on the 1st of April; but it
appears also, that more were sent to the hospital in March than in
April, and very near half of the May list must have been taken ill in
March[4]. The difference of being in port and at sea consists chiefly,
1st, In there being plenty of water while in port, so that it can be
used freely, not only to drink, but to wash the clothes; and we know
that cleanliness tends greatly to ward off the scurvy. 2dly, Though
no fresh meat nor vegetables could be procured at those ports, sugar,
which may be considered as a very antiscorbutic article of diet, could
always be procured at a very cheap rate, and the seamen, when in port,
used to exchange their salt provisions for it. 3dly, There is at sea
a dismal uniformity of life, favourable to indolence and sadness, and
therefore tending to hasten the progress and aggravate the symptoms of
the scurvy; whereas the change of scene and variety of objects, when in
port, tend to cheer and recreate the mind, and thereby to avert this
disease.

The squadron that came from England under Lord Hood, suffered, upon the
whole, much less from acute diseases, during the first months of their
service in this climate, than the ships that arrived with Lord Rodney,
which was probably owing, in part at least, to the former having
arrived at the driest and coolest season of the year. The Barfleur,
however, had a large proportion of all the three prevailing diseases;
and large ships are in general more subject to them than those of a
smaller rate. But of all the ships in the fleet, the Alfred had the
greatest proportion of the three sea epidemics. The Prince William
suffered more than any other ship in the fleet from the flux, and the
Princessa from the scurvy. In some instances, reasons can be assigned
for the prevalence of particular diseases in particular ships, such as
accidental infection, or the manner in which they have been victualled,
manned, or disciplined; but in many cases the cause is so subtile or
obscure as to elude our inquiry.

The most healthy of the new squadron, during this campaign, were the
Belliqueux and Panther; the former was a new ship, and came from
England with a very irregular and ill-disciplined crew. Soon after
arriving in the climate, she was threatened with a dysentery, which,
though it spread a good deal, did not prove severe nor mortal; but
being left at St. Eustatius on this account, while the rest of the
fleet was cruising, she soon became very healthy, and remained so. This
is the second instance we have had occasion to remark of a new ship
being healthy.

The Panther preserved her health by being on small separate cruises,
and frequently in port, not being attached to the main squadron. The
Sandwich was the only other ship not engaged in the long cruise.

Of the ships lately from England, that were employed in this cruise,
the Gibraltar seems to have been the least sickly. This ship left
England healthy; but having received a draft of dirty men when upon
the eve of sailing, a fever of the infectious kind broke out on the
passage, so that she arrived in the West Indies in a sickly state.
This fever disappeared very soon after; and it is proved by this,
as well as other facts, that a warm climate, so far from tending to
generate, or even to foster the infection of fever, tends rather to
extinguish it. The Gibraltar had been put under excellent discipline
by her former commander, while in the Channel service; and this being
afterwards kept up, the men were always clean and regular. This was the
Spanish Admiral’s ship, taken by the fleet under the command of Lord
Rodney off Cape St. Vincent’s, in January 1780. She was then called
the Phœnix, and was of a singular excellence both with respect to
materials and construction. Whether the cedar, of which a great part of
her timbers consisted, contributed to the healthiness, by its balsamic
effluvia, I will not pretend to determine.

The Invincible was also uncommonly healthy during this cruise, which
may likewise be ascribed to good discipline, and to her having been
more than three years in commission before sailing from England,
whereby the men were brought into order, and accustomed to each other
and to a sea life. This ship was almost singular in having no acute
diseases for several months after arriving from Europe; but at length
paid the tribute to the climate in May and June, as may be seen in the
Table.

From the account of the three frigates at the bottom of the list in
the Table, it appears how much more healthy they are than ships of the
line. The total complements of the three is exactly equal to that of
one seventy-four-gun ship; but their whole sickness and mortality is
less than that of any one ship of the line of that class, although the
Triton was uncommonly sickly for a frigate.

There seem to be several causes for the superior degree of health
usually enjoyed by this smaller class of ships. There is less chance of
mixtures of men in frigates, as their complement is smaller, and it is
more easy for the captain and officers to keep an eye over a few men
than a great number; for, in a great ship, there are generally men,
who, concealing themselves in the most retired parts, no one takes
cognizance of them, and they destroy themselves, and infect others,
by their laziness and filth. In the next place, there is a greater
proportion of volunteers and real seamen in frigates, and more landmen
and pressed men in ships of the line, the former being more in request,
on account of the greater chance of prize money. Lastly, a small ship
is more easily ventilated, and the mass of foul air issuing from
the hold, from the victuals, water, and other stores, as well as the
effluvia exhaling from the men’s bodies, is less than in a large ship.

Many other and more minute remarks might be made on different ships
in this season of hard service; but to do this would be tedious, and
the inspection of the Tables may suggest observations to the reader.
There is a striking and instructive fact, however, with regard to two
ships, which I cannot help relating. The Alcide and Invincible, both
of seventy-four guns, in working to windward, after the action with
the French fleet, on the 29th of April, anchored at Montserrat on the
11th of May, in order to water. They remained there only part of two
days, and they procured no refreshment, except a few bushels of limes.
The scurvy then prevailed to a great degree in both ships; but between
this time and the 23d of May, when they came to an anchor at Barbadoes,
sixty men, who had been confined with this disease, were discharged,
as fit for duty, from the sick list of the Invincible, and a hundred
and fourteen from that of the Alcide. These were the only two ships
that had the advantage of the limes; and during these twelve remaining
days of the voyage the scurvy continued to increase in all the other
ships. Dr. Lind is the first author who gives a decided preference to
lemons, limes, and oranges, over every other antiscorbutic; and the
above-mentioned fact proves as demonstrably as possible the infinite
advantage of this species of acid in scurvy.

The fleet was supplied with essence of malt during all this campaign;
and though it was, no doubt, of service, it was far from having that
powerful and manifest effect that the acid fruits had, and certainly
did by no means prevent the scurvy in all cases. I have strong
testimonies, however, of its beneficial effects from the surgeons of
several of the ships, particularly of the Gibraltar, Centaur, Torbay,
and Alcide, in all of which it was found either to cure the scurvy in
its first beginning, to retard its progress, or to mend the appearance
of scorbutic ulcers, and dispose them to heal.

I had conceived that melasses, being a vegetable sweet, must have
been a very powerful antiscorbutic; but the greatest part of the last
reinforcement of seven ships came from England furnished with this as
an article of victualling, as a substitute for a certain proportion of
oatmeal, which was withheld agreeably to a late very judicious order
of the Admiralty. But though I am persuaded that this article of diet
mitigated the disease, it was very far from preventing it; and the
Princessa in particular, which suffered most from the scurvy, was well
supplied with it.

There is reason to think that it is not in the vegetable sweet alone
that the antiscorbutic principle resides, but in this in conjunction
with the natural mucilage, such as exists in the malt. I suspect
likewise that the change which the essence undergoes in its preparation
tends also to rob it of some of its original virtue. But the melasses
are still farther altered by being deprived of the natural mucilage
by means of quick lime, with which all sugar is clarified in the
boilers. Dr. Hendy, of Barbadoes, to whom I have been obliged for
several remarks, informed me, that the liquor, before it undergoes this
operation, has been found by him to produce the most salutary effects
in the scurvy; but as this cannot be had at sea, we had no opportunity
of comparing it with other antiscorbutics. It is certain also that the
medical effects of the native sweet juices are, in other respects, very
different from what they are in their refined state; for manna, wort,
and the native juice of the sugar cane, are purgative; whereas sugar
itself is not at all so[5]. This affords a presumption, that they may
be also different in their antiscorbutic quality; and there is reason
to think, from experience, that the more natural the state in which
any vegetable is, the greater is its antiscorbutic quality. Vegetables,
in the form of sallads, are more powerful than when prepared by fire;
and I know, for certain, that the rob of lemons and oranges is not
to be compared to the fresh fruit. Raw potatoes have been used with
advantage in the fleet, particularly by Mr. Smith, of the Triton,
who made the scorbutic men eat them, sliced with vinegar, with great
benefit. This accords also with what Dr. Mertans, of Vienna, has lately
communicated to the Royal Society of London.

When the fleet arrived at Barbadoes on the 23d of May, it was found
that the number of sick on board amounted to sixteen hundred, and that
there was not accommodation for more than two hundred at the hospital.
As there was hardly any complaint but scurvy, the Admiral, at my
representation, issued an order for serving the sick on board of their
own ships with fruit and other vegetables and refreshments, such as
milk and soft bread. This course of diet commenced in the beginning
of June; and as the greater part of the fleet was near four weeks
thereafter in port, they enjoyed the advantages of it during that time;
and the very great diminution of sickness and mortality, which appears
by the Tables in that month, sufficiently evinces the benefit derived
from it. In less than four weeks the fleet, from being very sickly,
became extremely healthy.

It was remarked, that the men recovered faster on board than on shore;
and it would appear that land air, merely as such, has no share in the
cure of the scurvy, and that the benefit arises from the concomitant
diet, cleanliness, and recreation. The expedient of curing men on board
of their ships was here suggested by necessity; but it succeeded so
well, that it was adopted afterwards in preference to an hospital,
which is indeed a useful relief to a fleet where there are contagious,
acute disorders; but with regard to scurvy, I am convinced, that on
foreign stations, at least, where the accommodations of the sick are
more indifferent than in England, many advantages would arise from
supplying men with refreshments on board of their ships. It appears
that only four men died of this disease in the whole fleet in the month
of June, though there were so many ill of it; whereas it appears by
the books of hospitals, that scorbutic men die there in a much greater
proportion, and chiefly in consequence of other diseases, particularly
the flux, which they catch by infection, or bring on by intemperance.
It is farther in favour of this scheme, that great numbers of those
sent on shore are lost by desertion. It is also a great saving to
Government, the expence not being a fourth part of what it would cost
at an hospital.

The fleet left Barbadoes on the 10th and 12th of July, and continued
healthy till the greater part of it sailed for North America in the
beginning of August.




PART I.

BOOK II.

 Continuation of the MEDICAL HISTORY of the FLEET, from August, 1781,
 till the Conclusion of the War in April, 1783.




CHAP. I.

 Some Account of the Interval between the Campaign of 1781 and the
 Junction of the Reinforcement from England in April, 1782.----The
 main Body of the Fleet goes to North America--Lord Rodney goes to
 England, and returns to the West Indies with twelve Ships of the
 Line--Health of the Fleet in England--Sickness most prevalent in
 the Beginning of a War--A natural Tendency to Recovery in Ships and
 Individuals--Advantages of this Squadron in point of Victualling.


When the main body of the fleet went to America in August, Lord Rodney
went to England for the recovery of his health.--Wishing to lay before
the public boards several reforms that suggested themselves to me in
the course of the late service, I accompanied the Admiral, purposing to
return when the season for hostile operations should have brought back
the fleet from the coast of America.

Soon after arriving in England, I presented a memorial[6] to the Board
of Admiralty, proposing such means for the preservation of the health
of the fleet as had occurred to me during my past service.

The Board of Admiralty considered this memorial with all the attention
that could be expected in the general hurry of service, inseparable
from a great and extensive war; and I am happy in being able to say,
that, in consequence of my application, most of the particulars
recommended have since been so far carried into effect as to produce a
practical conviction of their utility.

Lord Rodney having recovered his health, hurried out to his station
with all the force that could then be equipped, as the enemy were
expected at the Caribbee Islands, with a superior force, after their
successes against us in the autumn campaign in America.

I had again the honour to accompany the Admiral. He first sailed from
Portsmouth, with four ships of the line, on the 14th of December, and
was to have been joined by two more that lay ready at Plymouth; but by
the time we arrived off this harbour the wind became contrary, whereby
we were detained there till the 14th of January, 1782. During this time
more ships were got ready, and six were added to the squadron; for the
public anxiety at that time called forth every exertion to strengthen
this reinforcement, upon which the fate of the whole West Indies was
supposed to depend.

This fleet cleared the Channel in the midst of a storm, and with the
wind at the same time so scanty, that we barely weathered Ushant; but
Lord Rodney’s perseverance and resolution, stimulated by the exigency
of the occasion, banished all hesitation and timidity. The rough
weather, and contrary winds, continued through the variable latitudes;
but having met with fresh blowing trade winds, common at that season,
we had the good fortune to get safe to Barbadoes with the whole
squadron on the 19th of February.

All the twelve ships[7] of this reinforcement had been on service for
a considerable length of time since they had been last commissioned,
except the Anson, a new ship, which had never before been at sea, and
the Fame and Yarmouth, which had lately undergone a thorough repair,
since which time they had been only for a few weeks at sea in the
Channel before they were ordered on this expedition.

The only ship that was sickly when we left England was the Fame, on
board of which some pressed men, with the infection about them, had
been received from the Conquestadore guardship; and the fever which
broke out in Plymouth Sound, where I was first sent for to visit that
ship, was probably owing to the infection which these men brought with
them. The other ships were, upon the whole, healthy; for it appeared
by the weekly accounts delivered to the Admiral, that the mortality,
including even that of the Fame, for the four weeks before we sailed,
had been only one in thirteen hundred, and that there had been about
one in twenty-nine on the sick list.

An opportunity offered on this occasion of comparing the health of
ships of war in England with that in the West Indies. The health of the
fleet in general at home was at this time about the proportion above
mentioned; but it is to be remarked, that it was healthier then than in
the former part of the war.

Plymouth hospital, which is calculated for twelve hundred men, was not
half full; and there were not at this time more than six hundred men
at that of Haslar, which is calculated to contain two thousand; but
the latter was generally full during the first two or three years of
the war, from the great fleets that put into Portsmouth. At one time
part of the sick were even obliged to be accommodated with tents in the
neighbourhood of the hospital, for want of room. But towards the end
of the year 1781 the infectious fever, which constitutes a great part
of the sickness in the European seas, was almost extirpated, and in
a cruise of five weeks in the north part of the Bay of Biscay, under
Admiral Darby, in September and October of this year, only six men were
buried in that time from twenty-eight ships of the line.

This was chiefly owing, as I apprehend, to the length of time which the
war had continued, in consequence of which the men of the respective
ship’s companies had been accustomed to each other, and habituated
to the mode of life peculiar to a man of war, regulating themselves
according to certain rules of good order and cleanliness. The causes
of the fever above mentioned, as shall be more fully illustrated
hereafter, are chiefly connected with the circumstances occurring in
the beginning of a war, when men of all descriptions are mixed, without
proper precautions being taken to guard against the infection imported
from jails or guardships. The sickness in the French fleet was still
greater in the beginning of the war than in the British; and this has
been the case in all the wars of this century. In the fleet commanded
by the Comte d’Orvilliers, in 1779, the sickness was so great as to
disable many of the ships from service, and great numbers of men were
landed at Brest, with a fever so malignant as to infect the inhabitants
of the town and country adjacent. I believe, besides, that the general
health prevailing at this time in the fleet in England, was, in part,
owing to the sour crout and melasses, which were now supplied more
amply than had ever been done before. The entire exemption from scurvy
in particular is to be ascribed to these improvements in diet.

There is a tendency in acute diseases to wear themselves out, both
in individuals that labour under them, and when the infection is
introduced into a community. Unless there was such a _vis medicatrix_,
there could be no end to the fatality of these distempers; for the
infectious matter would go on multiplying itself without end, and would
necessarily destroy every person who might be actually attacked, and
would infect every person who might be exposed to it. But animal nature
is so constituted, that this poison, after exciting a certain set of
motions in the body, loses its effect, and recovery takes place; and
those who happen not to be infected at first, become in some measure
callous to its impression, by being habitually exposed to it. There is,
therefore, a natural proneness to recovery, as well with regard to that
indisposition which takes place among a set of men living together,
as with regard to a single individual who actually labours under the
disease. Thus the most prevailing period of sickness is when men are
new to their situation and to each other, so that time of itself may
prove the means of prevention as well as of cure.

This consideration, however, ought not to supersede any part of
our attention with regard to the scurvy, which does not become
spontaneously extinct like acute diseases.

During the three first weeks of this passage from England to the West
Indies, there was wet and boisterous weather, but it had very little
effect in augmenting sickness; and though it not only subjected the men
to fatigue, cold, and damp, but prevented the ships from opening their
lower-deck ports till the 2d of February, between the 31st and 32d
degree of latitude, thereby producing close air and moisture where the
men sleep, yet, in the whole squadron, from its leaving England till
this time, there were only seven deaths, four of which were in the Fame.

The only sea epidemic that made its appearance was the infectious ship
fever, which, in many cases, was attended with pleuritic, rheumatic,
and other inflammatory symptoms, owing to the cold and wet, to which
the men were exposed in the variable latitudes. The warm, dry, fresh
breezes which we had during the remainder of the passage, were probably
what prevented any bad consequences from the former hardships, for
there died only four men from the above-mentioned date till we arrived
at Barbadoes; and it appeared by the Admiral’s weekly account, that the
proportion of the sick neither increased nor diminished from the time
we got into a warm climate and fine weather till our arrival on the
19th of February.

This squadron left England with several advantages in point of
victualling, which no ships had before enjoyed. They were amply
supplied with sour crout and melasses; they had all more or less wine,
of an excellent quality; and the Formidable had an entire supply of
it, in place of spirits, of which none was put on board. This slip had
hitherto, and did for some months afterwards, enjoy an extraordinary,
perhaps an unparallelled, degree of health. What farther contributed
to the health of this ship was, that she had been long in commission,
and most of the recruits with which the crew had been completed were
men turned over from other ships. There was also extraordinary medical
attention paid, particularly in watching the first beginnings of
complaints.

Upon the arrival of the squadron at Barbadoes, it was found, that,
the two hostile fleets having returned from North America in the
beginning of December, the campaign had opened with the siege of St.
Christopher’s, which had been invested by twenty-eight ships of the
line, and a considerable army. Our fleet, under Lord Hood, having
attempted, with great enterprise and skill, but without success, to
relieve it, Lord Rodney made haste to join them with the reinforcement
he had brought from England. He remained at anchor at Barbadoes only
one night, and in a few days came off Antigua, where he was informed of
the surrender of St. Christopher’s; and here, on the 25th of February,
he was joined by the rest of the fleet in their return to windward.




CHAP. II.

 Account of the HEALTH of the FLEET from the Junction of the
 Squadron from England, till the general Rendezvous at St. Lucia
 in the Beginning of April.----The Fleet found on the Station very
 healthy--Health of the Ships from the American Station--Health of
 the Ships from England compared with that of the Ships found on the
 Station--Small-pox prevalent--Instance of the remarkable Efficacy
 of Lemon Juice in curing the Scurvy--Additional Reinforcement from
 England--Watering Duty dangerous and unhealthy--The most healthy Ships
 those that had been longest in the Climate--List of the Numbers taken
 ill of each Complaint in March--Inflammation of the Liver not common
 in the West Indies.


The fleet which was found in the West Indies consisted of all the
sixteen that went from thence to America in August, 1781, (except the
Terrible, which had been lost) together with six ships of the line[8]
from the American station, the St. Albans, which arrived from England
in November, and the Russel, which had remained in the West Indies
during the hurricane months. They were all extremely healthy, having
only one man in twenty-eight on the sick list, and very few had been
sent to hospitals.

This fleet, after arriving from America, had lain at anchor for three
weeks at Barbadoes, where it had the advantage of the vegetable
refreshments which that island affords; but during three weeks that
it lay at anchor, in the face of the enemy, at St. Christopher’s,
the men were excluded from all communication with the shore, and had
no vegetable food, except some yams, with which they were supplied
from Antigua, in place of biscuit, of which there was at this time a
scarcity. These ships had therefore been in no port for six weeks,
except for a few days that they lay in the road of Antigua refitting,
and putting the sick and wounded on shore.

The men had also been deprived of their natural rest, and exposed to
the air during all the time that the fleet was at anchor before St.
Christopher’s; for they had been twice attacked by the enemy in that
situation, and were therefore under the necessity of keeping the ships
constantly clear for action; yet no increase of sickness followed.
This might partly be owing to the eagerness and alacrity of spirits
naturally excited in such a situation, and also to the fleet not lying
under the lee of any land, and having springs upon their cables, so
that they had all the perflation and all the purity of air which ships
enjoy when at sea. The fumigation which ships undergo in battle, has
also been thought to contribute to their health.

To whatever cause it was owing, the fleet we found in the West Indies
was at this time healthier than that which had just come from England;
and there was but little difference in the degree of health of the
different ships that composed it. Of those which left the West Indies
in August, and returned in December, the only one that could be said
to have any epidemic disease was the Prince William, which had never
got entirely free from the dysentery that was formerly mentioned as
prevailing so much on board of this ship last year. The disease was
kept up, by the ship never having been cleared of the men affected
with it, and by the crew in general being ill provided with slops[9],
a circumstance that would render them more susceptible of whatever
infection they might be exposed to.

There were also some remains of the same disease in the Intrepid, the
seeds of it having been more or less continued from the summer of 1780,
at which time it prevailed to a most violent degree. The Alfred had
a few of all the sea epidemics, and had been for a long time before
more or less in the same situation, from a neglect of cleanliness,
particularly of the men’s persons.

The only ship in which there was any thing like an epidemic was the
Canada, This ship, when at home, had for many months before she sailed
been in unremitting service, and very little in port. On the passage
from England to America, in August, 1781, there broke out a severe
dysentery, to which the scorbutic habit of the men, from being so
long at sea, probably predisposed them. Though it had abated much in
February, 1782, it was then by no means extinct, and continued till
April. The Prince George had been in commission all the war, and was a
model of discipline and cleanliness, and consequently of health. This
continued till the passage from America, when, upon the first cold
weather after leaving New York, there broke out a violent dysentery, of
which sixteen men died. This is agreeable to what Dr. Lind observes,
that the flux may be brought on by a sudden transition, either from
cold to heat, or from heat to cold. All the men that were ill of this
disease having been sent to the hospital at Barbadoes, and the usual
attention to cleanliness having been kept up, the disease entirely
vanished.

All the other ships of the American station had been more or less
visited with sickness after they left England, except the Bedford. This
was probably owing to this ship having been longer in commission than
any of the others, that is, for four years, and all that time under
the same commander. This last circumstance falls to the lot of few
ships; but a great advantage attends it; for the mutual knowledge and
attachment of the captain and ship’s company is naturally productive of
regularity and good discipline, and thereby of health.

The Royal Oak, Prudent, and America, which left England with the
Bedford, though they had been afflicted with the scurvy and other
complaints soon after arriving in America, had been quite healthy for
some time before coming to the West Indies, and were so much so at
this period, that, though there were a few sores and slight complaints
on their sick lists, there was not a man confined with illness, so
as properly to be called sick. The Royal Oak, having been the flag
ship of Admiral Arbuthnot, was manned with choice seamen, which is a
circumstance generally conducive to health; for these being accustomed
to a sea life, are more provident, more handy and methodical in all
that relates to diet, cloathing, and cleanliness. The scurvy, which
infected her upon first arriving in America, was successfully treated
on board by serving to those who were ill of it a mess, composed of
soft bread, baked on purpose, and mixed with wine and essence of malt.

The Prudent, though now quite healthy, had been sickly soon after being
put into commission in Europe, and upon first arriving in America. She
had been uncommonly sickly, when a new ship, upon her first voyage,
which was to the East Indies, during the peace. This remarkable degree
of sickness was probably owing to a particular experiment that was made
in preparing the wood of which she was built. This experiment consisted
in soaking the timber for a length of time in a strong pickle, in order
to make it less corruptible. The only other ship on which the trial of
this was made was the Intrepid; and it has been already mentioned that
this was an extremely sickly ship. The effect of it upon the wood was
to cause a constant moisture and mouldiness in the orlops and holds.
In the Intrepid, the sickness was never conquered till a practice was
followed of pumping and bailing her with great care, and putting a fire
into the well for six hours every day, by which means the dampness, and
the mildew produced by it, were removed and prevented, and the ship
thereby rendered healthy.

The two squadrons being united, and consisting of thirty-four ships
of the line, proceeded to St. Lucia, where they arrived on the 1st of
March.

I received monthly returns as formerly, and the form of them was
improved by adding a column for the numbers taken ill of the several
diseases in the course of the month. The returns of February are not
complete, there being none for the 1st of that month, as we had not
then arrived; but as the returns of the 1st of March have relation to
the preceding month, a judgement may be formed of the sickness and
mortality of February from the following table:


EXTRACT from the RETURNS of the 1st of March, 1782.

  +------------------+-----------+-----------+-----------+
  |                  |Put on the | Died last |Sent to the|
  |    DISEASES.     | Sick List |last Month.|  Hospital |
  |                  |last Month.|           |last Month.|
  +------------------+-----------+-----------+-----------+
  | Fevers           |      53   |     15    |      9    |
  |                  |           |           |           |
  | Fluxes           |     263   |     67    |      0    |
  |                  |           |           |           |
  | Scurvy           |     121   |      2    |      5    |
  |                  |           |           |           |
  | Other Complaints |     618   |     25    |     59    |
  +------------------+-----------+-----------+-----------+
  |    Total         |    1555   |    109    |     73    |
  +------------------+-----------------------+-----------+

  This account is abstracted from the returns of twenty-nine ships of
  the line, and two frigates.

The diseases and deaths under the head of “Other Complaints,” is much
more numerous in this month than usual, which is chiefly owing to the
preceding actions with the enemy, and to the prevalence of the small
pox. Of the deaths under this head, seventeen were in consequence
of wounds, six from small pox, one from a mortification[10] in the
shoulder, and one from consumption.

None of the epidemics affected one part of the squadron more than
another, except that the ships last from England had a less proportion
of the flux than the rest; and the few cases of this disease that were
in these ships arose after their arrival in the climate. The Conqueror
and Fame, which were the two most sickly ships, had no complaints but
fevers.

The fevers had now begun to take on some of the characteristic symptoms
of the climate; the chief of which is a greater abundance of bile. In
the Repulse, two men had the yellow colour of the skin, which is so
peculiar to the fevers of this climate.

The crew of the Anson caught an infectious fever from a guardship in
England; and when the Prothée sailed, there was a fever of the same
kind on board; but from the change of climate, the symptoms became
milder, and the disease disappeared in both these ships in the course
of this month.

The small pox prevailed more at this time in the fleet than I have ever
known it to do either before or since, and that both in the squadron
from England and in that from North America. There were six cases
in the Formidable, all of which did well, though two were of the
confluent kind.

Though there needs hardly any additional proof of the extraordinary
efficacy of lemon juice in curing the scurvy, yet it may be of service
to impress so useful a truth on the mind by mentioning such striking
proofs of it as occurred from time to time. The Arrogant spoke with
a Portuguese vessel near Madeira, from which some of this fruit was
procured, and the only scorbutic man on board happening to have some
of the most desperate symptoms, such as putrid gums, contracted hams,
the calves of the leg hard and livid, and frequent faintings, a fair
opportunity offered for trying its virtues. The man was allowed two of
them daily, and was perfectly well in sixteen days, during all which
time the ship was at sea, so that it was impossible to ascribe the cure
to any other cause.

The fleet remained at St. Lucia from the 1st till the 18th of March,
completing the water, provisions and stores, landing the sick at the
hospital, and also watching the motions of the enemy, who arrived about
the same time at Martinico from the siege of St. Christopher’s. During
this time we were reinforced with the Duke, of 90 guns, and the Warrior
and Valiant, of 74 guns, from England. On the 18th the whole fleet,
except the Invincible, which was detached with a convoy to Jamaica,
sailed on a cruise to windward of Martinico, in quest of a French
convoy expected from Europe; which having eluded us, and got into their
own harbour, the whole fleet returned to St. Lucia on the 30th of
March, excepting the Prudent, which was sent to Barbadoes.

We found at St. Lucia the Magnificent, of 74, and the Agamemnon, of 64
guns, which were the last reinforcement of this campaign, making the
British fleet on this station amount to forty ships of the line, a much
greater force than was ever before employed on foreign service. They
were all copper bottomed.

The weather continued fine all this month, yet there was some increase
of sickness, owing chiefly to the hardship the men underwent in
wooding and watering. In Choc Bay, where the fleet watered, there was
at this time a higher surf than was ever remembered, which made the
operation of watering (at all times noxious in this climate) uncommonly
toilsome and dangerous. It was, indeed, next to impracticable; for many
longboats were staved on the beach, by which several men had their
limbs broken, and some lost their lives, by being crushed or drowned;
but the necessity of the service admitted of no relaxation or delay.
There was no increase of wind to account for this surf, so that it was
owing either to something in the currents, or to some subterraneous
cause; and there had been felt at Barbadoes and St. Lucia, about this
time, a slight shock of an earthquake[11], to which many imputed
this extraordinary surf. In other respects, there were fewer causes
of sickness than usually occur to a fleet in port in this part of the
world; for the air of the road is remarkably pure, and there were fewer
temptations and opportunities of intemperance than at the other islands.

The monthly returns of the surgeons were very full and complete; but as
it would be tedious to insert at length those of every particular ship,
and as the number of ships fluctuated in different months, I shall do
no more hereafter than set down the general results from calculation,
so as to shew the proportional prevalence of disease and mortality in
each month.


TABLE, shewing the proportional Sickness and Mortality in March.

  +-----------------------------------------+
  | Transcriber’s Keys:                     |
  |                                         |
  | A Proportion of those taken ill in the  |
  |     Course of this Month.               |
  |                                         |
  | B Proportion of those who died, in      |
  |     relation to the Numbers of the Sick.|
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     20 |     64 |
  |                       |        |        |
  | Fluxes                |     35 |     71 |
  |                       |        |        |
  | Scurvy                |    126 |      0 |
  |                       |        |        |
  | Other Complaints      |     33 |    108 |
  +-----------------------|--------+--------+
  | General Proportion    |      9 |     76 |
  +-----------------------+--------+--------+

The first column is formed by dividing the whole number on board by
the number taken ill. The second column is formed by first adding the
number ill on board on the first of the month to the number taken ill
during the month, subtracting from this sum the number sent to the
hospital, and dividing the remainder by the number of deaths.

The number on the sick list of twenty-eight ships of the line, and two
frigates, on the first of this month, was eight hundred and forty-five;
the number put on the lists in the course of the month was one thousand
eight hundred and eighty-four; and the number sent to the hospital in
the same time was three hundred and seventy-three; and there died on
board thirty-one.

The total mortality this month, in relation to the whole number of men
on board, was one in six hundred and seven.

It almost always happens, that ships of war are more or less short of
complement, and allowance is made for this in all the calculations; for
having had an opportunity of inspecting the weekly accounts delivered
to the Admiral, it was always in my power to be informed how many there
were short of the legal complement of men in each ship.

It appears, from comparing the Tables of this month with those of the
preceding, that there had been a great increase of fevers and fluxes,
particularly of the latter. The fevers prevailed chiefly in the ships
lately from England, especially the Fame and Conqueror. In the Duke
there were a great number ill of fevers; but this ship not having
arrived from England till after the first of the month, is not included
in the calculation. The fluxes were most prevalent in the ships we
found on the station, particularly the Canada, Resolution, and Nymph
frigate. The scurvy had increased very little, but prevailed most in
the ships we found here. The only ships of the new squadron that had
this disease to a considerable degree, were the Conqueror and Nonsuch.
The former had indeed a good many ill of it; but the return having
been made in an imperfect manner, this ship is not included in the
calculation.

But the ships that were by far the most healthy were those that had
been the longest from England, the Ajax, Russel, Montague, Royal Oak,
and Prudent. There had been formerly a great mortality in all these
ships; and it would appear that this uncommon degree of health was
owing, in some measure at least, to this circumstance, that the most
weakly had been swept off by the different distempers to which they
were exposed; so that only the more hardy and robust had survived.

Under the head of “Other Complaints,” a much smaller number were put on
the list, and still fewer died, in this than the preceding month. This
difference is owing to the number that died of wounds last month.

There died on board, in the course of this month, thirteen of fevers,
seven of fluxes, and seven of other complaints, of whom five died
of small pox, one of asthma, and one of wounds he received at St.
Christopher’s.

In order to show more fully and minutely what are the complaints
incident to fleets in this climate, I shall set down a list of the
numbers taken ill of the different diseases and accidents during this
month, extracted from the returns of twenty-eight ships of the line,
and two frigates.

  Fevers                 806
  Fluxes                 463
  Scurvy                 130
  Ulcers                 129
  Small pox               49
  Pectoral complaints     40
  Venereal complaints     32
  Colds                   30
  Rheumatism              18
  Angina                  10
  Gravel                   3
  Dropsy                   1
  Ophthalmia               1
  Leprosy                  1
  Fistula in ano           3
  Hernia humoralis         1
  Abscess                  1
  Fractures                3
  Various slight
    accidents, as
    bruises, cuts,
    scalds, &c.          163
                        ----
                Total   1884

The number of ulcers bears here a smaller proportion to the whole than
it does in general to the sum total of the sick list; for being the
most tedious of all complaints, they consequently accumulate more than
any other. Thus many of the cases now set down as slight accidents,
will, in the ensuing month, be in the state of obstinate ulcers.

Most of the diseases of one hot climate resemble those of another,
so far as I know; but there is one disease which we hear of as being
extremely prevalent all over the East Indies, which is hardly ever met
with in the tropical regions of the West. This is the inflammation
of the liver, of which I remember to have seen only one well-marked
case, and it was that of a gentleman who had been in the East Indies,
and had been subject to it there: nor do I recollect more than one,
or at most two, cases of this sort out of several thousand cases of
various diseases that were reported to me. This is either owing to the
greater heat and dryness of the air in the East Indies, or some other
peculiarity with which we are not acquainted[12].

Every other inflammatory complaint exists more or less, though they are
much rarer than in cold and temperate climates. The phthisis pulmonalis
is not so common as in cold climates, but proves sooner fatal to most
constitutions. There are certain pulmonic complaints, particularly
those of the asthmatic kind, to which the climate of the West Indies
is remarkably favourable; but those in which there are tubercles and
ulceration seem to be hurried faster to a fatal termination. The
climates, from the thirtieth to the fortieth degree of latitude, seem
to be best suited to consumptive complaints. The rheumatisms that occur
in hot climates are mostly of the chronic kind.




CHAP. III.

 State of Health of the Fleet in April 1782----Battles on the 9th and
 12th--The Fleet very healthy--from the Quality of Provisions--from the
 Effects of Victory--Advantages of close Action--What Diseases most
 prevalent--Extraordinary Degree of Health in the Formidable.


This month being interesting, on account of the memorable engagements
that happened in it, the remarks shall, for this reason, be somewhat
more full and particular.

Three ships of the line having been sent to protect convoys to Jamaica,
and one having been sent to protect a convoy to Barbadoes, there
remained thirty-six at St. Lucia in the beginning of this month. By
the end of the first week their damages were repaired, their water and
provisions complete, and the sick in a great measure recovered.

An equal force of the enemy lay over against us at Martinico, the
two powers of Britain and France being to make this distant quarter
of the world the theatre for trying their strength, and deciding the
sovereignty of the seas. In the view of this great event, our commander
forwarded the necessary duties of the fleet with such zeal and
diligence, and watched the motions of the enemy with such vigilance,
that he overtook their grand squadron a few hours after they left their
own port, and engaged them two several days, with a success, glorious
and complete.

Nothing had been wanting to equip this fleet for the great and decisive
exertion it was to make. Every ship, except two, might be said to
be healthy, most of them were complete in men, well appointed with
officers, and well found in stores and provisions.--Conformable to this
was the eagerness, the confidence, and resolution, which led them to
success and victory.

After this battle, the whole fleet, with the prizes, bore away for
Jamaica, where part of it arrived on the last days of April, but the
greater part of it kept the sea, till after the middle of May.

As this month is more than usually interesting, the tables are given at
full length, and a column is added for the wounded.

The sum total, of the numbers of the men on board of the thirty-six
ships that composed the line of battle on the 12th of April, was
21,608, and the mortality during the month, exclusive of those who were
killed or died of wounds, was one in 862.

There was less sickness, and less death, from disease in this month,
than any of the former twenty-three months, in which I kept records of
the fleet, and less than in any subsequent month, till the fleet got to
the coast of America.

To account for this, it is to be observed, that the men had not
been exposed to the noxious air of the shore in watering, as in the
preceding month: they had received from England a fresh supply of
provisions, among which was sour krout, melasses, and essence of malt,
all in addition to the ordinary articles of victualling: many of the
ships were supplied with wine, in place of rum, and as the weather was
all along dry and fine, the men suffered the less from the exposure and
want of sleep, which are the necessary consequences of keeping ships
clear for battle for several days and nights together.


TABLE V.

ABSTRACT of the RETURNS for APRIL, 1782.

  Key:
  F Sick on board on the 1st of the Month.
  M Put on the List during the Month.
  D Dead.
  H Sent to the Hospital.

  +----------------+-----------------------+-----------------------+
  |    SHIPS’      |        FEVER.         |         FLUX.         |
  |    NAMES       +-----+-----+-----+-----+-----+-----+-----+-----+
  |                |  F  |  M  |  D  |  H  |  F  |  M  |  D  |  H  |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Formidable   |   0 |   6 |   0 |   1 |   2 |   7 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Barfleur       |   6 |  20 |   0 |   1 |   5 |  13 |   0 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Prince George  |   0 |  12 |   2 |   1 |   4 |  18 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Duke         |  57 |  78 |   2 |  32 |   0 |   3 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Namur        |   5 |  14 |   0 |   2 |  11 |   9 |   0 |   3 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Royal Oak      |   1 |   4 |   0 |   0 |  11 |  23 |   0 |   3 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Alfred         |   8 |  46 |   1 |   0 |   6 |  14 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Montagu        |   6 |  11 |   0 |   0 |   8 |   2 |   1 |   5 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Valiant      |   § |  10 |   1 |   0 |   § |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Monarch        |   5 |  21 |   1 |   0 |   3 |  10 |   0 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Warrior      |   0 |   2 |   0 |   0 |   6 |  12 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Centaur        |  12 |  20 |   0 |   1 |  10 |  15 |   0 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Magnificent  |   0 |  21 |   0 |   0 |   0 |   8 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Bedford        |  11 |  20 |   0 |   0 |   3 |  27 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Ajax           |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Canada         |   0 |   6 |   1 |   4 |  24 |  70 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Resolution     |  19 |  25 |   1 |   0 |  21 |  27 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Hercules     |   2 |  38 |   0 |   4 |   5 |  18 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Russel         |   3 |   3 |   0 |   0 |   5 |   4 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Fame         |  36 |  50 |   0 |   0 |   3 |   8 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Torbay         |  10 |  10 |   0 |   0 |   9 |   2 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Princessa      |   1 |   2 |   0 |   0 |   2 |   8 |   0 |   3 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Conqueror    |  30 |   § |   1 |  11 |   0 |   § |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Arrogant     |   2 |  16 |   0 |   0 |   6 |  33 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Marlborough  |   7 |  19 |   2 |   0 |  12 |  21 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Yarmouth     |   0 |   3 |   0 |   0 |   4 |   3 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Belliqueux     |  43 | 118 |   0 |   0 |   6 |   4 |   0 |   2 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Prince William |   4 |  27 |   0 |   0 |   2 |  24 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Repulse      |  20 |  40 |   0 |   0 |   2 |   2 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | St. Albans     |   1 |  22 |   0 |   0 |   0 |   6 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Agamemnon    |   2 |   5 |   0 |   0 |   0 |   1 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Prothée      |   6 |  13 |   1 |   0 |   5 |  49 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | America        |   2 |   5 |   0 |   0 |   3 |  14 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Anson        |   3 |   6 |   0 |   0 |   0 |  26 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Nonsuch      |   6 |  11 |   1 |   0 |   0 |   4 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Alcide         |   2 |   6 |   0 |   2 |   7 |  16 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Ramillies      |   § |  26 |   1 |   4 |   § |   6 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Nymph          |   2 |   7 |   0 |   0 |   8 |   9 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Flora          |   0 |   0 |   0 |   0 |   2 |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  |     Total      | 312 | 743 |  15 |  65 | 195 | 516 |   7 |  19 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+

  +----------------+-----------------------+-----------------------+
  |    SHIPS’      |        SCURVY.        |        WOUNDS.        |
  |    NAMES       +-----+-----+-----+-----+-----+-----+-----+-----+
  |                |  F  |  M  |  D  |  H  |  F  |  M  |  D  |  H  |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Formidable   |   0 |   5 |   0 |   0 |   0 |  37 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Barfleur       |   6 |  30 |   0 |   1 |   0 |  37 |   8 |   6 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Prince George  |   0 |   7 |   0 |   0 |   0 |  14 |   3 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Duke         |   0 |   1 |   0 |   0 |   0 |  60 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Namur        |   8 |   5 |   0 |   2 |   0 |  25 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Royal Oak      |   1 |   1 |   0 |   1 |   0 |  54 |   5 |  15 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Alfred         |  15 |  14 |   0 |   2 |   0 |  30 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Montagu        |   2 |   2 |   0 |   0 |   0 |  25 |   5 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Valiant      |   § |   0 |   0 |   0 |   0 |  37 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Monarch        |   0 |   1 |   0 |   1 |   0 |  33 |   2 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Warrior      |   0 |   0 |   0 |   0 |   0 |  20 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Centaur        |   5 |  15 |   0 |   0 |   0 |  14 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Magnificent  |   7 |  16 |   0 |   0 |   0 |  20 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Bedford        |   1 |  10 |   0 |   0 |   0 |  17 |   4 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Ajax           |   0 |   0 |   0 |   0 |   0 |  30 |   1 |   5 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Canada         |   1 |   8 |   0 |   0 |   1 |  12 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Resolution     |   0 |   0 |   0 |   0 |   0 |  19 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Hercules     |   0 |  12 |   0 |   2 |   0 |  18 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Russel         |   0 |   1 |   0 |   0 |   4 |  29 |   3 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Fame         |   0 |   7 |   2 |   0 |   1 |  12 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Torbay         |   3 |   2 |   0 |   0 |   0 |  25 |   3 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Princessa      |   0 |   0 |   0 |   0 |   0 |  19 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Conqueror    |  10 |   § |   0 |   0 |   0 |  23 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Arrogant     |   4 |  10 |   0 |   0 |   0 |  11 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Marlborough  |   0 |   6 |   0 |   0 |   0 |  16 |   1 |   1 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Yarmouth     |   3 |   3 |   0 |   0 |   0 |  33 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Belliqueux     |   0 |   3 |   0 |   0 |   0 |  10 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Prince William |   5 |  18 |   0 |   0 |   1 |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Repulse      |   3 |   2 |   0 |   0 |   0 |   9 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | St. Albans     |   0 |   0 |   0 |   0 |   0 |   7 |   1 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Agamemnon    |   0 |   0 |   0 |   0 |   0 |  23 |   7 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Prothée      |   0 |   0 |   0 |   0 |   0 |  24 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | America        |   2 |   0 |   0 |   0 |   1 |  27 |   2 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Anson        |   1 |   1 |   0 |   0 |   0 |  13 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | * Nonsuch      |  18 |  25 |   0 |   6 |   0 |   2 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Alcide         |   7 |   0 |   0 |   0 |   0 |  15 |   0 |   3 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Ramillies      |   § |   3 |   0 |   3 |     |     |     |     |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Nymph          |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  | Flora          |   0 |   0 |   0 |   0 |   0 |   0 |   0 |   0 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+
  |     Total      | 103 | 208 |   2 |  18 |   8 | 810 |  60 |  32 |
  +----------------+-----+-----+-----+-----+-----+-----+-----+-----+

  N. B. The Ships marked thus, *, came from England in February and
  March, 1782.

All the Ships named in the Table were in the Engagements in April,
except the Ramillies and the two Frigates.

In the Spaces marked thus, §, no Return was made.

Might not this extraordinary degree of health have also been owing,
in part, to the effects of success upon the spirits of the men? It
is related[13], that, when the fleet under Admiral Matthews was off
Toulon, in daily expectation for some time of engaging the combined
fleet of France and Spain, there was a general stop put to the progress
of disease, particularly of the scurvy, from the influence of that
generous flow of spirits, with which the prospect of battle inspires
British seamen. But if the mere expectation and ardour of a battle,
without any happy event, could have such a sensible effect, what must
have been the effect of the exultation of VICTORY, a victory in which
the naval glory of our country was revived and retrieved, after a
series of misfortunes and disgraces, which had well nigh extinguished
the national pride in every department of service! The plain and
honest, though unthinking seaman, is not less affected by this than
the more enlightened lover of his country. Even the invalids at the
hospital demonstrated their joy, upon hearing of this victory, by
hoisting shreds of coloured cloth on their crutches.

It would appear, that there is something in situations of exertion and
danger, which infuses a sort of preternatural vigour. When the mind is
interested and agitated by active and generous affections, the body
forgets its wants and feelings, and is capable of a degree of labour
and exertion, which it could not undergo in cold blood. The quantity of
muscular action employed in fighting at a great gun for a few hours, is
perhaps more that what is commonly employed in a week in the ordinary
course of life, and though performed in the midst of heat and smoke,
and generally with the want of food and drink, yet the powers of nature
are not exhausted nor overstrained; even the smart of wounds is not
felt; and the future health of those who survive unhurt by external
violence is so far from being injured, that it is sometimes mended by
this violent, but salutary agitation.

The loss in action, and the number of mortal wounds, were not so great
as might have been expected in a battle continued for a whole day.
This advantage was owing to the superiority of our fire, as well as to
the closeness of the fight, of which the Commander in Chief set the
illustrious example, by penetrating the enemy’s line with his own ship;
a bold and singular effort which first decided the event of the day.
When ships in action are opposed to each other at a small distance,
the velocity of cannon balls is so great, that in penetrating a ship’s
side, few or no splinters are torn off; and by these more men are
commonly killed and wounded, than by the ball itself. For the same
reason, a close shot does less damage also to the ship itself, than
a distant one; for a quick-flying ball makes an aperture less than
its own diameter, whereas a spent one produces innumerable deadly
splinters, at the same time shivering the object it strikes, and making
wide and extensive rents in it. The proportion of the wounded to the
killed, is also greater in distant, than in close fight, on account of
the great number of small splinters; and we have an experimental proof
of this, in comparing the action in Fort Royal Bay in April 1781, with
this near Dominica in April 1782. In the former, the enemy having kept
far to windward, and engaged at a great distance, the proportion of
the wounded to the killed was considerably more than four to one[14];
whereas in the latter, where the greater part of the battle was close,
the proportion of the wounded to the killed, was little more than three
to one[15].

Though it is a remark not belonging to a medical work, yet it may be
observed, that the greatest advantage that arose to us from close
action was, that the fire of the enemy was thereby silenced; for the
advantages would be mutual and equal, on the supposition, that the
French, in such a situation, were to keep the deck, and stand to their
guns equally well with the British seamen.

It appears, by examining the table, that the ships in which the fevers
chiefly prevailed this month, were those that came last from England,
and that those in which the fluxes prevailed most were chiefly of the
squadron we found on the station, namely, the Canada, Resolution, and
Prince William. The latter however recovered greatly in the course of
this month. Some of the Ships that arrived last from England, namely,
the Arrogant, Prothée, and Anson, were also considerably afflicted with
fluxes, but they were of an extremely mild kind; and the small number
of deaths from this disease in comparison with those from fevers, is a
proof of a former observation, that this is the safest form in which
an acute disease can shew itself. This small degree of mortality was
also owing to the judicious method of treating it which was in general
practised throughout the fleet; and it is but justice to the medical
gentlemen to say, that they shewed on this, as well as every other
occasion, great skill and attention in the treatment of the sick and
wounded.

The sum total of fevers and fluxes that have been put on the list
this month, is much the same as that of the preceding month; but the
proportion of fluxes in April is much greater.

The proportion of scurvy is somewhat increased; which is not to be
wondered at, when it is considered, that though the fleet had not
been so long at sea as is necessary to produce it, especially in this
climate, yet the men having had no refreshments when last in port, may
be considered as having been all that time at sea.

The superior degree of health in this month will appear in a still
stronger light, if we cast our eye on the column expressing the number
sent to the hospital, the proportion of which is, comparatively, very
small.

The ships that had been the longest from England, were still among the
most healthy. But of all the fleet, none was so free from sickness
and mortality as the Formidable. No man belonging to this ship died
of disease for the first four months after sailing from Plymouth,
though there were at times 900 men on board, and never less than the
established complement, which is 750; and so few were taken sick
in that time, that only thirteen were sent to hospitals, and their
complaints were small-pox and ulcers.

This ship left England provided with every thing that could be supposed
to conduce to the health of men, and may be considered as an experiment
to prove what degree of health may be attained by proper management and
attention. She was furnished not only with abundance of sour krout,
melasses, and essence of malt, in common with the other ships; but what
was peculiar to her, was an entire supply of excellent wine, in place
of spirits, of which none was used during the period mentioned.




CHAP. IV.

 Account of the HEALTH of the FLEET while it lay at Jamaica during
 May, June, and Part of July, 1782.----French Prizes Causes of
 Sickness--Their Difference from the English in point of Cleanliness
 and Discipline--Bad Effects of Land Wind and Watering Duty--Situation
 of Port Royal--Season uncommonly dry and windy--Fluxes more prevalent
 at Sea than in Harbour--Comparison of the Sickness at this Time with
 that of the Army and with that of the Squadron under Admiral Vernon
 forty-one Years before--Effects of Contagion and foul Air--Officers
 more affected than the common Men.


All the squadron that was left to windward of Jamaica, consisting of
twenty-four ships of the line, kept the sea during great part of May,
the last division of it not having come to Port Royal till the 25th of
that month.

The whole fleet remained in harbour during the remainder of the month,
and the whole of the next, except the Warrior, Prothée, and Russell;
the two former were sent on a cruise, in which the Warrior continued
quite healthy, as she had been ever since her arrival from England; and
in the Prothée a great check was given to the fevers and fluxes which
had begun to prevail at Port Royal. The Russell was sent to England
with a convoy.


TABLE, shewing the proportional Prevalence of Sickness and Mortality in
May.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill or      |
  |   wounded in the Course of the Month.   |
  |                                         |
  | B Proportion of those that died in      |
  |   relation to the Numbers of Sick or    |
  |   wounded.                              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     26 |     29 |
  |                       |        |        |
  | Fluxes                |     18 |     63 |
  |                       |        |        |
  | Scurvy                |     57 |     34 |
  |                       |        |        |
  | Wounds                |    627 |     60 |
  |                       |        |        |
  | Other Complaints      |     44 |    127 |
  +-----------------------+--------+--------+
  | General Proportion,   |        |        |
  |   including wounded   |      7½|     46 |
  |                       |        |        |
  | General Proportion,   |        |        |
  |   exclusive of Wounds |      8 |     48 |
  +-----------------------+--------+--------+

The whole number of sick on board on the first of this month, in
thirty-six ships of the line and two frigates, upon which the preceding
calculation is formed, was one thousand four hundred and eighteen. The
whole number taken ill in the course of the month was two thousand
eight hundred and twenty-eight; the number sent to the hospital was one
hundred and seventy-three; and there died on board ninety-four.

The proportion of those who died this month, in relation to the whole
number on board, was one in two hundred and eighty-seven.

There was a considerable increase of sickness and mortality this month
in all the common diseases, and chiefly in that part of the squadron
which was in port. There was less increase in the number of fevers
than either of the other two epidemics; but such was their increased
malignancy, that more died of them than of both the others. The number
of fluxes was more than double of what it was the preceding month, and
the mortality from them was also in a much greater proportion, as may
be seen from the Tables.

The fevers prevailed chiefly in port, and the fluxes at sea. A good
many of the latter, indeed, arose in the Alcide, though constantly in
port; but this seemed to be owing to contagion conveyed by some British
soldiers, who were sent on board of this ship after being retaken in
one of the French men of war, several of whom were ill of this disease.
But there were few fluxes in those ships at Jamaica in which the most
malignant fevers appeared. There were a few in those in which the
fevers arose from the air of the marshes on the watering duty; but
there were none on board of the French prizes, nor in those ships in
which that sort of fever was which proceeded from a similar cause, that
is, filth and animal effluvia. Upon the whole, in those ships in which
the fever was most malignant, there the fewest fluxes were found.

Several circumstances contributed to the increase of sickness and
mortality this month.

1st. The infection, or rather the foul air, of the French prizes, in
most of which a very bad fever broke out among the officers and men
that were sent from the ships of our fleet to take charge of them.

The discipline and internal œconomy of the French ships of war are
greatly inferior to those of the British. Their decks are never washed,
and there is a great defect in every point of cleanliness and order.
The free course of the air is obstructed by lumber of every kind, and
by bulkheads, which are not taken down even in the time of battle;
and the gratings are covered night and day with tarpaulins, even in a
hot climate. There are not even scuppers opened on the lower deck as
outlets to the water and filth, which necessarily accumulate there, and
for which the only vent is a pipe contrived on purpose, passing from
that deck along the ship’s side into the hold, which becomes thereby a
common sink, inconceivably putrid and offensive. And in addition to the
ordinary causes of corruption, there was one peculiar to the occasion;
for the blood, the mangled limbs, and even whole bodies of men, were
cast into the orlop, or hold, and lay there putrifying for some time.
The common sailors among the French have a superstitious aversion to
the throwing of bodies overboard immediately after they are killed, the
friends of the deceased wishing to reserve their remains, in order to
perform a religious ceremony over them when the hurry and danger of the
day shall be over. When, therefore, the ballast, or other contents of
the holds of these ships, came to be stirred, and the putrid effluvia
thereby let loose, there was then a visible increase of sickness. For
the first three weeks after the capture, the stench proceeding from the
numbers of wounded men contributed also to taint the air.

The Ville de Paris was much more sickly than the other prizes, not
only from her being larger, and thereby containing a greater mass of
foul air, but by receiving the surviving part of the crew of the Santa
Monica, one of our frigates, which had been cast away on the Virgin
Islands, and whose men were so reduced by hardship and intemperance,
that most of them were taken ill as soon as they came to breathe the
unwholesome air of the French prize. To whatever cause it was owing,
the fever was much more violent here than in the other prizes, and
it generally carried men off on the third or fourth day; and what is
remarkable, the officers were affected by it in a greater proportion
than the common men. One lieutenant, and every warrant officer, except
the boatswain, died of it. This was a proof that the sickliness was
owing to the bad air, and not to the intemperance and irregularity so
usual on board of prizes, which only the common men give into; and the
probable cause of the officers being most affected is, that they were
accustomed in common to a purer air, by living in the most clean and
airy parts of the ship.

It is also remarkable, that the Ville de Paris was healthy when taken,
and had been so ever since leaving France in March, 1781; nor had any
other of the captured ships of the line been sickly for some time
before, except the Ardent, when she arrived at Martinico four months
before, at which time the greater part of the crew were sent to the
hospital with fevers. This, as well as other facts of the same kind,
tends to prove, that when men come to be much habituated to bad air,
their health is not affected by it.

The French ships were purified by washing and scraping, by fumigating
daily with gunpowder and vinegar, and by the use of wind sails; but
nothing seemed to contribute so much to sweeten the air in them as
burning fires in the hold; for this tended both to make the putrid
matter exhale, and to carry it off, by producing a perpetual change of
air. Captain Curgenven, who at this time commanded the Ville de Paris,
had great merit from his very assiduous and successful endeavours in so
difficult a duty as the management and equipment of this great ship. In
consequence of the judicious measures taken, and the men becoming more
used to the bad air, the sickness ceased in the course of a few weeks.

In the accounts given in the tables, the French prizes are not
included, for the disorderly state in which they were at this time
prevented my receiving regular returns: but having made inquiry
concerning the mortality in the Ville de Paris, I found, that of a
crew of three hundred and twelve men, there died ten in the month of
May, and there were thirty sent to the hospital, whose cases were so
unfavourable, that about one half died. The only diseases were fevers.
The surgeon of the Ardent told me about the same time, that one third
of the crew of that ship was ill of fevers.

The second cause of the prevalence of sickness, while the fleet was at
Jamaica, was, the watering duty, which was carried on at Rock-fort,
about three leagues from Port Royal. It was the practice of many of the
ships to leave the water casks on shore all night, with men to watch
them; and as there is a land wind in the night, which blows over some
ponds and marshes, there were hardly any of the men employed on that
duty who were not seized with a fever of a very bad sort, of which a
great many died. The ships that followed a different practice were
somewhat longer in watering; but this was much more than compensated by
their preserving the health and saving the lives of their men.

The land wind which blows on the shore in the night time, is a
circumstance in which Jamaica differs from the small islands to
windward, over which the trade wind blows without any interruption: but
though this land wind blows upon Port Royal from some marshes at a few
miles distance, it does not seem to produce sickness, for it is a very
healthy place, and several of the ships enjoyed as good health as in
the best situations on the windward station. The bay which forms this
harbour is bounded towards the sea by a peninsula of a singular form,
being more than ten miles in length, and not a quarter of a mile broad
at any part. Great part of it is swampy and overgrown with mangroves,
and though of such small extent, we fancied that some of the ships that
lay immediately to leeward of this part were more sickly than those
that were close to the town of Port Royal, which stands at the very
extremity of this long peninsula upon a dry, gravelly soil.

The weather this month was uniformly dry in port; but at sea the
air was moist and hazy. Between Jamaica and Hispaniola, where part
of the squadron was left to cruise, dead calms prevailed; and this,
joined to the moisture of the air, was probably what caused the flux
to prevail chiefly in this part of the fleet. At Port Royal, on the
contrary, there was a strong dry breeze, which set in every day about
nine o’clock in the morning, and blew all day so fresh, that there was
frequently danger in passing from one ship to another in boats. This
is called, in the language of the country, the _fiery sea breeze_, an
epithet which it seems to have got not from its absolute heat, but from
the feverish feeling which it occasions by drying up the perspiration.
It was remarked, that this breeze was stronger this season than had
ever been remembered; and it sometimes even blew all night, preventing
the land breeze from taking its usual course. This year was farther
remarkable for the want of the rains that were wont to fall in the
months of May and June. We shall have occasion to remark hereafter,
that this was a very uncommon season also in Europe and America. The
heat, by the thermometer, this month, on board of a ship at Port Royal,
was, in general, when lowest in the night, at 77°, and when highest in
the day, in the shade, at 83°.

There was a considerable increase of scurvy in this month, compared
with the former months of this campaign; but very inconsiderable,
compared with what had occurred in cruises of the same length in former
years. The last division of the fleet had been at sea seven weeks, all
but one day, when it arrived at Port Royal; and though the scurvy had
appeared in several of the ships, it did not prevail in any of them to
a great degree, except in the Nonsuch. Out of fourteen deaths which
happened in the whole fleet from this disease, in May, seven of them
were in this ship, and several were sent from her to the hospital in
the last and most desperate stage of it. But, upon the whole, the cases
of the true sea scurvy in the fleet, in general, were few and slight,
and a great many of those given in the reports under the head of
scurvy, were cutaneous eruptions or ulcers, not properly to be classed
with it.

The cruise in the preceding year to windward of Martinico, may be
compared with that in May of this year; for the fleet in both cases had
been at sea about the same length of time. But the comparison is very
greatly in favour of the latter, which is most probably to be imputed
to the plentiful supply of melasses, wine, sour krout, and essence of
malt. But no adequate reason that I could discover can be assigned for
the prevalence of it in the Nonsuch to a degree so much more violent
than in the other ships; and it was here farther remarkable, that it
attacked every description of men indiscriminately; for I was assured
by the officers and by the surgeon, that not only the helpless and
dispirited landsman was affected, but old seamen, who had never before
suffered from it on the longest cruises. I have been led by this, and
some other facts, to suspect that there may be something contagious in
this disease.


JUNE.

The greater part of the fleet remained at Jamaica during this month,
refitting and watering. Twelve ships of the line were sent to sea on
the 17th, under the command of Rear-admiral Drake, but not being able
to get to windward on account of the fresh breezes that prevailed,
they returned to Port Royal on the 28th. Such of these ships as were
sickly, became more healthy while at sea; but some bad fevers arose,
particularly in the Princessa; and it is a curious circumstance, that
these fevers attacked only those men who had been on shore on the
watering duty; from which it would appear, that something caught or
imbibed, which is the cause of the fever, lies inactive for some time
in the constitution, some of the men not having been affected for more
than a week after they had been at sea.

The weather continued dry and windy, as in the former month; but the
heat was in general about two degrees higher, the thermometer varying
from 79° to 84½°.


TABLE, shewing the proportional Sickness and Mortality in June.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of this Month.                 |
  |                                         |
  | B Proportion of those who died, in      |
  |   relation to the Numbers of the Sick.  |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     11 |     19 |
  |                       |        |        |
  | Fluxes                |     20 |     83 |
  |                       |        |        |
  | Scurvy                |     47 |    231 |
  |                       |        |        |
  | Other Complaints      |     37 |     97 |
  +-----------------------+--------+--------+
  | General Proportion    |      6 |     39 |
  +-----------------------+--------+--------+

The proportion of deaths in relation to the whole numbers on board, was
one in one hundred and thirty-eight.

There was only one in thirty of the sick sent to the hospital in the
course of this month.

There was an increase both in the numbers and fatality of fevers.
This increase was chiefly in that sort of fever which depends on the
air and climate, the greater part of which was caught on the watering
duty. There was a diminution of those fevers depending on infection,
and the foul air of ships, which arose in the French prizes. The care
that was taken in purifying these ships was very effectual; for only
four died this month in the Ville de Paris, and fewer also were sent
to the hospital than in May. The increase of the other kind of fever
was chiefly owing to there being a greater number of ships in port, the
crews of which were employed in watering, and partly, no doubt, to the
increase of heat in the weather. The ships in which the fevers were
most fatal were the Monarch, the Duke, the Torbay, and the Resolution.
The sickness in the Duke was still in a great measure owing to the same
infection that had hitherto prevailed; for this ship had never been
cleared of the infectious fever, for want of room at the hospital. That
which broke out in the Torbay was also of the low infectious kind, few
of them having the symptoms of that which is peculiar to the climate,
which prevailed in the other ships. This ship, though formerly very
subject to infectious complaints, had been remarkably healthy for some
time past; but it would appear that there was a large stock of latent
infection, which shewed itself from time to time.

Some ships, particularly the Montague and Royal Oak, had no increase
of fevers or other complaints, though the one lay in port for seven,
and the other for eleven weeks, and were more or less exposed to the
causes of sickness which affected the rest of the fleet. This is a
proof, among many others, that a particular combination of causes
is necessary to produce a disease: no single one, however powerful,
being sufficient, without the concurrence of others. What seemed to
be wanting here was the predisposition requisite for the admission of
disease into the constitution; for the ships that enjoyed this happy
exemption were such as had long-established and well-regulated crews,
accustomed to the service and climate.

There had been this month a diminution both of the numbers and
mortality of fluxes, which is agreeable to what was before remarked,
that fevers were more apt than fluxes to prevail in the bad air of a
harbour[16]. It was also before remarked, that there were few or no
fluxes in those ships in which the fever was most malignant; and now
that the fever began to grow more mild in the French prizes, the flux
began to appear. In the Barfleur, Duke, and Namur, both diseases seemed
to prevail equally; but the fevers, though numerous, were more of the
low nervous kind than bilious or malignant; and the fluxes chiefly
attacked those who were recovering from fevers. We may farther remark,
that these three men of war were three-decked ships, of 90 guns, the
crews of which being more numerous, and composed of a more mixed set
of men, were consequently subject to a greater chance of infection,
and a greater variety of complaints. The Formidable still remained
healthy to an extraordinary degree. Some fevers were indeed imported
from the Ville de Paris by men that had been lent to that ship, and who
were taken ill after their return. Of these, a few of the worst cases
were sent to the hospital, and two died on board, who, with one that
died the preceding month, make the whole mortality of this ship, since
leaving England, amount only to the loss of three men.

There has been little or no increase of scurvy this month; for though
the numbers put on the list appear to be greater, the mortality is much
less. It may indeed appear a matter of surprise that there should have
been any scurvy at all, considering that the greater part of the fleet
was at anchor all this month. But as this was the greatest fleet that
had ever visited Jamaica, it was impossible to find fresh provisions
for the whole; and the small supply they had did not amount to one
fresh meal in a week. Port Royal is also remote from the cultivated
part of the island, so that fruit and vegetables were both scarce and
high priced, particularly this year, on account of the usual rains in
May and June having failed. There was, however, an allowance of fresh
provisions and vegetables made to the sick by public bounty; for as
the hospital could contain but a small proportion of the sick and
wounded, an order was given for the supply of fresh meat, fruit, and
vegetables, to the sick, and five hundred pounds of Peruvian bark were
also distributed as a public gratuity, besides sugar, coffee, and wine.

With these aids, and the various good articles of victualling from
England, the fleet was preserved uncommonly healthy for a West-India
campaign: for though the mortality had increased considerably during
our stay at Jamaica, yet the loss of men, upon the whole, was small,
compared with that of other great fleets in this climate on former
occasions. The greatest squadron, next to this, that had ever been
on this station was that under Admiral Vernon in the year 1741, at
the same season. From this fleet upwards of eleven thousand men were
sent to the hospital in the course of that and the preceding year, of
whom there died one in seven, besides what died on board of their own
ships and in two hospital ships[17]. The disproportion of sickness
in the two fleets will appear still greater, when it is considered
that Admiral Vernon’s contained only fifteen thousand seamen and
marines[18]; whereas that under Lord Rodney contained twenty-two
thousand. What added to the sickness of the former was the unfortunate
expedition to Carthagena in April, 1741; to which probably it was owing
that a much greater proportion of yellow fevers were landed from the
fleet at that time than from ours, as appears by the papers left by Mr.
Hume, who was then surgeon of the hospital. The hospital was then at a
place called Greenwich, on the side of the bay opposite to Port Royal,
and was very large; but it was found to be in a situation so extremely
unhealthy, that it was soon after abandoned and demolished, and the
hospital has since been at Port Royal.

It appears by the tables, that a greater number was put on the list
under the head of _other complaints_ in this month than the last.
This was owing to the great number of ulcers which I have remarked to
keep pace with feverish as well as scorbutic complaints; for when the
constitution of the air is favourable to disease, or the habit of body
prone to it, wounds and sores are found then to be more difficult of
cure. There were twelve deaths besides those occasioned by what have
been called the three epidemics. Of these, five perished by drowning
and other accidents, three died of ulcers, one of wounds received in
action, one of _cholera morbus_, and one of an abscess.

It has appeared that very few ships of this numerous fleet preserved
their health while lying at anchor; and it would seem that short and
frequent cruises are very conducive to health. It was eleven weeks from
the time that the first of our fleet came to anchor at Jamaica till the
main body of it sailed for America on the 17th of July. Great fleets
are in time of war under the necessity of being at one time longer at
sea, and at another time longer in port, than is consistent with the
health of the men, the ships being obliged to act in concert and to
co-operate with each other. This is one reason, among others, for ships
of the line being more sickly than frigates. As ships of war must be
guided by the unavoidable exigencies of service, it would be absurd
to consider health only; but if this were to be the sole object of
attention, a certain salutary medium could be pointed out in dividing
the time between cruising and being in harbour; and it is proper that
this should be known, that regard may be had to it, as far as may be
consistent with the service. I would say, then, that in a cold climate
men ought not to be more than six weeks at sea at one time, and need
not be less than five weeks, and that a fourth part of their time spent
in port would be sufficient to replenish their bodies with wholesome
juices. In a warm climate men may be at sea a considerable time longer,
without contracting scurvy, provided they have been under a course of
fresh and vegetable diet when in port.

Though contagion is not so apt either to arise or to spread in this
climate as in colder ones, there were several circumstances about this
time tending to prove that it may exist in a hot climate. Those ships
which had their men returned to them from the French prizes, in all of
which fevers prevailed, had an increase of sickness not only in the
men that were returned, but in the rest of the crew. There was another
presumption of contagion, from the proportion of mortality among the
surgeons and their mates, who were by their duty more exposed to the
breath, effluvia, and contact of the sick. There died, during our stay
at Jamaica, three of the former, and four of the latter, which is a
greater proportion than what died of any other class of officers or men.

It has been the opinion of some, that fevers do not arise from any
putrid _effluvia_, except those of the living human body, or some
specific infection generated by it while under the influence of
disease. It has been alledged in proof of this, that the putrid air in
some great cities is breathed without any bad effects; and a celebrated
professor of anatomy[19] used to observe, that those employed in
dissecting dead bodies did not catch acute diseases more readily than
other people. I believe this may be true, in a climate like Europe,
where cold invigorates the body, and enables it to resist the effects
of foul air; but I am persuaded it is otherwise in tropical climates.
The external heat of the air induces great languor and relaxation, and
we cannot breathe the same portion of air for the same length of time
in a hot as in a cold climate, without great uneasiness. The want of
coolness must, therefore, be compensated by a more frequent change of
air, and by its greater purity: any foulness of the air is accordingly
more felt in a hot climate; and, according to the modern theory, air,
already loaded with putrid phlogistic vapour, will be less qualified
to absorb the same sort of vapour from the blood in the lungs, in
which, according to this theory, the use of respiration consists. Be
this as it will, there is something in purity of air which invigorates
the circulation, and refreshes the body; and the contrary state of it
depresses and debilitates, particularly in a hot climate; and in this
way foul air may induce disease, like any other debilitating cause,
independent of infection, or any specific quality. There was no reason
to suspect any such infection in the Ville de Paris; for there was no
sickness on board of this ship when in possession of the enemy, and
the sickness that prevailed after her being captured seemed to proceed
from what may be called simple putrefaction. There was an instance
of the same kind in one of our own ships of the line, in which a bad
fever broke out in the beginning of July, which seemed to be owing
to the foul air of a neglected hold; for there was a putrid stench
proceeding from the pumps, which pervaded the whole ship. I perceived
this very sensibly one day, when visiting some officers who were ill of
fevers; and before I left the ship an alarm was given of two men being
suffocated in what is called the _well_, which is the lowest accessible
part of the hold. This fever was of a very malignant kind, and fell
upon the officers more than the men; for six of them were seized with
it, of whom three died on the third day after being taken ill.

The fevers, which were of the greatest malignity at this time, affected
the officers more than the common men. Only one captain died at Jamaica
while the fleet was there, and it was of this fever. We lost five
lieutenants, of whom four died of it; and this was the disease which
carried off the three surgeons. But foul air was not the only cause
that produced this fever among the officers, several of whom brought
it on by hard drinking, or fatiguing themselves by riding or walking
in the heat of the sun. It cannot be too much inculcated to those who
visit tropical countries, that exercise in the sun, and intemperance,
are most pernicious and fatal practices, and that it is in general by
the one or the other that the better sort of people, particularly those
newly arrived from Europe, shorten their lives.

Before leaving Jamaica, I sent to England a Supplement to the Memorial
given in, last year[20].




CHAP. V.

 Account of the HEALTH of the FLEET, from its leaving Jamaica on
 the 17th of July, till its Departure from New York on the 25th
 of October.----What Diseases most prevalent on the Passage to
 America--Rapid Increase of the Scurvy during the last Week of
 the Passage--Method of supplying the Sick at New York--The Fleet
 uncommonly healthy in October--State of the Weather and of Health in
 America in Summer and Autumn, 1782.


The season of the hurricanes approaching, and all the convoys destined
for England this year being dispatched, the main body of the fleet,
consisting of twenty-four ships of the line, left Port Royal on the
17th of July, under the command of Admiral Pigot, in order to proceed
to the coast of America. A great convoy for England had been sent off a
few days before, protected by the Ville de Paris and six other ships of
the line, which we overtook and passed at the west end of the island.
When we arrived off the Havannah, a large squadron of the enemy was
seen there in readiness to sail, which induced the Admiral to wait in
sight of it for the convoy, which did not come up till ten days after.
Owing to this delay, and our meeting with baffling winds on the rest of
the passage, we did not arrive at New York till the 7th of September.
We found there the Invincible and Warrior, which sailed after us, but
arrived before us, by having taken the windward passage.


TABLE, shewing the proportional Prevalence of different Diseases, and
their Mortality, in July, 1782.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     13½|     16 |
  |                       |        |        |
  | Fluxes                |     24 |     49 |
  |                       |        |        |
  | Scurvy                |     91 |      0 |
  |                       |        |        |
  | Other Complaints      |     20 |    134 |
  +-----------------------+--------+--------+
  | General Proportion    |      5½|     33 |
  +-----------------------+--------+--------+

The mortality this month, in relation to the whole numbers on board,
was one in a hundred and thirty.

There were only one in thirty-eight of the sick sent to the hospitals.

The fevers arose chiefly during the first two weeks after leaving
Jamaica, which renders it probable that the seeds of them were brought
from thence. Had they been owing to the heat simply, they would have
been as apt to arise in some subsequent part of the passage; for the
tropical heats at this season of the year extend to the 30th degree
of latitude, which we did not cross till the 22d of August, that is,
near five weeks after leaving Jamaica. The only ships in which the
fever could be imputed to infection or foul air were the Barfleur,
Alcide, and the Aimable frigate. The first had received, as recruits,
at Jamaica, men who had been confined for some time before in a French
jail, and a fever of a bad kind spread on board of her soon after.
The Aimable was a prize from the French; and the sickness was here so
evidently owing to foul air, that, whenever the contents of the hold
were stirred, so as to let loose the putrid effluvia, there was then an
evident increase of sickness. The fever in the Alcide was of a peculiar
slow kind, to be described hereafter, and seemed to be a continuation
of the same infection which had so long existed in that ship.

The Duke, which had hitherto been by far the most subject to fevers of
any ship in the fleet, became more and more free from them even in the
most early part of this passage, and might be said to be entirely so at
the time she arrived in America. The fever had been so very prevalent
in this ship since leaving England, that there was hardly a man who had
escaped it. Could this have any effect in making them less liable to
catch it a second time?

In the course of this passage the dysenteries came to prevail over the
fevers, as we have found to be commonly the case at sea. It appears
by the former table, compared with the next, that the mortality in
fevers was much the same, and that in the dysentery it was greater
than while the fleet was at Jamaica. This does not argue, however,
that the diseases were equally malignant, but was owing to the want
of an hospital, and of those comforts of diet which the sick enjoyed
on board while in harbour. This last was particularly felt in the
dysenteries, in the cure of which more depends upon diet than in most
other diseases. In all the calculations of mortality on board of ships,
if any have been sent to the hospital, they are to be deducted from the
number; and these make a greater difference in the mortality on board
than their numbers simply would indicate; for only the worst cases, and
those therefore who were most likely to die, used to be sent to the
hospital. But as the fleet was at sea during the whole of this month,
no allowance of this kind is to be made.


TABLE, shewing the proportional Sickness and Mortality in August.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     31 |     17 |
  |                       |        |        |
  | Fluxes                |     46 |     35 |
  |                       |        |        |
  | Scurvy                |     25 |     66 |
  |                       |        |        |
  | Other Complaints      |     27 |     43 |
  +-----------------------+--------+--------+
  | General Proportion    |  7½    |     31 |
  +-----------------------+--------+--------+

The mortality this month, in relation to the whole numbers on board,
was one in one hundred and sixty-nine.

The scurvy began to appear very soon upon this passage; for by the end
of August, at which time the fleet had only been six weeks at sea, and
that in a warm climate, and in dry weather, it had made considerable
progress. It first appeared and prevailed most in the Prince George
and Royal Oak, though they had been ten weeks at Jamaica. This was the
first sickness with which the latter had been affected since arriving
in the West Indies; and there was no perceivable peculiarity in either
of them to account for their being subject to it more early, or more
violently, than the rest of the fleet. If the disease is contagious,
as has been suspected, there might be a few men on board of them, who,
being uncommonly prone to the disease, would be soon affected, and
communicate it, or at least hasten the symptoms in those who might be
less predisposed to it. But this is only conjecture. Before the end of
the voyage, the whole fleet was more or less afflicted with it, though
it had been only seven weeks and three days at sea; but the men had
received so few refreshments while in port, that their constitutions
were prepared to fall into this disease. The Barfleur, Alfred, and
Princessa, were most affected with it next to the two ships mentioned
above.

The seventeen ships which arrived from England in February and March
were much less affected with it than the rest of the fleet, which was,
no doubt, owing to the wine, melasses, and sour krout, with which they
were so amply supplied. Though these articles were all expended before
leaving Jamaica, yet the good effects of them on the constitutions of
the men were visible in the course of this passage.

The America was the most free from it of all the ships of the old
squadron; and this was owing to the great humanity and attention of the
captain[21], who, as soon as any of the men were taken ill, allowed
them wine and other refreshments from his private store. There was
another proof in the Conqueror of the great importance of attending
to this disease in its earliest stage. Mr. Lucas, the surgeon of this
ship, by watching the first beginnings of it, by a proper regulation of
diet, and the administration of the essence of malt and juice of limes,
not only prevented the progress of the disease, but proved, that,
with great attention, it may even be cured at sea. It is of the utmost
consequence in this disease to put the men on the sick list on the
very first appearance of the symptoms, so that they may early have the
advantage of proper treatment and regimen. It is only at this period of
it that the effects of essence of malt are sensible; but we have seen
that the juice of certain fruits will cure it in more advanced stages.

There is a very important remark suggested by comparing the two
preceding tables with that which follows. It appears that in the month
of September a much greater number was taken ill of scurvy, and also
that there died of this disease a greater proportion than in the two
preceding months. All the mischief from it in that month happened in
the first week of it, during which as many died as in the whole month
of August; for the fleet came to an anchor on the 7th of September at
New York, where the worst cases were immediately sent to the hospital,
and those that remained on board were supplied with every necessary
refreshment. Had the fleet remained longer at sea, the mortality would
probably have increased in the same progression; and this circumstance
ought to be well considered in undertaking cruises.


TABLE, shewing the proportional Prevalence of Sickness and Mortality in
September.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  |  Fevers               |     49 |     31 |
  |  Fluxes               |     46 |     68 |
  |  Scurvy               | 15½    |     39 |
  |  Ulcers               |     68 |      0 |
  |  Other Complaints     |     62 |    226 |
  +-----------------------|--------+--------+
  |  General Proportion,  |      7 |     58 |
  +-----------------------+--------+--------+

The proportion of deaths, in relation to the whole numbers on board,
was one in three hundred and ninety-eight.

About one third of all the sick were sent to the hospital.

As the proportion of ulcers was uncommonly great, I thought it worth
while to make a calculation of it. The Barfleur had the greatest
number; and this ship, for causes I cannot assign, was more afflicted
with bad ulcers than any other in the fleet, for several months
together.

The fleet having arrived at New York in this unhealthy state, the first
care was to make provision for the sick. There were somewhat more than
fifteen hundred on the sick lists of all the ships, and the hospital
could accommodate little more than six hundred. In order that it might
not be overcrowded, and that each ship might have a just share of
relief, I went round the fleet to ascertain the due proportion of those
cases that were the most proper objects for being sent on shore. All
the infectious and acute Complaints, and some of the worst scorbutics,
were accordingly sent to the hospital. Those who were kept on board
being chiefly such as were affected with the scurvy, were supplied with
various refreshments in their respective ships, and seemed to recover
as soon as if they had been sent on shore. They had indeed almost every
advantage enjoyed by those at the hospital; for, besides fresh meat
thrice a week, and spruce beer daily in common with the other seamen,
each man on the sick list was supplied every week at the public expence
with four pounds of apples and half a pound of sope. There were also
thirty casks of limes taken in a prize, which were distributed among
the scorbutic men, and proved of infinite use. Admiral Pigot’s great
zeal for the good of the service, as well as his natural humanity,
induced him to listen to whatever was proposed for the benefit of the
men.

The supply of sope was a thing entirely new in the service; but the
good effect of all the other articles would most probably have
been defeated, unless the men had been furnished with the means of
cleanliness, which is the most essential requisite of health. The
advantage of this method will appear by the returns of next month to
have been very conspicuous; and it was on this occasion more than any
other that I saw realised in every particular the plan proposed in
the memorial to the Admiralty. It may be added, that the sick that
were left on board were not even without the recreation of the shore
enjoyed by those at the hospital; for most of the captains had the
attention to send daily on shore, for amusement and exercise, such as
were able to walk. Thus there were all the advantages of an hospital
obtained at much less expence to Government, and without the risque of
intemperance, desertion, or infection, which are the inconveniencies
connected with an hospital. What farther contributed to health at this
time was, a large quantity of excellent wine with which the fleet was
supplied.


TABLE, shewing the proportional Sickness and Mortality in October.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of those died, in relation |
  |   to the Numbers of the Sick.           |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     45 |    250 |
  |                       |        |        |
  | Fluxes                |     61 |     69 |
  |                       |        |        |
  | Scurvy                |     34 |    197 |
  |                       |        |        |
  | Ulcers                |    181 |      0 |
  |                       |        |        |
  | Other Complaints      |    127 |      0 |
  +-----------------------|--------+--------+
  | General Proportion    |     12½|    196 |
  +-----------------------+--------+--------+

The proportion of deaths in this month, in relation to the whole number
on board, was only one in fourteen hundred and seventy-eight.

About one in twenty-nine of the sick was sent to the hospital.

There was, upon the whole, less sickness and mortality in this month
than in any other during which I kept records of the fleet. This was,
no doubt, owing in part to the climate, but was chiefly the effect of
the extraordinary attention paid to the refreshments of the men. The
fleet was here exactly in the same situation, and at the same season,
two years before, but was not near so healthy.

Nor were the advantages derived from the great plenty of refreshments,
procured at this time at New York, merely temporary; for the men’s
constitutions were so much improved by them, that the part of the
fleet which remained under the command of Lord Hood was at sea for
twelve weeks without being affected by the scurvy. This was chiefly
to be ascribed to the previous refreshments; for we have seen, that,
in a passage of seven weeks from Jamaica to New York, the fleet was
greatly affected with the scurvy, in consequence of not having had the
advantages of fresh meat and vegetables when last in port. The climate
had, no doubt, also a share in keeping off the scurvy; for the greater
part of the twelve weeks was taken up in a cruise off St. Domingo; and,
I believe, it never was known that a fleet was so long at sea, in a
cold climate, without being greatly affected with this disease.

It appears, that though the proportion of fevers had increased somewhat
this month over that of fluxes, yet the former were less fatal; and, I
think, the true dysentery is more frequent in this climate, and more
apt to prove fatal in its acute state, than in the West Indies. I have
indeed preferred the term flux to that of dysentery, for this reason,
that the symptoms in many cases did not rise so high as properly to
constitute dysentery; and the disease proves fatal in the West Indies
more frequently in the chronic than in the acute state. The fluxes were
daily gaining ground when we left New York, and continued to prevail
to a great degree in the Magnificent, which remained in that climate
several weeks after us.

The climate and situation of the fleet had a greater effect in
diminishing ulcers than any other complaints; for the proportion of
them in this month is little more than one third of what it was in the
last.

The calculation for October was made upon thirteen ships of the line,
which sailed from New York on the 25th of that month.

The weather had then begun to grow cold; but few or none of the
diseases peculiar to a cold climate had appeared. There occurred, while
we were at New York, several cases of inflammation of the liver among
the officers and men who came from the West Indies. It was remarked
formerly, that this complaint hardly ever occurred in the West Indies;
but it would appear that the residing there disposes to an inflammation
of this organ upon changing to a colder climate.

The preceding summer had been uncommonly cold, not only in North
America, but in the whole temperate part of the northern hemisphere,
so far as I could learn by inquiry. In consequence of this, the crops
failed in Europe, America, and the northern parts of Asia. The same
circumstance had a remarkable effect on the reigning diseases of the
season at New York; for, instead of the bilious complaints common in
the end of summer and in autumn, a slight fever of the inflammatory
kind had prevailed. An epidemic catarrh had spread all over Europe,
and some part of Asia, in the earlier part of the year; and perhaps
this was connected with the peculiar state of the atmosphere about this
time. It was before observed, that there was something unusual in the
state of the weather at Jamaica while the fleet lay there; and it is
possible that this might be owing to the same general cause.




CHAP. VI.

 Account of the HEALTH of the FLEET from its Departure from New
 York till the Conclusion of the War.----Passage to the West
 Indies--Account of the Ships there during our Absence--Arrival of a
 Squadron from England--Of these, two Ships only were healthy--Causes
 of this--Inflammatory Complaints in the Union--Probable Cause of
 these--Comparison of the two Squadrons--Increase of Sickness from
 Recruits brought from England--from French prisoners.


Thirteen ships of the line sailed from America for the West Indies on
the 25th of October, under the command of Admiral Pigot, and the other
half of the fleet was left under Lord Hood, to watch the motions of the
French squadron, which was then at Boston.

The day on which we left the coast of America a storm came on, which
lasted two days; but the rest of the passage being fair and moderate,
we arrived at Barbadoes on the 20th of November, where the fleet
continued for the remainder of the month.

All the above-mentioned squadron, except two ships, is comprehended
in the calculation of the following table, and also the Magnificent,
Prudent, and Nonsuch. The two last had continued in the West Indies,
during our absence.


TABLE, shewing the Prevalence of Sickness and Mortality in November.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Number of Sick.                   |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     54 |     25 |
  | Fluxes                |     78 |    132 |
  | Scurvy                |     86 |      0 |
  | Ulcers                |     94 |      0 |
  | Other Complaints      |     46 |    103 |
  +-----------------------+--------+--------+
  | General Proportion    |     15 |     77 |
  +-----------------------+--------+--------+

About a sixth part of the whole sick were sent to the hospital this
month, and one half of these were sent to the hospital at Halifax from
the Magnificent.

The proportion of deaths this month, in relation to the whole number on
board, was one in eight hundred and eighty-seven.

Fewer were taken ill this month than the preceding, but more in
proportion died; which might partly be owing to the fleet having been
more at sea, and partly to the change of climate.

Fevers were now more numerous, and also more fatal than any other
disease; and we see them follow the contrary proportion to fluxes
in the progress to the southward, that they did in our progress to
the northward. These fevers prevailed chiefly in the Formidable and
Warrior. In the former it first appeared among some men that had been
pressed at New York from a privateer, some of whom were seized a few
days after our arrival at Barbadoes with the yellow fever, and they
were the only instances of it at this time in the fleet.

The scurvy continued to diminish, but the ulcers increased as we came
into the torrid zone.

Diseases in general were so slight and so few at this time, that the
whole squadron from America sent only forty-eight men to the hospital
at Barbadoes from its arrival to the end of the month.

It may be proper here to give an account of some of the ships that
remained on this station, while the main body of the fleet was in
America.

The Prudent, when she left us, was extremely healthy, and continued
so till a flux broke out in July, which was communicated by some men
from a cartel, who were ill of this disease. It spread among the ship’s
company, and prevailed for three months. The only deaths during the
seven months that this ship was separated from the fleet were, two from
flux, and one from scurvy, and only twenty-five were sent to hospitals.
This is a proof how much more healthy the windward station is than that
of Jamaica. The scurvy arose at one time, in a cruise of five weeks,
though there was no appearance of it at another time in a cruise of six
weeks. The cause of this seems to be the difference of the weather at
the two periods; for it was very wet in the former, and very dry in
the latter. The time in which this ship was most exposed to sickness
was while she was under repair at Antigua, a situation in which hardly
any ship escapes a severe visitation of sickness; yet this ship was
not at all affected by it, which seemed to be owing to the uncommon
pains taken by the captain to prevent the men from labouring in the sun
during the hot part of the day.

The Nonsuch was five months separated from the fleet, during which time
ten men died. Nine of these died of fevers, and one of the dysentery.
She sailed from Jamaica for Barbadoes about the same time that the
fleet sailed for North America, and was nine weeks on the passage.
A fever was the prevailing disease, and the men probably inhaled
the seeds of it at Jamaica, in common with most of the other ships’
companies that were there. The scurvy, which had formerly prevailed
so much, appeared at this time; but it was in a very moderate degree,
considering the length of the passage. None died of it, and few
were so ill as to require being sent to the hospital. Had this ship
gone into a colder climate, like the others, it would probably have
prevailed to a greater degree. The whole number sent to the hospitals
for various complaints, during the five months, was only thirteen.

The Nymph frigate was the only other ship left in the West Indies
which is included in the tables. There happened only two deaths in
her from June to October, both months included. One of these was from
scurvy, the other from asthma. She was in that time upon two cruises,
each of which lasted eight weeks. During the first the weather was dry
and fine, and during the other it was wet and sultry, with the same
effect upon health as in the Prudent; for in the second cruise the
scurvy prevailed to a considerable degree, but not at all during the
first. This disease was prevented from becoming violent or fatal, on
either occasion, by the great attention of Mr. Anderson, the surgeon.
He found great benefit from the essence of malt, when given early in
the complaint; and some limes having been taken in a prize, while this
disease was at the worst, the scorbutic men were so much recovered by
the use of them, that they were all able to return to duty before the
ship arrived in port.


DECEMBER.

The whole squadron remained at anchor at Barbadoes, and nothing worth
notice occurred till the arrival of a reinforcement of eight ships
of the line, under Sir Richard Hughes, on the 8th of December. This
squadron had been detached by Lord Howe, after the relief of Gibraltar,
and the action with the combined fleets on the 20th of October. It
consisted of one ship of 90 guns, one of 80, three of 74, and three of
64. They sailed from England on the 9th of September, and from that
time till their arrival at Barbadoes they had not been in port, except
for ten days that they were at Madeira, where they were supplied with
fresh meat, fruit, and vegetables, by which means the scurvy, which
had begun to prevail to a considerable degree, was almost entirely
eradicated, and the health of the men was surprisingly restored, for so
short a time.

When they joined us, however, there was a good deal of sickness on
board of them all, except the Union and Ruby. The former had been more
than three years in commission, and in that time had never been sickly,
and had now all the advantages of a long-established and well-regulated
ship’s company. All the rest had been newly commissioned and manned
when they left England. The superior health of the Ruby was owing to
her having been manned with the crews of other ships, some of which
had just arrived from the West Indies; whereas the others had been
manned chiefly by draughts of pressed men from guardships, or by raw
volunteers, of whom a great many were raised in Ireland about this
time. The Bellona and Berwick having been somewhat longer in commission
than the rest, were less sickly.

The following tables will shew the comparative state of health of the
squadron formerly on the station with that which had newly arrived from
England.


TABLE, shewing the Prevalence of Sickness and Mortality in the old
Squadron, in December.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of Sick.                  |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
   | Fevers               | 32     |     80 |
   | Fluxes               | 94     |     99 |
   | Scurvy               | 62     |      0 |
   | Ulcers               | 64     |      0 |
   | Other Complaints     | 57     |     71 |
   +----------------------+--------+--------+
   | General Proportion,  | 11½    |    124 |
   +----------------------+--------+--------+

The proportion of the deaths this month to the whole number of men
belonging to this part of the fleet, was one in eleven hundred and two.
There were fifty-six sent to the hospital, which was one in eighteen of
all the sick.


TABLE, shewing the Prevalence of Sickness and Mortality in the new
Squadron, in December.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Number of Sick.                   |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     11 |     55 |
  | Fluxes                |     86 |      0 |
  | Scurvy                |    107 |      0 |
  | Ulcers                |    191 |      0 |
  | Other Complaints      |     56 |     54 |
  +-----------------------+--------+--------+
  | General Proportion    |      5 |     64 |
  +-----------------------+--------+--------+

The proportion of the deaths this month to the whole number of men
belonging to this part of the fleet, was one in four hundred and forty.

There were one hundred and eighty-nine sent to the hospital; but the
proportion to the whole number of sick cannot be ascertained, as we do
not know how many were on the list on the first of the month.

The increase of fevers in the old squadron was chiefly owing to their
having spread in the Nonsuch; and they seemed to partake more of
that kind which originates in jails and ships, than of that which
is peculiar to the climate. The body of one of the men who died of
this fever was inspected at the hospital, and there was found to be
inflammation and even perforation of the intestines, without any
previous symptom that could lead to expect such an appearance, a
circumstance more likely to happen in the former sort of fever than the
latter.

The increase of scurvy was owing to the numbers that were taken ill
of it in the Magnificent on the passage from Halifax, from whence
she sailed in the beginning of this month, and joined the fleet at
Barbadoes in the end of it. There was a great deal of sickness in this
ship at Halifax, and on the passage, owing to the want of such clothing
as was suitable to that severe climate. One of the principal complaints
was an inflammatory sore throat.

There was no change in the situation of the fleet, only that four ships
of the line were sent on the 16th to cruise near Guadaloupe, and they
continued at sea till the beginning of February.

The new squadron was much afflicted with the jail fever, brought from
England; and it was much more prevalent, as well as malignant, on board
of the Suffolk than any of the rest. During the passage it prevailed
most in the Princess Amelia, not less than twenty having died of it.
It subsided in this ship before she arrived in the West Indies; but on
board of the Suffolk it continued to rage for some months after.

As the hospital at Barbadoes was too small to contain all the sick
of this squadron, only the cases of greatest danger and the most
infectious were sent on shore, and those that remained were provided
with fresh vegetables and milk on board of their own ships, in the same
manner as had been formerly practised with such success on similar
occasions. This was continued for four weeks, during which time they
all got into tolerable health, except the Suffolk.

There appeared, by the returns of the new squadron, to be a greater
number under the head of “Other Complaints,” which was owing to the
number of pulmonic complaints, the consequence of the influenza which
prevailed in Europe, at sea, as well as on shore, in the spring and
beginning of the summer of this year.

Though inflammatory complaints are rare in this climate, yet in a few
of the ships there was some appearance of them; and I remarked that
they occurred in those ships which were in other respects most healthy,
and most free from infection. A good many of the men were seized with
inflammatory sore throats in the Bellona a few days before she arrived
at Barbadoes, and this was in other respects the most healthy ship
next to the Union and Ruby. In the Union there was no violent acute
complaint whatever, which was very singular among so great a body of
men; but several rheumatisms, coughs, and catarrhs, arose in her this
month, and there even occurred two pleurisies in the following month.
The bowel complaints which occurred on board of this ship were also
of an inflammatory nature. These distempers seemed to proceed from
accidental exposure and irregularity; and is it not highly probable
that these causes, instead of producing local inflammatory complaints,
might have been the means of exciting bad fevers and fluxes, as in the
other ships, had the men been equally predisposed to them, by living in
foul air, or under the influence of infection?

The following tables will shew the comparative state of health of the
two squadrons in the three first months of next year.


TABLE, shewing the Prevalence of Sickness and Mortality in the old
Squadron in January, 1783.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     67 |     70 |
  | Fluxes                |    157 |      0 |
  | Scurvy                |     44 |      0 |
  | Ulcers                |      0 |      0 |
  | Other Complaints      |     48 |    117 |
  +-----------------------+--------+--------+
  | General Proportion    |     12½|    214 |
  +-----------------------+--------+--------+

The mortality this month, in relation to the whole number on board, was
one in twelve hundred and fifty-seven. About one fifteenth of all the
sick were sent to the hospital.


TABLE, shewing the Prevalence of Sickness and Mortality in the new
Squadron in January, 1783.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     12 |     48 |
  | Fluxes                |     29 |    153 |
  | Scurvy                |    320 |      0 |
  | Ulcers                |    137 |      0 |
  | Other Complaints      |     19 |      0 |
  +-----------------------+--------+--------+
  | General Proportion    |      5½|    109 |
  +-----------------------+--------+--------+

The proportion of deaths to the whole number on board was one in five
hundred and forty. About one in thirty of all the sick were sent to the
hospital.


TABLE, shewing the Prevalence of Sickness and Mortality in the old
Squadron in February.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     46 |     69 |
  | Fluxes                |    159 |      0 |
  | Scurvy                |     63 |      0 |
  | Ulcers                |    100 |      0 |
  | Other Complaints      |     51 |    136 |
  +-----------------------+--------+--------+
  | General Proportion    |     13½|    173 |
  +-----------------------+--------+--------+

The proportion of deaths to the whole number on board was one in
sixteen hundred and ninety-seven. One ninth of all the sick were sent
to the hospital.


TABLE, shewing the Prevalence of Sickness and Mortality in the new
Squadron in February.

  +-----------------------------------------+
  | Transcriber’s Keys                      |
  |                                         |
  | A Proportion of those taken ill in the  |
  |   Course of the Month.                  |
  |                                         |
  | B Proportion of Deaths, in relation to  |
  |   the Numbers of the Sick.              |
  +-----------------------+--------+--------+
  |                       |    A   |    B   |
  |       DISEASES.       |        |        |
  |                       | ONE IN | ONE IN |
  +-----------------------+--------+--------+
  | Fevers                |     30 |     50 |
  | Fluxes                |     34 |      0 |
  | Scurvy                |    212 |      0 |
  | Ulcers                |    174 |      0 |
  | Other Complaints      |     52 |      0 |
  +-----------------------+--------+--------+
  | General Proportion    |     11 |    185 |
  +-----------------------+--------+--------+

The proportion of deaths to the whole number was one in twelve hundred
and seventy-six. The proportion sent to the hospital was the same this
month as in the other part of the squadron.


TABLE, shewing the Prevalence of Sickness and Mortality in the old
Squadron, in March.

  +--------------------------------------------+
  | Transcriber’s Keys                         |
  |                                            |
  | A Proportion of those taken ill in the     |
  |   Course of the Month.                     |
  |                                            |
  | B Proportion of Deaths, in relation to     |
  |   the Numbers of Sick.                     |
  +-------------------------+--------+---------+
  | DISEASES.               | A      | B       |
  +-------------------------+--------+---------+
  |                         | ONE IN | ONE IN  |
  +-------------------------+--------+---------+
  | Fevers                  |     28 |  12½    |
  | Fluxes                  |     71 |   0     |
  | Scurvy                  |     46 |   0     |
  | Ulcers                  |    226 |   0     |
  | Other Complaints        |     76 |  44     |
  +-------------------------+--------+---------+
  | General Proportion,     |     11 | 194     |
  +-------------------------+--------+---------+

The proportion of deaths to the whole number was one in thirteen
hundred and sixty-one. About one ninth of all the sick were sent to the
hospital.


TABLE, shewing the Prevalence of Sickness and Mortality in the new
Squadron, in March.

  +-------------------------------------------+
  | Transcriber’s Keys                        |
  |                                           |
  | A Proportion of those taken ill in the    |
  |   Course of the Month.                    |
  |                                           |
  | B Proportion of Deaths, in relation to    |
  |   the Number of Sick.                     |
  +-------------------------+--------+--------+
  | DISEASES.               | A      | B      |
  +-------------------------+--------+--------+
  |                         | ONE IN | ONE IN |
  +-------------------------+--------+--------+
  | Fevers                  |     44 |      0 |
  | Fluxes                  |     49 |      0 |
  | Scurvy                  |    123 |      0 |
  | Ulcers                  |    183 |      0 |
  | Other Complaints        |     38 |    138 |
  +-------------------------+--------+--------+
  | General Proportion      |     12 |    403 |
  +-------------------------+--------+--------+

The proportion of deaths to the whole number was one in four thousand
and eighty-seven. About one in eleven of all the sick were sent to the
hospital.

The main body of the fleet remained at Barbadoes till the 12th of
January, when they went to cruise to windward of Martinico, in order to
intercept a French squadron expected from North America. This cruise
lasted four weeks; and intelligence being received of the enemy’s
having taken a different route, the whole fleet bore away for St.
Lucia, where it came to an anchor on the 8th of February.

In the course of the three months above mentioned, we see the two
squadrons approaching to each other, in point of health, till they
became pretty equal and similar; and the new squadron became even
somewhat more healthy than the old.

The increase of fevers in the old squadron was owing to two causes.
One was the importation of new-raised recruits brought from England
by some ships that arrived in the beginning of January. These were
distributed to such ships as stood most in need of men; and being very
dirty and ill cloathed, were likely to harbour infection. They were
evidently the cause of sickness in the Warrior and Royal Oak; for these
ships were before that time healthy, and the fever began with these
strangers, and spread amongst the former crew. It is remarkable that
the ships that brought them from England were not affected by them.

It was caught in the Royal Oak from six men that came from England in
the Anson, which men, though first put on board the Namur, communicated
no fever there, having been kept separate from the rest of the men; but
being sent to the Royal Oak, they were themselves first taken ill with
a fever, which afterwards spread to about thirty of the other men. What
was singular in this fever was, that the eyes and skin of all that were
affected by it became yellow, though without any particular malignancy;
for only two died on board, and one in the hospital. There was one
whose skin was very yellow, yet his complaint was so slight as never to
confine him to his bed.

The other cause of the increased proportion of fevers in the old
squadron was, the great number of these complaints that arose in the
Magnificent. This ship having been sent on a cruise about the middle
of February, and the weather being rainy, squally, and uncommonly
cold, for the climate, many fevers of the inflammatory kind appeared.
During this cruise she made prize of a large French frigate, called
the Concord, and the greater part of the prisoners being taken on
board, the fever from that time assumed a different type, with new and
uncommon symptoms; for, instead of being inflammatory and requiring
bleeding, as before, it became more of a low, putrid kind, and was
attended in most cases, if not in all, with a continual sweating;
so that, instead of evacuations, the remedies that were found most
effectual were the Peruvian bark, blisters, and opium. Thus we see
fevers variously modified according to men’s constitutions, the state
of the air, and the noxious _effluvia_ of the strangers that intermix
with them.

We find the proportion of fluxes increasing in the new squadron in
January and February, as they had formerly done in most of the ships
soon after their arrival from England. They were observed also to
prevail principally in those ships that had formerly been most subject
to fevers, and not to arise till the fever had subsided. They were
found, for instance, to arise later in the Suffolk, where the fever was
obstinate and malignant, than in the Princess Amelia, where the fever
had been at one time general and fatal, but not so violent and lasting
as in the other.

The four ships that were sent to cruise near Guadaloupe continued at
sea for seven weeks; and it was owing to the prevalence of scurvy in
these and in the Magnificent that the proportion of that disease was
greater at this time in the old than in the new squadron.

The fleet remained at St. Lucia till the accounts of the peace arrived
in the beginning of April. The service was then at an end, and I
returned to England with the first division of the fleet, which sailed
from St. Lucia on the 12th of April, under the command of Rear-admiral
Sir Francis Drake, who was at this time in extremely bad health, and
requested me to accompany him.




PART I.

BOOK III.

Of the Numbers and Mortality of different Diseases sent to Hospitals.




CHAP. I.

 Hospital at Gibraltar, 1780--at Barbadoes, 1780--Causes
 of Mortality from various Diseases--Accidents--the
 Hurricane--Wounds--Amputations--Scorches--Fluxes very apt to arise at
 the Hospital--Proportion that were received and died at Antigua--St.
 Christopher’s--St. Lucia, and at Barbadoes, 1782--at Jamaica, 1782--at
 New York, Autumn, 1780--1782--General View of the Admissions and
 Mortality at all the Hospitals during the War.


In order to judge of the loss sustained by disease, in the course of
that service of which a relation has been attempted, the sick sent to
the hospitals must be taken into account. I shall, therefore, give a
short view of the different diseases admitted, and their mortality, at
the several hospitals connected with the fleets in which I served. This
will serve also to illustrate the different effects that different
situations have upon the health and recovery of men[22].

The fleet which effected the first relief of Gibraltar, under the
command of Lord Rodney, consisting of twenty ships of the line, arrived
there in the third week of January, 1780, after a passage of three
weeks and a few days from England, in which they had an action with
the Spanish fleet, and obtained a victory over them, on the 16th of
that month. The whole fleet, except one ship, sailed from Gibraltar on
the 13th of February, and while it lay there, the diseases sent to the
hospital, and their respective mortality, were as follows[23]:

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |       622 |    65 |           9½|
  | Fluxes             |        17 |     0 |           0 |
  | Scurvy             |        13 |     1 |          13 |
  | Ulcers             |        20 |     3 |           7 |
  | Wounds             |        29 |     9 |           3 |
  | Other Complaints   |        12 |     3 |           4 |
  +--------------------+-----------+-------+-------------+
  |   Total            |       713 |    79 |           9 |
  +--------------------+-----------+-------+-------------+

[24]This comprehends not only the deaths in the time the fleet remained
there, but all that happened afterwards. The mortality, from wounds
and ulcers, is greater than might be expected in so fine a climate, and
at the coolest season of the year; but as the place was then besieged,
the sick and wounded could not be supplied with those refreshments that
were necessary to the recovery of the men, and wounds and ulcers are
complaints very apt to be affected by the quality of the diet.


The following is an Account of the Men admitted at the Hospital at
Barbadoes in the Campaign of 1780, that is, from the 16th of March till
the end of June:

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |       277 |    43 |           6½|
  | Fluxes             |        70 |    22 |           4 |
  | Scurvy             |       199 |    47 |           4 |
  | Ulcers             |        92 |    16 |           5½|
  | Wounds             |       167 |    61 |           2½|
  | Other Complaints   |       129 |    23 |           5½|
  +--------------------+-----------+-------+-------------+
  |     Total          |       943 |   212 |           4½|
  +--------------------+-----------+-------+-------------+

The fevers were chiefly from the five line-of-battle ships that came
immediately from Europe in March. Upon their arrival they sent on shore
one hundred and ninety-three men ill of fevers, only one with the
flux, fifteen with the scurvy, and five with ulcers.

When these ships returned to Barbadoes in May, along with the rest
of the fleet, the greater part of the sick were then also on board
of them. By that time the flux and scurvy had broke out. The former
prevailed chiefly in the Terrible; the latter in the Intrepid. That
part of the fleet which we found on the station sent on shore a very
small proportion of all the classes of complaints, except wounds.

Of the wounds, nineteen were amputations, of which there died nine,
mostly of the locked jaw. There were forty-six scorched by gunpowder,
of whom there died fourteen; so that, besides those who were killed
outright, and those who died on board in consequence of accidents of
this kind, before they could be sent to an hospital, about one fourth
of all the wounds, and the same proportion of all the deaths from
wounds, at the hospital, was owing to this cause. This circumstance
ought to induce commanders to take every precaution to prevent such
accidents. In the subsequent part of the war they were less frequent,
in consequence of that greater caution, and more accurate method of
working great guns, which were acquired by practice and experience[25].

In the account of the mortality, I have included only such as died
before the 1st of January, 1781; for if any were carried off after that
time, it was most probably by some incidental complaint. There were
sixty-five of them at that time remaining, and they were chiefly men
disabled by lameness waiting for a passage to England as invalids.

Out of the twenty-three that were killed by the fall of the house in
the hurricane on the 10th of October, eight were of the number above
accounted for; but these are not included in any of the classes of
deaths.

The mortality among the men admitted at this time was greater than
what occurred afterwards in any of the hospitals that I attended,
except that at Jamaica. The principal cause of this was, that as the
fleet was so much greater than had ever been known here before, there
was not suitable accommodation for such numbers as it was necessary to
send on shore, and we had not then fallen on the method of supplying
refreshments to the men on board of their ships. The circumstance by
which the men suffered most was, the great crowding which the want of
room made necessary. There is here no public building appropriated for
an hospital; so that this, as well as every thing else, being found
by contract, and the number of sick being so much greater than it was
usual to provide for, the whole was at this time conducted in a manner
not very regular.

It appears that the greatest mortality in any class of disease was that
of the fluxes, of which the greatest number sent to hospitals are such
as have languished for some time under this disease, in which state it
generally proves fatal in the West Indies, in consequence of incurable
ulcers in the great intestines, to which the heat of the climate, as
well as the scorbutic habit and sea diet, is particularly unfavourable.
But the whole of the mischief arising from it does not appear in the
table; for it was the most apt of any disease to supervene upon other
complaints which were under cure at the hospital. It more particularly
attacked those who were recovering from the scurvy, and was the cause
of the greater number of deaths under this head in the table. It was
found to be more contagious than fevers, either because the men’s
constitutions were more predisposed to it, or, perhaps, because the
infectious matter of it being more gross and less volatile, it is not
so readily dissipated by the heat of the climate; for, either from
this, or some other circumstance, infectious fevers are not so easily
generated, nor so apt to spread, as in Europe. That these fluxes were
owing to infection may be inferred from hence, that, when men ill of
the scurvy were cured on board of the ships they belonged to, they
were not liable to this disease, neither did they prevail at these
hospitals afterwards, when great care was taken to separate infectious
diseases from the others.

The only regular hospital on this station is that at Antigua. This
island being the seat of the royal dock yard, there is an established
hospital in time of peace as well as war. It so happened, that great
fleets never came here to put their sick and wounded on shore, as at
Barbadoes; so that the greater number of those received into it were
from single ships that came to careen. As there was, therefore, less
necessity for crowding, and as the slighter cases could be admitted,
there was a less proportion of deaths here than at most of the other
hospitals.

There were two other establishments for the reception of the sick and
wounded on this station, but they were only temporary. These were at
St. Lucia and St. Christopher’s, where the men being received in great
numbers at a time from large fleets, and as there were accommodations
only for the most urgent cases, the mortality approached more nearly
to that of Barbadoes. There died at St. Christopher’s, in the years
1780 and 1781, in the proportion of one in six, and at St. Lucia, in
the same time, one in five and a half, or two in eleven. The air of
the hospital at St. Lucia was remarkably pure, and this degree of
mortality was owing to the sick having been accommodated in tents and
huts. In the two last years of the war, when an hospital was built, and
regularly established, the mortality was not much above one half of
this.

Some authors have endeavoured to form an estimate of the success of
practice from the different rates of mortality; but this is extremely
fallacious; for the fatality of diseases will depend on their violence,
the proportion of deaths being very different in cases that are slight,
from what it is in those that are dangerous. We shall take a view,
however, of the hospital at Barbadoes at another period, in which
there seemed little or no difference in the violence of the disease,
and when the superior success seemed to be owing to the hospital’s not
being so crowded, and to the better attendance and treatment of the
sick. The following is a view of the diseases that were admitted in
the last three months of the year 1782, the greater part of which were
landed from the reinforcement of eight ships of the line that joined
the fleet at Barbadoes in the beginning of December:

  +--------------------+-----------+-------+----------------+
  | DISEASES.          | Admitted. | Died. | Proportion.    |
  +--------------------+-----------+-------+----------------+
  | Fevers             |       224 |    29 |        {  8    |
  |                    |           |       | NEARLY {       |
  | Fluxes             |        17 |     6 |        {  3    |
  |                    |           |       |                |
  | Scurvy             |        50 |     5 |        { 10    |
  |                    |           |       | ONE IN {       |
  | Ulcers             |        25 |    10 |        {  2½   |
  |                    |           |       |                |
  | Other Complaints   |        46 |     8 |        {  6    |
  +--------------------+-----------+-------+-NEARLY-{-------+
  |     Total          |       362 |    58 |        {  6    |
  +--------------------+-----------+-------+----------------+

It happened on this, as on the former occasion, that none were sent on
shore but such as were very ill, or had contagious complaints, the rest
being provided with refreshments on board of their ships. There were no
wounds at this time, but there was a greater proportion of fevers; so
that the complaints, upon the whole, might be said to be about equally
dangerous. The mortality now was, however, considerably less, and this
is to be imputed to the more favourable situation of the hospital,
which I did not allow to be overcrowded; and the men had all manner of
justice done them in point of attendance and accommodation.

I shall give another example of the same kind in the hospital at
Jamaica, when our fleet went there after the battle of the 12th of
April. All the men accounted for here were landed from the fleet under
Lord Rodney in May, June, and July, 1782[26].

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    NEARLY   |
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |       224 |    71 |           3 |
  | Fluxes             |        65 |    23 |           3 |
  | Scurvy             |        48 |    10 |           5 |
  | Ulcers             |        92 |    21 |           4 |
  | Wounds             |        70 |    18 |           4 |
  | Other Complaints   |        40 |    18 |           2 |
  +--------------------+-----------+-------+-------------+
  |     Total          |       539 |   161 |           3½|
  +--------------------+-----------+-------+-------------+

This uncommon degree of mortality was not owing to the bad air of the
place, for Port Royal is naturally as healthy as most parts in that
climate; nor was it owing to bad accommodations, or to neglect of any
kind; but is imputable entirely to this circumstance, that the hospital
being extremely small, those only were sent to it who were very ill.
There were at this time upwards of forty ships of the line at Jamaica,
and an hospital, containing only three hundred beds, could afford but
a very inadequate relief. Some officers are unwilling that any man
should die on board of their ships, for fear of dispiriting the others;
and many were sent to the hospital, in the most desperate stage of
sickness, that they might there die.

There cannot be a stronger proof than this of the fallacy of judging
of the success of practice by the proportion of the deaths; for the
sick on this occasion were better accommodated, better provided for in
every respect, and as regularly attended, as at any other period of my
service in the West Indies, yet the mortality was greater than at any
other time.

Having given instances of the common rate of mortality in hospitals in
Europe and the West Indies, I shall next give examples of the success
we had in North America, when the fleet was there in the autumns of
1780 and 1782.


ACCOUNT of the Sick landed at New York from the West-India Fleet,
consisting of eleven Ships of the Line, in Autumn, 1780.

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    NEARLY   |
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |        34 |     9 |           4 |
  | Fluxes             |       229 |    27 |           9 |
  | Scurvy             |       433 |    40 |          11 |
  | Ulcers             |        47 |     8 |           6 |
  | Other Complaints   |        82 |    10 |           8 |
  +--------------------+-----------+-------+-------------+
  |       Total        |       825 |    94 |           9 |
  +--------------------+-----------+-------+-------------+


ACCOUNT of the Sick landed at New York from the West-India Fleet,
consisting of twenty-six Ships of the Line, in Autumn, 1782.

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    NEARLY   |
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |       104 |    14 |           7 |
  | Fluxes             |       131 |    14 |           9 |
  | Scurvy             |       617 |    30 |          20 |
  | Ulcers             |        74 |    10 |           7 |
  | Other Complaints   |        70 |     4 |          17 |
  +--------------------+-----------+-------+-------------+
  |       Total        |       996 |    72 |          14 |
  +--------------------+-----------+-------+-------------+

The difference of mortality here, from what occurred in the West
Indies, is partly imputable to climate, and partly to the smaller
number of acute diseases. In the two accounts last stated, the
difference in favour of the latter seemed chiefly to arise from the
superior attention to the sick, and the better treatment of them. It
was mentioned before, that in autumn, 1782, at New York, they were
better supplied, both at hospitals and on board of their ships, with
every thing that could be wished, and that on this occasion almost
every scheme I had proposed was realised. The extraordinary success
in the scurvy was owing to the great quantities of vegetables that
were supplied; for several fields of cabbages had been planted in
the neighbourhood of the hospital for the use of the sick. This was
owing to the humane attention of Admiral Digby, who had also caused
cows to be purchased to supply the hospital with milk. Cleanliness,
and the separation of diseases, were also strictly attended to; and
I am persuaded that many of the scorbutic men were saved by keeping
them separated from the fevers and fluxes; for it has been observed,
that men ill of the scurvy, or recovering from it, are very apt to be
infected, particularly with the flux.

It appears, that the disease in which climate makes the greatest
difference is the flux. It was observable, that though the dysentery
at this time was more fatal on board of the ships at New York than in
the West Indies, yet it was less so at the hospital. The cause of this
seems to be, that the acute state of this disease, of which men die on
board before there is time to remove them to an hospital, is more fatal
in a cold climate; but when it becomes more protracted, which is the
case with most of the cases sent to hospitals, they then do much better
in a cold than in a hot climate.

I shall here subjoin an account of the numbers that were admitted, and
died, during the whole war, at the hospitals of the different parts at
which the fleets I was connected with touched.

  +----------------------+-----------+-------+-------------+
  | DISEASES.            | Admitted. | Died. | Proportion. |
  +----------------------+-----------+-------+-------------+
  |                      |           |       |    NEARLY   |
  |                      |           |       |    ONE IN   |
  +----------------------+-----------+-------+-------------+
  | At Gibraltar         |      2131 |   203 |          10 |
  |    Barbadoes         |      4604 |   861 |           5 |
  |    Antigua           |      6099 |   914 |           7 |
  |    St. Lucia         |      3363 |   478 |           7 |
  |    St. Christopher’s |       853 |   142 |           6 |
  |    Jamaica           |     10088 |  1672 |           6 |
  |    New York          |     17880 |  2179 |           7½|
  +----------------------+-----------+-------+-------------+
  |      Total           |     45018 |  6449 |           7 |
  +----------------------+-----------+-------+-------------+

I have been able to calculate the numbers of deaths from disease in
this great fleet, both on board and at hospitals, during the period
of my own service, which was three years and three months, and they
amounted to three thousand two hundred[27] independent of those that
were killed and died of wounds.

There died of disease in the fleet I belonged to, from July, 1780, to
July, 1781, about one man in eight, including both those who died on
board and at hospitals[28]. But the annual mortality in the West-India
fleet, during the last year of the war, that is, from March, 1782,
to March, 1783, was not quite one in twenty[29]. This difference was
partly owing to the general increase of health in fleets as a war
advances, partly to some improvements in victualling, and partly to
better accommodations as well as regulations in what related to the
care of the sick.

Though the mortality in fleets in the West Indies is, upon the whole,
greater than in Europe, yet it has so happened, that, in the late war,
the fleet at home has, at particular periods, been considerably more
sickly than that in the West Indies was at any one time. I was informed
by Dr. Lind, that, when the grand fleet arrived at Portsmouth in
November, 1779, a tenth part of all the men were sent to the hospital.
It appears[30], that in the years 1780 and 1781, a period at which the
fleet in the West Indies was most sickly, the medium of the numbers on
the sick list was one in fifteen, and many of these were very slight
complaints; whereas, in the fleet alluded to in England, the diseases
were mostly fevers, and so ill as actually to be sent to the hospital.
It appears likewise, that there was the greatest proportion of sick in
our fleet when it was on the coast of America in September, 1780[31].
This difference is owing to the greater prevalence of the ship fever,
and of the scurvy, in a cold than in a hot climate.

With regard to the mortality at hospitals, the comparison is greatly in
favour of those in England. This is owing to the greater regularity,
and the better accommodation and diet, which an hospital at home
admits of, as well as to the difference of climate. It has also been
mentioned, that, on most occasions, the hospitals I attended abroad
were so limited as to contain only the worst cases, in consequence of
which there would of course be a greater proportional mortality than
in the great hospitals of England.

The following is an account of the whole loss of lives from disease,
and by the enemy[32], in three years and three months, in the fleets
and hospitals with which I was connected:

  Died of disease[33]       3200
  Killed in battle           648
  Died of wounds             500
                            ----
           Total[34]        4348




PART II.

OF THE CAUSES OF SICKNESS IN FLEETS, AND THE MEANS OF PREVENTION.




INTRODUCTION.


In the year 1780 I printed a small treatise for the use of the fleet,
containing general rules for the prevention of sickness; and this part
of the work is chiefly taken from it.

My own opportunities of experience, as exhibited in the preceding
Part, have been sufficiently extensive to suggest many observations on
this subject; but as my object is utility, rather than the praise of
originality, I shall not confine myself to these. Great part of what
is to be advanced is taken from books[35] and conversation, as well as
my own experience, my design being to exhibit a concise view of all
the discoveries on this subject that have come to my knowledge. I have
assumed nothing, however, from mere report or testimony, having had
opportunities, from my own observations, of verifying or disproving the
assertions of others.

More may be done towards the preservation of the health and lives
of seamen than is commonly imagined; and it is a matter not only of
humanity and duty, but of interest and policy.

Towards the forming of a seaman a sort of education is necessary,
consisting in an habitual practice in the exercise of his profession
from an early period of life; so that if our stock of mariners should
come to be exhausted or diminished, this would be a loss that could not
be repaired by the most flourishing state of the public finances; for
money would avail nothing to the public defence without a sufficient
number of able and healthy men, which are the real resources of a
state, and the true sinews of war.

In this view, as well as from the peculiar dependence of Britain on her
navy, this order of men is truly inestimable; and even considering men
merely as a commodity, it could be made evident, in an œconomical and
political view, independent of moral considerations, that the lives and
health of men might be preserved at much less expence and trouble than
what are necessary to repair the ravages of disease.

It would be endless to enumerate the accounts furnished by history
of the losses and disappointments to the public service from the
prevalence of disease in fleets. Sir Richard Hawkins, who lived in the
beginning of the last century, mentions, that in twenty years he had
known of ten thousand men who had perished by the scurvy. Commodore
Anson, in the course of his voyage of circumnavigation, lost more
than four fifths of his men chiefly by that disease. History supplies
us with many instances of naval expeditions that have been entirely
frustrated by the force of disease alone: that under Count Mansfeldt in
1624; that under the Duke of Buckingham the year after; that under Sir
Francis Wheeler in 1693; that to Carthagena in 1741; that of the French
under D’Anville in 1746; and that of the same nation to Louisbourg in
1757[36].

That the health of a ship’s company depends in a great measure upon
means within our power, is strongly evinced by this, that different
ships in the same situation of service enjoy very different degrees of
health. Every one who has served in a great fleet must have remarked,
that out of ships with the same complement of men, who have been the
same length of time at sea, and have been victualled and watered in
the same manner, some are extremely sickly, while others are free from
disease. Is it not naturally to be inferred from hence, that the health
of men at sea depends in a great measure upon circumstances within the
power of officers, and, indeed, upon their exertions, much more than
medical care[37]?

It has appeared in the preceding part of this work, that the diseases
most prevalent among seamen are fevers, fluxes, and the scurvy. These
are indeed some of the most fatal that can attack the human body; but
there is a numerous tribe of complaints, which are also some of the
most severe scourges of human nature, from which they are in a manner
entirely exempt.--These are the diseases to which the indolent and
luxurious are subject, and which so far embitter their life as to
render their portion of worldly enjoyment nearly on a level with that
of the poor and laborious. The diseases alluded to are chiefly the
gout, stomach complaints, hypochondriac and other nervous disorders.
In all countries it is the better sort of people that are most subject
to these; for they are owing to the want of bodily exercise, to the
great indulgence of the senses, and a greater keenness and delicacy in
the passions and sentiments of the mind. Man being formed by nature for
active life, it is necessary to his enjoying health that his muscular
powers should be exercised, and that his senses should be habituated
to a certain strength of impression. Animal and vegetable nature may
be aptly enough compared to each other in this respect; for a tree or
plant brought up in a greater degree of shelter and shade than what is
suitable to its nature, will be puny and sickly; it will neither attain
its natural growth nor strength of fibre, nor will it be able to bear
the influence of the weather, nor the natural vicissitudes of heat and
cold to which it may be exposed.

It is to be remarked, however, that exercise and temperance may be
carried to excess, and that in these there is a certain salutary
medium; for when labour and abstinence amount to hardship, they are
equally pernicious as indulgence and indolence. This is strongly
exemplified in seamen; for, in consequence of what they undergo, they
are in general short lived, and have their constitutions worn out ten
years before the rest of the laborious part of mankind. A seaman, at
the age of forty-five, if shewn to a person not accustomed to be among
them, would be taken by his looks to be fifty-five, or even on the
borders of sixty[38].

The most common chronic complaints which a long course of fatigue,
exposure to the weather, and other hardships, tend to bring on, are
pulmonary consumptions, rheumatisms, and dropsies. It is also to be
considered, that these complaints, particularly the last, are farther
fomented by hard drinking, which is a common vice among this class of
men, and they are led to indulge in it by the rigorous and irregular
course of duty incident to their mode of life.

With regard to gout, indigestion, hypochondriac complaints, and low
spirits, there is something in hard labour of every kind that tends to
avert them, and particularly in that rough mode of it peculiar to a sea
life. There is also something in the harsh sensations from the objects
which seamen are in use to see, hear, and handle, which so modifies
their constitutions and hardens their nerves as to make them little
liable to what may be called the diseases of excessive refinement,
such as those above mentioned. I have, indeed, met with such diseases
at naval hospitals; but I always remarked that they were in landsmen
who had been pressed, and who had been bred to sedentary and indolent
occupations.

The diseases above enumerated, as well as most other chronic
complaints, being the offspring of indolence and luxury, while fevers
and feverish complaints fall equally on all ranks and descriptions
of men, it was a saying of some of the ancients, that acute diseases
were sent from heaven[39]; whereas chronic diseases were of man’s own
creation. But I shall endeavour in the course of this work to evince,
that, with regard to seamen at least, acute diseases are as much
artificial as any others, being the offspring of mismanagement and
neglect; with this difference, that they are imputable not so much to
the misconduct of the sufferers themselves, as of those under whose
protection they are placed.

If I were to add any other complaint to the three already mentioned,
as most prevalent, and peculiar to a sea life, it would be those foul
and incurable ulcers which are so apt to arise at sea, particularly
in a hot climate. The slightest scratch, or the smallest pimple, more
especially on the lower extremities, is apt to spread, and to become
an incurable ulcer, so as to end in the loss of a limb. The nature of
the diet, and the malignant influence of the climate, both conspire in
producing them.

The diseases most frequent and prevalent at sea have this advantage,
that they are more the subjects of prevention than most others, because
they depend upon remote causes that are assignable, and which increase
and diminish according to certain circumstances, which are in a great
measure within our power.

The prevention of diseases is an object as much deserving our attention
as their cure; for the art of physic is at best but fallible, and
sickness, under the best medical management, is productive of great
inconvenience, and is attended with more or less mortality. The means
of prevention are also more within our power than those of cure; for
it is more in human art to remove contagion, to alter a man’s food
and cloathing, to command what exercise he is to use and what air he
is to breathe, than it is to produce any given change in the internal
operations of the body. What we know concerning prevention is also more
certain and satisfactory, in as much as it is easier to investigate the
external causes that affect health than to develope the secret springs
of the animal œconomy.

This part of the work, therefore, is chiefly addressed to those who
direct the navy either in a civil or military capacity; for the general
health of ships depends so much upon the victualling and manning in
the first instance, and, afterwards, on the degree of discipline and
order which are kept up, that I am persuaded that a certain degree of
attention on their part would almost entirely eradicate disease from
our fleets.

Several remarks in this part of the work will be found so obvious,
that it might seem superfluous to mention them. But it has been my
intention to omit nothing that I have heard of or observed as a matter
of ascertained utility, and, I believe, the most experienced will find
either something new, or what they had not before sufficiently attended
to. Though the design of it is that of being extensively useful, yet my
trouble would be compensated, should it prove the means of health and
comfort to a single ship’s company; nay, I should not repent my labour,
could I enjoy the conscious certainty of its being the means of saving
the life of one brave and good man.

The prevention of disease has relation only to the external causes that
affect health, and I shall consider these under the four heads of

  I. AIR,
  II. ALIMENT,
  III. EXERCISE,
  IV. CLOATHING.




CHAP. I.

AIR.


Under this head I shall not only consider the natural state of the air
of the atmosphere in point of heat and cold, moisture and dryness,
purity and corruption, but also the different artificial impregnations
of it from the holds or other parts of a ship, or from the persons of
men who have been neglected in point of cleanliness.

The common air of the atmosphere at sea is purer than on shore, which
gives to a sea life a very great advantage over a life at land. This
advantage is still greater in the tropical regions, where the land
air, especially such as proceeds from woods and marshes, is so fatal,
and where the heat is also considerably less at sea than on shore. But
this superior purity of the air at sea is more than counterbalanced
by the artificial means of propagating diseases on board of a ship.
Since a sea life, however, has this great natural advantage to health,
the causes of disease peculiar to it are chargeable rather to the
mismanagement of men than to any thing unavoidable in nature; and we
are from this encouraged to exert our endeavours in removing them.

The effects of land air, however, are not to be neglected by those who
are studious of preserving the health of a ship’s company, for seamen
are exposed to it in various ways while they are in harbour; and this
is what we shall first treat of.


SECT. I.

Of the noxious Effects of LAND AIR in particular Situations.

All the diseases incident to a fleet, except the scurvy, are more
apt to arise in a harbour than at sea, and particularly the violent
fevers peculiar to hot climates. There are generally woods and marshes
adjacent to the anchoring places in the West Indies, and the men are
exposed to the bad air proceeding from thence, either in consequence of
the ship’s riding to leeward of them, or of people’s going on shore on
the duties of wooding and watering. Instances of this, without number,
might be adduced from the accounts of voyages to all the tropical
countries. Our fatal expeditions to the Bastimentos, and to Carthagena,
in former wars, are striking proofs of it; and we have seen the same
effects, though in a much less degree, while the fleet was at Jamaica
in 1782.

I have known a hundred yards in a road make a difference in the
health of a ship at anchor, by her being under the lee of marshes in
one situation, and not in the other[40]. Where people at land are so
situated, as not to be exposed to the air of woods and marshes, but
only to the sea air, they are equally healthy as at sea. There was a
remarkable instance of this on a small island, called Pidgeon Island,
formerly described, where forty men were employed in making a battery,
and they were there from June to December, which includes the most
unhealthy time of the year, without a man dying, and with very little
sickness among them, though they worked hard, lived on salt provisions,
and had their habitations entirely destroyed by the hurricane. During
this time near one half of the garrison of St. Lucia died, though in
circumstances similar in every respect, except the air of the place,
which blew from woods and marshes.

The duties of wooding and watering are so unwholesome, that negroes,
if possible, should be hired to perform them. In general, however, the
employing of seamen in filling water and cutting wood is unavoidable,
but it should be so managed as not to allow them, on any account,
to stay on shore all night; for, besides that the air is then more
unwholesome, men, when asleep, are more susceptible of any harm, either
from the cold or the impurity of air, than when awake and employed.

As the service necessarily requires that men should be on shore more
or less, however unwholesome the air may be, means are to be used
to prevent its pernicious impressions on the body. Certain internal
medicines, such as bitters, aromatics, and small quantities of
spirituous liquors, tend to preserve the body from its bad effects.
Of the bitters, Peruvian bark is, perhaps, the best; and there is a
well-affected instance of its efficacy in the account given by Mr.
Robertson of a voyage in the Rainbow to the coast of Africa; and by
the same means Count Bonneval and his suite escaped sickness in the
camps in Hungary, while half of the army were cut off by fevers. In
consequence of Mr. Robertson’s representation of the effects of bark
in curing and preventing the fevers of that climate, the ships of
war fitted out for the coast of Guinea have been supplied with it
gratuitously, and Government would find its account in extending this
bounty to all the tropical stations.

We have seen, in the former part of this work, that the fever produced
by the impure air of marshes may not appear for many days after the
noxious principle, whatever it is, has been imbibed; men having been
sometimes seized with it more than a week after they had been at sea.
It naturally occurs, therefore, that something may be done in the
intermediate time to prevent the effects of this bad air; and nothing
is more adviseable than to take some doses of Peruvian bark, after
clearing the bowels by a purgative. Some facts, related in the first
part of this work, show that an interval of ten days or a fortnight may
elapse between the imbibing of the poison and its taking effect. And,
in order to guard against the diseases of this climate in general, it
would be more proper to take some large doses of bark once in either
of these periods, than to make a constant practice of taking a little,
as I have known some people do, by which they may also render their
body in some measure insensible to its good effects. I knew a physician
of some eminence in the West Indies, who always enjoyed uninterrupted
health, and he imputed it to his taking from half an ounce to an ounce
of bark every change and full of the moon, as he thought that fevers
of the intermitting and remitting kind, were more apt to occur at
these periods. Whether this idea be well founded or not, the practice
is proper, upon the other principle that has been mentioned, and the
phases of the moon will at least serve as an aid to the memory.

The spices of the country, such as capsicum and ginger, for which
nature has given the inhabitants of the torrid zone an appetite, have
also been found powerful in fortifying the body against the influence
of noxious air. Either these, or the bark, or similar substances, of a
bitter and aromatic nature, given in a glass of spirits to men going
upon unwholesome duty, have been found to have a powerful effect in
preventing them from catching the fevers of the climate. The practice
may be thought too troublesome in the hurry of service in a great
fleet; and I in general avoid mentioning any thing but what is easily
practicable, and highly important to the body of seamen at large; but
such a precaution may be of service at least to officers, or to a
ship’s company, when service is easy, or on a small scale.

But besides the poisonous effluvia of woods and marshes, the sensible
qualities of the air are also to be attended to. If I were required to
fix on the circumstances most pernicious to Europeans, particularly
those newly arrived in the West Indies, I would say, that they are too
much bodily exercise in the sun, and sleeping in the open air; and the
practices most hurtful next to these are, intemperance in drinking,
and bad hours. The sickness and mortality among new comers may, in
general, be imputed to some one of these causes. It is in favour of
this opinion that women are not subject to the same violent fevers as
the other sex, which is probably owing to their not giving into the
above-mentioned irregularities.

The last direction I shall mention with regard to the preservation of
health in a harbour is, that the ship should be made to ride with a
spring on the cable, that the side may be turned to the wind, whereby
a free ventilation will be produced, and the foul air from the head,
which is the most offensive part, will not be carried all over the
decks, as it must be when the ship rides head to wind.

Having little experience of my own with regard to diseases at sea in
cold climates, I cannot recommend any particular precautions; but
Dr. Lind thinks that garlick infused in spirits is one of the best
preservatives against the bad effects of cold and wet. The French ships
of war are furnished with great quantities of garlick as an article
of victualling, and its effects seem to be very salutary. It would
appear, that substances of this kind are very conducive to health in
hot climates also. I was informed by Capt. Caldwell, that, when he
commanded a sloop of war on the coast of Guinea, he was supplied with
a large quantity of shalots by a Portuguese about the time he left the
coast, and his men were remarkably healthy on the passage to the West
Indies, while the other ships in company, who wanted this supply, were
very sickly.

But besides the obvious and sensible qualities of the air above
mentioned, there are certain obscure properties which we do not
understand, and which we find difficult to investigate; for there are
diseases prevailing in certain places which seem to depend on some
latent state of the air. Of this kind is the complaint of the liver,
so common in the East Indies, yet almost entirely unknown in the West
Indies; and in the West Indies there are certain diseases which prevail
in one island and not in another; such as the _elephantiasis_[41]
of Barbadoes, which is an affection of the lymphatics peculiar to
that island. In the climates of Europe there are also certain obscure
conditions of the air that favour one epidemic more than another, and
in some years more than others[42]. All this is very mysterious to us;
and although we could detect these properties of the air, we probably
could not prevent their bad effects, since man must every where breathe
the air, whatever its qualities may be.


SECT. II.

Of FOUL AIR from the Neglect of Cleanliness in Men’s Persons--INFECTION.

Nature has wisely so contrived our senses and instincts, that the
neglect of cleanliness renders a person loathsome and offensive to
himself and others, thereby guarding against those fatal diseases that
arise from bodily filth. The noxious air we speak of is generated
by men keeping the same clothes too long in contact with the body,
while they are at the same time confined and crowded in small and
ill-ventilated apartments. Such is the origin of the jail fever,
otherwise called the ship and hospital fever; and it seems to be with
reason that Dr. Cullen ascribes the low, nervous fever of Britain to
a similar origin, being caused, as he thinks, by an infection of a
milder kind, arising in the clothes and houses of the poor, who, from
slovenliness or indigence, neglect to change their linen, and air
their houses.

Man is evidently more subject to disease than any other species of the
animal creation, owing partly to the natural feebleness of his frame,
but still more perhaps to the artificial modes of life which his reason
leads him to adopt. There is no circumstance of this kind by which
health is more affected than by clothing. Some of the most fatal and
pestilential diseases are produced and communicated by it; for we see
that the greater number of fevers, particularly those of the low and
malignant sort, may be traced to the want of personal cleanliness.

There are few subjects more mysterious and difficult of investigation
than this of infection. The origin of specific contagions, such as
the small pox and the venereal disease, seems to be almost beyond the
reach of a conjecture; and why all the contagions we know, excepting
that of the bite of a mad dog, should be confined to one species of
animal, their effects not being communicable to any other, is equally
unaccountable. Why is the body incapable of being affected more
than once by certain morbid poisons; and whence comes the striking
and curious differences of susceptibility to infection in different
individuals at the same time, and of the same individual at different
times?

It would appear that the infection of fever, which we are chiefly to
consider here, does not, like some of the diseases above mentioned,
depend on the continued propagation of a certain poison, but that it
may spontaneously arise from a concurrence of circumstances, producing
a long stagnation of the effluvia of the body on the clothes, for want
of clean linen, while people are excluded from the free air, as in
jails, hospitals, or ships.

In order, therefore, to preserve the crews of ships from such diseases,
means should be taken not only to prevent the introduction of infection
already existing, but to prevent the generation of it on board.


1. Means of preventing the Introduction of Infection.

War being a state of violence and confusion, in which the hurry and
emergency of service may be such as to render it impossible to put
in practice all the rules which might be laid down concerning the
preservation of health, yet it is necessary that those who direct
the navy, either in a civil or military capacity, should be aware of
the causes of sickness and mortality, in order to guard against them
as far as is practicable. From an indolent acquiescence in this idea
of the hardships and inconveniences of war being unavoidable, I have
known neglect to arise in the conduct of officers with regard to those
under their command, as if it was not the duty of a commander to employ
his utmost attention to alleviate the misfortunes and mitigate the
sufferings of his fellow creatures; and we have seen that much more
of the calamities of war arise from disease than from the sword. The
like excuse might be framed for the neglect of stores and arms, which,
the hurry of service might equally expose to injury. We see, indeed,
infinite pains taken to prevent cordage from rotting, and arms from
rusting; but however precious these may be as the necessary resources
of war, it will not be disputed that the lives of men are still more
so; yet, though there is the additional inducement of humanity to
watch over the health of men, I do not think that this, in general, is
studied with a degree of attention equal to what is bestowed on some
inanimate objects.

Ships of war are exposed to infection chiefly by receiving such men
as have been raised by pressing, who are frequently confined in
guardships, under such circumstances of bad air and bodily filth
as tend to generate the most virulent infection. The service also
requires sometimes that men be received from jails, and they are either
criminals delivered over by the civil jurisdiction of the country,
or captives who have been restored by the enemy after a course of
confinement in their prisons. It may happen too, as we have seen[43],
that the enemy, who are made prisoners at sea, may have infection about
them, and will communicate it the more readily that they are strangers.

There are few fevers but what are infectious at some stage or other of
the disease; but it is not necessary that fever should actually exist
in order to create infection. In the most violent and pestilential
fevers, such as have sometimes originated in the jails of England, the
persons who communicated them were not affected with it themselves[44].
Infection, like some other poisons, does not affect those who are
accustomed to it, and therefore those who are in the habit of being
exposed to it frequently escape its bad effects, especially if it is
gradually applied, as must be the case with those about whose persons
it is generated. For the like reason, physicians and nurses are less
susceptible than others; and strangers, who are accustomed to a pure
air, are the most susceptible of any. It is observed by Dr. Short,
that contagious epidemics are more frequent and fatal in the country
than in London, and this may probably be accounted for on the same
principle; for every person in a great town is exposed to the breath
and effluvia of others, and to a variety of putrid exhalations, which
are unavoidable where multitudes inhabit together; but they are so
used to them, that they are not affected by them; whereas in the
country, where people are less accustomed to each other’s company,
and less used to impure air in general, they are the more readily
affected when infection is introduced among them. It may even admit
of a doubt if any society of men, living together, are entirely free
from morbid contagion. It certainly sometimes happens, that a ship,
with a long-established crew, shall be very healthy; yet, if strangers
are introduced among them, who are also healthy, sickness will be
mutually produced. This principle in the human constitution, by
which the presence of strangers affects it, is well illustrated by a
fact[45], founded on the best testimony, that, in one of the small
western islands of Scotland, which is so remote, that the inhabitants
are frequently without any communication with strangers for several
months together; they become so susceptible, in consequence of this
long interruption of intercourse, that they are seized with a catarrh
when strangers of any description come among them. It was said before,
that cleanliness was founded on a natural aversion to what is unseemly
and offensive in the persons of others; and there seems also to be
implanted in human nature, for the same purpose, an instinctive horror
at strangers, as is visible in young children and uncultivated people.
In the early ages of Rome, one word signified both a stranger and an
enemy[46].

These observations naturally suggest several useful and practical
remarks. It would appear that the utmost attention is necessary not
only to guard against the actual presence of disease, but to be
jealous of all new draughts of men, especially if they should come
from guardships, jails, or tenders, and have been turned over from
ships where disease is known to have prevailed; nay, that it is best
to avoid mixtures of any kind.

The infection of fevers seems different from most others in this,
that it is very various in its degrees of virulence. There is reason
to think that the poison of the small pox, and that of the venereal
disease, are in their own nature invariable, and that the difference
of these diseases, in point of malignancy, depends on the constitution
and other circumstances of those affected; whereas that of fevers
being of different degrees of activity, and being frequently obscure
and latent, is, on that account, the more treacherous, and ought to be
watched with the greater circumspection.

The mode of manning the navy by pressing, I take it for granted, is
unavoidable; at any rate, it would not become me to arraign a practice
which has had the public sanction for ages. It is, however, one of
the principal means both of generating and spreading the seeds of
disease, in consequence of the indiscriminate seizure of men for the
public service, and the confinement that is necessary to secure them.
And as the exigences of the service make it necessary to admit persons
of every description, there is no other remedy for this evil but to
annihilate, if possible, the contagion that may thus be conveyed into
ships of war. This is done by stripping and washing the new recruits
who may be suspected of importing infection; also by cutting off their
hair, clothing them with new clothes, and destroying the old, before
they are allowed to mix with the ship’s company in which they are to
enter.

Those who have put these methods strictly in practice, have been
sensible of their great utility; and the most exact attention is
necessary, as a single infected man, or even any part of his clothing,
may spread sickness through a whole ship’s company. When we reflect
what havock an infectious fever sometimes makes in a ship, it will
appear how very important this fort of attention is; and when the
cause of the sickliness of particular ships is traced to its source,
it will generally be found to have originated from taking on board
infected men at Spithead, or wherever else the ship’s company may have
been completed.

After the first edition of this part of the work was printed, an
excellent institution was established at Portsmouth for the prevention
of infection. A ship was appointed for the reception of the recruits
of the fleet to which they were carried, to be stripped, washed, and
provided with new apparel, before they joined their respective ships.
This had a visible good effect on the health of the fleet; and it was
planned and executed by Sir Charles Middleton, Comptroller of the Navy,
whole unwearied assiduity, as well as integrity and ability in that
important post, claim the highest praise and gratitude from his country.

It follows farther, from the preceding observations, that there is a
sort of risque in mixing two different sorts of men, even when there
is no actual disease or suspicion of infection; for, whether it is from
dormant infection, or merely from the circumstance of change of air,
such mixtures are known from experience to be sometimes productive
of sickness. The late Admiral Boscawen was so sensible of this, that
he avoided it, unless when some evident utility or necessity of
service made it proper; and upon this principle he used to resist the
solicitation of captains when they requested to carry men from one ship
to another upon changing their commands.

One probable reason, among others, for ships of the line being more
sickly than frigates or smaller ships is, that in greater numbers there
is a greater chance of men of various descriptions and modes of life
being mixed together.


2. Means of preventing the Production of Infection.

The infection of fever is not always imported from without, but may
be originally and spontaneously generated on board. The causes of
this, as mentioned before, are want of personal cleanliness, and also
confinement and crowding in close apartments.

In order to promote cleanliness, care should be taken that every man,
on his first entering into the service, be provided with a proper
change of linen, and that a frequent muster and review be made, in
order to inspect their persons, and to examine their stock of apparel.
A true seaman is in general cleanly, but the greater part of men in
a ship of war require a degree of compulsion to make them so; and
such is the depravity of many, that it is common enough for them to
dispose of their clothes for money to purchase spirituous liquors. A
muster and review, therefore, wherein men should be obliged once in
the week to present themselves clean before their officers, and to
produce a certain necessary quantity of clean apparel, would conduce
both to sobriety and cleanliness. The exertion of authority, and the
infliction of punishment, is so far from being considered by the men
as a hardship, that they expect it; and it is the duty of an officer,
as it is of a parent to a child, to constrain those entrusted to his
care to perform what is for their good. It is common also for men to
lay up their clothes in a wet and unwashed state, which in time is
productive of the most offensive and unwholesome vapours; and this can
be prevented only by their chests and bags being frequently inspected
by their superiors.

It must be evident to any one who reflects on this subject, that a
regulation of this kind is as necessary as any other part of duty; and
it deserves to be made an article in the public instructions, instead
of being left to the discretion of officers. This sort of discipline
is particularly necessary in ships of the line, in which one cause of
the greater unhealthiness is the difficulty of taking cognizance of
so great a number; for, unless some regular method, as by muster, is
established, there will be men who will escape notice, and skulk below,
indulging in laziness and filth.

The good sense and humanity of many captains in the late war, led
them to adopt certain methodical regulations for the preservation of
cleanliness and order. The only public sanction given to this sort of
discipline, was that of Lord Howe, who gave it in orders to those under
his command, that each ship’s company should be divided into as many
divisions as there were lieutenants, and that these should be divided
into squads, with a midshipman appointed to each; and that the officers
should be respectively responsible for the good order and discipline of
the men assigned to them.

It is an excellent custom, and pretty general in the navy, to allow
the men one day in the week for washing, when the weather and other
circumstances will admit of it. It would be a farther improvement in
the rules of the service to supply sope in the same manner as tobacco
and slops are supplied, that is, to let the men have what quantity
they want from the purser, who is allowed to charge it against their
wages[49].

Next to want of cleanliness, the circumstances most apt to give rise
to infection are, close air and crowding. A certain length of time is
necessary, in order that these should have this effect, and the longer
they take place, the more certainly will infection be produced, and it
will be the more virulent[50].

In order to admit air freely, the ports should be kept open whenever
the weather will permit this to be done. The great objection to free
ventilation is the danger of exposing men to the air in cold climates.
But it fortunately happens, that fire, while it is the most effectual
means of counteracting the cold air, is also the best means of
promoting ventilation; for wherever there is fire, there is a constant
change of air taking place by means of the draught to which it gives
occasion. This cannot be done with safety and convenience in all parts
of the ship; but frequent fires in the lower parts of a ship will prove
extremely salutary by drying up the moisture, and producing a change of
air, and also in a cold climate by the warmth it produces.

The hammocks and bedding should also be aired by exposing them upon
deck, especially after the ports have been long shut in consequence
of bad weather. They cannot be thoroughly aired unless they are
unlashed; and as this could not be conveniently done daily in men of
war, it might be done from time to time by the different divisions
in rotation[51]. When the men come to sleep upon them after these
operations, they experience the same agreeable sensations as from a
change of linen; and this must conduce to health as well as pleasure,
like all other natural and moderate gratifications. It may be farther
remarked in favour of cleanliness, that it is not only directly
conducive to health, but is naturally connected with habits of good
order, sobriety, and other virtues. The most cleanly men are always the
most decent and honest, and the most slovenly and dirty are the most
vicious and irregular.

A ship of war must have a much greater number of men on board than what
are necessary to navigate her; for, besides the marines, a great many
hands are necessary to man the great guns in time of action. For this
reason, there is a greater risque of the inconveniences of overcrowding
than in ships intended for commerce, and therefore much greater
attention is necessary with regard to ventilation and cleanliness.
There is a piece of management which tends also in some measure to
obviate the necessity of crowding. This is to berth the watches
alternately, by which it is meant, that one half of each watch should
lie on different sides, whereby they do not sleep so close, and are not
so much exposed to each other’s breath and to the heat and effluvia of
each other’s bodies. This has the farther advantage of preserving the
trim of the ship.

What has been said of the ship and men in general, applies still more
strongly to the sick, and the berth[52] assigned to them; for there is
nothing so apt to increase, and even generate, contagion, as a number
of sick together, unless uncommon attention is paid to cleanliness
and ventilation. This is so true, that, unless where the complaint is
very catching, it is best not to separate the sick; for if they are a
good set of men on board, those who are confined by sickness will be
better nursed and tended by their messmates than in a sick berth. But
if the state of infection renders separation necessary, the best part
for the accommodation of the sick, in a ship of the line, is under the
forecastle in a warm climate, and on the fore part of the main deck in
a cold one. When they are under the forecastle, however, they ought
to occupy only one side, as they would otherwise be disturbed by the
men who must pass to and from the head, and the men in health would, in
this case, be exposed also to contagion. As infection is most likely
to arise among the sick, attention to cleanliness and air is doubly
requisite where they lie; and it has a good effect to sprinkle hot
vinegar and diffuse its steams among them once or twice a day.

Thus we see that cleanliness and discipline are the indispensable and
fundamental means of health, without which every other advantage and
precaution is thrown away. Government never bestowed more attention
and expence upon the victualling of the navy than during the late war;
but it would be to little purpose to provide the most nourishing and
antiscorbutic diet, the most wholesome and cordial wines, the most
efficacious remedies, and the most skilful physicians and surgeons,
if the men are not constrained to keep their persons sweet, their
clothing and bedding clean, and their berths airy and dry. It is,
therefore, upon officers more than any others that the health of the
fleet depends; and I should be excused in the frequent mention I make
of this, were it known how often I have been the witness of the fatal
effects of the neglect of these rules.


3. Means of eradicating Infection.

When, from a neglect of the means above mentioned, an infectious
fever comes actually to prevail, and the infection, perhaps, adheres
obstinately to the ship in spite of cleanliness, good air, and diet,
and all the other means, which, if employed in due time, would have
prevented it, then some measures are to be taken for eradicating this
subtile poison.

The first step towards this is, to prevent the disease from spreading,
and this is done by separating the sick from the healthy, and cutting
off all intercourse as much as possible. For this end, it is necessary
to appropriate a particular berth to contagious complaints, and not
only to prevent the idle visits of men in health, but to discover and
separate the persons affected with such complaints as soon as possible,
both to prevent them from being caught by others, and because recent
complaints are most manageable and curable. Officers might be very
useful in making an early discovery of complaints, by observing those
who droop and look ill in the course of duty; for seamen think it
unmanly to complain, and have an aversion to be put on the sick list.
I have heard of a method practised in some ships, of keeping a book on
the quarter deck for the officer to mark the names of such men as might
look ill, or might be missed from duty upon calling the roll, in order
to afford the surgeon a means of finding out those who should be the
objects of his care.

Those whose profession it is to superintend the health of the ship,
would find it for their ease and interest, and should consider it as
their duty, to walk over the different decks once a day, or every other
day, in order to make an early discovery of those who may be taken
ill. Though I have laid great stress on the duty of the commander, as
the proper guardian of health, yet his assiduity will not avail unless
the surgeon also does his part, by such acts of attention as I have
mentioned, joined to skill in his profession.

Surgeons are, perhaps, more regarded in our service than in that of
other nations; but it would be for the public benefit if they were
still more respected and encouraged. To men of liberal education
and sentiments, as surgeons ought to be, and generally are, the
most effectual inducements for them to do their duty are flattering
attentions, and a certain degree of estimation in the eyes of their
officers. Liberality of manners, on the part of superiors, is the most
likely means of encouraging a conscientious performance of duty in this
profession; for though strict and distant behaviour may operate upon
the minds of those whose functions are merely mechanical, how can it
infuse that tender attention to human sufferings, and that sense of
duty, which may induce a man entrusted with the health and lives of his
fellow creatures to act his part with propriety and effect?

In order to prevent sickness from spreading, it is not sufficient to
cut off all personal intercourse. The clothes of men are as dangerous
a vehicle of infection as their persons; and it should be a strict and
invariable rule in case of death from fever, flux, or small pox, to
throw overboard with the body every article of clothing and bedding
belonging to it.

Upon the same principle, in case of recovery from any contagious
disease, as it would be too great a waste to destroy the clothes and
beds, they should be smoked, and then scrubbed or washed before the
men join their messes and return to duty. This precaution is the more
necessary, as infection in a ship is extremely apt to be communicated
by bedding, from the custom of stowing the hammocks in the netting, by
which they are brought in contact with each other. This, however, is
an excellent custom, as it not only clears the ship below, and serves
to form a barricade on the gunwale, but tends to air the bedding; and
this salutary effect should not be prevented, except in case of rain,
by the coverings, called hammock-cloths, by the use of which utility is
evidently sacrificed to an excess of neatness.

It sometimes happens that the number of sick in a ship is so great,
that it is not possible to take proper and effectual measures on board
for stopping the progress of disease. But when she can be cleared of
the sick by sending them to an hospital, no pains should be spared to
extirpate the remaining seeds of infection.

For this purpose, let their clothing and bedding be sent along with
them; let their hammocks, utensils, and whatever else they leave
behind, be smoked, and either scrubbed or washed before they are used
by other men, or mixed with the ship’s stores; let the decks, sides,
and beams of their berths, be well washed, scraped, smoked, and dried
by fire; then let them be sprinkled with hot vinegar, and, finally,
white-washed all over with quick lime.

Should any officer object to the trouble and inconvenience of all
this, let him reflect for a moment how much more troublesome and
inconvenient, as well as noisome and disagreeable, sickness itself
proves to be; let him reflect that the efficiency of the ship,
considered as a bulwark of defence, or an engine of annoyance, depends
on the number of healthy hands, and that his own character is to depend
on the exertions to be made by them in the day of battle, not to
mention the attention due from him as a man to the sufferings of the
objects themselves.

But besides these recent infections, it sometimes happens that the
seeds of disease adhere to the timbers of a ship for months and years
together, and can be eradicated only by a thorough cleansing and
fumigation. Sweeping, washing, scraping, and airing, are not sufficient
entirely to remove the subtile infectious matter; but they will
assist and will prepare it to be acted upon by heat and smoke, which
are the only means to be depended upon. A complete fumigation can only
be performed when the ship is in dock; and I shall here transcribe a
method recommended by Dr. Lind.

“It will be proper to remove every thing out of the ship, so that the
hold may be swept, and, when the men have withdrawn, to light a number
of charcoal fires in different parts, and to throw a handful or two of
brimstone on each. The steam of these should be closely confined by
shutting the ports and hatchways from morning till evening, no person
in the mean time being allowed to go below, nor for some time after
opening the ports and hatchways, that the steam may be dispersed.

“In order to purify the men’s clothes, it would farther be proper to
fumigate the hulk into which they are removed with tobacco once or
twice a week while their ship is in dock, the men remaining below as
long as they can bear it.

“The clothes and hammocks of the men should be exposed in the hulk
to the smoke of the tobacco, and those which are more particularly
suspected may be hung up the ship, and exposed to the steam of the
charcoal and brimstone.

“The ship having been already fumigated with tobacco, it will be
sufficient to use the fumigation of charcoal and brimstone above
described for three days, and, after the last day’s fumigation, the
inside of the ship should be well washed with boiling vinegar, and,
before the men return on board, all the decks should be scraped and
washed.”

When a ship is at sea, these precautions cannot be taken so completely;
but if infection is present, or is suspected, then cleansing and
fumigating may be practised in a less degree. I have known a ship at
sea fumigated with gunpowder kneaded with vinegar, so as to prevent it
from exploding, and to make it burn slowly with a spattering flame.
Flowers of sulphur[53], with about an eighth part of nitre, will
answer still better. A quantity of these is placed in each interval
of the guns between decks, every person being turned up, and the
ports and hatches shut till they are consumed, and till the smoke has
dispersed. It has also been recommended to burn resinous bodies, such
as the woods of fir, spruce, and juniper, as the smoke of these is more
salutary. Upon the same principle, the effluvium of tar is thought
wholesome; and the cables that are coiled in the lower parts of a ship
being soaked with tar, like most of the other ropes of a ship, probably
conduce to the health of a place otherwise dank and unwholesome.
Fumigation may also be performed by means of tar, either by throwing it
on red-hot irons, or a wood fire, which may be carried about between
decks in a pot or moveable grate, or over some cannon balls in a tub,
or by immersing a red-hot loggerhead[54] in a bucket of tar. If this
is done in the place occupied by the sick, it will have a still better
effect; and it will be of service to them to be removed for a short
time under the half deck or forecastle till this or other means of
purification are put in practice. In whatever manner fumigation is
performed, it will be of service to spread out the clothes and bedding
of the men, or to hang them upon lines, that they may be exposed to the
heat and smoke.

It will also be of great service to make the men expose their frowsy
clothes to the sun and wind. If a strong infection is suspected,
and it cannot be afforded to destroy the clothes, the best means of
eradicating the poison is to hang them for a length of time over pots
of burning brimstone in a large cask standing endways, with small
apertures to admit air enough for the brimstone to burn.

Fire in every shape is to be considered as the principal agent of
purification, by its heat and the ventilation it occasions, perhaps,
still more than its smoke. It has already been repeatedly inculcated,
that the great enemies of infection are ventilation and heat. I have
mentioned smoke and the effluvia of balsamic bodies, but these are
not to be depended on; and it is the more necessary to mention this,
as the attention bestowed on more trifling means may divert the mind
from a proper regard to what is more essential. It is mentioned by the
benevolent Mr Howard, that it is the custom in some parts abroad to
scatter fresh branches of pine or spruce in the hospitals, in order to
purify the air; but, trusting to this, they neglect the admission of
fresh air, which is the only effectual method of sweetening the air.

There is reason to think that the open air very soon dissipates and
renders inert all infections of the volatile kind, and of course the
warmer the air is the more readily it will have this effect. It is
accordingly observed, that infection is much less apt to be generated
about the persons of men, and that it adheres to them for a much less
space of time in a hot climate than in a cold or temperate one. This
is a remark, which, so far as I know, has not been made by any author;
and, till observation suggested it to me, I fancied the reverse to
be the truth. I have seen so many instances of filth and crowding
in ships and hospitals in the West Indies, without contagion being
produced, and which in Europe could hardly have failed to produce it,
or to render it more malignant, that I am convinced there is something
in tropical climates unfavourable to the production and continuance of
infectious fevers[55]. The ships which bring this fever from Europe
in general get rid of it soon after arriving in a warm climate; and
nothing but the highest degree of neglect can continue or revive it.

The facts above mentioned brought into my mind what is related of the
plague at Smyrna and other places, that it disappears at the hottest
part of the year. It is also curious and important to remark, that the
true pestilence never has been heard of between the tropics. It is not
easy to assign the cause of this effect of heat upon infection, as
every thing relating to this subject is very obscure. We can conceive
it to be owing to the greater degree of airiness which the heat of
the climate makes necessary, or to the use of fewer woollen clothes.
There may be something in the state of the body, particularly in the
pores of the skin, which disposes them less to imbibe or produce the
poisonous effluvia, or, when imbibed, it may more readily be thrown out
by perspiration with the other acrimony of the blood; or more probably,
as has been hinted above, the virulent matter is of such a degree of
volatility as to be readily dissipated in a certain degree of heat[56].

There is a fact, which, though seemingly of a contrary tendency, yet
is in reality in proof of the same opinion. It is, that these same
diseases disappear in circumstances of great cold. When England was
last visited by the plague, it disappeared in winter; and the same is
observed at Moscow and other places. In this case the infectious matter
is rendered _inert_, but not _extinct_, and the return of heat sets it
afloat in the atmosphere, so as to expose it to human respiration. Dr.
Guthrie informs us, that infection is entangled and fixed by the cold
of winter on the doors and walls of the houses of the Russian peasants,
and that upon the return of the warm season it is set loose by the
thaw, and then becoming active, produces diseases.

With regard to the West Indies, the precautions that have been laid
down are chiefly necessary when a ship newly arrives in the climate;
for it is during the first three or four months that sickness is apt to
prevail.

This does not depend upon any thing peculiar to the climate; for I
have known ships arrive without being visited with any sickness. It
seems to be owing, for the most part, to that flock of infection and
disease imported from Europe exerting its effects, and when this has
spent itself, the men remain in good health, unless exposed to the land
air or other accidents; for the air at sea in those climates, as well
as every where else, is extremely pure and wholesome, and there is no
where that seamen are more healthy or comfortable.


SECT. III.

Of the FOUL AIR generated in a Ship.

I mean here to distinguish the unwholesome vapour produced by the
contents of the ship from the infection produced by the effluvia of
men’s persons, which was treated of in the last section.

The means of preventing this foul air from being generated are,
cleanliness, dryness, and ventilation.

All parts of a ship may, if neglected, become dirty, and emit an
offensive vapour; but the parts under water consisting of the orlop and
hold, are more particularly so from the materials they contain, and
from the want of free access to the fresh air; accordingly, there is
always more or less stench in those parts, even in the best-regulated
ships.

It was mentioned in the first part of this work, that an opinion was
entertained by some that no foul air was productive of fevers but
such as proceeds from the living human body. I alledged that this was
otherwise, at least in hot climates; and some proofs of this opinion
were adduced, particularly from the French prizes. Though the neglect
of personal cleanliness is the principal source of disease, yet
cleanliness of every kind, and purity of the air in every respect, is
to be anxiously studied.

With regard to general cleanliness, it is hardly necessary to mention
sweeping, washing, and scrubbing of the decks; for the natural
propensity of the English[57] nation to neatness seldom allows any
neglect of these. Lord Howe, to whose virtues as a man, and abilities
as an officer, his country is so much indebted, gave it in general
orders to wash the upper decks every day, the lower decks twice a
week, and the orlop once a week at least. He also ordered that, every
washing, smoking, mustering, and review of clothes, or any other means
taken for the health of the ship, should be marked in the logbook,
and the reason to be assigned there if omitted at the stated times.
These rules are a good specimen of the order that ought to prevail in
every branch of public duty; for it is well known to every experienced
officer that it is a methodical proceeding of this kind which can alone
render service either easy or effective.

The loss of men’s lives from the foul air of the well is a common
accident in ships, and I have been myself witness to several instances
of it. Where there is the least suspicion of this, a candle should
previously be let down, and if it should be extinguished, it may be
concluded that the air is deadly. It becomes safe for men to breathe in
it by leaving it open for some time, or, more expeditiously, by letting
down fire in a pot or grate, which soon changes the air, by producing a
draught of it upwards.

It is a very salutary practice to let down fires frequently into the
well, both in order to purify the air and to dry the surrounding parts.
It was formerly mentioned that this was daily done in the Intrepid,
and the effect of it was to remove the wetness of the ballast and the
mouldiness which had overspread the sides and beams; and having had
the effect of sweetening and purifying the air, it seemed to be the
principal circumstance that tended to make this ship extremely healthy
from being the most sickly of all the fleet. This precaution, as well
as every other point of cleanliness, is more necessary in large ships,
because the mass of foul air, as well as the quantity of corrupting
materials, is greater[58].

The following fact strongly evinces the good effect of fire and
smoke:--When it was the custom for frigates to have their kitchens
between decks, they were much more healthy than in the present
construction, in which they have them under the forecastle, where the
heat and smoke are dissipated without being diffused through the ship,
and causing a draught of air upwards, as formerly. The men derived then
also great benefit and comfort from having a large fire, round which
they might assemble to warm and dry themselves in a sheltered place.
I leave it to those who preside in the construction of the navy to
determine how far it would be advisable to return to the old manner
of construction. The French ships of the line have their kitchens and
ovens between decks, and this must tend to counteract the effects of
their want of cleanliness. The Dutch ships of the line have their
kitchens on the orlop deck, which must be still more conducive to the
general purity of the air.

Moisture is pernicious both in itself and as the instrument of
putrefaction. All the complaints, called colds, are more owing to wet
than cold; and moisture may be the means of producing, or at least of
exciting dangerous fevers, when they would not otherwise appear. It
besides contributes greatly to the production of scurvy. Ships built
of ill-seasoned wood are found to be very unhealthy on account of the
moisture contained in it. The moisture of timber arises not only from
being used too soon after being felled, but also, as I am informed,
from being stripped of its bark and outer surface when piled and
exposed to the weather in dock yards. This method of smoothing and
piling the wood is only a late practice; and the advantage in point
of convenience and neatness seems to be more than overbalanced by the
detriment it thereby receives.

A wet hold diffuses moist vapour all over the ship; and it was a rule
with some of those commanders whom I observed to be most successful
in preserving the health of their men, not only to have daily fires in
the well, but to bail out the water when the pumps could not exhaust it
all, and never to allow it to collect to more than the depth of a few
inches. It is, therefore, very doubtful whether it is a good practice
to let in water, as is very commonly done in order to sweeten the
hold, for the same sweetness will be preserved if it is kept strictly
dry. If it should happen, indeed, that there should be a great deal of
putrid matter in the lower parts of the ship, from previous neglect or
unavoidable leakage, it may be adviseable to let in a quantity of water
in order to loosen and wash off what is offensive, and then to pump it
out.

There is a circumstance in the first fitting out of a ship well worth
attention, as highly conducive to the dryness and cleanness of the
hold. I mean the choice of the ballast; for that which is called
_shingle_, consisting all of pebbles, is far preferable to that which
is sandy and earthy, as it does not so readily soak and retain the
moisture and filth. Water or fluid of any kind readily subsides in it,
and should any putrid matter be entangled in it, there will be less
difficulty in washing it out.

The decks should not be washed so often when the weather is moist as
when it is fine, as it will be more difficult to dry them, and more
harm may arise from the moisture than benefit from the cleanness.
Washing should also be performed very early in the morning, even in the
best weather, in order that there may be time for the decks to become
dry in the course of the day. It is after a general washing that the
moveable fires, formerly described, are most proper and useful.

Every contrivance should be fallen upon to change the air in the
orlop and hold. Ventilators and windsails[59] are well adapted for
this purpose, and should be used as frequently and for as long a
time as possible. It has also a good effect in cooling the air in
the lower parts of a ship in the West Indies, to lift the gratings
of the hatches, raising them on their edges, and lashing them to the
staunchions. It contributes likewise to cleanliness and coolness to
keep the decks as clear as possible from[60] chests and other lumber,
which are in the way of sweeping and washing, and prevent also the free
course of the air.

Particular attention to ventilation is necessary in frigates, for
almost all that part in which the men sleep is excluded from the air,
and they are therefore very uncomfortable in the West Indies unless
small scuttles are cut in the sides. But if this should be objected to
as weakening or endangering the ship, there is a good contrivance for
the same purpose, which I met with on board of the Nymphe frigate.
It consists of a square wooden pipe, of about nine inches in the side
coming from between decks, running along the side of the ship, and
opening over the gunwale of the forecastle. There was one on each side.


SECT. IV.

Means of guarding against INFECTION and BAD AIR.

Infection never prevails to such a degree, as to affect every person
indiscriminately who is exposed to it. Even where the plague and
small-pox prevail to the greatest degree, there are some persons who,
though susceptible of these diseases, yet escape them. There are
certain other infections of a weaker nature, as was before observed,
and these will remain entirely inactive, till they find constitutions
so disposed as to be fit subjects of their action. The seeds of disease
may be compared to those of vegetables, which lye dormant, unless they
happen to fall into a situation peculiarly adapted for exciting their
activity. It is very difficult to account for this uncertainty in the
operation of infection, but it is extremely providential, that under
the most calamitous state of sickness, there are always some who are
in health and who survive, for the necessary purposes of life. If this
were not the case, it might happen that every person on board of a ship
might perish from sickness in the course of a voyage, a circumstance
which I believe has never been known to happen.

There is an endless variety in the constitution of the human frame,
both in mind and body, as well as in the features of the face. There
are, perhaps, no two individuals in the world in whom the same effect
precisely is produced by the same food, air, medicine, poison, or
passions of the mind. The different effects of infection, therefore,
upon different people, seem to depend, in many cases, on peculiarities
of constitution too obscure to be explained; but there are also known
circumstances which resist or encourage its effects.

The great power of habit[61] in taking off the effect of infection,
has already been mentioned, and it would appear that novelty gives
an increased energy and activity to all impressions, as well as those
on the senses. If a person, therefore, escapes the first attack of
infection, he will be more likely to continue exposed to it with safety
in future.

There are certain precautions necessary to be attended to by those
who are unavoidably exposed to contagion, particularly in the first
instance. Those who can afford a full diet, and a liberal use of wine,
have been observed to resist infection better than those who use food
and drink that is meagre and watery. It is also a good rule not to
go among the sick, nor otherwise to expose one’s self to infectious
air, with an empty stomach; for whether it is that the body is then
more susceptible, or that the pores of the skin and lungs are in a
more highly absorbing state, so as with greater readiness to inhale
the poison of disease, it is certain that a person in that situation
is more apt to catch harm from foul air of any kind. Whatever else
weakens and exhausts the body, renders it also more susceptible of
noxious impressions. Under the head of weakening powers, I comprehend
not only what empties the body of its fluids, such as loss of blood, or
a diarrhœa, but intoxication, fatigue, fasting, watching, and certain
affections of the mind, such as care and grief.

Cold and moisture may also be enumerated among the causes that invite
the attack of infectious diseases. They are of themselves simply
productive of catarrhs, rheumatisms, and the like disorders; but if
an infection should be accidentally present when the body is exposed
to them, then instead of these complaints, the disease peculiar to
that infection will be produced[62]. This was illustrated in the last
reinforcement we had from England; for while bad fevers were breaking
out in most of the other ships, the [63]Union was affected with those
complaints only which are simply the effects of cold and moisture. It
would be more proper, perhaps, to say, _exposure to the air_, than to
call it _cold_; for exposing the naked body to the open air, even in
the warmest climate, is prejudicial to health. This holds at least with
regard to Europeans who are accustomed to clothing, however the natives
of hot climates who are naked, may expose themselves with impunity.

It is of the greatest consequence to ascertain the extent of the
influence of infection, for the means of avoiding and preventing it
will very much depend upon this. It is now known, that infection
extends itself to a very small distance. There are, indeed, some
morbid poisons, such as that of the bite of a mad dog, and that of
the venereal disease, which require actual contact to make them
take effect. Others are more volatile, and seem to he inhaled by the
breath, or absorbed by the skin, but these do not extend far. That
of the plague[64] does not reach above a few yards, and that of the
small-pox and of fevers is probably equally limited. This discovery is
very valuable, by ascertaining the limits of danger; for when a person
imagines he runs the same risk when at a considerable distance from the
seat of disease, as if he were in contact with the person affected,
he will be apt to expose himself wantonly and unnecessarily to the
infection.

It seems to be owing to the ignorance of the extent of its influence,
that the plague has in general been so fatal; for in consequence of
the opinion that the whole surrounding atmosphere was affected, it
was vainly attempted to purify it by large fires in the open air, or
by [65]firing off artillery, instead of trusting to the separation of
the sick so as to avoid their near approach, and to the confinement
of those in health to their own houses, which are all the precautions
necessary to prevent its progress.




CHAP. II.

Of ALIMENT.


SECT. I. Of SOLID FOOD.

The most unnatural circumstance in a sea life is the food which men
use, and the disease most peculiar to it is one which is owing chiefly
to the nature of the aliment; for though other causes conspire in
aggravating the scurvy, the depraved state of the INGESTA is the main
and fundamental cause of it.

It is this disease that is most fatal to seamen next to fevers. It
was formerly as fatal, if not more so; but some modern improvements
have rendered it less frequent and violent. The habitual use of salt
provisions, besides producing evident symptoms of scurvy, begets
such a state of the constitution, that, upon the least scratch being
received, particularly on the lower extremities, a large and incurable
ulcer ensues; and this circumstance, trifling as it appears, is the
cause of losing an incredible number of men to the service, especially
in the West Indies. The greater part of the food of a ship’s company
is necessarily salted meat. Biscuit and pease, though of a vegetable
nature, are hard of digestion; and though they qualify the animal food,
they do not answer the purpose of fresh vegetables. Though officers
have a supply of live stock even for the longest voyages, it would be
impracticable to carry a quantity sufficient to preserve a whole crew
from the scurvy. But certain articles have of late been introduced
into use, of a durable and portable nature, which so qualify the salt
provisions, that they can be used without inducing this disease. These
are either such as are articles of common diet, viz. melasses and sour
krout, or those which are intended only for the sick and recovering,
such as portable soup and the preserved juice of lemons and oranges.

It is one of the most ancient and real grievances in the service,
that there has not been a sufficiently ample supply of nourishment
and cordials for the weak and recovering. This complaint is made by
[66]Dr. Cockburn, who was physician to the fleet in the end of the
last century; and it is a complaint that has not yet been entirely
redressed, nor has the subject been considered with the attention it
deserves. The only improvement in the sea victualling that I know of
from that time till of late, has been the use of raisins for puddings,
and the occasional use of vinegar, which is an article extremely
salutary, and was looked upon as the great preservative of health in
the Roman armies.

After the force of disease has been subdued at sea, men are frequently
lost by relapses, or pine away in dropsies and other chronic
complaints, for want of being supported by some cordial and nourishing
diet. It is mentioned in my memorial to the Admiralty, how insufficient
the small quantity of surgeon’s necessaries are; and it is recommended
that a large quantity of certain species of refreshment should be put
in the purser’s charge, which, being substituted for the common sea
victualling while men are ill or recovering, would cost Government
little or nothing. Besides the articles already mentioned, it was
recommended to set apart a quantity of the best wines, and to be
provided with brown sugar, dried fruits, barley, rice, sago, and salep.
To these might be added eggs, which, if greased and put in salt, may
be preserved fresh for a great length of time. Carrots and other roots
might also be preserved for the longest voyages by means of sugar; and
green vegetables might in like manner be preserved by means of salt.
But of all the articles, either of medicine or diet, for the cure of
the scurvy, lemons and oranges[67] are of much the greatest efficacy.
They are real specifics in that disease, if any thing deserves that
name. This was first ascertained and set in a clear light by Dr. Lind.
Upon what principle their superior efficacy depends, and in what
manner they produce their effect, I am at a loss to determine, never
having been able to satisfy my mind with any theory concerning the
nature and cure of this disease, nor hardly indeed of any other. An
ingenious treatise has been published on this subject by Dr. Milman,
to which I refer the reader, meaning to confine myself in this work
chiefly to what is practical.

Every person who has beheld with attention and feeling the tedious and
languishing series of suffering which the sick and recovering endure
for want of the means of supporting and recruiting their strength and
spirits, must wish that those who preside in the civil department of
the navy would seriously consider this subject, and complete the reform
that has already been begun.

With regard to the victualling of men in health, a most commendable
attention has been paid to the improvement of it. The ordinary articles
of victualling have not only been of excellent quality, but some new
articles have been added, from which the greatest benefit has been
derived. The chief of these are sour krout and melasses. The latter was
first brought into use by Captain Ferguson in the beginning of the late
war. He ordered it to be served with rice to the men who were affected,
or threatened with the scurvy, in the ship under his command. The
benefit experienced from it in this and other instances was so great,
that during the last two years of the war it was made a regular article
of sea victualling, and substituted in place of a certain proportion of
oatmeal[68].

As bread is one of the principal articles of diet, the utmost care
should be taken in preserving it, and great advantage would arise
from stowing it in casks that are water tight, instead of keeping it
in bags, or letting it lie loose in the bread room. Captain Cook, by
this method, and by giving it a cast in the oven in the course of the
voyage, preserved his biscuit found in every respect for more than
three years. But the greatest improvement in this article of diet would
be to have, in the form of flour, a greater proportion of what is now
allowed in bread. The flour might be made into puddings, and seems, in
this form, to be more nutritious and antiscorbutic than biscuit which
has undergone a strong force of fire. This sort of mess would be still
more proper and agreeable now that melasses is a stated article of
diet. Flour, by being well pressed and rammed, will keep as long as
biscuit, and it can be stowed in one fifth part of the space; it will,
therefore, cost much less in freight than the same quantity of it in
that form, and it may be baked abroad if necessary[69]. Malt, by being
well rammed, may also be preserved for a great length of time.

Of all the former articles of sea victualling, there was none more
abused than oatmeal. The quantity allowed to each man was twice as much
as he could consume, and the overplus went to the purser’s profits,
or was wasted by being given to the hogs, or even wantonly thrown
overboard. Melasses have, with great advantage, been substituted for
part of it, in the proportion of eleven pounds for two gallons of
oatmeal. The first trial of melasses was in the[70] Foudroyant, and it
answered so well, that, in a cruise under Admiral Geary in 1780, this
was the only ship free from the scurvy, and out of two thousand four
hundred men that were landed at the hospital with this disease, there
were none from this ship. It appears to be so similar in its nature
and effects to essence of malt, that it seems hardly worth while for
Government to be at the expence of providing the latter.

A certain proportion of barley has also of late been substituted for
part of the oatmeal, which being more light and palatable, makes a
pleasing variety, particularly to the sick and recovering. Captain Cook
carried wheat with him, and found it to answer equally well. Might not
potatoes also be a proper and salutary substitute, as they will keep
a considerable length of time in a warm climate, and they have been
successfully employed in their raw state for the cure of scurvy? It
would not be right, however, to abolish oatmeal entirely; for there is
a certain preparation of it which is an antiscorbutic of equal efficacy
with any whatever, except the juice of lemons and oranges. This is
flummery, or sowins, which is prepared by letting oatmeal and water
stand together till they grow acidulous, and then boiling them into a
jelly. I know of some well-attested instances of the crews of ships
being saved from the scurvy by this alone.

Butter is a good article of victualling in so far as it renders that
part of the diet which consists of grain and vegetables more palatable,
and thereby induces men to eat more. But as it is extremely corruptible
in a warm climate, hardly any being used by the seamen but what is
more or less rancid, it should never be sent to a tropical station.
Greater quantities of it are condemned than of any other article of
victualling, and it is therefore the most expensive to Government.
There are certain articles that are the natural produce of the
West-India islands, which may be substituted for it with the greatest
advantage. These are sugar and cocoa[71], which, during the last year
of the war, were served in place of butter with great success, and
this proved an alteration in diet not only salutary, but agreeable
to the seamen, whose inclinations are always to be consulted in such
changes[72].

When a ship is in port, encouragement should be given to the sale
of roots, greens, fruits, and sugar. The men have a good custom of
exchanging part of their bread, beef, and pork, for what they can
get from the shore; but as they in general prefer spirituous liquors
to the above-mentioned articles, the greatest care and vigilance
should be used to preclude men from such opportunities of injuring
themselves[73]. Every ship should be furnished with a seine, and other
implements for fishing, when in harbour.

When captures are made, in which there are such articles as sugar,
wine, rice, or fruits, it would be much better in many cases to allow
the immediate use of them at sea, where the men may be disposed to
scurvy or other diseases, than to wait for the conversion of them into
money.

Though it has been my object to introduce as many articles of diet as
possible, independent of salt provisions, it does not follow that these
are in themselves unwholesome. They are pernicious by being made almost
the sole and exclusive article; but if used in moderate quantity,
they are even in some respects well adapted for the food of seamen.
The nature of their life gives them a strong digestion: in their
duties they not only employ violent exercise, but use more muscles
and a greater variety of postures and motions than men of any other
profession. To such constitutions may not food of a refractory nature
and hard of digestion have even an advantage over what is more delicate
and digestible?

It does not appear that it is the salt quality of the provisions used
at sea that makes them productive of scurvy, but the want of their
native juices and of the nutritious principle. A small quantity of
salt is necessary to make all food palatable and wholesome, in so much
that it is reckoned one of the necessaries of life. All animals have a
craving for sea salt, and nature has kindly made it the most abundant
and universal of all saline bodies. Food, without this seasoning, not
only comes to be loathed, but the want of it renders the animal weak
and flabby. As it not only assists digestion, but invigorates all the
bodily functions by stimulating and bracing the fibres, it is in some
cases a valuable medicine. It is remarkable that men are very apt to
tire of a long continuance of fresh provisions[74], but never of what
is salt; and even under the scurvy the latter will be relished, and
sometimes preferred to most other kinds of food. It has been a practice
with some to make the scorbutic men drink sea water; but though it
is not attended with any manifest benefit, I never heard that it
aggravated the disease.

I was told by the gentlemen of the army at New York in 1780, that the
soldiers in cantonments were not near so subject to agues as the people
of the country; and the only difference in their mode of life was,
that the former had in their allowance a certain, proportion of salt
provisions.

In an unhealthy country I should think a free use of salt, as well
as spice[75], would be salutary; and when ships are in port it would
perhaps be better to allow a certain proportion of salt provisions,
because it would not only be wholesome and agreeable, but the men’s
constitutions would probably be more reconciled to an entire salt diet
when necessary: but I would except from this the crews of such ships
as have newly arrived from a long cruise or voyage, in which it may be
necessary to alter the constitution as quickly as possible by a diet
entirely fresh.

Nothing that I have collected from my own observation, or that of
others, has been neglected under this head, except one particular
caution with regard to the preparation of the victuals. The large
utensils employed to boil the provisions are made of copper, and it
sometimes happens from neglect that these are allowed to contract a
rust, which is one of the most active poisons we know. The neglect
consists chiefly in allowing any thing acid, or what is liable to
become acid, such as gruel or burgoo, to remain for a length of time
without being washed out; for when victuals have been prepared in
the boilers thus uncleaned, they produce the most violent effects,
even to the loss of life, as once happened in a ship belonging to our
fleet[76].


SECT. II. Of DRINK.

As the solid part of sea diet is very dry and hard, and as the salt it
contains is apt to excite thirst, a freer use of liquids than at land
is necessary, particularly in a hot climate.

It has been the custom, as far back as we know, to allow seamen the
use of some sort of fermented liquor. We need hardly inquire if this
is salutary or not; for it would be impossible at any rate to withhold
it, since it is an article of luxury, and a gratification which the
men would claim as their right. There is a great propensity in seamen
to intoxicating liquors, which is probably owing to the hardships
they undergo, and to the variety and irregularity of a sea life. But
there is reason to think that all sorts of fermented liquors, except
distilled spirits, are conducive to health at sea.

There is no doubt that malt liquor is extremely wholesome and
antiscorbutic. The common quantity of small beer allowed daily is so
liberal, that few men make use of their whole allowance; and there is
no objection to the constant use of it, except that it is apt to spoil
in the course of a few weeks, and that upon foreign stations the stock
can seldom be renewed. One of the greatest improvements that could
be made in the victualling of the navy would be the introduction of
porter[77], which can be preserved in any climate for any length of
time that may be necessary.

Spruce beer seems to possess similar and equal virtues with malt liquor
and it has this advantage, that the materials of it can at all times
be carried about and used occasionally. It agrees with malt liquor in
being a fermented vegetable sweet, the principal ingredient of it being
melasses. The other ingredient, from which it takes its name, being a
balsamic substance, seems to be more medicinal and antiscorbutic than
hops, and is therefore, perhaps, preferable to malt liquor. There have
been sufficient proofs of its virtues in single ships; and all the men
of war that go to America and the West Indies might be conveniently
supplied with it. Admiral Pigot provided a sufficient quantity for the
whole fleet; but the peace coming on prevented the trial of it.

The most salutary kind of drink next to malt liquor, and spruce beer,
is wine. The benefit which the fleet derived from it at different
times, and the advantage it has over spirits has been often taken
notice of in the former part of this work. It seems to be owing to this
that the French fleet sometimes enjoys superior health to ours, and
is less subject to the scurvy[78]. Wine is also preferable to every
other medicine in that low fever with which ships are so much infested;
and there is no cordial equal to good wine in recruiting men who are
recovering.

Spirits differ from wine in this respect, that they are a mere chemical
liquor, incapable of assimilation with our fluids, having lost in
distillation the native vegetable principle in which the whole of its
nutritious quality and great part of its medical virtue resides.

The abuse of spirituous liquors is extremely pernicious every where,
both as an interruption to duty, and as it is injurious to health. It
is particularly so in the West Indies, both because the rum is of a bad
and unwholesome quality, and because this species of debauchery is more
hurtful in a hot than in a cold climate.

It is with reason that the new rum is accused of being more unwholesome
than what is old; for, being long kept, it not only becomes weaker and
more mellow by part of the spirit exhaling, but time is allowed for the
evaporation of a certain nauseous empyreumatic principle which comes
over in the distillation, and which is very offensive to the stomach;
therefore, though this is the produce of the West-India islands, yet
what is supplied there is inferior to that which is brought from
England.

It was originally the custom to serve seamen with their allowance of
spirits undiluted. The method now in use, of adding water to it, was
first introduced by Admiral Vernon in the year 1740, and got the name
of _grog_. This was a great improvement; for the quantity of half a
pint, which is the daily legal allowance to each man, will intoxicate
most people to a considerable degree, if taken at once in a pure state.

The superiority of wine over spirits in any shape was so conspicuous,
that towards the end of the war the fleets in the West Indies and
North America were supplied with nothing but wine, and with a success
sufficient to encourage the continuance of the same practice in future.


Of WATER.

As water is a necessary of life, and as the health and comfort of men
at sea depend upon its quality, it deserves particular attention.

Spring water is to be preferred to running or stagnated water; for,
unless it is taken at the source, or near it, it is apt to be
impregnated with decayed vegetable and animal substances, such as
leaves, grass, wood, and dead insects. This inconvenience is greatest
in a hot climate, where every thing teems with life, and where the
materials of putrefaction are both more abundant and more prone to
corruption. This is the most pernicious kind of impurity; for the
mineral impregnations common in springs are seldom, in any degree,
unwholesome, and do not tend, like the other, to make the water
corrupt. At many of the West-India watering places the water is found
stagnated just above high-water mark; and care should be taken to go
higher up to take it where it is running.

The purest water is apt to spoil by producing a putrid glare upon
the inner surface of the cask which contains it. There is a great
difference in this respect between a new cask, especially if made of
moist wood, and that cask which has been hardened and seasoned by age
and use. Several contrivances have been proposed for preparing the
vessels that hold the water; but none have been found by experience so
effectual as letting them stand for some time full of sea water; and it
is a great advantage of this method, that it is so easily practicable.

It is in few places we meet with water such as that of Bristol,
which, in clean vessels, may be kept for any length of time. We may
consider all water kept in wooden vessels as more or less liable to
putrefaction; but there is a substance, which is neither rare nor
costly, that effectually preserves it sweet. This is _quick lime_,
with which every ship should be provided, in order to put a pint of it
into each butt when it is filled. It has the advantage of not being
injurious to health; but, on the contrary, is rather friendly to the
bowels, tending to prevent and check fluxes. In the year 1779 several
ships of the line arrived in the West Indies from England, and they
were all afflicted with the flux, except the Stirling Castle, which
was the only ship in which quick lime was put into the water. Nor does
it spoil the water for any culinary purpose. Its action in preventing
putrefaction consists, in part at least, in destroying vegetable and
animal life. An addition of putrescent matter is produced in water by
the generation of small insects; and the glare that collects on the
sides of casks, and also what collects on the surface of the water, is
a species of vegetation of the order called by naturalists _algæ_[79].
Quick lime is a poison to this species of vegetable life as well as to
insects: but upon whatever principle it depends, the property of it in
preserving water sweet is so well ascertained, that it is inexcusable
ever to neglect the use of it.

Quick lime is equally efficacious for this purpose, whether slacked or
unslacked; and though the latter form is more convenient for stowage,
by having less weight and bulk, yet the other is to be preferred for
the sake of safety; for if water should by chance reach the unslacked
lime, a great degree of heat is thereby produced, which has been known
to give occasion to the most formidable accidents.

The only other objection I know of to the use of quick lime is, that it
converts the water into a lime water, rendering it thereby disagreeable
to the palate and stomach: but the quantity necessary to preserve it
makes but a very weak lime water; for part of the lime is precipitated
by the mephitic air, or the aerial acid, as it is otherwise called, of
which there is some contained in the water. The accidental exposure to
the atmosphere, which also abounds with this sort of air, tends farther
to lessen the acrimony of the quick lime[80].

There are other substances which have been found useful in correcting
bad water. Alum and cream of tartar, as antiseptic bodies, have been
employed for this purpose. Vinegar and the vegetable acid juices and
fruits, such as tamarinds, may be used occasionally to take off the
putrid offensive taste which may have arisen in case the use of quick
lime has been neglected. In the fleet under Sir Charles Saunders, the
water of the river St. Lawrence having been found to produce fluxes,
this quality was removed by throwing four pounds of burnt biscuit into
each cask before it was used. But there is nothing so effectual, and
subject to so few inconveniences, as quick lime.

The next method to be mentioned of purifying water is filtration,
which not only separates the gross impurities, but removes the putrid
smell and taste. It is performed with a dripping stone, which is a
convenient contrivance for officers, but cannot furnish a supply for a
whole ship’s company.

When the water of wells or brooks is found loaded with mud, the
following expeditious method of filtration, described by Dr. Lind, has
been practised with success:--Let a quantity of clean sand or gravel
be put into a barrel placed on one end, without the head, so as to
fill one half or more of it, and let another barrel, with both ends
knocked out, of a much smaller size, (or let it be an open cylinder of
any kind) be placed erect in the middle of it, and almost filled with
sand or gravel. If the impure water be poured into the small barrel or
cylinder, it will rise up through the sand of both barrels, and appear
pure above the sand of the large one in the interval between it and the
small one.

But when water is offensive in consequence of being long kept, the most
effectual and expeditious method of sweetening it is by exposing it
to the air in as divided a state as possible. Boiling will not expel
the putrid effluvia contained in water; but such is the attraction of
air for this offensive matter, that the water need only be thoroughly
exposed to it to be rendered quite sweet. This is best done by a
machine invented by Mr. Osbridge, a lieutenant of the navy. It consists
of a hand pump, which is inserted in a scuttle made at the top of a
cask, and by means of it the water, being raised a few feet, falls
through several sheets of tin pierced like cullenders, and placed
horizontally in a half cylinder of the same metal. The purpose of it is
to reduce the water into numberless drops, which being exposed in this
form to the open air, is deprived of its offensive quality. The same
method will serve to separate the superfluous quick lime in the water.
It is a machine very deservedly in common use, and the working of it is
a moderate and salutary exercise to men in fair weather.

The following contrivance will be found to afford a sufficient supply
of sweet water to particular messes, and may be considered as an
artificial and more expeditious sort of dripping stone.--Let the
narrow mouth of a large funnel be filled with a bit of sponge, over
which let there be a layer of clean gravel or sand covered with a
piece of flannel, and over the whole another layer of sand. Muddy or
offensive water being poured upon this, runs or drops out clear; and
care must be taken to change the sand, sponge, &c. frequently, as they
will become loaded with the impurities of the water[81].

There should be in every ship an apparatus for distilling water in
case of distress. This consists merely of a head and worm adapted to
the common boiler, and distillation may go on while the victuals are
boiling. More than eight gallons of excellent fresh water may be drawn
off in an hour from the copper of the smallest ship of war[82]. I refer
for a more particular account of all this to the works of Dr. Lind,
who was the original inventor and recommender of this method.

This invention seems to have escaped others so long, from the idea that
the _desideratum_ in freshening sea water was some substance to be
added to it while under distillation. No such substance is necessary,
and, the more simple the mode of distillation, the fresher the water
will prove.

Rain water at sea is always pure and wholesome, and may be saved
occasionally by means of a sail or awning.




CHAP. III.

Of CLOTHING.


Nature has made man so defenceless, that even the rudest nations, in
the hottest climates, in general, adopt some sort of covering to guard
themselves from the weather. We may affirm, that clothing is the most
artificial circumstance in the life of man; and there is none, of which
the errors subject him to more inconvenience and hardship. Insensible
perspiration is performed by the pores of the skin, and being one of
the most important functions of the body, the suppression of it seems
to be one of the principal causes, or at least one of the most frequent
attendants on feverish and inflammatory complaints; and one of the most
common causes of this suppression is the application of cold to the
skin.

In order to keep up perspiration, it is necessary that the orifices
of the pores of the skin should be bathed, as it were, in the vapour
already secreted from them; and clothing seems to act in confining
this, as well as in preventing the escape of the natural heat and the
access of the external air. Though the air should not be cold, it will
check perspiration by carrying off this vapour and drying the skin.
In the warmest climates exposure of the skin to the external air is
unsafe; for it not only produces a feverish and uneasy sensation at
the time, but occasions the most dangerous internal disorders. In
consequence of the great sensibility and sympathy of the body, and from
the pores of the skin being open in a warm climate, exposure is in some
respects even more dangerous than in a cold one. Nothing is more apt to
bring on the locked jaw and tetanus than sleeping in the open air; and
it was observed in Jamaica, that when it was the custom to wear cotton
and linen clothes, the dry belly-ache was much more common than now
that it is the custom to wear woollen cloth.

We know besides, that the pores of the skin can absorb not only the
moisture that floats in the atmosphere, but a variety of foreign
bodies, whether noxious or medicinal, which may be applied to their
orifices; and as the air is in certain places loaded with noxious
matter, may not clothing be considered as a filter, as it were, to
separate the impurities of the air before it comes in contact with the
surface of the body?

It is therefore every where of the utmost consequence that sufficient
and suitable clothing should be provided.

It would certainly be for the benefit of the service that an uniform
should be established for the common men as well as for the officers.
This would oblige them at all times to have in their possession
a quantity of decent apparel, subject to the inspection of their
superiors. It would also be less easy to dispose of their clothes for
money without detection, and desertion would also thereby be rendered
more difficult.

It is of great consequence that the purser should lay in a sufficient
stock of clothing and bedding suited to the climate for which the
ship is destined, in order that there may be a sufficient supply
after having been on a distant station for a certain length of time.
I have known men suffer the greatest inconvenience and hardship, and
infectious diseases kept up, from the neglect of this.

The greatest evil connected with clothing is the infection generated
by wearing it too long without shifting; for to this cause we have
attributed the jail, hospital, or ship fever. The great importance of
cleanliness appeared when we were treating of infection, from whence we
may judge of what consequence it is that men should be provided with a
shift of linen, as that part of the clothing which is in contact with
the skin is most likely to harbour infection[83].

As clothing is not the gift of nature, being left to man’s own reason,
it is subject to caprice, and thereby productive of inconvenience
and disease. The necessity of it depends very much upon habit, like
every thing else relating to the human body, and therefore sudden and
unseasonable changes of apparel are very unsafe to health. It is also
found that a partial exposure of the body is more pernicious than a
general exposure. If I were writing for the more delicate part of the
world, I should illustrate this by the danger of exposing the feet
alone to cold or wet. It is seldom that seamen are susceptible to so
great a degree, for their hardy and exposed life steels them against
such impressions. But there is another circumstance which renders it of
the utmost consequence to defend the feet against external injury. It
frequently happens, that, without any visible symptoms of scurvy, the
constitutions of seamen are such, that, upon the least scratch being
received on the feet or legs, a large spreading incurable ulcer arises;
which sometimes ends in the loss of a limb; but at any rate disables
them from duty till a cure can be effected by the use of a fresh and
vegetable diet, or a change of climate. Next to acute diseases and
scurvy, this is the most destructive complaint incident to a sea life,
particularly in a hot climate; and I have known great numbers of good
men thereby lost to the service. It is, therefore, of the utmost
consequence that men should not only be supplied with shoes, but be
obliged to wear them, which is found to require a degree of compulsion;
for in the West Indies it is observed that seamen always wish to go
barefooted.

Since the first edition of this work was published, I have been
favoured with several valuable remarks on this subject, by Captain
Caldwell, an officer of great humanity and experience. Among other
remarks, he observes, that the different articles of clothing supplied
to sailors are, in general, too slight, and of too small a size, which
renders them expensive and inconvenient to large men. The trowsers, he
observes, should be much thicker, and larger, as the least shower goes
through them; and, in a cold climate, those made of _fear-nought_[84],
which do not cost more than the others, should also be allowed. What
a situation are men in when topsails are reefing in the winter season
while it rains, when cold and wet, with their trowsers sticking to
them, (which would not be the case if they were of flannel) and it is
not practicable that they should have change of clothing for every time
they are obliged to be wet? Thick, double-milled caps are much wanted
in bad weather to cover the head and ears. Dutch caps do not keep out
the weather, and will not stay on the head. It is commonly remarked
that the men who wear the thickest linen shirts are the most healthy.

Men, upon first entering into the service, are allowed the advance of
two months wages, in order to provide necessaries: but this, inadequate
as it is for a long voyage, is not extended to pressed men. It is also
argued against making large stoppages in seamen’s wages; that, by
diminishing what they have to receive when paid off, a discouragement
is thereby given to the service. But as we see men deserting from men
of war when several years wages are due to them, the most reasonable
and effectual encouragement seems to be to render their lives as
comfortable and healthy as possible.

But why might not most of the articles mentioned be supplied
gratuitously? In favour of which Captain Caldwell makes use of an
argument frequently inculcated in this work, viz. that so much
advantage would accrue to Government by preserving the health and lives
of men, and so much would be saved in hospitals, as would much more
than reimburse the extraordinary expence[85].




CHAP. IV.

Of EXERCISE.


It commonly happens in a ship of war that a great proportion of the
hands is landsmen; for, besides the men required to navigate the ship,
a great number is necessary to fight the guns, as well as for other
duties, and their health may be affected by the want of exercise.

It has been observed before, that one use of frequent reviews and
musters in a numerous crew is, to call forth men that would otherwise
be overlooked, to oblige them to come into the open air, to keep
themselves clean, and to prevent them from indulging in filth and
laziness. It is observed, that seamen are in general less subject
to scurvy than marines and landsmen, which seems to be owing to the
greater activity of their life and alacrity of their minds.

There is an essay on the causes of the pestilence, by an anonymous
author, published at Edinburgh in 1759, in which this disease is said
to be entirely the offspring of idleness, and he illustrates this by
its being more apt to arise in besieged towns than any other situation;
and he alledges that a false alarm of the plague will actually produce
it by throwing people idle, as was the case, he affirms, when the
plague was last at Messina.

There are always numbers who have been pressed into the service, to
whom a sea life is new, and who are therefore prone to indolence, low
spirits, and self-neglect. Men of this description are by far the most
apt to fall into the scurvy; and next to the quality of the food,
there is nothing contributes more to promote the scurvy than such a
disposition. It is indeed both a cause and a symptom of this disease,
and therefore idleness and _skulking_ should be rigidly discouraged,
unless the complaint is so far advanced as to render it cruel and even
impossible to force men to take exercise.

The Conqueror, of 74 guns, one of our squadron in the last year of the
war, was an instance of a ship in which only the prime seamen were
attacked with the scurvy, and this is to be accounted for upon the same
principle, for it proceeded from their having been exempted from the
duty of pumping, in which the inferior classes of men were constantly
employed, owing to the leaky state of the ship.

As low spirits and indolence have such an unfavourable effect upon
health, it would be wise, as well as benevolent, to promote whatever
produces jollity, contentment, and good humour, so far as is consistent
with sobriety and regularity. There are certain rough sports which are
now almost in disuse; and whoever would revive and encourage them,
would perform a useful office to the service.

A sea life frequently demands violent temporary exertions, from the
uncertainty of the weather, and other incidents; so that men are more
exposed to extreme fatigue and sudden calls of duty in this than in
any other situation of life. Nothing tends more to shorten life than
excessive bodily labour and watching; and it is for this reason that
seamen in general are short lived, and that their countenance and
general appearance make them appear older than they really are by
several years. This is remarkably the case when a seaman comes to be
upwards of forty and it has been mentioned before, that a person not
acquainted with this circumstance will make a mistake of ten years in
guessing at the age of a seaman from his looks.

Fatigue being therefore frequently the means of bringing on disease
and breaking the constitution, as much tenderness is due to men as is
consistent with the necessary duties of service. This is a circumstance
in which young officers are apt to forget themselves; and they should
take care how they _call all hands_ wantonly, and oblige men to make
exertions beyond their strength, especially as this will be submitted
to more readily by sailors than any other set of men, from the
generous alacrity of their nature.

It would be well if it could be rendered convenient at all times,
except in cases of danger or emergency, to put the men at three watches
instead of watch and watch. By the former arrangement they have eight
hours sleep and rest; by the latter only four hours are allowed, which
is not sufficient for refreshment, nor is there time for them to get
dry, in case they have been exposed to wet.

It would be a good rule to have as few men as possible out of bed in
the night-time, unless where active service renders it necessary; for,
if unoccupied, they lie about the decks, fall asleep, and catch cold.
In such situations, might not all the topmen but one remain on the
forecastle, where they might take exercise, which they could not do
aloft? I am indebted for this remark to the Rev. Mr. Ramsay, who joins
to a great knowledge of the sea service a warm and disinterested zeal
for its prosperity, and has been so good in several other instances as
to communicate to me the results of his experience and observation.

The good effects resulting from the indulgent treatment of men are,
that it encourages them to enter into the service, and to do their duty
with cheerfulness and resolution. There is something more daunting to
the mind of man to see his companions suffering under oppression and
languishing in disease, or perishing miserably from sores or sickness,
than in the terrors of fire and sword, which, as we have seen, make
the least part of the calamities of war. The good treatment of seamen,
in so far as it regards their health, is by no means incompatible with
strict discipline. Indeed strictness and even severity is necessary
with seamen; for it is observed with regard to men who are used to
arbitrary government, that they cannot bear indulgence and relaxation.
But the steady enforcement of discipline and regularity is so far from
being akin to cruelty, that it tends to prevent both sickness and
the commission of crimes, consequently rendering the infliction of
punishment less frequent and necessary. The chief excellence in the
character of an officer seems to consist in uniting strict discipline
with indulgence and humanity.


CONCLUSION.

The subject of the preceding remarks has been the prevention of
diseases and it has appeared that the means of this are not so much in
the province of the medical profession as of those who are entrusted
with the direction of the navy in a civil or military capacity; and
that with regard to cure and recovery also, a great deal depends upon
them, by their having it in their power to make a suitable provision
of proper diet and cordials. The great importance of the subject will
plead my excuse for again calling to mind, that such attentions are
not only dictated by humanity, but would be the greatest wisdom in an
œconomical and national light, considering how expensive it is to
_replace_ men and to support invalids, not to mention that it is upon
the health and lives of men that every public exertion essentially
depends, and upon which may depend not only the character of officers,
but the national character in the day of battle.

It must be confessed, that though there is still room for improvement,
the navy is now on a better footing with regard to the health and
comfort of seamen than it appears to have been in former times. The
victuals were in general in the late war of excellent quality; the
civil branch has shewn in many instances a readiness to adopt the means
and to furnish the articles that were recommended for the health of the
men[86]; and most of the commanders whom I have the honour to know are
humane, attentive, and intelligent.

To conclude; there is no situation of life in which there is room for
more virtues, more conduct and address, than that of a sea officer.
The men are thrown upon his humanity and attention in more views than
one: they are subject to a more arbitrary exertion of power than the
constitution of the date authorities in civil life, Englishmen giving
up into his hands, from considerations of public expediency, that which
they hold most dear, and of which they are most jealous, their LIBERTY.
It is the character of seamen to be thoughtless and neglectful of
their own interest and welfare, requiring to be tended like children;
but from their bravery, utility, and other good qualities, they seem
entitled to a degree of _parental_ tenderness and attention from the
state they protect and the officers they obey.


APPENDIX TO PART II.

 In order to exhibit a concise view of the most material observations
 contained in this part of the Work, a Memorial, delivered to the Board
 of Admiralty in October, 1781, is here subjoined.


MEMORIAL,

 Proposing Means for preventing the Sickness and Mortality prevailing
 among His Majesty’s Seamen in the West Indies.

I have for the two last years attended a squadron, consisting seldom
of less than twenty ships of the line, in quality of physician to the
fleet at Barbadoes and the Leeward Islands. I received, by the order of
the Commander in Chief, a monthly return from the surgeon of each ship,
setting forth the diseases, deaths, and other circumstances of the
respective ships companies. I also superintended the hospital of the
place where the fleet happened to lie when in port. These advantages
have afforded me an intimate knowledge of the nature and causes of the
sickness and mortality among the seamen, both on board of their ships
and in hospitals.

It appears by my returns, that there died in the course of the twelve
months preceding July last, on board of ships, seven hundred and
fifteen seamen and marines, of whom only fifty-nine died in battle
and of wounds. There died in the same time in hospitals eight hundred
and sixty-two: so that out of twelve thousand one hundred and nine
men, which is the sum total of the complement of twenty ships of the
line, there have perished in one year one thousand five hundred and
seventy-seven, that is nearly every seventh man.

There were also sent to England in the same year, three hundred and
fifty men, disabled by lameness and chronic complaints, the greater
part of whom will be for ever lost to the service.

The degree of sickness is very different at different times; but it
appears by the returns, that, at a medium, there has been one man in
fifteen on the sick list.

Having employed all the attention of which I was capable to find out
the causes of this sickness and mortality, in order, if possible, to
point out the means of prevention, I flatter myself with being able to
assign the most general causes, and to propose some effectual remedies.

When it is considered that sickness is almost entirely confined to
ships of two and three decks, and that some of these are as healthy
as frigates and merchant ships, though in the same circumstances of
service with others that are extremely sickly, we are led from hence to
infer, that sickness is not in its own nature unavoidable, and we are
encouraged to hope, that the attainment of general health is within
the compass of human management.

I humbly and earnestly solicit attention to some of the most material
observations and conclusions which have occurred in the course of a
service, which, though short, has been extensive; and whatever is here
proposed has this recommendation, that it is easily practicable, and is
no addition to the public charges.

First, I hardly ever knew a ship’s company become sickly which was well
regulated in point of cleanliness and dryness. It is the custom in some
ships to divide the crew into squads or divisions under the inspection
of respective officers, who make a weekly review of their persons and
clothing, and are answerable for the cleanliness and regularity of
their several allotments. This ought to be an indispensable duty in
ships of two or three decks; and when it has been practised, and at
the same time ventilation, cleanliness, and dryness below and between
decks, have been attended to, I have never known seamen more unhealthy
than other men. The neglect of such attentions is a never-failing cause
of sickness.

I would, therefore, with all becoming deference, suggest, that such
a regulation, instead of being left to the discretion of officers,
should be made a part of the public instructions. From some commanders,
who already practise these rules, the advantage of them comes to be
known; and would not a public sanction not only render them general
and permanent, but facilitate the duty of the officer, by making such
a regulation appear a matter of legal necessity, instead of his own
arbitrary act?

Secondly, Scurvy is one of the principal diseases with which seamen
are afflicted, and this may be infallibly prevented, or cured, by
vegetables and fruit, particularly oranges, lemons, or limes. These
might be supplied by employing one or more small vessels to collect
them at different islands, and such an expedient would prevent much
sickness, and save many lives. I am well convinced that more men would
be saved by such a purveyance of fruit and vegetables, than could
be raised by double the expence and trouble employed on the imprest
service; so that policy, as well as humanity, concur in recommending
it. Every fifty oranges or lemons might be considered as a hand to the
fleet, inasmuch as the health, and perhaps the life, of a man would
thereby be saved.

Thirdly, The use of wine, in place of rum, has been found extremely
conducive to health. In the course of my observation I have met with
the most unquestionable proofs of the benefit that would arise from
this substitution. It is a farther reason for such a change, that good
rum is seldom or never supplied in the West Indies.

Fourthly, The necessaries provided for the sick by the present
establishment are not at all adequate, especially on a distant station,
where the supply is not regular, and the quantity at best is such as
can contribute but little to their comfort and recovery. An ample
provision might be made for the sick, without any additional expence,
in the following manner:

It is a rule in the service, that though men are sick, their ordinary
allowance of salt meat and other victuals is nevertheless served out,
and is either used by the other seamen, who stand in no need of it, or
is wasted. Now, if the pursers were instructed to provide themselves
with certain species of necessaries, such as Madeira wine, sugar, rice,
and dried fruits, to serve to the sick, in place of rum, and the common
provisions of the ship, such a regulation would be productive of the
very best effects, in recovering the health, and preserving the lives
of those men who have the misfortune to be taken ill in a situation
necessarily destitute of most of the comforts that can alleviate their
sufferings. I cannot help here applauding a late regulation, by which
melasses are substituted for part of the oatmeal; for the quantity of
the latter heretofore legally allowed was so much greater than what was
necessary, that one half of it has commonly been wasted.

It is to be observed, in general, with regard to the West Indies, that
ships on service are to be considered, in a great measure, in the light
of ships constantly at sea; for, excepting the island of Barbadoes,
there is no other port in which fresh meat and vegetables can be
procured in any quantity, and therefore sour krout, melasses, and such
other articles of antiscorbutic diet as can be supplied on board, are
absolutely necessary. Fleets could hardly exist here, were it not that
a warm climate is naturally more unfavourable to the scurvy than a cold
one.

Fifthly, Though the health of a ship’s company depends chiefly on
diet, and that discipline and order which is the business of officers,
yet much depends also on the medical art, particularly in the West
Indies; and as surgeons frequently cannot do justice to the men without
wronging themselves, in a country where the price of every thing is
exorbitant, and medicines often unsound, Government would find its
account in supplying gratuitously some of the most costly articles,
particularly Peruvian bark in a fresh state, from time to time, from
England.

Sixthly, It is now the general custom to send every sick person on
shore to an hospital, where there is frequently worse air and worse
accommodation than on board, from overcrowding the apartments.
Contagious diseases, though not so common as in Europe, are here
often mixed with those that are not so, whereby numbers are infected
and carried off; and, besides this, the land air is infinitely more
unwholesome in the West Indies than the air at sea or in a road. The
scurvy is perhaps not at all contagious, nor is it very difficult of
cure; but a number of cases of it terminate fatally from the flux
or fever, caught either by contagion in hospitals, by the noxious
influence of land vapours, or by intemperance. I beg leave, therefore,
humbly to suggest, that as few sick as possible of any disease, but
what is contagious, be sent to hospitals, and that some method be
established for the supply of vegetables and other refreshments to the
sick on board of their ships.

Seventhly, Crowding, filth, and the mixture of diseases, are the great
causes of mortality in hospitals. There should be a space of five
hundred cubic feet allowed for each man; and in general the sick had
better remain on board than be crowded beyond that degree; or relief
should be provided to the hospital by an hospital ship, which, for
reasons already given, is preferable to any accommodation on shore; and
such an institution would be more particularly proper for the reception
of convalescent men.

I would beg leave, therefore, earnestly to recommend that cleanliness,
the separation of diseases, and a competent space, be regularly
enjoined and strictly enforced in hospitals; and in order to make this
more practicable in the great scale of service now going on, I would
farther propose that hospital ships be established for the reception
of the sick or recovering. I know from extensive experience and close
observation, that these circumstances are more essential than even
medicine and diet.

These are a few remarks extracted from a series of observations, and
derived from great opportunities of experience. Many other remarks
would suggest themselves; but I purposely confine myself to what is
highly important, and easily practicable, with little or no addition to
the public expence. Some of the improvements recommended are indeed an
immediate, and all of them will be an eventual, saving to the public.

The alterations that have been proposed are,

1st, The establishment of a certain method and discipline, in order
to secure regularity and cleanliness among the men, and to render the
ships clean and dry.

2dly, The supply of fruit and other vegetables for the cure of the
scurvy.

3dly, The substitution of wine[87] for rum.

4thly, The provision of an adequate quantity of necessaries for the
sick.

5thly, The gratuitous supply of certain medicines.

6thly, The curing of certain diseases on board instead of sending them
to hospitals; and,

Lastly, The preventing of filth, crowding, and the mixture of diseases
in hospitals, by proper regulations, and by establishing hospital ships.

I beg leave again to call to mind, that 1518 deaths from disease,
besides 350 invalids, in 12,109 men, in the course of one year, is an
alarming waste of British seamen, being a number that would man three
of His Majesty’s ships of the line; and what I advance is from a real
conviction that a due attention to the above-mentioned propositions
would save more than two thirds of the seamen that would otherwise die
in that climate. It was to set this in a proper light that I requested
leave to quit my duty during the absence of the greater part of the
squadron in the hurricane months; and should any thing I propose meet
with public approbation, and be carried into effect, I should esteem it
a recompence far above any other gratification I can derive from the
service.

  LONDON,
  October 13, 1781.

  To the Right Hon. the Lords Commissioners
  of the Admiralty.

       *       *       *       *       *

Next year the following Supplement to the preceding Memorial was sent
to the Board of Admiralty:


SUPPLEMENT to the MEMORIAL delivered last Year to the Board of
Admiralty.

Since my return to my duty on this station, additional experience has
afforded me farther practical confirmation of the utility of the former
proposals.

The great squadron employed on this station has, by the attention of
the Commissioners of Victualling, and also of the Commander in Chief,
been supplied with most of the articles recommended, in such quantities
as to prove their efficacy; and indeed the small degree of mortality in
comparison of former times, is a sufficient demonstration of this.

I beg leave to give an instance in the Formidable of the great and
salutary effects of the proposed improvements. This ship left England,
furnished not only with sour krout and melasses, in common with most
others in the squadron, but what was peculiar to herself was, an entire
supply of good wine in place of spirits; and an experiment has been
made in this instance, under my own eye, to ascertain what degree of
health it was possible to attain in a great ship in this climate. With
the above advantages, together with good discipline and medical care,
no man[88] died of disease from December, 1781, to May, 1782, and
only thirteen were sent to hospitals, whose complaints were small pox
and ulcers. In the months of May and June last, when at Jamaica, there
died of disease in this ship, three men, and seventeen were sent to the
hospital, most of whom had contracted their sickness on board of French
prizes.

In the rest of the fleet the health was in proportion to the wine and
other refreshments, and the cleanliness, good order, and discipline
observed.

In the squadron I attended the last five months, which seldom
consisted, during the last three months of that time, of less than
forty ships of the line, there have died of disease about 350 men,
and about 1000 have been sent to hospitals; a degree of sickness and
mortality which, though not greater than what frequently prevails
in Europe, I am persuaded would have been still less, had the
improvements proposed been complied with in a manner more extensive and
complete, and had the general rules of discipline and cleanliness been
kept up with due and equal strictness throughout the fleet.

This last article, which, being the most important, I have placed
first in the preceding memorial, it is only in the power of supreme
authority to enforce; and my additional experience and observation have
so far confirmed me in the opinion of the utility of this, as well as
the other articles, that I hope to be again pardoned for repeating my
humble and earnest solicitations that these regulations may be farther
extended and enforced.

  FORMIDABLE,
  At Port Royal, Jamaica,
  July 16, 1782.




PART III.

DESCRIPTION AND TREATMENT

OF THE

DISEASES

MOST COMMONLY OCCURRING IN

FLEETS IN HOT CLIMATES.


It was mentioned in the Introduction to this work, that though my
opportunities of experience were extensive, several obstacles had
prevented me from making observations so accurately as could have been
wished. These were chiefly the bad accommodation of the sick at some
of the hospitals, and the shortness of our stay at any one place,
which seldom exceeded six weeks or two months, and prevented me from
completing such observations as I have happened to be engaged in.
But having practised among great numbers, observations necessarily
arose from the comparison of so many cases; and amidst the variety of
situations connected with the emergencies and hardships of war, nature
is seen in certain portions and under certain trials which are not
met with in common life. I shall therefore describe the diseases such
as they occurred, and shall add such remarks on practice as I could
ascertain.

The following observations shall be confined chiefly to what I have
called the sea epidemics, viz. Fevers, Fluxes, and the Scurvy.




CHAP. I.

Of FEVERS.


Though it is impossible to refer every particular case of fever to a
distinct class, on account of the mixed and anomalous symptoms that
arise, yet there are certain distinguishing features which afford
sufficient ground for dividing them into different kinds, and such a
division will at least serve to facilitate description, and to afford
room for laying down the outlines of practice.

The fevers which occurred most frequently on board of ships, and
at naval hospitals belonging to the fleet in which I was employed,
were the infectious ship fever, (which is the same with the jail and
hospital fever) the bilious remitting fever, and the malignant yellow
fever.


1. Of the infectious SHIP FEVER.

This does not occur so frequently in hot as in cold climates, both
because it is the disease of ships newly fitted out, which they seldom
are in the West Indies, and because there is something in the warmth
of a climate which prevents the production of contagion, as has been
formerly remarked. But as great fleets arrived from time to time in
the West Indies from Europe, with numbers of men labouring under this
fever, there were sufficient opportunities of making observations upon
it.

It has been so well described by Sir John Pringle, Dr. Lind, and other
writers, that it is unnecessary to enter into a minute detail of all
its different appearances in its several stages; and I shall content
myself with recounting some of the most distinguishing symptoms, and
with marking the peculiarities that arose from the influence of the
climate.

This fever is extremely various in its symptoms and in its degree of
malignity and fatality. We are told in some of the histories of the
jail distemper, that, upon its first attack, few escaped that were
seized with it; but that afterwards it grew more mild; and it has been
already observed, that the contagious poison of fever differs from that
of small pox and other specific infections, by varying in its degrees
of virulence.

There are, however, certain characteristic symptoms pretty constant in
this fever in all its forms.

One of the most remarkable of these is a greater degree of muscular
debility than what takes place in other fevers, and it deserves to
be mentioned first, as being one of the most constant. It is also a
tolerably true index of the degree of malignity, the danger being
in proportion to this symptom. In the more advanced stages of the
fever, a tremor of the hands, and of the tongue when put out, is a
constant symptom, and seems to be connected with this weak state of the
muscular fibres. I have seen, however, extreme debility without tremor
in cases too of the greatest danger, and it was observable in these
that there was little or no delirium.

Another striking character of this fever is the delirium of a
particular kind which usually attends it. Sensation and reason are
here in a state uncommonly depraved; and it is in this sort of fever
oftener than any other that we find a total deprivation of them in the
symptom called _coma_. The delirium is seldom of a wild, ungovernable
kind, such as occurs in inflammatory continued fevers, in the violent
paroxysms of intermitting and remitting fevers, or in inflammations
of the brain. It is, however, connected with great suffering; and
this consists in anguish rather than pain, shewing itself by outward
tremor, agitation, and what is called the _floccorum collectio_; also
by sighing, mumbling, and moaning, symptoms always indicating danger.

Delirium is a symptom, to the nature and appearances of which I have
been particularly attentive, in consequence of a painful and diligent
attendance upon some cases in which I was particularly interested from
friendship and affection, and in which this was a remarkable symptom.
It seems chiefly to consist in a false reference of our sensations,
whether external or internal; and this is in no sort of fever more
evident than in this. When any painful impression, for instance, is
made by an external body, the patient, if in a state of delirium, does
not refer it justly to the part affected; but the general agitation and
incoherence of sentiments will be aggravated for the time. I have known
a degree of heat applied to the extremities sufficient to blister them,
yet the part did not shrink, though the raving and general uneasiness
were increased. In like manner, with regard to internal sensations,
when an irritation is excited to expel the urine or _feces_, the mind
does not recognize it as such, but from a sense of uneasiness, probably
mistaken for something else, an effort is made to relieve nature,
which is done without a proper consciousness, and certain symptoms
are produced which are well-known marks of danger in this fever. In
watching those who have been under the influence of delirium, I have
observed it increase when any particular want of nature urged, and
this would continue for some time, the patient being incapable of
procuring himself immediate relief on account of the false reference
of sensation that has been mentioned; but he would become calm after
voiding the urine or _feces_, or after receiving something to drink,
according to the particular want that was present at the time. So
great is the disorder in the common course of sensation in this fever,
that a person ill of it has been even unconscious of inflammations of
vital parts, which, in the natural state of the nerves, would have
excited the most acute pain, and would have been distinctly referred
to the part affected, but were not discovered nor suspected till
inspection after death[89]. I remember one case in which there were
found large erosions, and even holes in the intestines, without any
preceding complaint that could have led to suspect such an appearance.
It would appear that the motions excited in the brain and nerves in
such cases, instead of producing the sensations naturally belonging to
them, serve to excite disagreeable emotions of a different kind, in
which delirium consists. It seems to be from the same depraved state
of sensation, that when a phthisical person is seized with this sort
of fever, his cough is for the time suspended. I have seen the same
circumstance occur in a maniacal case. From a like cause it sometimes
happens in dangerous cases of fever, that in the height of delirium the
_epiglottis_ loses its natural irritability, so that liquids in the
act of swallowing are apt to get into the windpipe, so as to excite
coughing and threaten suffocation, as I have observed in some cases
that came under my care.

All these different forms of delirium are signs of a body extremely
disordered in its functions, and forbode great danger.

The next symptom I shall mention as most characteristic of this sort
of fever is, the spots known by the name of _petechiæ_ and _vibices_,
which, though far from being constant, are, perhaps, more peculiar to
it than any other symptom. They occur only in the latter stages of
the disease, and in cases of considerable danger. The common opinion
concerning their cause is, that the blood is in such a dissolved state,
that the red part of it is effused into the cellular membrane. The
appearance in such bodies as I have inspected, seems to favour this
opinion; for there was hardly any coagulation of the blood in the great
vessels, and instead of those firm substances, called _polypi_, in
the heart, there were only soft grumous bodies, which were so tender
in their consistence, that, upon being handled, they, as it were,
dissolved. Since the improved method of treating these fevers has been
generally adopted, this symptom seldom occurs; for in most cases it may
be called an artificial symptom, chiefly arising from close apartments
and the heat of bed clothes.

It may be considered as a peculiarity of this fever, that it is more
indefinite in its crisis than most others. In continued fevers of the
inflammatory kind, there are frequent attempts at remission, there are
certain periodical exacerbations, and there is generally a distinct
crisis marked by a freedom of the secretions and turbid urine: but in
the fever of which we are treating, though the patient is generally
somewhat worse towards the evening and during the night, its course is
more equable, and the transition from sickness to health is insensible
and gradual, being seldom marked with any perceptible crisis.

The symptom next to be taken notice of, though a minute one, is very
constant and characteristic in this sort of fever. It is a peculiar
heat in the skin, communicated to the hand of another person. It is
usual to grasp the wrist of the patient after feeling his pulse, in
order to examine the state of the skin in point of heat and moisture;
and in doing this a glow of heat is impressed on the palm of the hand,
which lasts for some hours, if one should neglect so long to wash the
hands. I have never met with this symptom in any of the sporadic fevers
of England, though I am informed it sometimes occurs in these.

The fever we are treating of differs also from the sporadic nervous
fever of England, and from most others of the continued kind, in
being attended with a more copious secretion of bile, which, when
thrown up, is generally green, or, as it is otherwise called, of a
porraceous colour. This symptom takes place in all climates; but is
more remarkable in a hot climate, as might be expected.

These are the chief characteristic symptoms of this fever. I shall next
point out such modifications of it as occurred in the West Indies from
the influence of climate.

In the first place, when this fever prevailed on board of any ship
that arrived from a northern climate, it was soon after succeeded by,
or, as it were, converted into, a dysentery; for those ships that
arrived either from England or North America with the greatest stock of
feverish infection, were the most subject to fluxes, after being two or
three months in the West Indies. This was formerly made use of as an
argument, to prove that the dysentery proceeds from the same cause with
fever, taking a different determination, from circumstances of climate
and constitution.

Secondly, It sometimes happens that men, under the influence of this
infection, are more apt than others to be affected with symptoms
peculiar to the climate upon their first arrival. A very striking
instance of this has been mentioned in the case of men that were
pressed into the Formidable at New York, some of whom had the common
ship fever on the passage; others, upon our arrival at Barbadoes, were
seized with the yellow fever, and were the only men in the fleet who
had it at that time. There was another instance in the recruits brought
from England by the Anson, who were seized with a fever on board of
the Royal Oak; and in this fever the skin and eyes were yellow, though
without any symptoms of malignancy[90].

Thirdly, It happened in some ships[91] that the infection was kept up
for several months after arriving in the climate, from a neglect of
cleanliness, or the want of an opportunity of removing those who were
infected to an hospital. It did not in these take a dysenteric turn, as
in most of the other ships, but differed from the ship fever of colder
climates, as above described, in some particulars, which I shall here
enumerate. All the symptoms were milder: it was more protracted, and
less dangerous. In the beginning there was but little difference, only
the symptoms were less violent; but in the succeeding period of the
disease the pulse deviated very little from the natural standard, and
the skin felt cold and clammy. The tongue was white; and this did not
seem so much owing to any fur covering it, as to its being itself of
a pale, lifeless colour, as well as the face, and it appeared larger
in size than natural. The teeth were clogged with a white fur. Those
affected with this fever were subject to faintings, and had a constant
uncomfortable languor and listlessness. Most of them had a deep-seated
pain in the occiput, and an oppression at the stomach, but without any
inclination to vomit. The unfavourable symptoms were _coma_, _delirium_
and a yellowness of the skin. I never remember to have seen _petechiæ_
in any of them. The favourable symptoms were a warm moisture, or a
miliary eruption on the skin, and a gentle _diarrhœa_, which, however,
if neglected, was in danger of degenerating into an incurable flux.
A great number were seized with this fever in the Alcide, in July,
1783, and what is remarkable, most of them had the tape worm, as I
was informed by Mr. Telford, the surgeon of that ship, who frequently
obliged me with valuable remarks; and he observed also, that it
was evidently infectious, and that the skin communicated the same
disagreeable feeling to the hand as was mentioned above.

Though the inflammatory fever does not often occur in hot climates,
yet, as it is of great consequence to distinguish it in all cases from
the infectious fever of which we are treating, it may not be improper,
nor uninstructive, here to point out the most remarkable differences.
There is more resemblance in their symptoms, especially towards the
beginning, than might at first be supposed; and as it is very material
to avoid error with regard to the practice, which, in these two sorts
of fevers, ought to be very different, and even opposite, I have taken
particular pains to discriminate them.

The continued inflammatory fever is very uncommon in the West Indies;
but in the form in which I have met with it in North America and
England, there are cases in which the blood is sizy during the whole
course of the disease, even without local affection, though, in
general, there is more or less rheumatism, or pulmonic inflammation.
The symptoms which chiefly distinguish such cases from the fever before
described are, a greater degree of muscular strength, a more violent
delirium, pale urine, a more parched tongue and skin, greater heat
and thirst, and a pulse more frequent and strong, with a particular
sharpness. There is another symptom sometimes occurring, which I
consider as strongly characteristic of a fever of an inflammatory
nature. This is a watery diarrhœa, without _fæces_ and without gripes,
the stools consisting chiefly of the drink as it was taken in. There
seems here to be a suspension of the power of absorption as well as
secretion in the bowels, in consequence of a general spasm on the
extreme vessels; for there is hardly even bile or mucus in the stools.
There is also a particular appearance of the mouth connected with this
type of fever, which is better learned by the eye than by description.
It consists chiefly in a want of moisture on the lips, and a dryness
and shining appearance of the teeth. With these symptoms, it will be
found that the patient will bear the lancet in very advanced stages of
the disease. These fevers seldom occur but in a sporadic way, unless
when there is some peculiarity of season, as at New York in autumn,
1782. They are also more frequent among the better than the lower sort
of people.

By comparing these symptoms with those of the infectious fever above
described, there will appear an obvious difference in their nature, and
evident reasons for varying their treatment.


TREATMENT of the SHIP FEVER.

When the body is thrown into disorder by an attack of fever, the first
step to be taken is to clear the stomach and bowels of their crude and
acrid contents, consisting either of the food imperfectly digested,
or the depraved natural secretions. So great is the disturbance
produced by such offending matter, that, when nature is freed from
this embarrassment, the functions of the body are frequently by this
alone restored to their proper exercise, and a remission produced. It
seems probable also, that this evacuation proves salutary not only
by removing the morbid stimulus, but by preventing the absorption of
corrupted or ill-concocted juices into the mass of blood, which would
tend still farther to derange the functions of life. But perhaps
the circumstance that first suggested the utility of evacuating the
stomach, as the first step in the cure of fevers, was the nausea so
common in the beginning of them, which may be considered as a natural
indication of this practice. It farther appears rational, that, as
acute diseases generally come on suddenly, and find the body in a
state of repletion from the recent _ingesta_, the most obvious means
of relief should be to free the bowels, and particularly the stomach,
from what is foreign and oppressive to it. It seems also probable, that
the _nausea_ and the act of vomiting have a salutary effect independent
of evacuation; for I have seen relief produced from these when nothing
was evacuated. Such, indeed, is the great and universal influence and
sympathy of the stomach, that the operation of vomiting affects every
fibre of the body, and has been known to resolve tumours in the most
distant parts. An early administration of an emetic is therefore the
first step to be taken in the treatment of this as well as most other
fevers.

If it is given in small divided doses, it will most probably evacuate
the bowels downwards; and the most convenient form for this purpose is
a solution of emetic tartar. If it should not have this effect, some
brisk purgative medicine should be given soon after the operation of it.

I mention these evacuations before blood letting; for though this ought
to be first in those cases in which it is proper, it is here seldom
necessary, and we may pronounce it to be a remedy very ill adapted
to this sort of fever, particularly in a hot climate. It sometimes
happens, however, that there is violent head-ach, pain of the back
and limbs, with a throbbing pulse; and these symptoms may in the very
beginning not only justify, but require the losing some blood before
the administration of the emetic or purgative.

The next means of relief I shall mention, and also the most probable
means of cutting short the disease, is to excite universal sweat.
This being an imitation of nature, is founded on reason as well as
experience; for it is by sweating that the fit of an intermittent
is relieved and terminated; and continued fevers in general, if not
always, begin with a fit of the same kind. A dry skin, accompanied
with heat, is one of the most constant as well as troublesome and
uneasy symptoms in all fevers; and it would appear from the peculiar
heat of the skin in this sort of fever, that there is either a more
than common acrimony of the matter of perspiration, or something
peculiar in the mode of circulation on the surface of the body.
Sweating does not seem to operate entirely by the evacuation of
acrimony, for no relief is procured by it if it is partial; and it
is evident from a number of facts that the state of the brain and
_viscera_ depends on that of the external surface of the body; for a
free state of the pores of the skin, provided it is general, tends more
than any other circumstance to relieve internal pain, and also to take
off delirium. The good effect of sweating seems, therefore, chiefly to
depend on a general relaxed state of the small vessels on the surface
of the body; and it ought to be effected, if possible, by gentle,
soothing means, and not by such regimen and medicines as heat the body
and accelerate the circulation. This intention is best answered in the
beginning by moderate doses of antimonial medicines, and either James’s
powder or tartar emetic may be employed. The first is a more certain
sudorific, being less apt than the other to run off by the bowels;
and its effect will be still more certain, if accompanied with a mild
opiate, rendered diaphoretic by _Spiritus Mindereri_, which will both
prevent the antimonial from acting roughly, and will determine its
operation to the skin. A sweat kept up by these means, together with
plentiful warm dilution, from twelve to twenty-four hours, is the most
probable means of bringing about a complete remission of the fever;
and in this case a fresh accession is to be prevented by the immediate
administration of the bark.

These are the means proper for stopping the fever in the beginning,
or tending to render its future progress more safe; and though, with
this view, free evacuations have been recommended, yet, if the fever
should go on, great caution is necessary in this respect in the future
treatment, debility being the symptom chiefly to be guarded against.
Purgatives may, indeed, be occasionally necessary, in consequence of
accumulations of bile taking place; but, in general, the evacuations by
stool should not be more frequent than in health; and some of the cases
which were most unmanageable and fatal, were those in which there was
a spontaneous _diarrhœa_. With regard to blood letting, it is always
hurtful after the first two days, unless some inflammatory affection of
a vital part should arise.

The natural evacuation, which may with most safety and advantage be
solicited and encouraged in this disease, is, that by perspiration;
and it is observable, that in those cases for which nature does most,
there is a universal warm sweat, which has generally a very offensive
smell, and seems to be a salutary effort of the constitution to cure
the disease. Where this takes place, little medical assistance is
necessary, except to keep it up chiefly by warm dilution; and there is
no circumstance in which the judgement of a physician is shewn more
than in discerning those cases in which his chief business is to look
on, where nature, being equal to the task, ought not to be disturbed by
the active and officious interposition of art. We should not, however,
aim at producing a profuse sweat, except with a view to effect a
remission immediately after the first evacuations. In the course of the
disease, it is only necessary to keep up a gentle moisture or softness
of the skin.

The head being particularly affected in this sort of fever, the patient
is extremely restless and delirious, especially at night; and there is
a medicine which has a most pleasing effect in procuring both rest and
perspiration. This is a combination of an opiate with an antimonial
medicine, which was administered in the evening with great success;
and the sudorific effect is rendered more certain by the addition of
some saline neutral, especially _Spiritus Mindereri_[92]. I tried
pure opiates in the early stage of this, fever, but found them not to
answer; though in the low[93] fevers of England, and in the advanced
stages and convalescent state of this fever, they are extremely safe
and useful. Pure laudanum is also given by Dr. Lind, at Haslar, with
great success in the height of the disease; but in the West Indies
there is a greater tendency to acrid excretions, and the effect of pure
opium in causing a retention of these, seems to be the cause of its
disagreeing in that climate in the first stage of this fever.

It may here be observed, that the addition of a little neutral salt
alone will sometimes so qualify the operation of opium, as to prevent
its bad effects, such as the increase of febrile heat and delirium, and
the stupor and head-ach which, when given alone, it frequently induces
the following day. I have generally employed nitre with this intention;
but this does not seem so well adapted to this disease as some other
neutral salts, as it tends too much to lower the powers of life.

But with a view to perspiration, the _Spiritus Mindereri_ is the most
effectual neutral medicine when conjoined with an opiate, and there
is not, perhaps, a more safe and pleasing diaphoretic known than a
combination of it with syrup of poppies[94]. There is some neutral salt
in Dover’s powder, and this has more effect than could be expected
from so small a quantity of an inert medicine; for I know from trials
of my own, as well as those of others, that ipecacuanha and opium
given together, in the proportions prescribed in that powder, will
not have the same effect as when joined with the neutral salt. This
is an instance of those useful combinations of medicines which can be
discovered only by experience, but which every physician ought gladly
to adopt in practice upon good testimony and fair trial, though he may
not be able to account for their effects, nor to explain their mode of
operation.

There is nothing more important than plentiful warm dilution; and the
infusion of sauge, or any such light aromatic, is rather more proper
than farinaceous decoctions, or any compositions in which there is wine
or spirits. Success in this, as well as other diseases, depends on
attention to nursing as much as upon medicine; for what would it avail
here to administer medicines for promoting perspiration, unless they
were assisted with fluids to allay thirst, to dilute the acrimony in
the first passages and in the vessels, and to furnish the materials of
free perspiration?

But however desirable it may be to procure sweat, this is not to be
attempted by close rooms and bed clothes, nor by hot medicines, such
as volatile salts, serpentary, spirituous tinctures, or aromatics.
These, according to the testimony of Sydenham, tend to increase the
heat and delirium, and to produce _petechiæ_, miliary eruptions, or
local inflammations. In the intervals of the anodyne diaphoretic above
described, _Spiritus Mindereri_ and small doses of camphor, with
proper dilution, may be safely employed to procure a soft skin.

The only other means I shall mention with this view is, the application
of warm moisture to the surface of the body, which may be done by
soaking the feet and hands in warm water, or by fomenting the feet and
legs with stupes[95]. These operations have the effect of bringing on
a general relaxation on the skin, thereby taking off febrile agitation
and delirium, and inducing sleep. I sometimes, with seeming benefit,
ordered cataplasms to be applied to the feet, merely of the emollient
kind, without mustard or any other acrid substance, being intended to
relax, and not to stimulate.

In the use of pediluvia and fomentations, there is a difference worth
attending to between the practice in this fever, and that in the
inflammatory fever before described, for they are as hurtful in the
latter as they are beneficial in the former. I have observed, in
general, that they have a bad effect in all cases where there is sizy
blood, particularly where the breast is affected.

Delirium is one of the most constant and alarming symptoms in this
disease, and the removing of it depends much upon the attendants as
well as the physician. It has been said before, that it depended on
a false apprehension of the impressions or natural sensations. When
a person, for example, labours under delirium, and is affected with
thirst, the minds is either so agitated with other objects, that
this sensation is overlooked, or, instead of producing a craving for
drink, it excites some other disagreeable emotion in consequence of
the disordered state of _sensorium_. This last seems to be probable
from the cessation of delirium, which will take place upon any natural
want being satisfied; I have seen a temporary stop put to the patients
raving by making him drink, or upon his discharging his urine or
_feces_; for he is then unconscious of thirst and other natural wants,
is therefore ignorant of the means of satisfying them; and when he
does so, he fancies he is about something else which is the subject of
his delirious thoughts. This observation leads to a material practical
purpose; for it follows from it, that unremitting attention should be
given to the patient’s feelings and all his possible wants, as those
natural notices and instinctive cravings which occur in health are now
wanting, in consequence of the depraved state of sensation.

Most of the remarks that have hitherto been made apply to the earlier
stages of the disease. The principal remedies applicable in the more
advanced stages are, blisters, Peruvian bark, opium, and wine.

I have found what Dr. Lind says concerning the efficacy of blisters
confirmed by my own experience, especially in those fevers in which
there was great delirium, _coma_, and head-ach; but I have not
experience enough to say whether they were as useful in the beginning
of the disease in the West Indies as he found them to be in England.

The men that were brought from the ships to the hospitals were affected
with the disease in various stages; but as we had in general a very
inaccurate history of the several cases, the method of treatment
upon their first admission was pretty nearly the same in all; and it
consisted, in the first place, in washing their face, hands, feet, and
legs, with warm water and vinegar, from which they derived the greatest
comfort, being commonly very dirty. There ought to be a [96]warm bath
at every naval hospital kept in constant readiness; for there are so
few conveniences on board of a ship for preserving bodily cleanliness
among the sick, that the surface of the body becomes loaded with
filth, so that the operation of the warm bath could not fail to be
highly comfortable and salutary as the first step to their cure when
brought on shore. We had generally very indistinct information about
the state of their bowels, as well as other circumstances, on account
of their delirium; but it was at any rate useful, or at least safe,
to give them a clyster. They were enjoined plentiful dilution; and if
they were low, some wine and water was allowed. In the evening, the
anodyne diaphoretic medicine was administered, and a blister applied
to some part of the body. In consequence of this method, we seldom
failed to find the patients better next morning; and it was tried in
such numbers, that the efficacy of it was sufficiently ascertained. It
happened in some cases, that these means were omitted, and a comparison
of these with the others served to ascertain the true efficacy of the
medicines; the stationary state of the symptoms, when the disease
was thus left to itself, sufficiently proving the propriety of the
treatment above described.

It is an important question to what circumstances of this fever the
Peruvian bark is adapted. An early and indiscriminate use of it is
recommended in some late publications, upon the authority of which
I tried it without regard to the stages or symptoms, and without
any prejudice either for or against the practice; but I found that
this powerful remedy was in danger of doing much harm, unless great
attention was paid to circumstances, in order to ascertain the proper
seasons for giving it. The symptoms that forbid the use of bark are
chiefly foul bowels, hard pulse, sizy blood, great delirium, dry
tongue, a hot and dry skin, and inflammatory affections of the viscera.
It was found extremely pernicious in an early stage of the disease
previous to evacuations; and the object of practice at this time should
be to relieve the habit by means of these, in order to produce a
general relaxation of the secretions, and to render the skin cool and
soft, thereby paving the way for the bark.

It is not necessary, however, especially in the advanced stages of the
disease in this climate, to wait for an absolute remission, in order to
administer the bark. In a cold or temperate climate it will seldom be
found advisable to give it in any period of this fever; but in a hot
climate it is sometimes admissible where there are symptoms of general
debility, such as a small pulse and muscular weakness, even though the
frequency of the pulse, delirium, and a dry skin and tongue, should
indicate some degree of fever. It may be remarked, by the bye, that a
dry tongue is a fallacious symptom, for it may happen in consequence of
the patient’s breathing through the mouth instead of the nose, without
any fault in the secretions of the _fauces_. The symptom which forbids
the use of the bark more absolutely than any other is an inflammatory
or dysenteric state of the bowels, in which cases it seems to be
invariably pernicious.

Where it happens that we are extremely anxious to throw in the bark,
as we usually are in the West Indies, where fevers are very rapid
and dangerous, and yet the symptoms seem hardly to admit its use, it
was very commonly tried either in conjunction with some antimonial
medicine or neutral salt, or these were given alternately with it, in
order to soften and qualify its effects by preventing it from heating
or otherwise aggravating the symptoms. Antimonial wine or _Spiritus
Mindereri_ were conveniently employed with this intention.

With regard to the quantity of bark to be given, it may be proper in
doubtful cases of this kind to begin with small doses, in order to feel
how far it agrees or not; but in general it may be laid down as a rule
with regard to this medicine, that, where it is really proper, and the
medicine to be depended on, it is to be given in as large doses and as
frequently as the stomach will easily bear it.

The next remedy mentioned was opium. It is a medicine more admissible
and useful in this than any other kind of fever. The same cautions
nearly apply in the administration of it as have been given with
regard to the Peruvian bark. The caution with regard to foul bowels is
particularly necessary in a hot climate, where an over secretion of
bile is so apt to take place. When, the Boreas frigate arrived from
England in March, 1783, there was a very bad fever of the infectious
kind on board, some cases of which being sent to the hospital at St.
Lucia, were treated unsuccessfully with bark and opium, which I had
been induced to try upon the authority of the authors above alluded
to. I attributed this want of success to the neglect of previous
evacuation; for, upon inspecting the bodies, the intestines were found
full of bilious _feces_. I profited from this, and was more successful
in the other cases. It were to be wished that physicians could oftener
bring themselves to confess their errors in practice, and their
writings would be more instructive; for it is of consequence to know
what we are to avoid as well as what we are to follow.

It has been mentioned that the best effects arise from the conjunction
of an antimonial with an opiate; but, in this sort of fever,
antimonials, and even most of the neutral salts, are hurtful after the
first stage, and opiates may after this be given alone or combined with
camphor. With regard to the precise period of leaving off antimonials,
it must be left to discretion, and the constitution of the patient is
the best guide. There is so great a difference in patients in this
respect, that all practical precepts should be qualified by a due
discrimination of constitutions. Absolute and dogmatical rules are so
far from applying in the practice of physic, that there are some cases
of the same disease that require a treatment even opposite to what
is in general most adviseable. This may be very aptly illustrated by
the small pox, of which there are cases that ought to be treated very
differently from the general method laid down by Sydenham, and in which
cordial medicines are highly proper and necessary. This difference
in diseases themselves seems to be one great cause of the difference
of opinion among physicians on practical points, each party finding
some countenance in experience for their general doctrine, do not
make allowance for the varieties that exist in nature; so that, in one
sense, both may be said to be in the right. If the patient is not very
much sunk, and if there are bilious symptoms, or an obstinate dryness
in the skin, a few grains of James’s powder may be given with advantage
even in an advanced period of the disease. If a hot and dry skin should
at this period be the only troublesome symptom, it will be more safely
and effectually removed by camphor combined with something opiate and
the _Spiritus Mindereri_, which is the only neutral now admissible,
than by antimonials, which, at this time, would be in danger either of
ruffling the patient by their operation on his stomach and bowels, or
of weakening him too much either in this way, or by exciting profuse
sweats. Evacuant medicines of every kind being then improper, clysters
are the only laxatives to be employed in case the state of the bowels
require them.

Having mentioned camphor, it may be proper here to remark, that it is
a medicine of which I have found it extremely difficult to ascertain
the virtues and effects; and in consequence of this ambiguity, I
believe there are few articles of the materia medica more abused in
practice. In all inflammatory affections, and in the beginning of all
fevers where there is much heat and thirst, I think I have observed it
to aggravate the symptoms. It seems in no case to be more proper than
at certain periods of this fever, and especially when there happens
to be spasmodic pains of the stomach, or tremors and cramps in the
extremities.

In this advanced stage of the fever, in which the most common symptoms
are weakness, restlessness, tremors, and low delirium, no medicine
was found so much to be trusted to as opium, which here acts as a
cordial as well as an anodyne and antispasmodic. It may be given, in
the camphorated julep, in the form of tincture, from five to ten drops
every six or eight hours, or some of the officinal compounds, such as
the theriaca or mithridate, may be employed with advantage. I have
thought also, that, at this period, castor conjoined with opium seemed
to improve its virtue. This was first suggested to me by Mr. Crudie,
an ingenious German surgeon, whom I employed as an assistant at the
hospital at St. Lucia; and since I have been physician to St. Thomas’s
hospital, I have found the most pleasing effects, in similar cases,
from a composition used there, the principal ingredients of which are
opium and castor[97].

In this state of the fever I have also used with advantage the
decoction of Peruvian bark and serpentary, as recommended by Sir John
Pringle; and when the skin is cold and the circulation is very languid,
as is sometimes the case, volatile salts and powder of serpentary may
very properly be employed.

But in the advanced state, and in the worst forms of this disease,
there is perhaps no medicine superior to wine. This was given either
pure, or diluted with water for common drink, and sometimes to the
quantity of a quart in twenty-four hours. In delicate people, such as
we meet with in private practice, the quantity ought to be less.

There is this caution necessary with regard to the use of wine, that
when the fever is gone off, and only extreme debility remains, the free
use of it is not safe nor proper; for, in a weak and exhausted state,
a person is more apt to be [98]heated and intoxicated by any fermented
liquor, than in health, or even in the preternatural and disturbed
state of actual disease, such as occurs in this fever.

After the disease is removed, a long state of weakness is apt to
succeed, especially in a warm climate. The most proper remedies,
then, are bitters, such as decoctions of Peruvian bark, infusions
of quassia bark, gentian, or camomile flowers. These answer better
than the bark in substance, which is now apt to nauseate and load
the stomach, and the patient is apt to take an aversion to this and
whatever else he took in a state of sickness. The best strengthening
medicines are such as comfort the stomach and create appetite; and we
may mention Huxham’s tincture of bark, in small doses, and a moderate
use of wine, as the most proper for these purposes. Where colliquative
sweats take place, elixir of vitriol is serviceable, and with this
intention I have joined it, with evident advantage, to the evening
anodyne, which, without such a corrector, tends rather to aggravate
this symptom. I have known assafœtida prove a useful stimulus to the
stomach at this time, and it may even be used while the fever subsists,
especially where the secretions of the fauces are scanty. This medicine
is recommended by Sir John Pringle in the same circumstances. But I
consider the prudent use of opiates, particularly at bedtime, as the
most effectual cordial and strengthening medicine in this convalescent
state.

But with regard to the management of the sick at this time, as much
depends on diet as medicine. Nothing has been said concerning this in
the acute state of fever, because no nourishment is then necessary. In
that state there is a loathing of all food, and the powers of digestion
and assimilation seem to be then suspended, so that alimentary
substances become not only an useless load, but offensive and hurtful
by turning acid or putrid. It is likewise evident from fact, as well
as reason, that nature, in this situation, does not require sustenance;
for we frequently see people labouring under fevers who do well and
recover, though they have been entirely without nourishment for a
length of time in which the like abstinence in a state of health would
have proved fatal. The friends and attendants of the sick, from a
prejudice not unnatural, but not considering the difference between
health and that state of derangement which takes place in fever, are
for ever wishing to supply the patient with nourishment, and every
physician meets with trouble in counteracting this officiousness.
Nevertheless, when the fever draws out to a considerable length, and
the principal symptom is that state of weakness which, in low fevers,
runs insensibly into that of convalescence, then it is necessary to pay
the utmost attention to nourishment, and nothing tends more to insure
and hasten recovery than the assiduous administration of light and
nourishing food, the same cautions being observed which have just been
mentioned with regard to cordials. One of the greatest hardships of a
sea life is the want of those articles of diet that are suitable to a
recovering state, and many lives are lost from this circumstance, after
the force of the disease has been subdued[99].

With regard to the peculiar form, before described[100], which this
fever assumes a few months after ships have been in a hot climate, we
found camphor, volatile salts, and serpentary, the best remedies. As
there was a remarkable coldness of the skin, I was induced in one case
to try the hot bath, and with good effect, from which it seems probable
that a short stay in a bath, of a heat from 96° to 100°, so as to have
its warming and stimulating, without its relaxing effects, would answer
well in fevers of this kind.


2. Of the BILIOUS REMITTING FEVER.

This is peculiar to tropical climates, and arises in the same
situations in which intermitting fevers arise in temperate and cold
climates. It seldom arises at sea, unless where there has been previous
exposure on shore, of which some examples have been mentioned in the
first part of the work. It may generally be traced to the air of woods
or marshes; and in our fleet hardly any men were attacked with it but
those who were employed in the duties of wooding and watering.

The most distinguishing symptom is a copious secretion of bile which
attends it. Its course, in general, is shorter than that of the fever
before described; and though the symptoms are more violent, they are
not so equal and steady, owing to the tendency there is to remission.
The symptoms are particularly violent at the beginning, in so much
that some of the men, after being exposed upon duty to the heat of
the sun and the air of marshes and woods, would become frantic, being
seized almost instantaneously with _delirium_ resembling madness. This
fever, when it arises merely from the effluvia of woods and marshes,
has a natural tendency to remit; nay, some fevers at St. Lucia,
proceeding from this cause, were of the pure intermitting form from
the beginning. But in many of those that arose at Jamaica little or
no remission was to be perceived; and it was distinguished from the
ship fever by the bilious vomits and stools, more violent delirium,
and head-ach, and by being attended with less debility. The greater
tendency to the continued form at this time was probably owing to this
circumstance, that the men who were exposed to the land air in wooding
and watering, were then exposed also to such causes as naturally
produce continued fevers, such as infection, the foul air of the
French prizes, intemperance, and hard labour. There was in some cases
a yellowness of the eye, and even of the whole skin, but without the
other symptoms that characterise the yellow fever, properly so called.

In cases that proved fatal, the symptoms, for some time before death,
resembled very much those of the fever before described at the same
stage. There was either _coma_ or constant delirium, great seeming
anguish, the mouth and tongue very dry, or with only a little ropy
slime, a black crust on the teeth, picking of the clothes, and
involuntary stools.


TREATMENT OF THE BILIOUS REMITTING FEVER.

The measures proper to be taken in the beginning of all fevers are
pretty nearly the same. There is little difference in the first
treatment of this from that of the ship fever, except that blood
letting is here more frequently proper, and that a more free evacuation
of the bowels is necessary on account of the more copious secretion of
bile.

In full and athletic habits the disease very commonly begins with
pains in the limbs, back, and head, with a strong throbbing pulse; in
which case it is proper first of all to let blood at the arm. This
is also highly proper and necessary in those cases mentioned above,
in which the patient becomes suddenly frantic. But though the cases
requiring blood-letting are more frequent in this sort of fever than
that already treated of, yet great caution and nice discernment are
necessary with regard to it, in all cases, in a hot climate. As fevers
in such a climate run their course faster, the symptoms succeeding each
other in a more close and hurried manner, greater expedition, as well
as discernment, are required in timing the different remedies than
what are necessary in a cold climate. Blood letting unseasonably and
injudiciously employed either endangers life, or has a very remarkable
effect in protracting recovery, by the irrecoverable weakness it
induces.

With regard to the evacuation by the bowels, it has already been
mentioned in another part of the work, when on the subject of
prevention, that, before the fever comes on, there is a languor and
general feeling of indisposition, and that then an emetic and a
purgative, followed by some doses of the bark, were the most likely
means of preventing the attack of the disease. If the fever has
properly begun, which is announced by a _rigor_ taking place, then no
time is to be lost in procuring evacuation; and, after blood letting,
if the symptoms should require it, the best medicine is tartar emetic,
which, if given in small divided doses, at short intervals, will most
probably evacuate the whole intestines by vomiting and purging, and may
even prove sudorific. But it will nevertheless be proper to administer
a purgative medicine soon after; and what we found to operate with most
ease, expedition, and effect, was, a solution of purging salts and
manna, either in an infusion of sena, or in common water, or barley
water, with some tincture of sena added to it.

The next step towards procuring a remission is, to open the pores
of the skin, which is best done by small doses of James’s powder or
emetic tartar, assisted by the common saline draughts, which will be
given with most advantage in the act of effervescence, or by _Spiritus
Mindereri,_ together with plentiful warm dilution. I once, by way of
comparison, tried the two antimonial preparations above mentioned in
a number of men ill of this fever, who were sent to the hospital at
one time, giving emetic tartar to one half, and James’s powder to the
other, and their effects were so similar, that I could perceive no
reason for preferring the one to the other. Antimonial medicines seem
better adapted to this than any other sort of fever, and may be more
freely given in it.

These are the most likely means of bringing about a remission; and if
this is effected, nothing remains to be done but to throw in as much
Peruvian bark as the stomach will bear.

But whether from a fresh accumulation of bile, or some other
circumstance, it may happen that the fever is kept up; and in this
case there is commonly a sense of weight or uneasiness about the
_hypochondria_, which seems to indicate that the redundant bile is in
the gall bladder or ducts of the liver. In this case a repetition of
evacuants is necessary, and calomel will be found to answer remarkably
well as a purgative, its stimulus being so extensive as to loosen
and bring away bile when the saline purgatives, such as that above
mentioned, had failed of having that effect. I have known these to
pass through the intestines without relieving the uneasy sensation
about the stomach as calomel is found to do; and it will be still more
effectual for this purpose, if given alone in a dose, from five to ten
grains, and followed some hours afterwards by some other purgative.
After this, antimonial medicines are again to be had recourse to; and
these, as well as purgative and neutral medicines, are safe and useful
in a more advanced stage of this fever than they are in the ship fever;
for the strength is not so apt to sink, and the state of the bowels
requires them more. Antimonials, however, are to be used sparingly and
cautiously as the fever advances; for I have known them, when given
only a few days after the first attack, to have the effect, in some
constitutions, of making the stomach swell, and of producing a general
sense of heat and uneasiness.

After the evacuations of the bowels, the anodyne diaphoretic may be
very seasonably given in the manner formerly mentioned; for it will not
only tend to sooth and procure sleep after the commotion that has been
excited, but by its gentle sudorific effect will assist in completing
the remission.

The principal point of management in the fevers of this climate is, to
throw in the Peruvian bark in proper season. I formerly took occasion
to differ from the opinion of those who alledge that little or no
discrimination is necessary with regard to the circumstances in which
bark is proper in continued fevers. I made fair and unprejudiced trials
of this, but always found that some sort of remission, especially
towards the beginning of the disease, was necessary, in order to make
the use of this medicine safe and proper. The greatest vigilance is
indeed required that the administration of it be not omitted when
it is at all adviseable, as the course of fevers is very quick and
critical in this climate. I have watched many nights with some friends
in whose health I was particularly interested, to catch the hour when
it might be allowable to give it; and where the propriety of it was
somewhat ambiguous, it was usual to qualify it either by conjoining
some antimonial or neutral salt with the first doses, or by giving them
alternately with it, as has been formerly mentioned.

Under the use of these means, the favourable symptoms are, a warm moist
skin, a strong steady pulse, with the pulsations under a hundred in a
minute, a natural countenance, and being free from delirium. But if the
fever should not yield during the first week, but takes an unfavourable
turn, the pulse then becomes more small and frequent, there is a
general agitation, the tongue is tremulous when put out, there is great
thirst and delirium, with a dry and hot skin. In these circumstances,
besides the continuation of the antimonials in smaller doses, with the
anodyne diaphoretic, and the occasional use of purgatives, blisters
now become proper; and we found also camphor combined with nitre an
excellent medicine at this period of the disease.

Should the patient survive to the end of the second week, the treatment
then comes to resemble more and more that of the infectious fever
already described. Bark may be given, though there should be no proper
remission, and cordials and opiates may be more freely used. Attention
to the state of the bowels will still be necessary, since repeated
accumulations of bile are apt to occur even in the most advanced
stage, and gentle emetics of ipecacuana, as well as laxatives, may
be necessary. For the same reason also, greater caution is requisite
in the use of pure opiates than in the infectious ship fever before
treated of. In order to keep the bowels soluble, it was a very usual
practice, and found very useful, to conjoin a few grains of rhubarb
with each dose of the bark.


3. Of the YELLOW FEVER.

The fever last treated of may be said to be peculiar to a hot climate;
but the hot seasons of temperate climates produce something resembling
it. That now to be described never occurs, so far as I know, except
under the influence of tropical heats. Such a fever is indeed known
without the tropics; for it is very common in Carolina in the hot
season; but there the heat is even greater than that of the West
Indies. In order to produce it, there must be, for some length of
time, a heat seldom falling below seventy-five degrees on Fahrenheit’s
thermometer.

Though it differs from the fever last described, both in its causes and
symptoms, it is not meant to say that it is so distinct as to form a
separate species of disease, like the measles and small pox. Unless the
characters of fevers are strongly marked, it is difficult, and even
impossible, to refer them to any particular species; and the different
concurrence of causes and constitutions is so various, that great
numbers of ambiguous cases occur.

With regard to the cause of the yellow fever, it differs from the
bilious remittent in this, that the air of woods and marshes is not
necessary to produce it; for it most commonly arose from intemperance
or too much exercise in the heat of the sun. It was observable,
however, that it was more apt to arise when, besides these causes,
men were exposed to unwholesome air, particularly the foul air of
ships, whether from infectious effluvia, or proceeding merely from the
putrefaction that takes place in neglected holds.

It is also remarkable with regard to it, that it is confined almost
entirely to those who are newly come from a cold or temperate climate.
The same remark is made by the French, who therefore call it _fievre
de matelot_[101], considering it as peculiarly incident to those who
have newly arrived from a long voyage. It would appear also, from what
has been formerly mentioned[102] that those men, who have been exposed
to that sort of infection that prevails in ships in cold climates are
more particularly the subjects of the yellow fever when they arrive in
a hot climate. It is farther in proof of the same opinion, that there
are medical gentlemen, natives of the West Indies, who have hardly
ever seen it, their practice lying at a distance from any sea-port
town where strangers usually arrive. Of these strangers, those who are
young, fat, and plethoric, are most apt to be attacked; and more of our
officers in proportion were seized with it than common men.

It has been said, that it never attacks either the female sex or
blacks. This is in general, though not absolutely, true; for I knew
a black woman, who acted as nurse to some men ill of this fever at
Barbadoes, who died with every symptom of it.

This fever assumes various forms, according to the peculiar
constitutions of different men, and other circumstances; but
in the following description I shall enumerate the most common
appearances:--In general it begins with short alternate chills and
flushes of heat, seldom with those rigors which constitute the regular
cold fit, and with which most other fevers begin. These are immediately
succeeded by violent head-ach, pain in the back, universal debility,
sickness, and anguish at the stomach. There is commonly, in the
beginning, a good deal of bile on the stomach, which is thrown off by
vomiting, either natural or excited by an emetic. Those men who were
taken ill of this fever in the Alcide, in the end of the year 1781, had
a sore throat in the beginning; but this is not a common symptom.

In the course of this disease there is by no means a free secretion
of bile, and least of all in those cases that are most violent, and
prove the soonest fatal. In cases that are more protracted, and less
desperate, there are frequent accumulations of it, as appears by the
vomits and stools[103].

The eye in a few hours takes a yellow tinge, which soon after extends
more or less over the face and whole skin. This is a symptom so
striking and constant, that it gives name to the disease, though
it is not absolutely either peculiar or essential to it. There is
something contagious in this symptom, which seems somewhat singular,
and difficult to be accounted for. It was observed in the Royal Oak
and Alcide to extend to men who were but slightly indisposed; and at
the hospital it spread to men in the adjoining beds, without imparting
any malignity to their diseases.

There is something very peculiar in the countenances of those who
are seized with it, discernible from the beginning by those who are
accustomed to see it. This appearance consists in a yellow or dingy
flushing or fullness of the face and neck, particularly about the
parotid glands, where the yellow colour of the skin is commonly first
perceived. There is also in the eye and muscles of the countenance a
remarkable expression of dejection and distress.

One of the most constant and distinguishing symptoms of this fever is
an obstinate, unremitting, and painful _pervigilium_, which is the more
tormenting, as the patient is extremely desirous of sleep. It is seldom
that even a _delirium_ comes to his relief to make him forget himself
for a moment; but he continues broad awake, night and day, with his
reason and senses sound, in a state of the most uneasy agitation.

But the most distinguishing symptom, and that which is expressive of
the greatest danger, is, an unconquerable irritability in the stomach,
which can be brought to bear nothing. An almost incessant retching
takes place, which commonly, on the third day, ends in what is called
the _black vomit_, the most hopeless of all the symptoms attending it.
When this is examined, the colour is found to be owing to small dark
flakes, resembling the grounds of coffee, and seems to be blood which
had oozed from the surface of the stomach, a little altered. Indeed
pure blood is sometimes thrown up, and we know that the red globules
enter the smaller order of vessels, and issue by them; for bleeding at
the nose is a common symptom about this time; and some relate that it
also escapes by the ears and pores of the skin, which I never saw, but
can readily believe it. At the same time, the stools grow black, and
the urine is frequently of a very dark colour, which seem to be owing
to the same cause. I never remember to have seen any one recover after
these symptoms came on.

There seems to be a general _error loci_ of the more tenacious and
globular parts of the blood into the smaller order of vessels, to which
the yellow colour is in a great measure owing; and when any part of the
skin is ever so little pressed upon, a damask red colour remains for
some time, the small vessels readily admitting the red globules. It
is certain that a yellow colour of the skin may be produced by such an
_error loci_, without any suspicion of the presence of bile. We have an
illustration of this in the ecchymosis which follows upon an external
contusion. In this case the red part of the blood is mechanically
forced either into the smaller order of vessels, or into the cellular
membrane, which occasions a livid appearance, and in the course of the
recovery the same parts become yellow, probably in consequence of some
of the gluten of the blood assuming this colour after the red parts
have been removed by absorption or otherwise.

In the worst form of this disease there is all along an uncommonly
distressing sensation of universal anguish, particularly about the
stomach, where there is a sense of burning heat, which, as the
miserable sufferers themselves express it, becomes unspeakable torture.

A sense of weight at the breast, deep and frequent sighing, and a great
failure of muscular strength, are dangerous symptoms in all stages of
the disease.

Upon the first attack the skin is extremely hot and dry, and the pulse
hard and frequent; but the external heat soon becomes very little
different from the usual standard of health, and the skin feels soft
and moist. There sometimes happens an eruption of small pustules, with
white heads, on the trunk of the body, which is a favourable sign; and
I have seen a head-ach disappear upon this breaking out. The pulse does
not serve as an index of danger; for, after the hurry of the first
attack, it becomes very moderate in point of frequency, varying from
eighty to a hundred pulsations in a minute, and is natural in point of
regularity and strength.

In these circumstances this fever differs from that which was last
described; and it also differs from it in being attended with little
delirium. I have seen cases in which the senses were not affected from
beginning to end; and I never observed that violent and incessant
delirium which attends other dangerous fevers.

The state of the _fauces_ is also different from that of most other
fevers, for there is no excessive thirst. The tongue is somewhat white
and foul; but I do not remember ever to have seen it black and dry.

A want of action in the bowels, and an insensibility to purgative
medicines, indicate great danger; and, next to the black slimy stools,
one of the most unfavourable symptoms is, when the _feces_ are like
white clay, as I have seen in some cases that ran out to the length of
a week before they proved fatal. When the black vomit and stools occur,
death commonly happens on the third or fourth day. A bilious diarrhœa
spontaneously coming on, is a very favourable symptom.

In more unpromising cases the urine is scanty, and in the last stage
of life it becomes of a very dark colour, as was mentioned before. A
plentiful secretion of urine is a very favourable circumstance, and
seems to be one of nature’s methods of curing the disease; for such
cases are observed to terminate well. I remember one case in particular
in which several quarts were made daily for several days together,
and it was of a very dark saffron colour, but looked green where
the surface was in contact with the side of the pot. I inspissated
a small quantity of it, and found a large residuum, which was very
deliquescent, and seemed to be all saline. In a hot climate the urine
does not shew that separation and deposition which denote the crisis
of fevers in cold climates, and this is perhaps owing to there being
less mucilage and more alkali in the former, on account of the more
putrescent state of the fluids. Upon adding a little vinegar to the
urine in the case above mentioned, it became turbid like the critical
urine of the fevers of Europe.

At the approach of death, cold clammy sweats come on; the pulse
continues regular and of a certain degree of strength, but grows
gradually slower. I have counted it at forty pulsations in a minute.
The patient is frequently sensible to the last moment; nor does the
countenance sink into what is called the _Hippocratic_ appearance. In
other cases I have seen, at this time, _coma_, and not infrequently
convulsions. Broad livid spots sometimes also appear on the skin.
Extreme muscular debility, a great difficulty of deglutition, and a
dimness of the eye-sight, are likewise common symptoms in the last
scene.

The different stages which lead to dissolution following each other
thus rapidly, there is not that gradual failure of the powers of nature
that usually give warning of approaching death; but the springs of life
run down, as it were, at once, the wretched sufferer expires, and is
happily delivered from the most extreme misery of which human nature is
capable.

Such is the general train of symptoms in this fever, taken entirely
from my own observation; but great varieties occur both in the symptoms
and duration, so great indeed, that it is hardly recognisable for the
same disease. I shall give specimens of such anomalous cases in two
that occurred at Port Royal, on board of the Canada, in July, 1782.

A lieutenant of that ship had been subject, for four days, to fits of
retching, without any bilious discharge or pain in the stomach; and,
except a white tongue, he had no symptom of fever in that time, nor
any thing to prevent him from doing his duty. On the fourth day, when
I first saw him, he began to complain of a fixed pain in the pit of
the stomach, which was not very violent, and about the same time a
yellowness began to appear on the white of the eye. He took a laxative
medicine, which had the desired effect, and some volatile spirits, with
some drops of thebaic tincture in simple mint water, for the pain in
his stomach. He had a good night. Next day the complaint of the stomach
was better; but there was great muscular debility. He had several
natural stools; and as there seemed little indication but debility,
he took nothing that day except an infusion of some bitters and
aromatics in wine. As he did not want for appetite, he eat some broth
and chicken; and nothing to give any alarm happened this day, except a
short qualm, in which he was faint, with a sense of cold, feeling to
himself, as he said, as if he should have expired. In the afternoon he
began to have black-coloured stools, which was the first symptom that
clearly betrayed the nature of the disease. He was then ordered as much
Peruvian bark as he could take with red wine, and these his stomach
bore. Decoction of bark was also given him in clysters. He had a strong
voice, and was quite sensible, but grew weaker and weaker with frequent
returns of the qualms, and he expired that evening before ten o’clock.

I have not the least hesitation in ranking this case with the fevers
last described, though so many of the usual symptoms were wanting. This
gentleman, though of a lively, active disposition, was of a slender
make, and of a dingy, doughy complection, and his case gave me the
idea of a disease attacking a constitution which, not having powers
to struggle with it, is overwhelmed without making resistance[105].
In those robust, plethoric habits, which are most commonly attacked,
there is a sufficient degree of strength to excite the violent symptoms
before enumerated.

A few days after this gentleman’s death, another officer of the same
ship was taken ill with the same sort of fever, and it was also
attended with several unusual symptoms. Neither his skin nor eyes were
yellow; the skin was hot and dry throughout the disease, and during
the three first days there was a diarrhœa, which was neither bilious,
putrid, nor mucous, but consisted in watery stools. There were no
gripes, nor any local pains whatever; but I never remember to have
seen more suffering from that general anguish, particularly about the
stomach, which attends this sort of fever. On the third night he began
to vomit and purge blood, which soon terminated in that dark-coloured
discharge which is a symptom so characteristic and fatal in this
disease. He continued sensible till within eight hours of his death,
which happened on the fourth night. The pulse was full and pretty
strong during the whole course of the disease; but there was all along
great debility and frequent sighing, symptoms that ought always to
create alarm.


TREATMENT OF THE YELLOW FEVER.

I feel this as the most painful and discouraging part of this work, the
yellow fever being one of the most fatal diseases to which the human
body is subject, and in which human art is the most unavailing.

It seems hardly to admit of a doubt that there are particular instances
of disease, in their own nature, _determinedly fatal_, that is, in
which the animal functions are from the beginning so deranged, that
there are no possible means in nature capable of controlling that
series of morbid motions which lead to dissolution. Of this kind
appear to be the greatest number of cases of the plague, many of the
malignant small pox, and some of fevers, particularly of that kind
now under consideration. It is extremely difficult to ascertain such
cases from observation; and it may be said that the opinion of the
existence of them is favourable to ignorance and indolence. But, on the
other hand, it may be questioned if more harm is not likely to arise
in medicine by being too sanguine and officious, than by a diffidence
of art and trusting to the powers of unassisted nature? Were we
thoroughly acquainted with the animal œconomy, we should perceive _à
priori_ in what instances the seeds of disease would either operate
so as necessarily to terminate in death, or when they were within the
command of art. But we can derive little or no information from this
source, on account of our great ignorance of the secret operations
of the living body; so that the only grounds of judging are our
observation and experience concerning the usual event of disease, and
the effects of remedies. Though these are circumstances attended with
great uncertainty and ambiguity, yet I believe it will be admitted as
the opinion of the most chaste and experienced observers, that there
do really exist diseases whose course cannot be diverted by any means
that can be employed. This opinion, I have said, is, in one view,
extremely discouraging; yet, to the mind of a feeling and conscientious
practitioner, who must often find his best endeavours baffled in many
diseases as well as this, and who might be apt to look back and accuse
himself of some fault or omission, it affords this satisfaction to
his reflections, that the want of success may have been owing to
something in the nature of the disease, and not to his want of skill
and attention.

But though the fatality of this disease is discouraging, let us not
despond, but rather redouble our diligence in observing what assistance
and relief nature may admit of.

It is proper in this as in every other fever of this climate, to begin
the cure by cleansing the first passages. This does not produce the
same relief as in the common bilious fever, probably because there is
a less free secretion of bile, and therefore less oppression from the
collection of it.

With regard to blood-letting, the most that can be said in its favour
is, that if there should be a hard throbbing pulse, with violent pain
in the head and back, it is _safe_ in the first twelve hours. This
limitation is necessary, at least with regard to common seamen, who do
not bear evacuations so well as officers and others, who are used to
a better diet, and to whom the loss of blood has, in some cases, been
found useful in the early stage of this fever. It is, however, in all
cases extremely dangerous, except in the circumstances mentioned above.
The blood is said to shew a buff in the beginning of the disease, but
in the second stage, it is mentioned by a French author[106], that it
hardly coagulates or separates. But even the appearance of a buff,
without considering other circumstances, does not always argue the
propriety of blood-letting[107].

The great object in the cure of this fever is, to bring the stomach to
bear the bark. There are here wanting most of the circumstances that
in the other cases forbid the use of it; for there is no preternatural
quantity of bile in the stomach and intestines, nor is there a hot and
dry skin, nor violent delirium. The only obstacle to its administration
is the great irritability of the stomach, which is the most fatal
symptom of the disease; and the principal part of the management
of the patient consists in the prevention or removal of this. The
stomach is to be treated with the utmost tenderness and attention. One
gentle emetic at the beginning is all that is allowable; and as fresh
collections of bile are less apt to occur, the repetition of it is less
necessary.

It is best to abstain altogether from antimonial medicines, and to
render every thing, whether food, drink, or medicine, as grateful as
possible. The liquid most apt to stay upon the stomach is the juice of
the acid fruits of the climate, such as[108] oranges and lemons. It
happens frequently, however, that acids come to be loathed extremely,
so as to nauseate the stomach and to encourage retching. In this case
I have found a composition of wine and water with lemon juice and
nutmeg, sweetened with sugar, and given warm, to be a very grateful
and salutary drink. The patient sometimes prefers the decoction of
farinaceous substances to every other liquid; and in one case in
particular, which did well, the patient was led by taste to prefer warm
water gruel to every thing else, and the great quantity he drank seemed
to have a considerable share in his recovery, by keeping up a warm
moist skin and producing a great flow of urine.

In order to check vomiting, the saline draught, in the act of
effervescence, has been employed with evident advantage; but in most
cases this symptom is so obstinate as to discourage all attempts to
remove it. I have known magnesia in mint water have a visible effect in
soothing the stomach, particularly when given immediately after some
acid beverage.

I was informed by Dr. Young, physician to the army, that he found
an infusion of chamæmile flowers one of the best medicines in this
vomiting; and a surgeon of one of the line-of-battle ships informed
me, that he also found advantage from it in alleviating this symptom.
The French author above mentioned affirms, that milk, boiled with
some flour or bread, given in the quantity of a spoonful at a time,
and frequently repeated, had more effect than any thing he tried in
stopping the vomiting in this fever. I have seen this symptom relieved
by fomenting the stomach with stupes wrung from the decoction of bark,
and sprinkled with camphorated spirits and tincture of bark[109].

But nothing I have ever seen tried had so great an effect in removing
this irritability of stomach as a blister applied to it externally;
and it is a remedy which, so far as I know, has not been hitherto
recommended. In other fevers, when the head was not particularly
affected, I preferred this part for the application of a blister, for
it is in some respects more convenient than between the shoulders, and
the stomach is the part more affected perhaps than any other in all
fevers. But in this fever I was led to apply it to this part, both
from its being affected in an uncommon degree, and from observing,
upon inspecting the bodies of those who died, that the only morbid
appearance that could be discovered was an inflammatory suffusion on
the inner membranes of the stomach.

I have employed opiates both externally and internally to allay this
symptom, but without the effect that might have been expected from so
powerful a sedative.

As the stomach will seldom, even in the most favourable cases, bear
such a quantity of bark as to subdue the disease, it must be exhibited
in every other way that can be thought of, such as by clyster and by
external fomentation, both of which I have employed with good effect. I
used to order a pint of decoction of bark to be injected every three or
four hours, and the fomentation to be employed nearly as often. I have
heard of the decoction of bark being used as a warm bath with success;
but I cannot decide concerning this practice from my own experience.

I have no other internal remedy to recommend; for whatever power of
retention the stomach may have should be employed in taking bark. If it
should become tolerably retentive, camphor will be found of service;
and if given in the evening with an opiate, perspiration and sleep will
probably be procured, by which the patient will be greatly relieved.

Blisters to the thighs and legs seemed to coincide with the general
intention of cure, and they appeared to be of advantage in the cases in
which they were tried.


4. Of the Effects of Flowers of Zinc and White Vitriol in the Cure of
obstinate INTERMITTENT FEVERS.

It frequently happens in the West Indies that intermittent fevers are
so obstinate as to resist the common means of cure by the Peruvian
bark; so that these complaints become extremely distressing to the
medical practitioner as well as to the patient. Indeed this was a
difficulty that occurred so often, that I was sometimes tempted to
think, either that the great reputation of this medicine is not so
well founded as is commonly believed, or that the bark generally in
use in these times is not of so good a quality as that employed by the
physicians who first established its character.

But, in the first place, the experience upon which its reputation was
first built was in a temperate climate, where very few agues are found
to resist it when properly administered. In the next place, there is
reason to believe that, in fact, the medicine itself now commonly in
use is not equally powerful with what was first employed; and a species
of it, called the Red Peruvian Bark, has lately been discovered, or
rather, perhaps, revived, which is certainly of a superior quality,
and has been found to cure intermittents in which the common sort had
failed[110].

However this may be, it is an undoubted fact that obstinate agues are
much more frequent in the West Indies than in Europe; and something to
supply the insufficiency of the bark seemed to be a _desideratum_.

I was informed by Dr. Hendy, of Barbadoes, that he had found the
flowers of zinc to answer in cases of intermittent fever, in which
even the bark and every other remedy and mode of treatment had failed.
It was found very successful in the like cases, both in my own trials
at the hospitals, and by the surgeons of the men of war to whom I
recommended the use of it. In order to judge what may be expected
from it, I shall give a specimen of its success in some cases, at the
hospital at St. Lucia, of which I kept an accurate account, in the
months of February and March, 1783.

About the time the fleet arrived there, six cases of intermittent
fevers were sent to the hospital from different ships. One was of six
weeks continuance, and had been some times of the tertian, sometimes of
the quartan type. Two were quartans; one of which was of two months,
the other of eight months duration. Two were regular tertians; of which
one had only had two fits, but was a relapse after a week’s exemption
from an attack of several weeks. The other was of three months
continuance, attended with an eruption on the hands and arms. The
sixth case was a quotidian of three weeks, attended with a cough of the
same standing, and joined with sea scurvy.

In all of them the bark had been given at some period or other; and the
flowers of zinc were now tried in all, except the last. In three out
of the five this medicine had the most visible good effects. In one
the disease was so speedily removed, that there was only one fit after
the first day of taking this medicine, and the other two had recovered
perfectly after it had been used for seven days.

In these cases there can be little or no ambiguity with regard to the
real efficacy of the medicine, as the disease had lasted from two
to six months, and there was no other circumstance of change in the
situation or treatment of the patients that could account for their
recovery.

Of the two cases in which it failed, one was the tertian of three
months, attended with the eruption; the other was the relapsed tertian
of three days.

With regard to the dose, I began with giving it in the quantity of two
grains thrice a day, which, in some, produced the desired effect, and
without the least sensible operation on the stomach or bowels. If this
dose did not stop the fits after a few days trial, it was increased to
three grains, which, in some, would produce a little sickness. I found
that four grains ruffled the stomach a good deal; but if the patient is
gradually habituated to it, even more than this may be given without
inconvenience.

In those cases in which it was successful it was not found necessary to
give more than two grains at a dose, except in one of them, in which
three were given the day before the fit ceased. In the two unsuccessful
cases the medicine had a fair trial for a fortnight; but one of them
getting no better, and the other seeming to get worse, it was left off.

The cases to which this medicine is adapted are those that have
extremely distinct remissions, with no symptoms of bile nor any local
affection. When agues come to be long protracted, they are frequently
what may be called nervous; that is, consisting of certain morbid
motions that seem to be induced by habit, after the original cause is
removed, and with a tolerable enjoyment of appetite, sleep, and all the
functions of life, during the intermission.

The two cases in which the zinc failed recovered by the use of the
bark. This had been unsuccessfully tried before, and its good effects
now might either depend on its having been left off for some time,
whereby the body recovered its sensibility to its virtues, or it might
be in consequence of administering it in ardent spirits with a few
grains of capsicum and ginger, additions which I found to improve its
effects in other cases, and is a mode of giving it well suited to this
climate.

The zinc was not tried in the sixth case, on account of the local
affection and the remission being short and imperfect.

The white vitriol, being a salt of zinc, might be supposed to possess
the same virtues; and it would appear to do so from some facts[111]
that were reported to me in the West Indies, and also from some trials
made by me at St. Thomas’s hospital since I came to England.

Though this is a medicine of very considerable powers, I do not mean to
put it in competition with the bark, by proposing it as a substitute
for it, or by representing it as superior to it in all circumstances;
but only to propose it as a valuable subsidiary in particular cases.
The account I have given is faithfully extracted from a diary of
my practice; and were I to say more in its favour than the future
experience of others may warrant, I should do more harm than service
to its reputation. Many good medicines have had their characters hurt
by being over-rated by the first proposers of them, who are naturally
sanguine and partial, without, perhaps, intending to deceive. But
when others find that their virtues do not come up to what has been
asserted, they are apt to run into the other extreme, and explode them
altogether; so that what was given out as good for every thing, is now
found to be good for nothing[112].




CHAP. II.

Of FLUXES.


These seem to arise in the same circumstances, and to be owing to
the same general causes, as fevers. They may, in some sense, be
considered as fevers, attended with peculiar symptoms in consequence
of a determination to the bowels, just as fevers in cold climates are
sometimes attended with rheumatism and catarrh. We have seen, in the
first part of this work, that the dysentery arose chiefly in those
ships which had been subject to fevers.

This determination to the bowels is owing to a variety of causes, but
is chiefly connected with external heat; for it is most common in hot
climates, and towards the end of summer or in the autumns of cold
climates, owing probably to a greater acrimony of the secretions of the
intestines, and particularly of the bile. Dysenteries arise in camps
also at the same seasons, and in the same circumstances as bilious
fevers[113].

Besides climate and season, the other circumstances determining to
the one disease more than the other are, 1. A difference in the
constitutions of different men; for in the same ship it sometimes
happens that both diseases prevail equally, though all the men are
using the same diet and breathing the same air. 2. The nature of the
occasional cause. A dysentery, for instance, is more likely to arise
from an irregularity in eating or drinking; a fever from being exposed
to the weather, particularly marsh effluvia. 3. The particular species
of infection that may happen to be introduced. Suppose, for example,
that a ship’s company is predisposed to acute distempers, and one man
or more ill of the dysentery should be brought on board, this will
become the prevailing disease, as happened in the Torbay in August,
1780. If the like number of fevers should be introduced, then fevers
will be the prevailing disease.

These two diseases may therefore be considered as _vicarious_,
the one substituting itself for the other according to particular
accidents, and both proceeding from the same general causes; and
this is no new idea of mine, but seems to have been Dr. Sydenham’s,
when he calls the dysentery a _febris introversa_. It may be farther
added, that dysentery is the latest form in which this cause, which
is common to both, can exert itself; for it is a disease more within
the reach of art; and some of the most dangerous symptoms attending
fevers, particularly _delirium_, seldom occur in dysentery. When it
proves fatal, it is in consequence of violent local affection, and
that in general after it has taken a chronic form. When an incipient
fever turns into a dysentery, all the symptoms, and particularly the
head-ach, delirium, and _coma_, if there should be any, are immediately
relieved. And the most favourable cases of the yellow fever are those
in which a bilious diarrhœa comes on, while the most fatal are those
in which the bowels are so torpid as to be insensible to any stimulus
either from their own contents or from medicine.

I shall not enter into a minute description of this disease in all its
stages, as this has been so ably executed by Sir John Pringle, Sir
George Baker, and other authors, but shall only give a sketch of some
of the most remarkable symptoms, particularly such as are peculiar to
the climate and manner of life, so as to explain the varieties that may
be necessary in the mode of treatment.

The fluxes that arose in the fleet were either what may be called the
acute idiopathic dysenteries, or a dysenteric state of the bowels from
neglected diarrhœas, which was most apt to occur in the convalescent
state of fevers, or in men labouring under the scurvy. The body is more
susceptible of infection in a state of weakness from these or any other
causes; and in hot climates the dysentery seems to be more infectious
than fevers; for at hospitals it was so frequently communicated to men
who were ill of other complaints, that it was in these the principal
cause of mortality. For this reason, I was at more pains with regard to
this disease than any other, in keeping those who were ill of it in a
separate ward.

I have met with some violent and untractable cases which proved
fatal in the acute state; but, in general, this disease draws out to
a chronic form in this climate, and does not prove mortal for many
weeks. The usual cause of death appears, from the inspection of the
bodies, to be an ulceration of the great intestines, particularly
of the descending colon and the rectum. This part of the intestinal
tube is most affected from its being the receptacle of all the acrid
secretions from the rest of the canal; and it is naturally more subject
to congestions of the fluids and incurable ulcers, as appears from
the rectum being so liable to the hæmorrhoids and the _fistula_. This
ulceration of the great intestines is so common, that, out of eight
cases which I inspected after death, seven had this appearance. The
case in which there was none was not so much a case of dysentery as
of inflamed bowels, brought on by the man having drank to excess of
spirits while he was recovering from a dysentery. The acute _tormina_
which always occur in the first days of the disease seem owing to an
inflammation, which terminates in ulcers; and these being constantly
irritated by the sharp humours, produce the _tenesmus_, which is the
symptom most essential to dysentery in the after part of the disease.
Any diarrhœa may in this manner become dysenteric. During the acute
griping at the beginning, the stools are loose and copious; but as
soon as the tenesmus takes place, they are scanty, which is most
probably owing to the spasmodic strictures in the great intestines,
in consequence of irritation upon their excoriated surface. The
inflammatory state is more lasting and violent in a cold than a hot
climate, the gripings are more severe, and the danger is also greater
in this stage of it.

The state which the great intestines fall into in old dysenteries
seems to have something in it peculiar to itself: the several coats
become thick and spongy; their texture is obliterated and destroyed;
and they become of a black or very dark purple colour. This, however,
cannot be called mortification; for the fibres of the gut do not lose
their tenacity, nor is there that putrid and dissolved state in which
gangrene consists; but it advances in time to such an extreme state
of disease as to be entirely incapable of recovering its natural
appearance and functions, and proves therefore the cause of death.

The greater frequency and obstinacy of these chronic fluxes in hot than
in cold climates seems to be owing to the same weakening of the powers
of life which make recovery in general so tedious, and particularly
that of wounds and ulcers. The greater quantity of acrid bile will also
tend to keep up the ulceration. Dysenteries have this disadvantage,
that the Peruvian bark, which is the most powerful restorative in other
complaints of this climate, is here found to be inadmissible on account
of the heat, thirst, and other febrile symptoms, which it seldom fails
to induce in all stages of this disease.


TREATMENT of FLUXES.

There are few diseases in which a prudent employment of art is more
useful, or in which early means of relief are more requisite than in
this[114].

Where the dysentery is the original disease, and when the patient is
robust and plethoric, with acute pain and a strong pulse, blood-letting
may be practised with advantage in the beginning of the complaint. But
there is no part of the practice in this disease in which the climate
and manner of life makes a greater difference than in this; for in a
temperate climate it frequently happens that repeated blood-letting is
necessary; but in a hot climate, where the fibres are relaxed, and in
the constitutions of seamen, whom we seldom or never find plethoric,
the inflammatory symptoms requiring this evacuation do not run so high,
nor continue so long.

It is in all cases of the utmost consequence to administer as early as
possible a brisk saline purgative. An ounce and a half or two ounces
of purging salts may be dissolved in a quart of barley water or water
gruel, and given warm in cupfuls, at small intervals, till a free
and copious evacuation is produced. If there should be much fever,
or sickness at stomach, two grains of emetic tartar will be a great
improvement of this medicine; and there will be this farther advantage
from its use, that if the stomach should be loaded with bile, in which
state it is more irritable, an evacuation upwards will also be excited
to the great relief of the patient.

This early and seasonable measure will, in many cases, put a stop
to the disease, especially if the patient is thrown into a sweat
immediately after the bowels have been thus thoroughly evacuated. It
is of great service in this disease to promote free perspiration, and
even a plentiful sweat, which may be effected with great advantage by
giving, at bed time, a medicine composed of opium, ipecacuana, and a
little neutral salt, accompanying it with plentiful warm dilution.
Nothing tends more to relieve griping and tenesmus than a general,
warm moisture on the skin. The ipecacuana, which is an ingredient in
this medicine, is one of the best anti-dysenteric remedies we know;
the opium procures rest; and this, joined to the sudorific effect of
the whole, not only gives a temporary relief, but tends to carry off
the disease. It is most properly given in the evening; for there would
be this inconvenience in constantly encouraging a sweat, that if the
tenesmus should return, it would either be checked by the patient
getting frequently out of bed, or there would be danger of his catching
cold. I am well aware that we cannot be too cautious with regard to the
use of opium in the beginning of this disease; but it is admissible
more early in a hot climate than a cold one, as the inflammatory
symptoms are less violent and can be sooner subdued; besides, it
becomes an entirely different medicine when conjoined with the other
ingredients that have been mentioned.

The best medicine in the day time we found to be small doses of
ipecacuana alone twice or thrice a day; and if there should be fresh
collections of bile, small doses of the saline purgative will be
necessary. Ipecacuana in this intention, may be given in the dose of
two grains in athletic constitutions, such as those of seamen; but
in the more delicate constitutions, such as are commonly met with in
private practice, one grain is a sufficient dose. I have found manna
and tamarinds a good addition to this medicine in the earlier stages of
the disease, where there was much bile; but in a more advanced stage
of it they are apt to produce gripings and flatulence.

The marks of a redundance of bile are, a sickness at stomach, a sense
of scalding at the anus when the stools are passing, and the yellow
or green colour of the stools themselves. It is apt also to excite
symptoms of fever, such as a foul tongue, a hot and dry skin, with
thirst. When collections of it are suspected in this disease, it is
best to evacuate it by vomiting, for it is thereby prevented from
irritating the bowels, and from arriving at the inflamed parts with,
perhaps, increased acrimony, acquired in passing through the whole
length of the intestines.

Some gentlemen of the fleet informed me that they found oil of almonds
a useful addition to the purgative. Others as well as myself made a
practical comparison of the saline purgative with that composed of
rhubarb and calomel, as recommended by Sir John Pringle, and we gave
the preference to the former, as more easy, speedy, and effectual in
its operation, especially in the first stage. Cases may occur, however,
in which the other may be more advisable; for where there is a sense
of weight about the stomach, which most probably arises from the
biliary organs being clogged with bile, and where emetics have failed
to remove it, or the weakness of the patient may render them improper,
then calomel has the best effect: for it was formerly observed, that
it tends to loosen the secretions, and to stimulate the more distant
excretories, such as the biliary ducts.

It is very important to caution young practitioners concerning the
employment of opium in all stages of this disease, but especially in
the beginning; for though it is an excellent remedy when seasonably
and judiciously employed, it is very liable to abuse, particularly
in the hands of the inexperienced, who may be tempted to give it
improperly from an anxiety to relieve; but as more harm may arise from
an unseasonable administration of it than could be compensated by the
best-timed use of it, it is best to err on the side of caution and
omission. The principal caution to be observed with regard to this
remedy is, to premise suitable evacuation, such as blood-letting, if
necessary, but more especially purging. It is always pernicious to give
it in its pure state during the _tormina_, so common in the first days.
By these I mean the abdominal gripings, which denote inflammation, and
are entirely different from the _tenesmus_, which is a more constant
and characteristic symptom of the disease, and seems to arise from
irritation and spasms of the rectum and colon.

It was in this disease that I first observed the good effects of a
small quantity of neutral salt in taking off the inconveniencies
attending opium, such as the feverish heat and confusion of the
head, which it is apt to produce in many constitutions; and as the
administration of the anodyne coincided with the evening dose of
ipecacuana, I was led to adopt a form similar to that of Dover’s
powder, but with only half the quantity of opium; or, it was given
in a liquid form, by combining twenty drops of thebaic tincture and
a drachm of ipecacuana wine, with nitre from five to ten grains, in
any simple vehicle in form of a draught. There is a very observable
difference, in some cases, between opium given in a liquid and in a
solid form; and the former is much more certain in its effect when the
intention is to procure speedy and effectual ease.

I have observed great benefit from the use of external remedies in
dysentery, and these have, perhaps, been too much neglected by authors
and practitioners. The warm bath is of great service, especially where
the gripes and tenesmus are severe, and where the fever has been taken
off by previous evacuation. Fomentations or warm applications of any
kind to the abdomen give temporary relief; and it will be found of
advantage to keep those parts, at all times, well defended from the
cold air. Blisters to the abdomen were also found of use, and likewise
acrid liniments, composed of oil, volatile spirits, and tincture
of cantharides. Where the stomach has been much affected, I have
perceived relief from fomenting it with stupes, upon which thebaic
tincture and camphorated spirits were sprinkled, as recommended by Dr.
Lind. I was once affected with a bad dysentery in the West Indies,
and I thought myself much relieved by the warm bath and a blister.
Strangury is not an uncommon symptom in this disease, independent of
cantharides, and the most sensible and effectual relief is derived from
fomentations to the pubis and perinæum, as I also experienced in my own
case.

What has been hitherto said regards chiefly the acute dysentery; but
the most frequent and troublesome complaint that occurred at the
hospital, was the same disease in what may be called its chronic state.

There is a considerable variety of symptoms in all the stages of this
disease, but particularly in the more advanced or chronic state, so
that a corresponding variety is necessary in the modes of treatment,
and there are few diseases in which there is more room for exercising
the judgement.

In all stages of it an accurate discernment is necessary with regard
to the use of opiates, and great part of the practice here consists in
timing these well. They are least admissible in the beginning, where
evacuation is the principal object; but as the disease advances they
become more and more allowable and useful. The principal cautions
necessary in their administration are, 1. To premise sufficient
evacuation, so that the intestines may not be loaded with bile,
_scybala_, or any other irritating matter at the time of giving the
opiate. 2. To obviate the effects which an anodyne has of causing a
retention of the contents of the intestines. This may be done, either
by giving something purgative along with it, or after it has produced
its quieting effect. The former method seems preferable; for as soon as
the effect of the opiate is over, the purgative is ready to act; and
in this way it is so far favourable to the operation of the purgative
that large feculent stools will be discharged: whereas, had the
purgative been given alone, it would have been more apt to produce
scanty griping stools, attended with tenesmus. Rhubarb answers well in
such cases, and may be given in a dose from twelve to twenty grains,
according to the age and constitution. 3. To prevent feverish heat
and delirium. This was proposed to be done in the first stage of the
disease, by combining it with ipecacuana and a little neutral salt.
With the same intention, it may now be joined with a few grains of Dr.
James’s powder, or _vitrum ceratum antimonii_, in which form it would
not be so strongly sudorific, an effect not so much required in the
chronic as in the acute state.

The principal causes that keep up the flux, and render it so obstinate,
are, 1. A too great secretion of bile, either continual or frequently
recurring. 2. Ulcers in the great intestines. 3. A lienteric state of
the bowels. 4. A retention of _scybala_.

The first cause is much less frequent than might be expected by those
who fancy that every disease of this climate proceeds from bile.
When there does occur a redundancy of bile, there is more occasion
for the employment of evacuant medicines, and more need of caution
in that of opiates. A medicine that will dispose the liver, or the
circulating system in general, to form less bile, is a _desideratum_ in
physic; but, in case of an excessive flow of it, emetics and mercurial
purgatives, as has been already mentioned, are the best means of
evacuating it; and care should be taken that it be discharged before it
accumulates too much, or becomes acrid by too long retention.

In order to obviate that irritation in which tenesmus consists, some
benefit was found from the injection of emollient and anodyne clysters,
to wash off and dilute the acrimony, and to sooth and heal the parts. A
strong infusion or decoction of linseed or starch may first be given to
the quantity of near a pint, to be evacuated after a short retention,
and then a few ounces of the same, with thirty or forty drops of
laudanum, to be retained for a length of time, in order to procure
rest. Instead of this last, I have known a small quantity of warm
milk, with syrup of poppies, used with advantage in private practice.

I was at first tempted to think that a very frequent injection of such
clysters would be very useful, by washing and healing the colon and
rectum, and preventing farther exulceration. But besides the objection
arising from the tenderness of the parts, which, in some cases, renders
the operation itself painful, I found that if they were given oftener
than once a day, they rather increased the uneasiness, and made the
patient feel languid and exhausted; so true it is that no practical
rule can be established from reason alone without being brought to the
test of experience. The rectum seems to have a peculiar sensibility,
and a remarkable consent with the whole system; for a stool will
induce syncope, or even death, in a state of great debility. Clysters
may be pernicious, even though they produce no evacuation of _feces_;
and Sydenham has remarked, with respect to other diseases, that their
unseasonable or too frequent use greatly debilitates and disturbs the
patient. When not abused, however, they are of the most eminent service
in this and other complaints.

Certain medicines, which have been called _sheathing_, have been
recommended to be taken by the mouth. Of this kind are mucilage, oil,
and wax. I have made trial of mucilage, such as starch, without any
sensible effect, probably because it loses its qualities by the powers
of digestion before it reaches the part upon which it is intended
to act. With regard to oil, I have hardly enough of experience of
my own to decide; but some of the surgeons of the fleet informed me
that they found advantage from combining it with the purgatives. I
was discouraged from using it by finding that it was apt, in the West
Indies, to become rancid on the stomach, and, for this reason, I
seldom, in any case, employed the castor oil, which, though produced in
that climate, seems to answer better as a medicine in Europe. But since
my return to England I have used, with great benefit, at St. Thomas’s
hospital, a medicine, composed of tincture of rhubarb and oil, in old
dysenteries, attended with discharges of blood. I took the hint of this
from finding it of great service in deep-seated piles, as recommended
by Dr. Griffith[115]. It is necessary to combine something purgative
with the oil, otherwise it might be altered by digestion, or absorbed,
or might become rancid by too long retention in the first passages. Wax
is a body not changeable by digestion, and seems therefore well suited
for the purpose of sheathing the bowels; and I have found advantage
from the preparation of it recommended by Sir John Pringle[116], on the
authority of Dr. Huck. I have also seen some advantage in old fluxes,
in St. Thomas’s hospital, from the use of spermaceti, given with an
equal quantity of conserve of roses and half as much absorbent powder,
agreeably to a form in use at that hospital.

The climate has a great influence in preventing these ulcers from
healing, upon the same principle that it prevents the cure of external
sores and wounds, so that there are cases that admit of no cure but
from a change of climate. I have seen in some cases of old dysentery,
small, round, ill-conditioned ulcers break out on the surface of the
body, which seemed to proceed from the same general habit that produced
those of the intestines. There was something peculiar in the appearance
of those external sores, being like small round pits, as if a part of
the skin had been removed by caustic, and with little or no discharge.
In a case of this kind, which proved fatal, I found the whole surface
of the great intestines beset with small ulcers, not unlike those on
the skin.

Since the first edition of this work was published, I have met with a
pamphlet, written by Dr. Houlston, of Liverpool, in which the friction
of mercurial ointment on the abdomen is recommended as a cure for
old fluxes; and I have tried this practice in some very obstinate
cases in St. Thomas’s hospital with evident success. In these cases
it is probable the disease is kept up by a vitiated state of some of
the various secretions belonging to the intestinal canal, which the
mercurial alternative tends to correct.

The next cause that was mentioned of the long continuation of fluxes,
was a lienteric state of the bowels. This consists in a great
irritability of the whole alimentary canal, whereby all the _ingesta_
are transmitted so fast, that there is no time for assimilation. Liquid
aliment, such as broth, is particularly subject to this inconvenience.
There are few cases of long-protracted fluxes in the West Indies,
without this symptom in some degree.

The remedies that are here found of most service are such as counteract
irritability or relaxation. It is in cases where this is the prevalent
symptom that opium may be most freely used. Frequent and small doses of
the compound officinals, such as theriaca, pulvis e bolo compositus, or
diascordium, have been found of service. Though the relaxation would
seem here to indicate the Peruvian bark, yet I have hardly ever known
it employed in any form in this or any other stage of the disease,
without being hurtful. But there are other bitters not only safe but
useful in restoring the tone of the bowels; of this kind are simaruba,
quassia, and chamomile flowers. The first has been reckoned a specific
in this sort of flux; but though its powers are undeniable, it will
be found frequently to fail[117]. I have also used, with advantage, a
tincture of gentian and cinnamon in Port wine. Something aromatic has
a good effect when added to the bitter, being adapted to prevent or
obviate flatulence, which is a common and troublesome symptom in this
complaint.

That class of remedies which may be called pure astringents, might seem
at first sight well calculated for cases of this kind. Of this sort are
the _terra Japonica_ and _extractum campechense_; but though I have
seen evident benefit from this last, there are few cases in which such
medicines are found by experience to be of material service. Where the
cause consists in simple relaxation, they will effect a cure; but it
more frequently happens that the disease is kept up by a vitiated state
of the secretions, or a depraved action of the bowels.

The absorbent earths are a more useful remedy in this form of the
disease. They have, perhaps, a restringent effect independent of their
power of absorbing acid. It is certain, however, that great part of
their use consists in the destruction of acid, which is very apt to
be generated in that depraved state of digestion which takes place in
advanced fluxes, particularly in this lienteric state of the bowels. In
the early and acute state the vegetable purgatives, such as cream of
tartar, tamarinds, and manna, are proper; but in this advanced stage
they are hurtful by the acidity and flatulence which they produce, and
both the food and medicines should be so calculated as to avert and
correct those inconveniencies. There is something in vegetable acids
extremely unfriendly to a weak state of the bowels in general, tending
to bring on spasmodic gripings, and preventing a healthy digestion and
assimilation, as we know in the case of heartburn, and of those who
make use of vinegar to check corpulency, by preventing the formation
of blood. Vegetable acids, however, are admissible where there is
a redundancy of bile, or where the excrements are putrid; and Dr.
Zimmerman recommends tamarinds as a useful medicine in what he calls
the putrid dysentery.

Lime water has been recommended in old flaxes, and I tried it in
several cases; but, except in one, I could not perceive any benefit
from it.

Absorbents may very properly be combined in prescription with some of
the compound-officinal opiates, and a medicine will thereby be formed,
which will have at once the advantage of an anodyne, a bitter, an
astringent, a carminative, and absorbent. As these earths have little
or no taste, they may also be added, with propriety, to the common
drink, as in the form of the chalk julep, or _decoctum album_. It
may be thought that here and elsewhere I have not been so particular
as I ought to be concerning the forms and doses of medicines; but
circumstances, such as age, constitution, and symptoms, make these,
in a great measure, discretionary; and any one who is sufficiently
conversant with physic to be entrusted with the charge of the sick,
will have sufficient judgement to vary his practice accordingly. It
has, therefore been my object rather to give the general principles of
treatment than the particular forms of medicines.

A proper regulation of diet, as well as medicine, is of the utmost
consequence in this disease. A free indulgence of animal food is
pernicious, particularly in the first stage of it. In the chronic
state, a moderate use of it is allowable, and in the lienteric state
it answers better in a solid form than that of broth, which is apt to
gripe and to run quickly through the bowels. The best general articles
of diet are farinaceous bodies; and these are greatly improved by
being toasted brown before they are used. It was observed, in a former
part of this work, that the flux was supposed to have been prevented,
in the fleet commanded by Sir Charles Saunders, by throwing burnt
biscuit into the water used by the crews of the ships. It is a good
practice to put a well-burnt toast into all that the patient drinks,
and toasted bread, or panada made of toasted bread or biscuit, is one
of the best articles of diet. Brackish water ought to be avoided, as it
ruffles the bowels when in so delicate a state. Fermented liquors are
improper, except when the disease is advanced, and where weakness and
relaxation are the prevailing symptoms. Malt liquor will hardly ever
agree, on account of its acidity and flatulence. Of wines, Port is to
be preferred as the most strengthening; Madeira as the least subject
to acidity; and, for the common men, no drink of the fermented kind is
safer than a moderate quantity of spirits diluted with water.

Warm clothing is of the utmost consequence in this disease, and
external warmth of the abdomen tends greatly to sooth the bowels. I
have seen good effects from a warm gum plaster constantly worn on that
part. Though cold is in general hurtful and unsafe, I have nevertheless
known the sailors, who, by their habits of life, are commonly heedless,
bathe in the sea when labouring under what they call the white flux,
without any bad effects.

It sometimes happens that this disease baffles every effort both
of medicine and diet, so that a change of climate becomes the only
resource.

The last cause of habitual flux that was mentioned was the retention
of _scybala_, which keep up the irritation and tenesmus. It is very
natural to neglect purgative medicines when there seems already to be
too great a discharge by the bowels; but there is this inconvenience
from omitting them for a length of time, that those hard lumps of
feces, called _scybala_, are apt to collect in the cæcum and cells of
the colon, as I have seen upon inspecting the dead bodies; and the
fibres of the intestines being weakened, their natural strength is not
sufficient to expel them without being stimulated by a purgative. It is
therefore necessary to give some evacuant medicine from time to time,
even though there should be no griping nor any marks of acrimony in
the intestines. Rhubarb is allowed to be one of the best medicines for
this purpose; and I have also known a combination of salts and sena
have a good effect after a long neglect of purgative medicines. It is
probable, from the durable effects produced, that these do not operate
merely by the expulsion of _scybala_; and we can conceive that they may
be of service by the removal of certain depraved fluid secretions, or
that they may stimulate the vessels to a more healthy action and a more
natural secretion. Be this as it will, experience teaches that in all
fluxes it is of advantage to interpose from time to time some purgative
medicine.

From the preceding view of the variety of causes which tend to keep up
this disease, it will appear that great judgement and discrimination
are necessary in varying the practice according to circumstances; and
there is no disease in which there is room for more attention and
nicety in adapting the different remedies to the different symptoms.
We can hereby also account for the various characters that different
remedies have had, some having been extolled by one practitioner
while they have been pronounced insignificant by another; for no one
remedy will suit all the various cases of this disease. As it is of
the greatest consequence to distinguish these cases, I have been more
particular and diffuse on this article than any other; and having
laboured under this complaint myself, I was naturally led to take
a greater interest in its treatment, and had also thereby a better
opportunity of making observations on it.




CHAP. III.

Of the SCURVY.

I shall not be so minute either in the description or treatment of the
scurvy, as of the preceding diseases. A detail of this kind would lead
to unnecessary prolixity and repetition; for the prevention and cure
of it consisting in diet rather than medicine, have been fully handled
in the former parts of this work; and the subject, in the descriptive
as well as the practical part, has, in a manner, been exhausted by Dr.
Lind. With regard to the theoretical part, I refer the reader to the
ingenious treatise lately published by Dr. Milman.

It has appeared that the principal source of scurvy is a vitiated or
scanty diet, and that it is very much promoted by cold, moisture,
filth, sloth, and dejection of mind. Hard labour has been assigned
by some as a cause; but this is not conformable to my observation
in general, and what has been related to have happened in the
Conqueror[118], more particularly led me to be of a contrary opinion.

The principal differences of the symptoms of the scurvy in hot and
cold climates, so far as I have observed, are, that in the former the
livid hardness on the extremities is an earlier symptom, and in the
latter the gums are sooner affected, and the difficulty of breathing is
a more frequent and more uneasy symptom. This difficulty of breathing
is one of the most fatal symptoms, and is most frequent in those cases
in which there are the fewest external marks of the disease, and is
probably that form of the complaint which attacks a vital part by a
sort of translation from the extremities.

There is a remarkable symptom sometimes attendant on this disease which
has escaped authors, and is mentioned in Mr. Telford’s Report, page 23.
This is the _nyctalopia_, or weakness of the eye-sight, which was also
common in the garrison of Gibraltar[119], among those who were affected
with the scurvy, a disease that prevailed much during the late siege of
that place.

With regard to the cure, enough has been said in the preceding parts
of this work to prove that fresh vegetables are the most effectual
antiscorbutics. I shall here mention a fact farther in proof of this,
which has not before been taken notice of. When the fleet arrived at
Barbadoes in May, 1781, part of the soldiers, who served as marines,
were affected with the scurvy, and being sent to the army hospital,
where, at that time, no fresh animal food was allowed, they recovered
much faster by being confined to vegetable articles, than the seamen
who were fed upon fresh animal food without any fresh vegetables.

It has farther appeared, that there is something in a particular class
of fruit of the lemon and orange kind, which far surpasses every other
remedy, whether dietetic or medicinal. Numberless instances have
occurred, in the preceding part of this work, of men having recovered
at sea from using the juice of this fruit alone, even under all the
inconveniences of a sea diet. When the juice is intended to be kept for
a length of time, it should be expressed and bottled, a small quantity
of spirits being added to preserve it for if fire is used in preparing
it, as in the form of a rob, I know for certain that its virtues will
be thereby very much impaired. It is very difficult to say upon what
principle these fruits act, for no sensible effects are produced by
them except a small increase of some of the secretions.

It ought to be mentioned here as a fact of great consequence, though
very little known, and never, I believe, published before, that
the juice of limes and lemons is the best detergent of any external
application that has yet been tried in scorbutic ulcers. Nothing was
found so effectual in preventing these from spreading, and in disposing
them to heal, as an emollient poultice with[120] lemon or lime juice
sprinkled on its surface; or it was applied by soaking in it the lint
with which the sore was dressed, and also as a lotion, in which case
it was used diluted with two or three times its quantity of water; for
if used pure, it was found too irritating, and was apt to bring on a
fungous disposition. This precaution is particularly necessary with
regard to limes, the juice of which is a much more concentrated acid
than that of lemons. Mr. Lucas, surgeon of the Conqueror, favoured me
with several valuable remarks in proof of this practice. A poultice
was always found a good application in these cases, by its power of
absorbing the acrimonious discharge, which would otherwise irritate the
neighbouring parts. I have been informed by a navy surgeon, who served
in the former war, that he has known the most obstinate ulcers cured
by applying a paste of oatmeal and water, the surface of which was
sprinkled with Goulard’s preparation of lead.

The fleet was furnished with essence of malt; but its powers were so
inconsiderable, that some of the surgeons denied that it had any. In
trials, however, that were made in an early state of the disease, it
was found to have a sensible effect in checking and removing it. It
was also found of evident use in the bad ulcers so apt to arise in
scorbutic habits, and in this intention was superior to the Peruvian
bark as an internal alterative. Indeed, in those ulcers that were truly
scorbutic, the bark was found to be of very little use; and, next to
what has been already mentioned, joined to the advantages of diet,
opium was found of the greatest service in disposing these, as well as
all other ill-conditioned sores of hot climates, to heal.

I have mentioned the scorbutic habit as distinguished from the scurvy,
but there seems to be no difference except in degree; for a person may
be laid to labour under the disease before it betrays itself by any
obvious symptom, and it must have gathered a certain degree of force
before visible symptoms are produced. The chief mark of this latent and
incipient stage of the disease is that incurable state of ulcers that
has been mentioned, whether they appear spontaneously or in consequence
of slight accidents. There is another mark of this scorbutic habit
which is not mentioned in any description of the disease I have ever
seen. It is a soft, indolent tumour which arises under the skin on a
part which has received a small blow, or contusion, so slight as not to
break the skin. It most commonly appears about the elbow or fore-arm,
and generally disappears without any inconvenience, what it contains
being absorbed. A surgeon, who opened one of them, (a practice,
however, not to be approved of) informed me that it consisted of
fluid blood. We may also reckon a languor, or sense of weight, as one
of those marks of scurvy which occur before the more obvious symptoms
appear.

In this state of the disease, the articles of lesser powers, such
as malt and melasses, may be of service by preventing its farther
progress, or the appearance of actual symptoms, and by restoring the
constitution.

In some of the early stages of this disease the effervescing mixture
of acids with fixed alkali may probably also be of use. I never could
perceive any sensible benefit in those cases in which I tried it,
though some of the gentlemen of the fleet reported to me that they
thought it of service.

There is no article of the _Materia Medica_ yet known that possesses
any considerable power over this disease without the assistance of
proper diet. With this assistance, however, it is found, that whatever
tends to increase the fluid secretions, hastens very much the recovery
of the scorbutic patient. I have observed a very striking instance of
this in the effects of a spontaneous diarrhoea; for I have seen those
hard livid swellings on the legs, that form one of the most constant
symptoms of this disease, almost disappear, and the hams, from being
contracted, become flexible in the course of twelve hours after the
purging came on. I have endeavoured to imitate this with purgatives,
but never with the same effects as the natural looseness. A free
flow of urine is also found to promote the recovery, and vinegar of
squills is one of the most effectual medicines in this intention. It
is likewise of singular service to excite sweat; for an obstruction
of perspiration seems to be one of the principal constituents of the
disease. The goose skin, which is an early and constant symptom of this
disease, seems to be owing to a constriction of the exhaling vessels.
Dover’s powder has been employed with advantage as a sudorific, with
decoction of the woods drank warm, and plentiful warm dilution.
Camphor, combined with nitre, has been found one of the best remedies,
and it acts both as a diaphoretic and diuretic.

Such external applications as relax the skin are found also to forward
the cure. The contraction of the hams and the livid hardness of the
calves of the legs are relieved by emollient cataplasms. Burying the
legs in the earth, which has a sensible good effect, seems to act on
the same principle, for it makes the parts sweat profusely.

There can be no doubt that in the scurvy there takes place in certain
parts of the body a stagnation of the humours in the small vessels,
particularly of the lower extremities, and that it is to this
circumstance that the livid hardness of the fleshy parts of the legs
is owing. The effect of medicine in removing this, must be to restore
the action of those torpid vessels, so as to bring the stagnated
fluids again into circulation[121] Purgatives seem to act upon it as
they do in the dropsy, by exciting absorption. The irritation of the
bowels and their increased secretion thus affecting the minute vessels
in all parts of the body, is the result of that sympathy or balance
established between every part of the system, in order to support the
harmony and effect the purposes of the animal œconomy.

It has long appeared to me, that the scurvy is owing rather to a defect
of nourishment than to a vitiated state of it. In fact, that sort of
food which is supposed most commonly to induce the scurvy, is, in most
cases, not putrid, but is in an unnatural and depraved state by being
drained of its juices, which run off in brine; and perhaps some of the
more subtile and nutritious parts are wasted by evaporation. It is not
found that salt of itself has any effect in inducing the scurvy, and
indeed it can be induced under a state of diet in which there is no
salt, as we know from some instances quoted by Dr. Lind; and some cases
are related by Dr. Monro and Dr. Milman, in the Medical Transactions,
which are in proof of the same opinion. But the case most in point to
prove that it depends on a defect of aliment, is that of Dr. Stark,
who, by way of experiment on himself, reduced his diet to the least
quantity he could subsist upon, and was thereupon affected with the
symptoms of the sea scurvy. I have also known some symptoms of it arise
in old people in consequence of long abstinence, owing to the want of
appetite.

It would appear that the aliment we take in acts in two ways in
increasing the vigour of the body. First, by assimilation, whereby it
affords the matter of which the solids of the body are made, in order
to carry on growth in youth; and to repair the waste of parts in adult
age. A very small quantity of matter is necessary for these purposes;
and as a proof of it, we see people supported equally well with very
different quantities and qualities of food. Secondly, Food is necessary
as a stimulus, either by a power it has of soothing the nerves of the
stomach, and the other surfaces to which it is applied, or by its
volume in distending the intestines and blood vessels. It is upon this
principle that luxury renders the great quantities of food we take
in necessary; and those species of food which satisfy most by their
stimulus are by no means such as are the most nutritious. It is also
upon this principle, that in cases of accidental hardship from want
of food, or in barren and inclement countries where food is scarce,
the body is supported, in some measure, by what contains little or no
nutritious matter, such as pure water, or the bark of trees powdered
and kneaded into a sort of bread, as we are told of the inhabitants of
Lapland.

There are other familiar and well-established facts, which prove, that
either from the influence of disease, from habits of life, or the
nature of particular animals, life can go on for a length of time with
little or no aliment. This is the case in fevers, in sea-sickness,
in certain singular cases that have been recorded[122], in torpid
animals, and in animals of cold blood. Though a man in health will die
if deprived of food for a very few days, it does not follow that this
is owing to the want of matter to repair the waste of the body. The
craving for food, and the faintness from long abstinence, arise from
the want of the accustomed stimulus, especially in those who are used
to live well; and a person feels himself most refreshed by food and
drink when newly taken in, and before it can be applied to the purpose
of nutrition.

As there is a continual waste and decay, however, both of our fluids
and solids, some degree of reparation is absolutely necessary,
especially to animals of warm blood; and such _ingesta_ as would
give the stimulus of food, without being possessed of any nutritious
principle, would indeed continue life for a certain time; but disease
would ensue. The provision used at sea answers, in a great measure, to
this description; for unless the powers of digestion and assimilation
are remarkably strong, salt beef and biscuit, which have been long
kept, do not contain much more nourishment than saw-dust, or the bark
of a tree, and the disease induced by this diet is the scurvy.

The nature and symptoms of the scurvy countenance this opinion: for
as the means of renewing the animal matter of our bodies is withdrawn
under this course of diet, nature, in consequence of an accommodating
principle, observes a sort of frugality, and the animal œconomy adopts
such measures as may be productive of the least possible waste and
corruption of the fluids. Accordingly all the secretions become scanty;
and, in particular, one of the first symptoms of this disease is a
suppression of perspiration, as appears by the goose-skin that attends
it. There is a paucity of urine. There is also a great languor in
the circulation, which may be considered either as a means adopted by
nature to prevent that vitiated and effete state of the fluids which a
brisker action might induce; or it may happen from a want of that due
supply of nourishment necessary to produce a vigorous action of all the
functions.

We have a proof of this general languor not only from the great
aversion to motion, and the great disposition to syncope, but from
the inspection of the dead body, from which it appears that the
whole circulating system, being more flaccid and less elastic, is
subject to preternatural distention. The heart is accordingly found
enlarged in bulk, the size of the cavities being increased; and in
the extremities, where the circulation is naturally most languid,
the small vessels carrying the colourless part of the blood, are so
far enlarged as to admit the red part of it, as appears by the livid
colour; and where this is the case, these vessels being unable to
carry on the circulation, a stagnation ensues, as is evident in those
livid appearances most common about the calves of the leg, which feel
like a hard cake. I have examined those parts in the dead subject, and
found a want of fluidity in the contents of the vessels, but could not
discover any thing like _eechymosis_; from which I concluded that the
colour was owing to an _error loci_, and the hardness to stagnation and
coagulation of the fluids, and a want of action of the vessels.

The incurable state of ulcers, so common in this disease, is also
what we might expect from the defect of fresh assimilated juices; for
where a breach is made, either by nature or accident, in the solids,
particularly of the extremities, the proper suppuration is prevented by
the depraved state both of the fluids and vessels; and we cannot expect
that renewal of solid parts in which healing consists, where both the
instruments and materials of its formation are so defective.

I shall conclude what I have to say on this subject, by shortly
considering whether or not this disease is ever contagious.

There is something in the nature and history of the scurvy that
would lead us at once to pronounce that it is not infectious; for
the external causes on which it depends are so obvious, and seem so
adequate to account for its appearance and prevalence upon certain
occasions, as at first sight to exclude every other external cause.

But it seems extremely unphilosophical to deny the reality or
possibility of any thing in Nature, from our supposed knowledge of the
means and causes she employs, particularly in a branch of science so
obscure as the animal œconomy. Could we, therefore, prove the point
as a matter of fact, it would be in vain to deny it, from our fancied
acquaintance with Nature’s modes of operation.

The facts which give a suspicion of the scurvy being infectious are,
1st, What is related by Dr. Lind, that the sea scurvy spread at one
time from the naval hospital to the people of the adjacent country.
2dly, There occurred several instances, in the first part of this
work, of this disease prevailing to a much greater degree in some[123]
particular ships than others, though upon the most accurate inquiry
there was found no difference in the diet, or any other external or
predisposing cause adequate to account for this. We can conceive, that
those ships having accidentally a few men, whose constitutions were
remarkably predisposed to this disease, might catch it earlier than in
other ships, and communicate it to the rest of the crew.

The only practical inference that would lie from the establishment
of this fact would be, that when the disease begins first to appear,
the men affected should be separated from the rest; and this is a
good practice, whether this opinion is true or not; for such men
ought to be put in one mess, in order that they all may live upon the
same antiscorbutic articles of diet, and that they may more easily be
debarred from the use of their common provisions, of which this disease
does not make them lose the relish.




CHAP. IV.

Of the WOUNDS received in the Actions of April, 1782.

 Loss in the Battle and from Wounds--Fatality of the locked
 Jaw--Treatment of it--Some Ships more subject to it than
 others--Different from other Cases of Tetanus--It is not cured by the
 Removal of the Part--It may come on after the Part is cured--Effect of
 Climate in producing it--Accidents from the Wind of a Ball--Accidents
 from the Explosion of Gunpowder--Means of preventing them--General
 Observations on Sores and Wounds.


Though surgery was not properly in my department, yet, having had
a fair opportunity of collecting facts concerning this branch of
practice, I thought it my duty to pay some attention to it.

The whole number of men wounded in the actions of April, 1782, amounted
to eight hundred and ten.

Of these, sixty died on board before the end of the month, five in the
course of the following month, and two in June.

There were ninety-seven wounded men sent to the hospital at Port Royal,
of whom there had died twenty-one when the fleet left Jamaica on the
17th of July.

So that the whole loss of men in the battles of April, and their
consequences, is as follows:

  Killed outright                         266
  Died of their wounds on board            67
  Died of their wounds at the hospital     21
                                          ---
                                 Total    354

Of those who died on board, fifteen[124] were carried off with the
Symptoms of the locked jaw; but of those sent to the hospital, only
one. The reason that so few in proportion were affected with it in the
hospital may have been, that none of the wounded were landed till near
the end of the third week after the principal action. The danger of
this symptom was then, in a great measure, past, though I have known
it to take place in every period from the second or third day till the
fourth week.

Only three men in the whole fleet recovered from this alarming
complaint; and as it is interesting to know every thing relating to so
desperate a symptom, I shall give a short account of each.

The first was a seaman of the Montagu, who had his thigh wounded by
a splinter which carried away part of the integuments and _membrana
adiposa_, and lacerated in a small degree the _vastus externus_
muscle. The wound did extremely well till the 23d day, when the jaw
became almost entirely fixed, and the whole muscles of the wounded
side were thrown into frequent spasms. Mr. Young, the surgeon, who
was always anxious and assiduous in his duty, consulted with me, and
we had immediate recourse to the warm bath, which gave a degree of
instantaneous relief, and was repeated twice a day for half an hour.
He was sensibly better every time; in nine days was entirely free of
the symptom, and continued afterwards to do well. The only other means
taken for this man’s recovery, besides what were used with the other
wounded men, were from three to five grains of opium, which he took
every day, in divided doses.

The next was a seaman of thirty years of age, belonging to the
Magnificent, who had the _humerus_ broken and shattered by a splinter
which entered the deltoid muscle. Several large portions of bone were
extracted, and the artery was laid bare on the inside. On the fifth day
there came on a large ichorous discharge, with a low quick pulse and
depressed spirits, and the jaws began to close, with pain and stricture
on both sides about the articulation of the lower jaw. He had every day
since the accident taken half an ounce of Peruvian bark, combined with
opium or rhubarb, according as it made him loose or costive. This was
continued, and the part externally was kept constantly moist all round
with volatile liniment, to which a fourth part of _tinctura thebaica_
was added. Next day the jaw was almost entirely fixed, so that it was
with difficulty that a little wine and water could be introduced with a
spoon. Mr. Harris, the surgeon, now wisely determining to do something
vigorous in this unpromising situation, beat up twelve ounces of opium
moistened to the consistence of a cataplasm with the thebaic tincture,
and applied one half to each side of the jaw. The patient this day
swallowed a pint of the bark decoction with half an ounce of nitre, and
took a diaphoretic draught of twenty drops of thebaic tincture and
thirty of antimonial wine. He had also the smoke of tobacco thrown up
his nostrils.

On the third day after the attack he could open his mouth half an
inch. The cataplasms were taken off, beat up afresh with the tincture,
and applied anew. The bark and other medicines were continued. On the
fourth day the stricture and pain of the jaw went entirely off, but the
cataplasm and volatile liniment were applied for three days longer. The
wound produced a laudable discharge, every symptom became favourable,
and he continued to recover.

The only other person who recovered from this symptom was a man in the
Bedford. Several died of it on board of this ship; and as the same
means of relief were skilfully employed in all the cases by Mr. Wickes,
the surgeon, the success seemed owing more to something favourable in
the man’s constitution, than any thing peculiar in the treatment, which
consisted in the administration of the warm bath, opium and camphor,
with mercurial friction on the jaw.

This accident affected some ships remarkably more than others,
particularly the Barfleur and Bedford, though their wounds had nothing
peculiar, nor were in a greater proportion than in the rest of the
fleet. Four were carried off by it in each of these ships. It has
formerly been observed, that great ships acquire peculiar habits, or
dispositions, which incline the constitutions of the men to one disease
more than another. This complaint took a run in some particular ships
last year also after the battle of the Chesapeak; and I have known it
prevail in some particular hospitals more than others. In the present
instance, it may have been owing either to something peculiar in the
constitution, or air of the ships; or we can conceive it to be owing
to some sort of nervous sympathy, just as the _epilepsy_[125] has been
known to spread from one boy to another, at a school, in consequence
of imitation, dread, horror, or some such delicate nervous or mental
affection. We have in yawning an example of a spasmodic affection
spreading from one person to another. If this is the case in the locked
jaw, those affected by it should be removed from the presence of the
other wounded men, lest the idea of the sufferings of others should be
so fixed in their mind, or so impress them with the fear of the like,
as to invite the attack of the same complaint.

Though the locked jaw, in consequence of wounds, resembles frequently
in its symptoms the tetanus which arises without any external accident,
yet there are many cases of the former which differ materially from
the violent symptoms of the other, as described by authors. In most
cases of the locked jaw from wounds the spasms are not so general, so
violent, nor attended with such exquisite pain. It sometimes happens
that the convulsive twitchings are even accompanied with a sort of
pleasure, as in the case of a lieutenant of the Montagu, whose case was
related to me by Mr. Young, the surgeon of that ship, a man of skill
and observation in his profession, and upon whose fidelity and accuracy
I could perfectly rely. This officer had been wounded in the elbow at
the battle of St. Christopher’s by a splinter, whereby the capsular
ligament of the joint was injured. On the ninth day, symptoms of the
locked jaw came on, and soon after the whole muscles of the wounded
side were affected with frequent convulsive twitchings, which, as he
himself said, afforded a pleasant sensation, exciting laughing like an
agreeable titillation. He died on the fourth day after it came on, and
had no pain to the last.

The locked jaw from accident differs also from other cases of tetanus,
in respect to its cure; for the latter has been successfully treated by
cold bathing, as is related by Dr Wright[126] and Dr. Cochrane[127];
but it is acknowledged by the latter that this treatment did not answer
when the complaint proceeded from a wound.

It is to be remarked, that the locked jaw did not take place in those
cases in which the wounds had a foul and gangrenous appearance more
than others; for those that digested and cicatrized favourably, were
equally apt to be affected by it; and though amputations are most
liable to this symptom, the slightest injuries, even a scratch, will
sometimes bring it on.

It would be difficult, therefore, to establish any particular treatment
that would tend to prevent accidents of this kind; but Mr. Bassan,
surgeon of the Arrogant, one of the line-of-battle ships engaged on the
12th of April, mixed laudanum with the dressings of all the wounds, and
no locked jaw occurred.

In the Bedford there occurred a curious circumstance concerning this
complaint. In one of the cases that proved fatal, the symptoms did not
come on till the wound was so far healed that all dressing had been
laid aside.

Mr. Wood, surgeon of the hospital at Jamaica, informed me, that in
cases of the locked jaw from injuries to small members, such as
fingers, he had tried the effect of amputating the part after the
symptoms had come on, but without any effect in putting a stop to them.

Would it not appear, from the two last mentioned facts, that this
symptom is not kept up, nor even takes place in the first instance,
from an immediate present irritation, but that the constitution comes
to be so modified, or receives such an impulse, as it were, that
the complaint runs its course independent of the presence of that
_stimulus_ which excites it?

It would be difficult to assign a satisfactory reason why this accident
is more frequent in hot than in cold climates. The effect of external
heat upon the living body is not to raise its temperature even when the
heat of the air exceeds that of the body[128]; so that we are to seek
for the effects of it in some of those affections peculiar to animal
life. And as the outward temperature of the air does not affect the
general mass of the body, all the effects produced by it must depend
on impressions made on the external surface of the body and lungs; and
the skin, which may be considered as a large expanded tissue of nervous
fibres endowed with universal sympathy and great sensibility, affects
every organ and every function of the body, according to the state of
the air in contact with it, whether cold or hot, moist or dry, pure or
vitiated. This sympathetic sensibility of the skin is chiefly affected
by the state of the perspiring pores on its surface; for it is only
when these are open that the impression of the air on the skin produces
catarrhs, rheumatisms, and internal inflammations in cold climates;
and the external temperature in hot climates being such as to keep
the pores almost always open, this seems to be a principal reason
of that universal irritability prevailing there, and of the general
sympathy that prevails between every part, particularly as connected
with the organs of perspiration[129]. This readiness of one part to be
affected by another in hot climates is well illustrated by the sudden
translation of certain diseases. I have seen, for instance, a catarrh
cease, and be converted, as it were, into a diarrhœa, and this as
quickly disappearing, a pain in the foot would arise, like an attack of
the gout. All this would happen in the space of a few hours.

But, in cold climates, wounds are by no means exempt from the locked
jaw; for it sometimes occurs in England, where I have seen it even in
the winter season[130].

Since my return to England I have received some new and useful
information on this subject in conversing with Dr. Warren, physician
to the King; and as any observations derived from so much acknowledged
skill and sagacity must be valuable, I shall here relate what he was so
kind as to communicate to me.

This eminent physician, in attending a case in which he was nearly
interested, and in which his endeavours were rewarded with success,
found the greatest benefit from opium and the warm bath. The opium was
given in the form of tincture, in moderate, but pretty frequent, doses.
The bath was composed of milk and water, and the addition of milk was,
no doubt, an improvement; for there is something in this as well as
oil extremely soothing to the human nerves. Dr. Warren had intended to
make trial of a bath of oil in case this had failed. He mentioned the
following observation, with regard to the external application of oil,
which could only have been suggested by that anxious attention that was
paid to the case. It was found, that the uneasiness arising from the
spasm was allayed by constantly drawing a feather wetted with oil over
the temples, which had an evident effect in lulling the pain and spasm;
for when this operation was left off, there was an immediate recurrence
of these symptoms[131].

It would appear, therefore, from this as well as the former cases,
that opium and the warm bath are the only remedies yet known which
are of service in this complaint, and much will depend on the
judicious management of them. The method of administering the opium,
recommended by Dr. Warren, seems to be the most judicious, especially
in constitutions not habituated to this medicine.

There is a certain medium in giving opium, by which its best effects
are obtained, for in an under dose it will produce disturbance instead
of rest; and when it is given in large quantities it frequently
defeats the very end for which it is given, by throwing the body into
convulsions which terminate in death. The rule for judging of the
proper limits of this dose is, by its effect in inducing that stupor
or insensibility which renders the senses incapable of irritation; for
in this, as well as in every other case of disease, the cure seems
ultimately to be the work of nature, the effect of medicine being only
a secondary operation, by which it removes some obstacle to the natural
efforts of the constitution. Though a dose of opium greater than
ordinary is required to produce this insensibility in cases of spasm,
and though the constitution in that situation will bear more, yet even
here it may be given to excess; and by beginning with small quantities,
and giving it in frequent rather than large doses, the constitution
will thereby be better reconciled to it, and it will also with more
convenience admit of that gradual increase which is peculiarly
necessary with this medicine. These ideas were suggested to me by Dr.
Warren; and it may be farther added, in recommendation of his method,
that the liquid form is preferable to the solid, as the effects of it
will sooner be seen, and a better judgement can be formed how far it is
proper to push it.

Great attention is also necessary in regulating the heat of the bath;
for if it is not sufficiently warm, it will not have the effect of
producing a due relaxation; and if it should be too hot, it will
stimulate too much, and will have the farther inconvenience of making
the patient very faint in a short time. It cannot be well regulated
without a thermometer, and 93° upon Fahrenheit’s scale is perhaps the
best temperature. I have kept a patient in a bath of that heat for six
hours, which he could not have endured for half an hour had the heat
been three or four degrees higher.

The circumstance next in consequence, in the cure of this complaint,
is the keeping up a moisture on the skin, and guarding the surface of
the body from the access of the air. This is particularly necessary
with regard to the part itself, which should be constantly enveloped in
warm, anodyne, and emollient applications. The good effects of this is
particularly exemplified in the case which recovered under the care of
Mr. Harris, who gave the diaphoretic medicine, composed of antimonial
wine and laudanum, and applied the anodyne cataplasm to the external
_fauces_. It was remarked, that the locked jaw was most incident to
those wounded men who lay in parts of the hospital where they were
exposed to a current of air; and the cases of tetanus that most usually
occur in the West Indies, independent of wounds, are those of slaves
who fall asleep in the night-time in the open air.

Since the first edition of this work, there has appeared an Essay on
the Locked Jaw by Dr. Rush, physician to the American army in the late
war, in which he recommends, from his own observation, Peruvian bark,
wine, and blisters, and to dress the wounds with mercurial ointment, in
the cure of this complaint. From some trials I have since made of the
bark in St. Thomas’s hospital, I have reason to think well of it as a
remedy in this disease.

There is a singular species of accident to which engagements at sea
are liable, the WIND OF A BALL, as it is called. If a cannon ball in
its flight passes close to any part of the body, it renders it livid
and numb for some time[132]. It is most dangerous when it approaches
the stomach; and there was an instance of a man in the last battle,
who, upon a ball passing close to his stomach, dropped down dead
instantaneously, without the least visible marks of injury. Another,
in consequence of a ball passing close to his belly, remained without
sense or motion for some time, and a large livid tumor arose on the
part, but he recovered. I attended a man at the hospital at Barbadoes,
who had the buttons of his trowsers carried off by a cannon ball,
without its having touched the body. The _pubis_ was livid and swelled
for some time after: he suffered exquisite pain from strangury, which
seemed to proceed from a _paralysis_ of the bladder, for he voided no
water without a catheter for near three months, after which time he
recovered. I know a brave young officer[133] in the army, who had his
epaulette carried off by a cannon ball at Charlestown, in consequence
of which the shoulder and adjacent parts of the neck were affected
for some time. A like accident happened to a marine officer in one of
the late engagements; but in neither of these was the head materially
affected, nor is it so apt to be affected in this way as the stomach.
I never knew death the consequence of the wind of a ball on the head;
though an officer[134] in the Sultan, at the battle of Grenada, was so
stunned by a shot passing near his temple, as to be insensible for some
time, but he recovered entirely in a few hours[135].

The class of wounds most peculiar to a sea engagement are scorches from
the accidental explosion of gunpowder; and in most of the campaigns
in which I have served they have been very frequent and fatal. Few
accidents, however, of this kind happened in the late engagements; so
that we had but little experience of this sort of wounds in April,
1782. But on former occasions they were very frequent, and the best
application to the burnt parts was found to be linseed oil, which
some of the surgeons mixed with lime water, others with cerusse, and
both compositions answered well. Opium was found of great use in
alleviating pain and procuring rest, care being taken to guard against
costiveness by the use of clysters. In the battles of 1780 and 1781,
one-fourth part of the whole killed and wounded was from this sort of
accident; but on the 9th and 12th of April, 1782, only two accidental
explosions of gunpowder happened in the whole fleet, by one of which
one life was lost, by the other, two. This difference was owing partly
to greater experience and habits of caution acquired in the course
of the war, and partly to certain improved methods in working the
artillery introduced by Sir Charles Douglas, which, like all his other
valuable improvements, tend to give facility and expedition, as well
as to save the lives of men. The circumstances which tend to prevent
explosions are, 1st, The wetting of the wads, which prevents their
inflaming and blowing back when they fight the weather side of the
ship; a circumstance which, without this precaution, gives occasion
to a number of accidents by the burning parts catching the loose
powder, or setting fire to the cartridges. 2dly, The use of goose-quill
tubes and small priming boxes, made of tin, instead of the large horns
formerly in use, whereby great quantities of powder were scattered
about and exposed to accidental fire. 3dly, The use of locks, which was
practised with great success in several ships, and was found to make
the operation both more safe and more expeditious.

It frequently happens that men bleed to death before assistance can
be procured, or lose so much blood as not to be able to go through
an operation. In order to prevent this, it has been proposed, and on
some occasions practised, to make each man carry about him a garter,
or piece of rope-yarn, in order to bind up a limb in case of profuse
bleeding. If it should be objected, that this, from its solemnity, may
be apt to intimidate common men, officers at least should make use of
some such precaution, especially as many of them, and those of the
highest rank, are stationed on the quarter deck, which is one of the
most exposed situations, and far removed from the cockpit, where the
surgeon and his assistants are placed. This was the cause of the death
of Captain Bayne, of the Alfred, who, having had his knee so shattered
with a round shot, that it was necessary to amputate the limb, expired
under the operation, in consequence of the weakness induced by loss
of blood in carrying him so far. As the Admiral, on these occasions,
allowed me the honour of being at his side, I carried in my pocket
several tourniquets of a simple construction, in case accidents to any
person on the quarter deck should have required their use.

It sometimes happens, however, that no hæmorrhage arises from a limb
being carried off by a ball. The surgeon of the Fame related to me an
instance of this, in which the thigh was cut through by a shot near
its upper part, all except a little flesh and skin, and yet not the
least hæmorrhage followed. This may have been owing to the limb being
entirely severed, or nearly so, whereby the vessels contracted more
easily than if they had been partially divided. All that was done for
this man was to remove the limb, and to saw off the jagged end of the
bone. He survived six days, still without bleeding, and died of the
locked jaw.

I was informed by several of the surgeons, that the method of taking up
the vessels by the _tenaculum_ was found to answer extremely well; and
many of them imagined that the locked jaw was not so apt to be brought
on by this mode of operation as by that of the needle. But it is hardly
to be attempted in time of action, for want of steadiness and a good
light, and it was chiefly at the hospitals that this practice was found
so successful.

Mr. Alanson’s method of amputation by a great retraction of the
muscles, so that the fleshy parts shall meet over the bone and unite
in the first intention, was attended with great success in the West
Indies, particularly at the hospital at St. Lucia, under the care of
Mr. Bulcock.

It may be remarked, that though all sores and wounds in the foot and
leg are difficult of cure in a hot climate, I have observed, that,
where the constitution is good, those in the thighs, arms, trunk, and
head, are rather more easy of cure than in Europe, and that parts
divided by incision very readily unite by the first intention. In
reasoning upon this, it may be said, that as healing depends on a
certain degree of vigour in the powers of life, this should not err
either on the side of excess or defect. If it is too great, as in the
case of a hale, plethoric constitution in a cold climate, too much
inflammation is apt to be excited; and if too feeble, as happens in
a hot climate, in the lower extremities, which are far removed from
the source of life and circulation, the salutary effort is not strong
enough to generate new organised parts. But in the trunk of the body,
in such a climate, the powers of the animal œconomy are in that just
medium which is most favourable to this operation of nature.


THE END.


APPENDIX

TO

PART III.

It has been suggested to me, that it would add to the utility of this
Work to subjoin a list of the remedies best suited to the practice of
physic at sea, with their quantities, and to give a set of formulas
for the direction of young practitioners. I have accordingly made out
a gross computation of the requisite quantities of the most useful
and necessary articles of the Materia Medica, and also a few of the
most commodious and simple forms of administering some of the most
efficacious remedies for the most common diseases.

It is of consequence every where, but especially on board of a ship,
to simplify practice, as much as possible, with regard to the number,
the preparation, and the administration of medicines. Where a great
number of compound medicines are given, it is extremely difficult to
ascertain, by accurate and satisfactory observations, what are their
real effects; and as there are not conveniences at sea for great
pharmaceutical nicety, the plainest forms should be adhered to. And as
all operations are rendered more practicable and easy by being reduced
to a stated method, this is an additional inducement for studying
plainness and simplicity in preparing and administering remedies. This
uniformity is more attainable in the public service than in private
practice; for in the former all the patients are of one sex, they are
all adults, and they are generally of robust constitutions.

In the list hereto subjoined the articles are distinguished into
PRINCIPAL and SECONDARY; and when a surgeon considers how limited his
funds are, I hope he will not think that I have made a disproportionate
assortment in reducing the number and quantities of the latter, my view
in this having been that he may better afford an ample proportion of
such medicines as are really efficacious and indispensable in the cure
of diseases. It may be affirmed, without vanity or arrogance, that the
printed list of articles with which the navy surgeons are enjoined to
supply themselves is very injudicious considering the present improved
state of the medical art; and it is of great importance that the
due proportion of each article should be ascertained as nearly as
possible, that no unnecessary expence may be incurred, and that the
chest may not be encumbered with unnecessary articles.

There are no simple distilled waters in the following list, as they
are very corruptible, and too bulky to carry to sea. Their place is
supplied by a small quantity of oil of mint, which may be occasionally
added to common water, in the proportion of a drop to an ounce. There
are no tinctures inserted, except laudanum, the traumatic balsam, and
compound spirit of lavender, as the surgeon, having a proper supply of
spirit of wine or rum, may make them on board of the ship.

In the following list the surgical articles are not enumerated. There
is a new article which I beg leave to recommend, as it has lately been
found extremely useful, and is now used in large quantities in the
hospitals in London. This is linseed meal for poultices. The surgeon
should also be provided with a sufficient quantity of linseed oil, as
it has been found to be one of the best ingredients in dressings for
scorches. See page 540.

The quantity of each article is adapted to an hundred men for one year,
so that a calculation can easily be made for any number of men, and for
any length of time.


  ASSORTMENT OF MEDICINES

  TO BE

  CARRIED TO SEA,

  FOR

  ONE HUNDRED MEN, FOR ONE YEAR.


PRINCIPAL ARTICLES.

Peruvian bark, ten pounds, and if the ship is destined for a hot
climate, twenty pounds. This article should be provided by the Public.
See p. 359.--Calomel, two ounces and a half--_a_ Emetic tartar, one
ounce and a half--Ipecacoanha, four ounces--Opium, one ounce--_b_
Purging salts, ten pounds--Senna leaves, two pounds.


SECONDARY ARTICLES.

Aloes, half an ounce--Ammoniacum, two ounces--Balsam of copaiva,
three ounces--_c_ Traumatic balsam, four ounces--Camphor, three
ounces--Cantharides, one ounce--Capsicum, three drachms--Castor, an
ounce and a half--Chamæmile flowers, or hops, two pounds--Cinnamon,
an ounce--Prepared chalk, or oystershells, six ounces--Conserve of
roses, half a pound--_d_ Cordial confection, two ounces--_e_ Cathartic
extract, half an ounce--Extract of hemlock, three ounces--Extract of
logwood, one ounce--Gentian, five ounces--Ginger, three ounces--Gum
arabic, four ounces--Gum guaiacum, three ounces--Powder of jalap,
one ounce and a half--_f_ Laudanum, four ounces--Linseed, one
pound--Magnesia, six ounces--Manna, eight ounces--Whole mustard seed,
half a pound--Myrrh, four ounces--_g_ Crude mercury, two ounces--


_Names in the last Edition of the London Pharmacopœia._

_a_ Antimonium tartarisatum.--_b_ Either Glauber’s salts, natron
vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s
salt answers better in a hot climate, being less deliquescent
from the heat and moisture of the climate.--_c_ Balsamum benzoes
compositum.--_d_ Confectio aromatica;--_e_ Extractum colocynthidis
compositum.--_f_ Tinctura opii.--_g_ Hydrargyrus.

_a_ Corrosive sublimate, an ounce--Nitre, eight ounces--Oil of
almonds, one pint--_b_ Castor oil, half a pint--Linseed oil, three
pints--Essential oil of mint, one ounce--_c_ Jamaica pepper, four
ounces--_d_ Blistering plaster, ten pounds--Quaffia, eight ounces--Salt
of hartshorn, two ounces--_e_ Salt of steel, half an ounce--_f_ Salt of
wormwood, ten ounces--Castile sope, half a pound--Sarsaparilla, three
pounds--Serpentary, four ounces--Spermaceti, four ounces--Rectified
spirit of wine, one pint--_g_ Weak spirit of vitriol, half a pint--_h_
Volatile aromatic spirit, half a pint--_i_ Spirit of Mindererus,
two pints, or the volatile salt and vinegar may be kept separately,
and added occasionally--Spirit of turpentine, four ounces--Dried
squills, half an ounce--Flowers of sulphur, one pound--Golden sulphur
of antimony, half an ounce--Cream of tartar, one pound--Vinegar, six
pints--_j_ White vitriol, six drachms--Wormwood, one pound--_k_ Flowers
of zinc, two drachms.


 NECESSARIES _to be put in charge of the Purser, and served out to the
 Sick in place of the common sea provisions. See page 358._

BARLEY, three hundred pounds--Eggs, greased and put in salt, twenty
dozen--Extract of spruce, twelve pounds--Lemon juice clarified, and
preserved by adding to it a small proportion of ardent spirits, five
gallons--Raisins, fifty pounds--Rice, two hundred pounds--Coarse sugar,
one hundred pounds--Sago, twenty pounds--Salep, ten pounds--Portable
soup, fifty pounds--Tamarinds, ten pounds--Best white wine, three
hundred gallons--Best red wine, one hundred gallons.


_Names in the last Edition of the London Pharmacopœia._

_a_ Hydrargyrus muriatus.--_b_ Oleum ricini.--_c_ Pimento.--_d_
Emplastrum cantharidis.--_e_ Ferrum vitriolatum.--_f_ Kali
præparatum.--_g_ Acidum vitriolicum dilutum.--_h_ Spiritus ammoniæ
compositus.--_i_ Aqua ammoniæ acetata.--_j_ Zincum vitriolatum.--_k_
Zincum calcinatum.




FORMULÆ QUÆDAM

MEDICAMENTORUM

IN MEDICINA FACIENDA APUD NAUTAS

ACCOMMODATIORES.


IN FEBRE CONTINUA.


PULVIS EMETICUS COMMUNIS.

 ℞. Pulveris radicis ipecacoanhæ grana decem, antimonii tartarisati
 grana duo, misce.


MISTURA CATHARTICA COMMUNIS.

 ℞. Foliorum fennæ uncias sex, aquæ ferventis libras sex. Macera donec
 pene refrixerit & adjice vel natri vitriolati vel magnesiæ vitriolatæ
 libram unam cum semisse. Dein cola & admisce tincturæ sennæ uncias
 octo. Dosis est ad uncias tres.--Interdum conducit adjicere singulis
 dosibus, vel pulpæ tamarindo um semunciam, vel mannæ semunciam, vel
 antimonii tartarisati semigranum, vel pulveris jalapìi grana decem.


ENEMA COMMUNE.

 Aquæ marinæ tepidæ uncias duodecim.


POTUS COMMUNIS.

 Decoctum hordei.--Conveniat adjicere singulis libris pro re natà, vel
 pulpæ tamarindorum unciam dimidiam, vel crystallorum tartari drachmam
 unam, vel nitri scrupulum unum, vel acidi vitriolici diluti guttas
 decem, vel succi limonum unciam unam, vel gummi arabici scrupulos
 duos, vel vini uncias quatuor, vel frustum panis tosti.


VINUM EMETICUM.

 [136]℞. Antimonii tartarisati scrupulos duos, aquæ ferventis uncias
 duas, vini albi uncias octo. Solve antimonium in aquâ & adde vinum.
 Assumatur drachma una omni quadrante horæ, donec vel vomitus cieatur,
 vel alvus moveatur. Deinde assumatur semi-drachma sextâ quâque horâ.


PILULA FEBRIFUGA.

 ℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi Dris.
 James drachmam unam, conservæ rosæ quantum latis sit. Simul contunde
 & divide in pilulas duodecim. Deglutiatur una quartâ vel sextâ quâque
 horâ.


MISTURA SALINA ET ANTIEMETICA.

 ℞. Kali præparati drachmam unam, succi limonum, vel aceti, vel acidi
 vitriolici quantum satis sit ad saturandum salem, aquæ puræ uncias
 sex. Bibatur tertia pars ter die.--Conducit pro re nata adjicere,
 vel pulveris antimonialis grana quinque, vel acidi vitriolici diluti
 guttas quinque, vel cretæ præparatæ scrupulum unum, vel aquæ menthæ
 semunciam.--Interdum conducit sumere hanc misturam statim postquam
 Kali & succus limonum mixta fuerit, scilicet in ipsâ ebullitione. Hoc
 imprimis utile est quando vomitus vel nausea molestus sit, & licet
 adhibere magnesiam vice Kali, & acetum vice succi limonum.


[137]PILULA DIAPHORETICA.

 ℞. Opii purificati grana duodecim, antimonii tartarisati grana sex,
 conservæ rosæ semi-drachmam, farinæ glycirrhizæ, vel tritici quantum
 satis sit. Contunde simul & divide in pilulas viginti quatuor.
 Devoretur una horâ somni. Interdum prosit dare unam bis die.


[138]MISTURA SEDATIVA.

 ℞. Misturæ camphoratæ uncias sex, tincturæ opii guttas viginti Misce.
 Bibatur tertia pars ter die.--Aliquando conducit admiscere singulis
 dosibus aquæ ammoniæ acetatæ drachmas tres, vel vini emetici guttas
 triginta.


[139]BOLUS SEDATIVUS.

 ℞. Confectionis aromaticæ scrupulum unum, opii purificati grani
 quartam partem, castorei Russici grana decem, tincturæ opii guttas
 quatuor. Misce. Assumatur sextâ quâque horâ.


BOLUS SERPENTARIÆ COMPOSITUS.

 ℞. Pulveris serpentariæ Virginianæ grana decem, camphoræ grana
 quatuor, confectionis aromaticæ quantum satis sit. Assumatur ter
 die.--Interdum conducit addere pulveris corticis Peruviani drachmam
 dimidiam, vel superbibere decocti corticis Peruviani uncias duas.


ELECTUARIUM AD CONVALESCENTES.

 ℞. Pulveris corticis Peruviani, florum chamæmeli, singulorum unciam
 unam, pulveris zinziberis scrupulos duos, syrupi quantum satis
 fit. Dosis est circiter drachma ter die.--Interdum adjiciantur vel
 rubiginis ferri drachmæ tres, vel pulveris terpentariæ Virginianæ
 drachmæ duæ.


IN FEBRE INTERMITTENTE.

Adhibeantur in initio eadem medicamenta ac in initio febris continuæ.
Deinde

Sumatur corticis Peruviani drachma una, secundâ vel tertiâ quâque horâ,
vel etiam singulis horis, absente paraxysmo febrili.--Interdum confert
dare singulas doses ex spiritûs vini tenuis (_rum_ dicti) unciâ unâ.

Si cortex frustra adhibeatur fauste adhiberi possint medicamenta infra
præscripta.

 [140]℞. Zinci calcinati semi-drachmam, conservæ rosæ quantum satis
 fit. Contunde simul & divide in pilulas quindecim. Sumatur una ter
 die, augendo dosim si premerit morbus & si ferat ventriculus.


Vel,

 ℞. Zinci vitriolati grana duodecim aquæ puræ uncias tres Sumatur
 tertia pars ter die augendo dosim si opus fuerit & si ferat
 ventriculus.


Vel,

 [141] ℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas sex.
 Misce. Sumatur paucas horas ante paroxysmum.


Vel,

 [142] Cortice Peruviano frustra dato, aliquando conferat dare ægro
 quotidie, vel calomelanos, vel pilularum ex hydrargyro quantum &
 quamdiu sufficiat ad levem ciendum ptyalismum, & deinde instituere
 curam de integro cum cortice Peruviano.


Vel,

 [143] Sumantur tincturæ



 IN DIARRHŒA SIMPLICI.


 BOLUS AD DIARRHOEAM.

 ℞. Cretæ præparatæ scrupulum unum, pulveris rhabarbari grana
 quindecim, pulveris corticis cinnamomi grana sex, opii purificati
 granum dimidium, tincturæ opii guttas quinque, syrupi quantum satis
 fit. Semel sumatur.

 ℞. Misturæ cretaceæ (Pharm. Lond.) cum duplici gummi arabico libram
 unam, tincturæ opii guttas decem. Absumatur totum partitis vicibus
 nychthemero, incipiendo duodecim horas post datum medicamentum
 novissime præscriptum.--Interdum adjiciatur tincturæ cinamomi uncia
 dimidia.


IN CHOLERA MORBO.

 ℞. Decocti hordei vel avenæ libras tres, pulveris gummi arabici unciam
 unam cum semisse, tincturæ opii guttas triginta. Hauriatur quam primum
 libra una, & deinde libra dimidia omni horâ usque ad levamen mali.--Si
 parabilis fuerit caro vitulina, vel pullus, jusculum tenue ex altero
 utro factum vice decocti supra dicti adhibeatur.


IN DYSENTERIA ACUTA.

Sumat æger quamprimum emeticum commune.

 ℞. Decocti hordei libras duas, salis cathartici unciam unam cum
 semisse, antimonii tartarisati grana duo. Misce. Hauriatur tepide
 primò libra dimidia, & deinde unciæ quatuor omni horâ donec alvus
 copiose & iteratim dejecerit.

 ℞. Pulveris ipecacoanhæ grana duodecim, conservæ rosæ quantum satis
 fit. Contunde simul & divide in pilulas duodecim. Sumatur una ter die.
 Si æger vehementer febricitârit satius erit dare ter die vini emetici
 drachmam unam ex cyatho amplo decocti hordei tepidi.

 [144]℞. Pulveris ipecacoanhæ grana duo, pulveris opii purificati
 exsiccati granum unum, nitri grana octo. Misce. Sumatur horâ somni.


ENEMA EMOLLIENS.

 ℞. Amyli unciam dimidiam, aquæ puræ uncias decem. Coque ad idoneam
 spissitudinem.


Vel,

 ℞. Seminum lini drachmas sex, aquæ puræ uncias duodecim. Coque per
 quadrantem horæ & cola liquorem pro enemate.


ENEMA ANODYNUM.

 ℞. Enematis emollientis uncias quatuor, tincturæ opii guttas
 quadraginta. Misce.


IN DYSENTERIA CHRONICA.


BOLUS CATHARTICUS.

 ℞. Pulveris rhabarbari grana quindecim, calomelanos grana quinque,
 conservæ rosæ quantum satis fit ut fiat bolus. Mane sumendus, &
 repetendus post paucos dies si opus fuerit.--Vice hujus interdum
 conducat dare misturæ catharticæ communis uncias duas.


SOLUTIO CAMPECHENSIS.

 ℞. Extracti ligni Campechensis drachmam unam cum semisse, tincturæ
 cinamomi unciam unam. Tere simul & admisce aquæ puræ uncias quinque.
 Sumatur uncia una ter die.


DECOCTUM AMARUM.

 ℞. Corticis simaroubæ vel quassiæ drachmam unam, aquæ puræ libram unam
 cum semisse. Decoque ad libram unam. Absumatur totum quotidie tribus
 vicibus. Adjici possint singulis dosibus pro ratione symptomatum, vel
 cretæ præparatæ scrupulus unus, vel pulveris ipecacoanhæ granum unum,
 vel tincturæ cinamomi drachmæ duæ, vel tincturæ opii guttæ quinque.

 [145]In casibus rebellibus confert illinere quotidie hypogastrium
 unguenti ex hydrargyro drachmâ dimidiâ.

 Sit pro potu communi in hoc morbo aqua pura, frusto panis recens tosti
 adjecto, & pauxillo spiritus vini tenuis (_rum_ dicti) admixto. Sit
 pro victu communi salab, vel farina tritici in pulmentum tenue ex aquâ
 purâ cocta.


IN INTESTINIS INFLAMMATIS.

[146]SOLUTIO SALIS CATHARTICI.

 ℞. Decocti hordei libram unam, magnesiæ vitriolatæ uncias duas. Misce
 ut fiat solutio. Bibatur, post sanguinis missionem, uncia una omni
 semihorâ donec alvus bis dejecerit.

 Adhibeantur hypogastrio cucurbitulæ cruentæ, vel hirudines plures.
 Applicetur ibidem epispasticum satis amplum. Injiciatur enema cum oleo
 & pauxillo sale cathartico.


IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus æstuosis _DRY
BELLY ACHE_ dicto.

[147]PILULÆ CATHARTICO-ANODYNÆ.

 ℞. Extracti colocynthidis compositi drachmam dimidiam, opii granum
 unum & dimidium, olei menthæ guttam unam. Contunde in massam & divide
 in pilulas decem. Sint pro una dosi. Paucas post horas, si alvus non
 rite responderit, exhibeantur misturæ catharticæ unciæ duæ, vel[148]
 olei ricini uncia una, & repetantur ut opus fuerit.--Interdum in hoc
 malo divexat vomitus cui auxilio est, mistura antiemetica. Vide page
 551.

 Perfricetur hypogastrium oleo tepido.

 Ineat æger in balneum tepefactum ad 93° therm. Fahren. per horam unam
 vel etiam diutius.

 Denique suffletur in anum fumus nicotianæ.


Vel,

 ℞. Nicotianæ drachmas duas aquæ puræ ferventis libram unam.--Fiat
 infusum & cola pro enemate.


IN HÆMORRHÖIDE.


BOLUS HÆMORRHOIDALIS.

 ℞. Florum sulphuris drachmam dimidiam, conservaæ rosæ, vel pulpæ
 tamarindorum quantum satis fit. Assumatur bis die.

 Si sanguinis ex ano profluentis magna fuerit vis, & præcipue si ex
 alto fonte effluxerit, valde proderit medicamentum infra præscriptum.

 [149]℞. Olei lini recens expressi drachmas sex, tincturæ rhabarbari
 drachmas duas. Misce. Sumatur bis die.--Vice olei lini adhibere licet
 olei amygdalæ unciam dimidiam, cum mucilaginis gummi arabici drachmis
 duabus.


IN ALVO ASTRICTA.

PILULÆ LAXANTES.

 ℞. Aloes socotrinæ drachmam unam, syrupi quantum satis sit. Contunde
 & divide in pilulas viginti. Sumantur duæ pro re natâ.--Aliquando
 conducit adjicere vel pulveris zinzberis vel pulveris capsici grana
 quindecim, vel olei menthæ guttas decem.--Vice aloes licet adhibere
 extractum colocynthidis compositum.


ELECTUARIUM ECCOPROTICUM.

 ℞. Pulveris jalapii unciam dimidiam, pulpæ tamarindorum unciam unam,
 pulveris zinziberis semi-drachmam, syrupi _melasses_ dicti quantum
 satis sit. Sumatur circiter drachma pro re natâ.--Interdum prosit
 adjicere crystallorum tartari drachmas duas.


IN CATARRHO.


LINCTUS.

 ℞. Conservæ rosæ unciam unam, mucilaginis gummi arabici unciam
 dimidiam, olei amygdalæ drachmas duas, succi limonis, vel acidi
 vitriolici quantum satis sit ad gratum saporem conciliandum. Misce.
 Sumatur pauxillum sæpius.--Interdum adjiciatur vel salis nitri drachma
 una, vel tincturæ opii guttæ decem.

 Sit pro potu communi decoctum hordei in quo coquatur uvarum passarum
 uncia una, & sub finem cocturæ seminum lini drachmas duas pro singulis
 libris decocti.

 Si febricitârit æger, sumantur mistura salina & pilula febrifuga ter
 die.


IN PLEURITIDE ET PERIPNEUMONIA.

 ℞. Decocti hordei libras duas, pulpæ tamarindorum quantum satis-fit ad
 gratum saporem, nitri drachmam unam. Misce. Hauriatur affatim pro potu
 communi. N. B. Si tamarindi moverint alvum sæpius quam semel aut bis
 die adhibeatur vice ejus syrupus _melasses_ dictus.

 Sumatur mistura salina & pilula febrifuga sextâ vel quartâ quâque horâ.


IN HÆMOPTÖE.

Hauriat æger infusi rosæ uncias tres quater die. Interdum adjiciatur
vel tincturæ opii guttæ quatuor, vel nitri grana decem.


HAUSTUS OLEOSUS.

 [150]℞. Olei amygdalini, aquæ menthæ simplicis singulorum unciam unam,
 manræ drachmas tres. Misce. Sumatur ter die. Sæpe conducit adjicere
 singulis dosibus tincturæ opii guttas quatuor vel quinque.


IN TUSSI ASTHMATICA.


PILULÆ PECTORALES.

 [151]℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis drachmas
 duas, pulveris radicis scillæ grana sex opii purificati grana tria,
 syrupi _melasses_ dicti quantum satis sit. Contunde simul & divide in
 pilulas quadraginta octo. Sumantur quatuor bis die.


IN ASTHMATE A DIATHESI HYDROPICA PROVENIENTE.


PILULÆ SCILLITICÆ.

 ℞. Radicis scillæ aridæ grana duodecim, conservæ rosæ quantum satis
 sit. Contunde simul & divide in pilulas duodecim. Sumatur una vel duæ
 bis vel ter die.


Vel,

[152]HAUSTUS DIURETICUS.

 ℞. Aquæ puræ unciam unam & dimidiam, pulveris scillæ aridæ grana duo,
 tincturæ lavendulæ compositæ guttas trigintæ, kali præparati grana
 decem. Misce. Sumatur bis vel ter die.--Interdum adjicere liceat
 haustui vespertino tincturæ opii guttas viginti.


Vel,


BOLUS CÆRULEUS CUM SCILLA.

 [153]℞. Pilularum ex hydrargyro grana quinque vel usque ad decem,
 pulveris radicis scillæ grana duo. Misce. Sumatur horâ decubitûs, per
 tres vel quatuor noctes consequentes.


IN RHEUMATISMO ACUTO.


MISTURA DIAPHORETICA.

 ℞. Aquæ puræ uncias tres, aquæ ammoniæ acetatæ unciam unam & dimidiam,
 pulveris antimonialis grana quindecim. Sumatur tertia pars ter
 die.--Interdum adjiciantur nitri grana quinque singulis dosibus.

 Bibatur affatim decoctum hordei tepidum, cum nitri scrupulis duobus in
 singulis libris.


HAUSTUS SUDORIFICUS.

 ℞. Misturæ camphoratæ unciam unam & dimidiam, aquæ ammoniæ acetatæ
 unciam dimidiam, vini emetici guttas quadraginta, tincturæ opii guttas
 viginti. Misce. Sumatur horâ somni, vel etiam sæpius sed cum dimedia
 tinctura.


IN RHEUMATISMO CHRONICO.

 ℞. Tincturæ guaiaci volatilis drachmas duas. Sumatur ex cyatho potûs
 communis ter die. Vel sumatur gummi guaici semidrachma super bibendo
 haustum ex salis cornu cervi serupula aquæ unciis tribus.

 ℞. Pulveris ipecacoanhæ compositi (Pharm. Lond.) scrupulum unum.
 Sumatur hora somni alternis noctibus.

 In casibus rebellibus pro remedio efficaci compertum est dare quotidie
 calomelanos granum unum vel grana duo.


IN HYDROPE.


PULVIS HYDRAGOGUS.

 ℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana
 quindecim, pulveris zinziberis grana quinque. Misce fiat pulvis,
 fumatur alternis diebus.


MISTURA DIURETICA.

 ℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias duas,
 kali præparati drachmam unam. Misce. Hauriamur unciæ tres bis
 die.[154]Vice infusi gentianæ licet adhibere infusum absynthii.


TINCTURA SCILLÆ. Pharm. Lond.

Sumatur drachma una bis die ex haustu potûs communis.


PILULA EX ELATERIO.

 ℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur in
 pilulas sex. Sumatur una bis die.

 [155]Ægro licet, imo prodest hoc morbo laboranti bibere ad libitum ex
 liquore aliquo siti extinguendæ accommodato, veluti aquâ hordei cum
 crystallis tartari.


IN ERYSIPELATE.

 [156]℞. Pulveris corticis Peruviani drachmam unam. Sumatur omni horâ
 vel interpositis duabus vel tribus horis.


IN MORBO VENEREO.


1. IN GONORRHOEA.

Hauriatur ad libitum infusum lini, vel decoctum hordei cum gummi
arabici drachmis sex in singulis libris.

Sumantur calomelanos grana duo quotidie per viginti circiter dies.

 [157]℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati granum
 unum. Misce. Injiciatur pauxillum in urethram bis vel ter die.


IN GONORRHOEA BENIGNA.

 ℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ guttas
 triginti. Misce. Sumatur bis die.


2. IN ULCUSCULIS.

In initio feliciter adhibetur causticum.

 ℞. Calomelanos drachmam dimidiam, conservæ rosæ quantum satis sit.
 Contunde in massam & divide in pilulas triginta. Sumatur una quotidie,
 vel interdum dimidia ter die, ut cieatur ptyalismus modicus. Perstet
 æger in usu medicamenti hujus per dies acto postquam sanata fuerint
 ulcuscula.

 Pro medicamento topico, utile erit inspergere ulcusculum cum pulvere
 hydrargyri nitrati.


3. IN BUBONE.

Illinatur artus lateris affecti infra inguen cum unguenti ex hydrargyro
drachmâ dimidiâ quotidie.

Si abierit bubo in ulcus mali moris omittatur pro tempore usus
hydrargyri & sumatur quotidie [158]opii purificati granum unum primo
semel, dein bis, denique ter die vel etiam sæpius, & pulveris corticis
Peruviani drachma una ter quaterve die.--Interdum conducit sumere
pulveris sarsæparillæ drachmas duas ter die, vel extracti cicutæ grana
tria ter die, augendo paullatim usque ad grana decem.


4. IN VERA LUE, anginâ scilicet osteocopiis, exostosibus & defædatione
cutis.

Illinantur membra quotidie cum unguenti ex hydrargyro drachmis duabus
quotidie usque dum cieatur ptyalismus[159] per dies triginta ad
minimum vel donec evanuerint symptomata.--Interdum vice litûs adhibere
conveniat vel calomelanos granum unum ter die, vel pilularum ex
hydrargyro grana quinque bis die, vel

 ℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram
 unam. Fiat solutio, & sumatur uncia dimidia bis die. In ulceribus
 tonsillarum pernotabili est auxilio suffitum ex cinnabare in fauces
 inhalare semel vel bis quotidie.

 Si ulcera mali moris exorta fuerint in quavis corporis parte, eadem,
 ut jam de bubone dictum est, fiant.


IN SCORBUTO MARINO.

Sumat æger quotidie succi limonum unciam unam ter quaterve die.

 ℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi _melasses_
 dicti libras sedecim pondere, extracti pini uncias octo pondere,
 spumæ vel fæcis cerevisiæ libras duas mensurâ. Misce & agita valide
 cum baculo, dein sinatur abire in fermentationem, ut fiat cerevisia,
 deinde servetur in vase clauso. Ut diutius servari potest, proderit
 admiscere spiritûs vini tenuis Gallici, vel qui _rum_ dicitur, libras
 duas aut tres. Si infirma fuerint viscera adjicere juvabit vel lupuli
 vel summitatum absinthii vel quassiæ, vel zinziberis quantum satis
 sit. Hauriat æger libras duas quotidie.

 ℞. Farinæ avenaceæ libras tres, aquæ puræ congios quatuor. Misce.
 Macera donec liquor fiat acidulus, dein effunde dimidium & adjiciatur
 par copia aquæ puræ, & coque ad idoneam spissitudinem, ut cogatur in
 pulmentum. Sit pro victu assiduo cum vini & sacchari non purificati,
 vel syrupi _melasses_ dicti quantum sufficiat ad gratum saporem
 conciliandum.

 Ad alvum solvendam commode adhiberi potest electuarium eccoproticum
 cum crystallis tartari. Vid. p. 556.


THE END.




INDEX.


  A.

  ABSORBENTS useful in fluxes, 491, _& seq._

  _Action_, close, the advantages of it, 103, _& seq._

  _Air_, superiority of that at sea, 225.
    --Noxious effects of it at land in a hot climate, 227.
    --Extent of its influence, 228.

  _Alcide_, sickly on the passage to America, 36.
    --Subject to various forms of fevers, 39.

  _Aliment_, want of proper, chief cause of scurvy, 300.
    --Increases the vigour of the body in two ways, 510.

  _America, North_, hotter in summer than the West Indies, 30.
    --Fleet goes there to avoid the hurricanes, 35, 146.
    --Uncommon season there, 156, _& seq._

  _Amputation_, the number that died of it at Barbadoes, 190.

  _Amputation_, Mr. Alanson’s method of performing it, 543.

  _Antimonials_, best adapted to bilious fevers, 420.
    --A caution with regard to them, 422.

  _Army_ at St. Lucia, diseases in it, 127.
    --Mortality in it, 27, 228, _& seq._

  _Asthma_, climate in the West Indies favourable to it, 97.


  B.

  _Barbadoes_, more refreshments at it than any other island, 27.
    --Ravaged by a hurricane, 41.
    --Composed of coral rock, 89.
    --Conjecture concerning its origin, _ibid._

  _Barfleur_, fevers on board in consequence of recruits from a French
        jail, 142.

  _Bark, Peruvian_, its effects in preventing fevers, 230, _& seq._
    --When useful in continued fevers, 390, _& seq._, 402, 422, _& seq._

  _Bark, Peruvian, red_, some account of it, 457.

  _Barricading a ship_, what meant by it, 21.

  _Bath, warm_, of use in the dysentery, 480.
    --In the locked jaw, 522.
    --Its proper temperature, 535.

  _Battle_, the ardour of, favourable to health, 22, 77, 101.
    --Number killed in, 209.
    --Loss in those of April, 1782, 520.

  _Bedding_, utility of airing it, 260.

  _Bile_, a defect of it in the worst cases of yellow fever, 429,
     _& seq._
    --Theoretical disquisition on its influence in fevers, _ibid._

  _Bile_, the marks of a redundance of it in dysenteries, 477.
    --Its tendency to prolong fluxes, 483, _& seq._

  _Blindness_ from the scurvy, 24, 501.

  _Blisters_ of use in the ship fever, 399.
    --For removing irritability of stomach in the yellow fever, 453,
      _& seq._
    --Of service in dysentery, 480, _& seq._

  _Blood_, a remark concerning the buff upon it, 450.

  _Bloodletting_, cautions with regard to it in ship fevers, 388.
    --In bilious fevers, 418.
    --In the yellow fever, 450.

  _Butter_, objections to its use, 310.


  C.

  _Calomel_, in certain cases, the best purgative, 421.

  _Camphor_, estimate of its virtues, 407.

  _Catarrh, epidemic_, one in Europe affected men at sea, 157.
    --Communicated by strangers not affected with it themselves, in one
      of the Western Islands, 244.

  _Causes_, a combination of them necessary to produce diseases, 126,
      _& seq._

  _Chronic complaints_ brought on by hardship, 218.

  _Cleanliness_ the principal means of health, 254, 337.

  _Clothing_, its great influence upon health, 238.
    --Advantages and disadvantages of it, 334, _& seq._

  _Cocoa_ substituted, with advantage, for butter, 311.

  _Cold_ favourable to infection, 258.

  _Cold_ hurtful in all climates, 297.

  _Colica pictonum_, forms of medicines adapted to it, 555.

  _Coma_, a symptom in the ship fever, 373.

  _Commission, Ships long in_, most healthy, 54, 79, 93, 167.

  _Constitution_, the great variety of it, 294.
    --Regard to be had to it in practice, 406.

  _Coppers_, cautions with regard to them, and instance of poison from
      neglect of them, 317, _& seq._

  _Cordials_, a caution with regard to them, 410.

  _Crowding_, bad effects of it, 192.

  _Cruises_ to windward of Martinico, 48, 180.
    --Near Jamaica, 120.
    --How long they ought to be continued
  consistent with health, 148, _& seq._
    --A long one off St. Domingo, without the scurvy appearing, 154,
        _& seq._

  _Cullen, Dr._, his opinion of the origin of nervous fevers, 237.
    --His great merit, 445.


  D.

  _Delirium_, a remarkable symptom in the ship fever, 373.
    --Explanation of it, _ibid._, _& seq._
    --Means of removing it, 398, _& seq._
    --Sudden and violent in bilious fevers, 416.

  _Diaphoretic_, what safest and best, 395.

  _Diet_, a table of the daily allowance of it in the navy, 311.
    --A method of providing what is suitable to the sick, 335.

  _Diet_, a caution with regard to it in convalescent fevers, 358.

  _Diet_, what best in fluxes, 494, _& seq._

  _Dilution_, the great advantage of it, 391, _& seq._

  _Discipline_, advantage of, to health, 348, 355.

  _Diseases_, list of all those on board of the fleet, 94.
    --What sorts seamen are most subject to, and most exempt from, 216.

  _Diseases_, acute, tend naturally to wear themselves out, 70.
    --Imputed anciently to supernatural influence, 220.
    --Owing to neglect, _ibid._

  _Dropsy_, medicines adapted to it, 558.

  _Dysentery_ depends on the same cause as fevers, 36.
    --Arises in the Prince George from cold weather, 79.
    --More fatal in its acute state in a cold than a hot climate, 155.

  _Dysentery_, appearances upon dissection, 471, _& seq._

  _Dysentery_, forms of medicines adapted to it, 553.


  E.

  _Earthquakes_ frequent in the West Indies, 88.

  _Effluvia_, what kind of them produce diseases, 134, _& seq._

  _Elephantiasis_, peculiar to Barbadoes, 235, _& seq._

  _England_, health of the fleet there compared to that in the West
      Indies, 67, _& seq._
    --Fleet there more sickly at particular periods than in the West
      Indies, 208.

  _English_, their cleanliness only of modern date, 282.

  _Erasmus_, his account of the causes of pestilential diseases in
      England, 282.

  _Erysipelas_, Peruvian bark the best medicine in it, 558.

  _Exercise_, the advantage of it, 343.

  _Exercise_ in the sun very pernicious, 233.

  _Expeditions_, list of, frustrated by disease alone, 214.

  _Explosions_ of gunpowder, frequent and destructive, 539.
    --Means of preventing them, 540.


  F.

  _Fatigue_ tends to shorten life, 346.

  _Fevers_ depend on the same cause as fluxes, 36, _& seq._
    --More prevalent in port than fluxes, 113, 127.
    --Assume a different type upon the importation of infection, 182.
    --Difference of its infection from that of some other diseases,
        244, 249.

  _Fever, ship_, description of it, 371.
    --Treatment of it, 386.

  _Fever, inflammatory_, principal symptoms of it, 384.

  _Fevers, intermittent_, some unusual remedies for them, 456, _& seq._
    --Forms of medicines adapted to them, 552.

  Fires, the most effectual means of sweetening the air of a ship, 117.
    --The most powerful means of destroying infection, 276, _& seq._

  _Flour_ preferable to bread for exportation, 307.

  _Fluxes_ depend on the same cause as fevers, 36, _& seq._
    --Prevail least when fevers most violent, 44, 113.
    --Apt to arise in ships soon after their arrival in the West Indies,
        19, 84, 183.
    --More frequent at sea than in port, 113.
    --More frequent in ships that have been subject to fevers, 183.
    --Why so frequent and fatal at West India hospitals, 192, _& seq._
    --Observations on them, 466.
    --Treatment of them, 473.

  _Formidable_, extraordinary degree of health on board of her, 107,
        128, 365.
    --Causes of it, 72, 108.
    --Fever arises in her from men lent to another ship, 128.
    --From pressed men, 161.

  _French ships_, their discipline and œconomy inferior to British, 114.

  _Frigates_ more healthy than ships of the line, causes of this, 54,
        _& seq._
    --More healthy when their fire place was between decks, 287.
    --A contrivance for ventilating them, 292.

  _Fumigation_, method of performing it, 270, _& seq._


  G.

  _Gibraltar_ relieved by Lord Rodney, 19.
    --Admissions and deaths at the hospital there, 187, 205.

  _Gibraltar_ man of war, account of her, 53.

  _Grosislet Bay_, description of it, 28.

  _Gunpowder_, accidents from it, 190, 539, _& seq._

  _Guthrie, Dr._, his observations on infection in Russia, 279.


  H.

  _Habit_, effect of it in resisting infection, 294.

  _Hæmorrhages, internal_, oil and tincture of rhubarb of eminent
      service in them, 486, _& seq._

  _Hæmorrhage_, a limb sometimes carried off without any ensuing, 542.

  _Hæmorrhoids_, medicines adapted to them, 555.

  _Hardship_ impairs health and shortens life, 218.

  _Heat_ communicated to the hand, a symptom of the ship fever, 378,
      _& seq._

  _Hemisphere, Northern_, a cold summer general all over it, 157.

  _Herodotus_, his account of the clothing and health of the ancient
      Ægyptians, 284.

  _Hospitals_ not so proper for the sick as their own ships, 60.
    --Account of diseases sent to them, 185.
    --At Gibraltar, 187.
    --At Barbadoes, 189, 197.
    --At St. Christopher’s, 195.
    --At St Lucia, _ibid._
    --At Jamaica, 198.
    --At New York, 201, _& seq._
    --General view of them all, 205.
    --Proportion of deaths in them no criterion of the success of
        practice, 195, 200.

  _Hurricane months_, 28.

  _Hurricane_, a violent one in the West Indies--its good effect on the
     health of the inhabitants, 40, _& seq._

  _Hypochondriac_ complaints do not affect the laborious part of
     mankind, 219.


  I.

  _Jaw, locked_, account of those affected by it in the battles of
      April, 1782, 520, _& seq._
    --Its symptoms different from those of the tetanus, 526.
    --Wherefore most frequent in hot climates, 529, _& seq._

  _Indolence_ a cause of scurvy, 345.

  _Infection_, the obscurity of and difficulty of investigating it, 238.
    --Various ways in which it is introduced into a ship, 241.
    --It may arise without the presence of fever, 242.
    --Habit renders people insensible to it, _ibid. & seq._
    --It never affects all indiscriminately who are exposed to it, 245.
    --It does not pass from one species of animal to another, 249.
    --How to prevent the production of it, 254.
    --Means of eradicating it, 264.
    --Method of guarding against it, 293.
    --Less frequent in hot climates than cold, 276.

  _Inflammatory_ complaints most frequent in ships where no infection,
      172.

  _Inoculation_, conjecture concerning the cause of its safety, 247.

  _Intermittent fevers_ sometimes arise on board of a ship, 32.
    --Some unusual remedies for them, 456, & _seq.q._

  _Intestines_, great, the principal seat of the dysentery, 470.


  L.

  _Labour_ necessary to health, 217.
    --Pernicious if in excess, _ibid._
    --What diseases it tends to avert, 219.
    --Scurvy prevented by it, 344.

  _Land wind_ at Jamaica, 119.
    --Not at the small islands, _ibid._

  _Lemon juice_, extraordinary instance of its efficacy in scurvy, 86.
    --The most effectual remedy in scurvy, 303.

  _Lemons and limes_, their juice the best detergent in scorbutic
     ulcers, 502, _& seq._

  _Lientery_, a symptom in obstinate fluxes, 489.

  _Limes_, instance of their great antiscorbutic effect, 56.

  _Liver_, inflammation of it seldom known in the West Indies, 95.
    --But appeared at New York in men belonging to the West-India fleet,
      156.


  M.

  _Magnesia_, given with acids, removes sickness of the stomach, 452.

  _Malt liquor_, the utility of it, 320.

  _Malt, essence of_, a weak antiscorbutic, 57, 504.
    --Of service in the beginning of scurvy, 146, 164.

  _Manners, Lord Robert_, his death lamented, 520.

  _Marshes_, their exhalations cause fevers, 43.

  _Melasses_, method of using it, 305.
    --Great utility of it, 308.

  _Mixing of men_, bad consequences of, 252, _& seq._

  _Moisture_, the bad effects of it, 288.

  _Mortality_, method of calculating the proportion of it, 88.
    --Greater at sea from the want of an hospital and of proper
      diet, 143.
    --In the fleets and hospital at different periods, 205.
    --In the army in the West Indies, 206.
    --In England, 207.
    --Total in the fleet for three years and three months, 209.

  _Mortification_, an uncommon instance of it in the shoulder, 83.


  N.

  _Necessaries_, Surgeons, their quantity very inadequate, 302.

  _New York_, the fleet therein 1780, 38.
    --in 1782, 150.

  _Nyctalopia_, a symptom of the scurvy, 24, 501.

  _Nymph_ frigate, account of her health, 164.


  O.

  _Oatmeal_, the abuse of it, 308.

  _Observations_, the difficulty of making them, 9.

  _Officers_, more affected by foul air than common men, 116, 137.

  _Opium_, advantage of combining with antimonials, 392.
    --With neutral salts, 395.
    --Its use in continued fevers, 404, 408.
    --Cautions and directions with regard to it in fluxes, 476, 479.
    --Its use in ulcers, 504.
    --The best method of giving it in the locked jaw, 532, _& seq._

  _Osbridge_, Lieut, his ingenious contrivance for sweetening water,
      331.


  P.

  _Pediluvia_ hurtful in inflammatory fevers, 397.

  _Petechiæ_, a symptom in the ship fever, 377.

  _Phthisis pulmonalis_, not so common in the West Indies as Europe, 97.
    --but more rapid, _ibid._

  _Phœnix_, Spanish Admiral’s ship, her excellent materials and
      construction, 53.

  _Pigeon Island_, remarkable proof of its healthiness, 228, _& seq._

  _Plague_, its infection does not spread far, 298.
    --Means of preventing it from spreading, _ibid._ and 299.
    --Never known in tropical climates, 277, _& seq._

  _Porter_, its effect in preventing scurvy, 320.

  _Potatoes, raw_, a remedy for scurvy, 60.
    --Proposed as an article of victualling, 309, _& seq._

  _Prudent_, effects of soaking her timbers in pickle, 81.

  _Pulmonic_ complaints, medicines adapted to them, 556.

  _Putrefaction_, simple, effluvia of it may produce fevers, 134,
      _& seq._


  Q.

  _Quick lime_, the best preservative of water, 326, _& seq._


  R.

  _Recruits_, new raised, the cause of sickness, 180.

  _Returns_, intention of them, 6, 7.
    --Specimens of them, 23.
    --Method of forming them into tables, 24.

  _Rheumatism_, forms of medicines adapted to it, 557.

  _Royal Oak_, cause of her health, 80.
    --Method of curing the scurvy on board, 81.

  _Ruby_, remarkably healthy, 167.


  S.

  _St. Lucia_, woody, mountainous, and rainy, 27.
    --Proportion of deaths at the hospital there, 195.

  _Salt_, the good effects of it in diet, 314.

  _Sandwich_, health of, on her first arrival, 19.

  _Scorches_, great numbers killed and wounded in this manner, 190.

  _Scurvy_, in a cruise to windward of Martinico, 49.
    --In a cruise near Jamaica, 121.
    --High degree of it in the Nonsuch, _ibid._
    --On the passage to New York, 148.
    --Why less of it in the ships last from England, 147.
    --Its rapid progress in the latter part of a cruise, 148, _& seq._
    --Method of curing it on board of the fleet at New York, 151.
    --Numbers that died of it according to Sir Richard Hawkins, 214.
    --In Commodore Anson’s Squadron, _ibid._

  _Scurvy_, observations on it, 499.
    --What meant by the latent state of it, 505.
    --The best remedies for it, 506, _& seq._
    --In what manner the nature of the diet induces it, 509.
    --Whether it is infectious, 516.

  _Seasons_ in the West Indies, account of them, 28, _& seq._

  _Ships_, new, not more unhealthy than others, 19, 52.
    --Disadvantage in changing their commanders, 80.
    --Why large ones most sickly, 128, 133, 253.

  _Shingle ballast_, the advantage of it, 289.

  _Shoes_ of great use to seamen, 339.

  _Sick_, what the best place for them in a ship, 262.

  _Sickness_, method of calculating the proportion of it, 90.

  _Situation_, effects of the difference of it upon health, 28.

  _Small-pox_ very prevalent in the fleet, 85.

  _Sope_ supplied on board of the fleet, 145.
    --Its great utility, 151, 257.

  _Sour krout_, manner of using it, 305.

  _Splinters_ more destructive than balls, 103.

  _Spices_ good against noxious air, 230.

  _Spruce beer_, the great advantage of it, 320.

  _Strangers_ communicate disease to each other without any apparent
      previous disease, 243.

  _Surf_, danger from it in watering at St. Lucia, 88.

  _Surgeons_, a greater proportion of mortality among them and their
      mates, 134.
    --Advantage of encouraging them, 266.

  _Sweating_ of use in curing the ship fever, 388, _& seq._
    --In the dysentery, 475.

  _Sweet vegetables_ more antiscorbutic and medicinal in their natural
      state, 58.


  T.

  _Tables_, method of forming them, 90.

  _Tenaculam_ recommended in amputation, 543.

  _Thermometer_, general range of it in the West Indies, 29.
    --Observations on it at Port Royal, 124.

  _Thucydides_, his observations on the plague at Athens, 296.


  U.

  _Ulcers_ keep pace with scorbutic and feverish complaints, 132.
    --Proportion of them, 150.
    --Very frequent in the Barfleur, _ibid._
    --Great effect of a cold climate in diminishing them, 156.
    --Form a considerable part of sea complaints, 221.
    --Apt to arise in scorbutic habits, 339, 500, 505.

  _Uniform_ for common seamen recommended, 336.

  _Union_ remarkably healthy, 167.
    --Subject only to inflammatory complaints, 173, 297.

  _Urine_, appearance of it in the yellow fever, 437, 440, _& seq._


  V.

  _Venereal disease_, the medicines best adapted to the various forms
      of it, 559.

  _Vernon_, Admiral, health of his fleet compared with Lord Rodney’s,
      131, 198.
    --The first who caused the spirits allowed the seamen to be
      diluted, 324, _& seq._

  _Victory_, 12th of April, 1782, 99.
    --Its effects on the health of the men, 101, _& seq._

  _Ville de Paris_, sickness and mortality on board after being
      captured, 115.
    --Foundered, 210.

  _Vinegar_, use of it in the navy, 302.
    --In the Roman armies, _ibid._

  _Vitriol, white_, used as a remedy in intermittent fevers, 462.

  _Vomit, black_, the most dangerous symptom in the yellow fever, 436.


  W.

  _Wall, Dr._ recommends opium in low fevers, 393.

  _War_, why fleets most sickly in the beginning of it, 69.

  _Warren, Dr._, his successful treatment of a case of the locked jaw,
      532.

  _Water_ of springs preferable to running water, 324.
    --Quick lime the best preservative of it, 326.
    --Various other means of correcting it, 329.
    --Distillation from sea water recommended, 332.

  _Watering duty_ dangerous and unwholesome, 88, 118.

  _Well_ of a ship, great danger of foul air in it, 285.
    --Method of preventing it, _ibid._

  _Wind of a ball_, the effects of it, 537.

  _Wine_, the great advantage of it in the French fleet, 322.
    --Superior to spirits, 324.
    --Its utility in continued fevers, 410.

  _Women_, why not so subject to acute diseases in the West Indies as
      men, 234.

  _Wounds_, number that died of, 209.
    --Account of those received in April, 1782, 520.


  Y.

  _Yams_ used in place of bread, 76.

  _Yellow fever_, 425.

  _Yellowness_ of the skin not always a symptom of malignity, 181.


  Z.

  _Zinc_, effects of it in obstinate intermittent fevers, 456.
    --Cases in which it is proper, 461.




FOOTNOTES:

[1] These were the Conqueror, the Cornwall, and the Boyne, which were
so damaged in the battles, that they were obliged to bear away for St.
Lucia.

[2] The following may serve as a specimen of these returns:


STATE of HEALTH of His Majesty’s Ship ALCIDE. Carlisle Bay, Barbadoes,
1st June, 1781.

  +--------------------+--------------------+----------------------+
  | Sick now on Board. | Died in the course | Sent to the Hospital |
  |                    |   of last Month.   |   in the course of   |
  |                    |                    |     last Month.      |
  +--------------------+--------------------+----------------------+
  |  Fevers        4   |    Of Fever 1      |   Ill of Scurvy 35   |
  |    Flux        5   |                    |                      |
  | Scurvy        26   |                    |                      |
  | Catarrh and }  7   |                    |                      |
  | Rheumatism  }      |                    |                      |
  |              --    |                    |                      |
  |      Total    42   |                    |                      |
  +--------------------+--------------------+----------------------+

REMARKS.

During the course of last month we had one hundred and fourteen of
the men, who contracted the scurvy in the late long cruise, recovered
by the use of limes, which were procured at Montserrat. A pint of
wine, with an equal quantity of water, made agreeable with sugar and
tamarinds, is served to each patient daily. The regimen is exactly the
same as mentioned last month.

Since we came into port, very few have been seized with scurvy, but
several complain daily of fluxes and feverish complaints, none of which
seem at present to be of any consequence.

Four patients have last month complained of an almost total blindness
towards evening, accompanied with head-ach, vertigo, nausea, and a
sense of weight about the precordia. The pupil is then extremely
dilated, but contracts readily when a strong light is presented to it.
Two of them had the scurvy in a high degree, one of them slightly,
and the other seemed entirely free from it. I am not well acquainted
with the nature or cure of this disease, which I believe is called
Nyctalopia by some systematic writers.

I gave those who were affected with it an emetic, which brought up a
great deal of bile, and relieved the symptoms both of the head and
stomach. This encouraged me to a repetition of it, which seemed also to
be attended with benefit. I likewise applied blisters behind the ears,
and gave bark and elixir of vitriol, with the antiscorbutic course, to
those that required it.

I can form no probable conjecture concerning the cause of this disease.
I have observed a dilation of the pupil in scorbutic patients, and they
complained of a cloud before their eyes, with imperfect vision, which
disappeared as the scurvy went off.

  WILLIAM TELFORD.

  To Dr. BLANE,
  Physician to the Fleet.


[3] Although this hurricane, in itself and its consequences, was so
destructive to the lives and health of men, yet, with regard to the
inhabitants on shore, it had a surprising and unexpected effect in
mending their health. I wrote an account of this hurricane to the late
Dr. Hunter, who communicated it to the Royal Society, and the following
passage is extracted from it:

“The consequences of this general tumult of nature, on the health
of man, was none of the least curious of its effects. I made much
inquiry on this head, not only of the medical gentlemen who had the
charge of hospitals, and of the physicians of the country, but of the
inhabitants, and every one had some cure to relate either of themselves
or their neighbours, in a variety of diseases. Nor could I find that
either those who were in health, or those who were ill of any disease
whatever suffered from it, otherwise than by its mechanical violence;
but, on the contrary, that there was a general amendment of health.
This is a fact, which I could neither credit, nor would venture to
relate, were it not supported by so many concurring testimonies. It had
a visible good effect on the acute diseases of the climate. The chronic
fluxes, of which there were then some at the naval hospital, were
cured or much relieved by it. But the diseases upon which it had most
evident and sensible effects, were pulmonic consumptions. Some recent
cases of phthisis, and even the acute state of pleurisy, was cured by
it; and in the advanced and incurable state of it, the hectic fever
was removed, and remarkable temporary relief afforded. A delicate lady
of my acquaintance, who was ill of a pleurisy at the time, and passed
more than ten hours in the open air, sitting generally several inches
deep in water, found herself free of complaint next day; had no return
of it; and when I saw her a few weeks after, was in much better health
and looks then usual. The people observed that they had remarkably keen
appetites for some time after, and the surviving part of them became
uncommonly healthy; some of both sexes, whom I had left fallow and thin
a few months before, looking now fresh and plump.

It is very difficult to account for this, as well as every thing else
in the animal œconomy; but it was probably owing in part, at least, to
the very great coldness and purity of the air from the upper regions
of the atmosphere. Great agitation of mind sometimes also produces
a revolution in health; and we know that the effect of external
impressions in general is very different when the mind is vacant, from
what it is when occupied and interested by objects, whether of pleasure
and satisfaction, or of danger and suffering.”

[4] In order to ascertain more exactly the degree of sickness in each
month, a column was afterwards added to the form of the returns,
expressing the number taken ill of the several diseases in the course
of the month.

[5] I was informed by Captain Caldwell, that when he commanded the
Hannibal, of 50 guns, his crew was so much afflicted with the scurvy,
in a passage of nine weeks from St. Helena to Crookhaven, in Ireland,
that ninety-two men were confined to their hammocks in the last stage
of that disease, though they had been supplied with sugar at St.
Helena, and served with it on the passage. They remained three weeks at
Crookhaven; at the end of which time every man was fit for duty: and
though they had fresh provision, they had no fresh vegetables, so that
their cure is to be ascribed to the use of lemons and oranges, which
the Captain very humanely ordered to be purchased for them from on
board of a foreign ship that happened to put into the same harbour.

[6] See Appendix to Part II.

[7] They were the Formidable and Namur, of 90 guns; the Arrogant,
Conqueror, Marlborough, Hercules, and Fame, of 74 guns; the Yarmouth,
Repulse, Prothée, Anson, and Nonsuch, of 64 guns.

[8] These were the Prince George, of 90; the Bedford, Canada, and Royal
Oak, of 74; the America and Prudent, of 64 guns.

[9] This is a term in use for the different articles of seamen’s
cloathing, particularly shirts and trowsers.

[10] The mortification in the shoulder, mentioned above, was somewhat
singular. It happened to a man in the Yarmouth, who, after being for a
week ill of a fever and flux, was one day, early in the morning, seized
with a pain in the upper part of the right arm, which immediately began
to mortify. He soon after became convulsed, and died the same day about
two o’clock.

[11] Earthquakes are frequent in the West Indies, and perhaps proceed
from a weaker operation of the same cause that originally produced
the islands themselves, which seem all to have been raised from the
sea by subterraneous fire. There are evident vestiges of volcanoes in
them all, except Barbadoes; but there are other unequivocal marks of
this island having been raised from the bottom of the sea; for it is
entirely formed of coral, and other sub-marine productions, of which
the strata are broken, and the parts set at angles to each other, as
might be expected from such a cause. There is, perhaps, at all times
in the caverns of the earth, elastic vapour struggling to vent itself,
and when near the surface, it may sometimes overcome the incumbent
masses of matter, and produce certain convulsions of nature. In the
account of the hurricane which I wrote to Dr. Hunter, I gave reasons
for believing, from the testimony of the inhabitants, that hurricanes
are attended with earthquakes; and if a conjecture might be advanced
concerning the cause of this, it might be said, that as the atmosphere
is lighter at that time, by several inches of the barometer, the
elastic vapour, confined by the weight of the incumbent earth and
atmosphere, being less compressed, may exert some sensible effects,
producing a sort of explosion.

[12] Since the publication of the first edition of this work I have
been informed that this complaint is not so rare on shore as in the
fleet, which may be partly owing to the greater coolness of the air at
sea, and partly from the seamen not having been a sufficient length
of time in the climate to be affected with this disease, as few of
them had been more than two years from England. But as this affection
of the liver was very common in the fleets and naval hospitals in the
East Indies, it is evident that there is a great difference of the
climates in this respect. It is worth remarking, that it sometimes
breaks out in the West-India Islands like an epidemic. The complaint,
for instance, was very little known in the island of Grenada, till
about the year 1785, when it became very frequent in a particular
quarter of the island; and the gentleman who sent the description of
it to England alledged, that there were the most unequivocal proofs of
its being contagious. It was most successfully treated by very copious
bloodletting, and in exciting a salivation by mercury. See Dr. Duncan’s
Medical Commentaries, Decad. 2, vol. I.

[13] Dr. Lind, on the authority of Mr. Ives, surgeon to Admiral
Matthews.

[14] London Gazette, _June_, 1781.

[15] This is well illustrated by the manner in which Captain Nott,
of the Centaur, was killed in Fort-Royal Bay. This brave man, having
carried his Ship nearer the enemy than the rest of the line, but
nevertheless at a great distance, had his signal made to keep the line,
and having gone into his cabin, as it is said, to examine the import of
the signal, a cannon ball struck him in the groin, and it was so far
spent, that it stuck in his body. It tore away a whole plank of the
ship’s side, the splinters of which killed a young gentleman, the only
person near him.

[16] I have seen an account of the diseases of the army at St. Lucia
for a whole year, kept by Mr. Everard Home, an ingenious gentleman
belonging to the army hospital, and it appears, that, during ten
months out of the twelve, the dysentery was the predominant disease.
This seems to contradict the opinion, that the land air is more apt
to occasion fevers than fluxes; but it is to be remarked, that the
sickness of the soldiers on this island was not so much owing to the
malignant influence of the air, the situation of the garrison being
high and airy, as to the bad accommodations and provisions, together
with hard labour.

[17] See Essay on the Yellow Fever, by Dr. Hume, in a Collection of
Essays published by Dr. D. Monro.

[18] Campbell’s Lives of the Admirals, Vol. IV.

[19] The late Dr. William Hunter.

[20] See Appendix to Part II.

[21] Captain Samuel Thompson.

[22] As my own stay at different ports was short, and as my own
knowledge could not extend beyond that period, Dr. Farquarson, First
Commissioner of Sick and Wounded Seamen, very politely gave me leave
to inspect the books of the different hospitals at his office, and I
collected from them the fate of all the men that were landed.

[23] It is proper to mention, that the name of the disease in the
hospital books being taken from the ticket sent on shore with each sick
person, great accuracy is not to be expected, as this is frequently
done in a careless manner. My returns were made with great exactness;
and, in the latter part of the war, the hospital books may also be
depended upon in this respect, the tickets, at my request, having been
made out with accuracy.

[24] In this, and the other tables, the smaller fractions are neglected.

[25] See the last chapter of Part III.

[26] In the year 1741, the fleet under Admiral Vernon was at Jamaica at
the same time of the year; and the following is the account of the men
sent to the hospital in May and June:

  +--------------------+-----------+-------+-------------+
  | DISEASES.          | Admitted. | Died. | Proportion. |
  +--------------------+-----------+-------+-------------+
  |                    |           |       |    NEARLY   |
  |                    |           |       |    ONE IN   |
  +--------------------+-----------+-------+-------------+
  | Fevers             |       957 |   255 |           3½|
  | Fluxes             |       267 |    73 |           3½|
  | Scurvy             |       314 |    41 |           7½|
  | Other Complaints   |       167 |    26 |           6 |
  +--------------------+-----------+-------+-------------+
  |       Total        |      1703 |   395 |           4 |
  +--------------------+-----------+-------+-------------+

There was on board of this fleet about two thirds of the number of men
that was on board of the fleet in 1782. I cannot ascertain how many
died on board of the ships in Admiral Vernon’s fleet; but the deaths at
the hospital alone are somewhat more than what happened to our fleet
both on board and at the hospital.

[27] I was enabled, after coming to England, to ascertain the deaths
in that part of the squadron from which I happened at any time to be
absent, by having leave from the Navy Board to inspect the ships’ books
deposited at their office.

[28] See Appendix to Part II.

[29] The mortality of the army in the West Indies is much greater; for
it appears by the returns of the War Office, that there died in the
year 1780, two thousand and thirty-six soldiers, which being calculated
by the numbers on the station, and those who arrived in the convoy in
March and July, the annual mortality is found to be one in four. The
greatness of this mortality will appear in a still stronger light, when
it is considered that those who serve in the army are the most healthy
part of the community. When I was at the encampment at Coxheath in the
year 1779, I was politely favoured with a sight of the returns, both of
the general officers and physician, and it appeared that in an army of
ten thousand and eighty-nine men, there died, from the 10th of June to
the 2d of November, forty-three, exclusive of twelve who died of small
pox. This being calculated, is equal to an annual mortality of one in
a hundred and nine; and it was not half so much in the encampment of
the former year. It appears by Mr. Simpson’s tables, that the mortality
of mankind in England, from the age of twenty to forty-five, which
includes the usual age of those who serve in the navy and army, is one
in fifty.

[30] See Table II.

[31] See Table II.

[32] None are comprehended but those who were killed or wounded
in battles in which the whole fleet was present, this account not
including those who fell in single actions in frigates or other ships.

[33] It would appear, that, anciently, though the slaughter in battle
was greater than in modern times, yet that disease was still more
destructive than the sword. One of the oldest testimonies to this
purpose is in the History of Alexander’s Expedition, by Arrian--τους
μεν ἐν ταῖς μαχαις ἀπολωλεκασιν, ὁι δε ἐκ των τραυματων ἀπομαχοι
γεγενημενοι, ὁι πλειοῦς δε νοσω ἀπολωλεσαν.--Arrian. Hist. Alex. Exped.

  Lib. v. cap. 26.


[34] Upwards of three thousand were also lost at sea in ships of war
belonging to the same fleets in the hurricane of October, 1780, and in
the storm in September, 1782, in which the Ville de Paris and the other
French prizes were lost on their passage to England.

[35] The authors from whom I have borrowed have been chiefly Dr.
Lind and Capt. Cook. To the former we are indebted for the most
accurate observations on the health of seamen in hot climates; of the
improvements made by the latter, an excellent compendium may be seen in
Sir John Pringle’s Discourse before the Royal Society, on the occasion
of adjudging a prize medal to Capt. Cook for his paper upon this
subject.

[36] In the late war sickness alone was not the cause of want of
success in any instance, except in the last action in the East Indies,
in which so many men were ill of the scurvy, that there were not hands
enow to manage the guns.

There is another fact in history, which, though not so applicable to
this subject as those above recited, forcibly evinces how important a
study the health of men ought to be in military affairs. When Henry V.
was about to invade France, he had an army of fifty thousand men; but
owing to a sickness which arose in the army, in consequence of some
delays in the embarkation, their number was reduced to ten thousand at
the battle of Agincourt. The disease of which they chiefly died was the
dysentery.

  RAPIN.


[37] It is not meant by this to insinuate that every commander is
absolutely accountable for the health of his ship’s company, and
censurable when they are sickly; for this may depend on his predecessor
in command, or a stubborn infection may have prevailed from the
original fitting out or manning of the ship which he may not have
superintended.

[38]

        Οὐ γαρ ἐγωγέ τι οῗδα κακώτερον ἄλλο θαλάσσης,
        Ανδεά τε συγχεῦαι, εἰ καὶ μάλα καρτερὸς εἴη.

      ΟΜΗΡ. ΟΔΥΣ. Θ.


        Dire is the ocean, dread in all its forms!
        Man must decay, when man contends with storms.

      POPE.


[39] Wherever causes are obscure, superstition naturally ascribes
them to some preternatural influence; and what seemed farther to have
encouraged this, anciently, was, that violent epidemics occurred most
frequently in camps and at sieges where great political conjunctures
were likely to arise, in which superior powers were supposed to
interest themselves. Thus we read in Homer of fatal diseases being sent
as punishments by the gods. But the pestilential diseases so often
mentioned by poets and historians as prevailing in cities and armies,
were probably nothing else but fevers, produced partly perhaps by the
scarcity and bad quality of provisions, but probably still more by
corrupted human effluvia, which was very apt to he produced by the
want of personal cleanliness, to which the mode of cloathing among the
ancients would more particularly subject them, especially in camps and
besieged towns.

[40] If the experiments of modern philosophy are to be depended on,
they go a certain way to account for the unwholesomeness of air from
woods in hot climates, and in wet weather; for Dr. Ingenhousz found
that the effluvia of plants in the night time, and in the shade, are
more poisonous in hot than in cold weather; but though there is a
salubrity in the effluvia in sunshine, the heat of the weather makes
no difference with regard to this. He found also that vegetables, when
wet, yield an unwholesome air.

It is difficult to ascertain how far the influence of vapours from
woods and marshes extend; but there is reason to think that it is to a
very small distance. When the ships watered at Rock Fort, they found
that if they anchored close to the shore, so as to smell the land
air, the health of the men was affected; but upon removing two cables
length, no inconvenience was perceived. I was informed of the following
fact, in proof of the same, by the medical gentlemen who attended the
army in Jamaica:--The garrison of Fort Augusta, which stands very near
some marshes, to which it is to leeward when the land wind blows, was
yet remarkably healthy; but it became at one time extremely sickly upon
the breaking in of the sea in consequence of a high tide, whereby the
water which was retained in the hollows of the fort produced a putrid
moisture in the soil, exhaling a vapour offensive to the smell, and
with all the noxious effects upon health commonly arising from the
effluvia of marshes.

[41] Dr. Hendy has lately published an ingenious treatise upon this
disease.

[42] See Sydenham’s Works.

[43] See Part I. Book II. Chap. VI.

[44] We have a proof of this fact in particular, in the account of the
jail distemper, which broke out at the Old Bailey in the year 1750.

[45] See Martin’s History of the Western Islands, and Medical
Communications, Vol. I. page 68.

[46] There are some contagious diseases which cannot be propagated but
by their own peculiar infections, as has been before observed, just
as the seeds of vegetables are necessary to continue their several
species; so that if the infectious poison were lost, so would the
disease. Of this kind are the small pox, and the other diseases to
which man is subject but once during life. There are other diseases
which produce infection without having themselves proceeded from it. Of
this kind are fevers and fluxes.

But there is no infection of any kind, however virulent, that affects
indiscriminately all persons exposed to it. If a number of persons,
who never have had the small pox, are equally exposed to it, some will
be seized, while others will escape, who will be affected at another
time, when they happen to be more susceptible. It is doubtful how far
the habit of being exposed to such specific infections renders the
body insensible to them, as was said with regard to fevers; but there
is another principle of the animal œconomy laid down and illustrated
by Mr. Hunter, which goes at least a certain length in explaining
this variable state of the body with respect to its susceptibility
of infectious diseases. This principle is, that the body cannot be
affected by more than one morbid action at the same time. If a person
is exposed to the small pox, for instance, while he labours under a
fever, or while he is under the influence of the measles, he will not
catch the first till the other has run its course. It may happen,
therefore, that people escape the effect of contagion in consequence
of being at the time under the influence of some other indisposition,
either evident or latent: and supposing the body to be exposed to a
number of noxious powers at the same time, one only could take effect.
But it seems difficult to explain why some of those who are actually
seized, and who have previously been to all appearance in equally good
health, shall have it in a very mild degree, while in others it will
be malignant and fatal. This is very remarkable with regard to the
small pox, which are in some cases so slight, that they can hardly be
called a disease, while in others they are so malignant, as hardly to
admit of any alleviation from art. May not this, in some measure, be
explained from some of the principles above mentioned, in the following
manner:--The small pox, in their mildest form, are attended with little
or no fever, which, therefore, is not essential to them; and when we
see them attended with various forms of fever, and thereby prove fatal
even in the most hale constitutions, we ought not to attribute this to
any thing in the nature of the small pox, but rather to say, that they
have served as an agent in exciting a fever, for which there happened
to be some previous latent disposition, that would not otherwise have
exerted itself, and that this disposition, or contamination, as it
may be called, may have been induced by some past exposure to morbid
effluvia, which either from habit, or some other circumstance, may not
have been sufficiently powerful to excite the constitution to fever
without some such stimulus. Any other occasional circumstance producing
disturbance or irregularity in the functions of the body, may, in like
manner, excite any particular kind of fever to which the body may at
that time be disposed. Thus the amputation of a limb will have this
effect; also exposure to cold or fatigue, and intemperance in eating or
drinking.

It would appear from these considerations, that there are certain
circumstances, or temporary situations of constitution, which invite
infection, and render its effect more certain and violent in one case
than another. There are artificial methods, however, of obtruding it,
as it were, upon the constitution, though not particularly disposed, or
even though averse to receive it; and may not this, in some measure,
account for the greater safety of some diseases when communicated by
inoculation, than when caught in the natural way?

But these, as well as many other facts in animal nature, do not admit
of a satisfactory explanation upon any principle as yet known. Even the
most common operations of the body, such as digestion and generation,
when considered in their causes and modes of action, are so obscure and
mysterious, as to be almost beyond the reach of rational conjecture. A
little reflection will teach us the utmost modesty with regard to our
knowledge of such things; for nature seems to have innumerable ways
of working, particularly in the animal functions, to which neither
our senses can extend, nor perhaps could our intellects comprehend
them. Had we not, for instance, been endowed with the sense of sight,
nothing could have led us even to suspect the existence of such a
body as light; and there may be numberless other subtile and active
principles pervading the universe, relative to which we have no senses,
and from the knowledge of whose nature and exigence we must for ever
be debarred. We have, indeed, become acquainted with electricity by
an operation of reason; and animals have lately been discovered to
which the electric fluid serves as a medium of sense through organs
calculated to excite it, and to receive and convey its impressions.

But there are few subjects we can study that are more subtle and
obscure than the influence of one living body on another. There is a
familiar instance of the great subtilety of animal effluvia, and also
of the fineness of sense in a dog’s being able to trace his master
through crowds, and at a great distance; and we can conceive that
infectious matter may adhere, and be communicated in a similar manner.
We have endeavoured to illustrate the great obscurity of its operation
by an allusion to generation, digestion, and other animal functions,
with which it is equally obscure and inexplicable. It is similar to
generation in this, that its influence does not pass from one species
of animal to another; for the poison of the plague, that of the small
pox, that of fever, and the venereal disease, do not affect brutes[47],
nor do the infectious diseases of brutes affect different species of
them, nor the human species. The only exception to this, that we know
of, is the bite of a mad dog.

From these facts, and also from what was formerly mentioned of
contagion not affecting indiscrimately all that may be exposed to
it, it would appear that some nice coincidence of circumstances is
necessary to modify an animal body, so as to receive its action. There
must be a sort of unison, as it were, or sympathy, betwixt different
living bodies, so as to render them susceptible of each other’s
influence.

It is none of the least curious facts with regard to infection, that
there are some species of it by which the body is liable to be affected
only once in life. When this is considered, it is indeed conformable to
what happens in the course of the disease itself; for, unless there was
in the body a power of resisting it, there could be no such thing as
recovery. Where the disease actually exists, the continued presence of
the poison, which is also infinitely multiplied, would infallibly prove
fatal in all cases, unless the living powers were to become insensible
to it[48].

[47] Hunter’s Experiments.

[48] Mr. Hunter’s Lectures.

[49] It is sincerely to be wished that this were adopted, and it is
surprising that an article so salutary and necessary, and so difficult
to be procured on foreign stations, should not have been the object
of public attention, rather than a mere article of luxury, such as
tobacco. But in order that it might not be a matter of choice with
seamen, it would be worth while to supply them with it at prime cost,
or even as a gratuity, and then they might be compelled to use it
for the purpose of cleanliness. There are other articles of less
importance, but being necessary to enable men upon foreign stations to
keep themselves neat and clean, deserve to be made the object of public
instruction. These are handkerchiefs for the neck, thread, worsted,
needles, buckles, and knives.

[50] At the time I am writing this, (March 8th, 1785) there has
occurred a fact which proves the effect of time in generating
infection. There now prevails a contagious fever in several of
the hospitals in London, and, among others, in that to which I am
physician. In another hospital it has been so violent, that there has
been a vulgar report that the plague had broke out in it. The same
fever also prevails among the poor at their own houses. The cause
of it seems to be, that the cold weather has been uncommonly long
and severe; for the frost began early in December, and the cold has
hitherto been more like that of winter than spring. The thermometer
all this month has varied from 30° to 35°. Cold is favourable to
infection, by preventing ventilation; for people exclude the air in
order to keep themselves warm, and the poor in particular do so on
account of their bad clothing, and their not being able to afford fuel
to make good fires. Heat is the great destroyer of infection, and seems
to act by evaporating, and thereby dissipating it; and the effect of
fires in apartments is to produce a constant change of air, thereby
preventing its stagnation and corruption, and the accumulation of
unwholesome effluvia. With this view, a chimney is of great use, even
though no fire should be kept in it, as it serves for a ventilator.
But if an aperture were to be made in an apartment merely with a view
to ventilation, it should be placed in that part of the wall next the
ceiling; for foul air naturally tends upwards, and the external air
entering at the top of a room, would not be so apt to subject those
within to the effect of cold, as it would not blow directly upon them.
There would also be this advantage in jails, that apertures in this
situation would not be so liable to be forced for the purpose of escape
as if they were nearer the floor; and in hospitals they would be out
of reach of those who, wishing to indulge in warmth, at the expence
of pure air, might be induced to shut the windows. But an external
communication with the air any where is of the utmost importance; and
it is observable in Mr. Howard’s account of prisons, that the jail
distemper was most frequently to be met with where there was no chimney.

[51] It is of some consequence to attend to the materials of the
seamen’s beds; for, instead of flock, they are frequently fluffed with
chopped rags, which, consisting of old clothes, emit a disagreeable
smell, and may even contain infection.

[52] By a _berth_ is understood the interval between two guns, or any
space between decks, which is sometimes formed into a sort of apartment
by means of a partition made of canvass.

[53] It is remarkable that this method of purifying was practised in
the most ancient times, as we learn from the following passage in
Homer, where Ulysses is represented fumigating the apartments of his
palace in which the suitors had been slain:

        Τὴν δ᾿ἀπαμειζόμενος προσεφη Πολυμητις Ὀδυσσευς
        Πυρ νυ̃ν μοι πρώτιστον ἐνὶ μεγάροισι γενέσθω.
        Ως ἔφαθ’. ουδ’ἀπιθησε φιλη τροφος Ἐυρυκλειος
        Ἠνεγκεν δ᾿ ἄρα πυρ και θηιον. αυταρ Ὀδυσσευς
        Ἒυ διεθέιωσεν μέγαρον και δῶμα και ἀυλήν.

      ΟΜΗΡ. ΟΔΥΣ. Χ.

        Bring sulphur straight, and fire, the Monarch cries;
        She heard, and at the word obedient flies.
        With fire and sulphur, cure of noxious fumes,
        He purg’d the walls and blood-polluted rooms.

      POPE.

This practice was probably founded in superstition, rather than the
knowledge of nature. That some divine influence should be ascribed to
fire was very natural, as the principal deities of the ancients were
only personifications of the elements; and it is worthy of remark, that
their name for sulphur signifies _something divine_ το θεῖον, which
was probably owing to its being found in those chasms of the earth, in
Sicily and Italy, which were supposed to communicate with the infernal
regions; for the whole Greek mythology relating to these was taken
from the phænomena attending the subterraneous fires in those parts.
It is curious farther to remark, in other instances, how facts useful
to mankind, the truth of which has been confirmed in later times by
the more enlightened knowledge of nature, were first suggested by some
superstitious circumstance. Thus the wound received by Sarpedon could
not be cured, according to the Poet, till, by divine intimation, he was
desired to apply to it the rust of the spear with which it had been
inflicted, in consequence of which it healed. But the weapons in those
days were made of brass, so that the rust of the spear must have been
the _ærugo æris_, which has been found by the experience of modern
surgery to be one of the best detergents in ill-conditioned sores.
It is probably, from a false analogy, founded on some such incident,
that an idea prevails among the vulgar, which has become proverbial,
that some part taken from the offending body is good in all external
injuries. Thus some part of a mad dog is said to have a virtue in
curing his bite. Herein may be seen the difference of that knowledge
which is suggested by superstition, and that which is acquired by the
observation of nature.

[54] A loggerhead is a large round mass of iron, with a long handle to
it.

[55] A fact, related in Anson’s Voyage, is also strongly in proof
of the same opinion. When the rich Spanish prize was taken, it was
necessary to crowd the prisoners into the hold, for fear of an
insurrection, which was to be dreaded from their numbers; yet, when
they arrived in China, none of them had died, nor had any disease broke
out. They suffered only in their looks, being wan and emaciated to a
great degree.

[56] It may be brought as a farther proof of a warm climate being
unfavourable to every sort of infection, that though the itch is very
common in ships and hospitals in Europe, I do not remember ever to have
met with it in the West Indies, except in ships newly arrived from
England.

[57] This circumstance, in the character of the English, is only of
modern date; for we learn from Erasmus, who was in England about
two hundred and fifty years ago, that they were then extremely
slovenly. The following passage is extracted from a letter he wrote
to a physician in York, after his return to Holland:--“Conclavia
solâ fere strata sunt argillâ, tum scirpis palustribus, qui subinde
sic renovantur ut fundamentum maneat aliquoties annos viginti sub se
fovens sputa, vomitus, mictum canum et hominum, projectam cerevisiam et
piscium reliquias, aliasque sordes non nominandas.” He adds, that the
windows were very ill calculated for ventilation, and imputes to the
closeness and filthiness of the houses the frequent and long continued
plagues with which England was infested, and particularly the sweating
sickness, which, he says, seemed peculiar to this country. He mentions
that his own country had been freed from the pestilence by certain
changes that the State had made in the houses, in consequence of the
advice of some learned man. Erasm. Lib. xxii. Epistol. 13.--It is
probable that the greater number of those epidemics, called plagues,
were only bad infectious fevers. What would contribute still more to
the production of infection was the want of linen, which was hardly in
use in those days. The disappearance, or at least the great diminution
of such complaints in modern times, particularly in London, has been
ascribed to the great increase in the proportion of vegetable food; but
it is certainly more owing to the improvement in personal cleanliness,
and to the greater spaciousness and neatness of houses. As a farther
proof of this, it may be mentioned that in the charity, called
the Charterhouse, in London, founded by Henry the Eighth, for the
maintenance and education of poor boys, their sustenance is all animal
food, as it was at the original institution, yet they are extremely
healthy. The same observation applies to Winchester school, which was
founded some ages before that.

There are some passages in ancient history in confirmation of the same
opinion. Herodotus relates, that the ancient Egyptians were the most
healthy of all the nations, except the Libyans, and he imputes this to
the invariableness of their weather, and the serenity of their sky.
But he mentions in another part of his works, that they were also the
most cleanly of all people, not only in their household utensils, but
in their persons, and that their clothing was chiefly of linen, which
it was one of the principal studies of their life to wash and keep
clean--ἑιματα δε λινεα φορεουσι ἀιει νεοπλυτα ὲπιτηδευοντες τουτο
μαλισα. Herodot. Euterp. 37.--It is remarkable that he makes no mention
of the plague, though he gives a very minute account of the country
from his own observation, from whence it may be naturally inferred,
that it did not then exist there, though Egypt is now so subject to it,
that the plague is supposed by many to be an endemial disease in it.
It would appear also from another passage in this historian, that he
uses the word λοιμος, which we translate _plague_ in a loose sense to
signify any violent acute distemper; for he relates that a great part
of the army of Xerxes, in their retreat from Greece, perished by the
_plague_ λοιμου and dysentery, in consequence of famine. Herod. Lib.
viii. cap. 115.

[58] It is proper also to observe here, that those ships which are
built of winter-felled timber are much drier than those built of what
is summer felled; and this circumstance should have been mentioned
with regard to the Montague, for the cause of her healthiness,
notwithstanding her being a new ship, was probably from being built of
winter-felled timber. It should, therefore, be strictly enjoined to
fell the wood in winter; for those who are employed to do it have an
interest in doing it in summer, on account of the value of the bark.

[59] A windsail is a long cylinder of canvass, open at both ends, kept
extended with hoops, and long enough to reach from the lowermost parts
of the ship through all the hatchways into the open air.

[60] It is not necessary that seamen should have chests, for bags or
wallets answer their purpose equally well, and are much more convenient
in respect of stowage.

[61] Since the first edition of this work, I have met with a fact in
confirmation of this principle, with regard to the cutaneous complaint
called the _ring-worm_. This had prevailed in a private school in the
neighbourhood of London, which I visited, but it had to all appearance
become extinct; yet it nevertheless affected those boys who were newly
sent to the school.

[62] It is mentioned by Thucydides, that while the plague raged at
Athens, the people were affected with no other disease; from which it
would appear that those persons who would otherwise have been attacked
with some particular indisposition, were seized with the plague in
place of it. Vide note p. 247.

[63] Part I. Book II. Chap. VI.

[64] It is related by the travellers into Turkey, that the Christians
save themselves from it, merely by shutting themselves up in their
houses, and the inhabitants, who sleep on the open roofs of the houses,
do not catch it even from those of the adjacent buildings, though the
wall that separates them is of no great heighth.

[65] Vide Opera Ambrosii Parei.

[66] See Essay on Sea Diseases.

[67] Limes, shaddocks, and perhaps all the other fruits of that class,
possess the same virtues; but I have most frequently observed good
effects from lemons.

[68] In the course of the passage from England to the West Indies in
February, 1782, the following directions for using the sour krout and
melasses were given in public orders by the Admiral to the different
ships of the squadron:

“The allowance of sour krout made by the public boards in England, is
two pounds to each man every week; and the Admiral orders that from a
pound and a half to two pounds (beginning with the lesser quantity,
and increasing as the men may find it palatable) be boiled with every
gallon of pease on a pease day. The cooks are desired not to wash it,
nor to put it into the coppers till the pease are sufficiently broken.
“Half a pound is directed to be issued raw to each man on beef days,
and a quarter of a pound on pork days. It is recommended that the
allowance of vinegar be saved, particularly on meat days. When sour
krout runs short, the pease and beef days to have the preference; when
shorter still, the pease days. Melasses having been allowed in lieu of
part of the oatmeal, in the proportion of eleven pounds to two gallons,
the Admiral directs, that a pound of melasses be boiled with every
gallon of oatmeal on Mondays, Wednesdays, and Fridays, mixing it and
stirring it round with the burgoo immediately after it is drawn off.
He directs that half a pound of melasses be issued with every three
pounds of flour over and above the common proportion of raisins; and
to prevent any abuse, it is directed that the purser’s steward pour
it into the platter with the flour of which the pudding is made. The
Admiral forbids the use of pease in lieu of oatmeal, as has sometimes
been the practice.”

These rules were suggested by Sir Charles Douglas, captain of the
fleet, whose benevolence is equal to his known professional skill; and
he had ascertained the utility of the preceding directions when captain
of the Duke in the former part of the war.

[69] In the French ships of war there is an oven large enough to supply
not only all the officers and sick, but part of the crew, with soft
bread every day. The advantages attending the use of flour in place
of bread are so great and obvious, that the former will probably, in
time, be substituted entirely for the latter. There is a proof of its
being practicable to use it in place of bread in British ships of war,
even with their present conveniences, communicated to me by Captain
Caldwell. When he commanded the Agamemnon, of 64 guns, at New York, in
the end of 1782, there happened to be no bread in store to supply that
ship on her passage to the West Indies, and flour was given in place
of it. The men, without any inconvenience, were able to bake it into
bread for themselves, and it proved so salutary, that Captain Caldwell
ascribed the uncommon degree of health which his men enjoyed to the use
of the flour. The only objection that can be made to it is the greater
consumption of wood occasioned by baking; but this may be obviated by
adopting the grates invented by Mr. Brodie, in which the ovens are
heated by the same fire with which the victuals are boiled.

[70] Mr. Napeane, afterwards Under Secretary of State, was at that time
purser of the Foudroyant, and acted a very benevolent and disinterested
part, by being instrumental in introducing this reform in the navy
victualling.

[71] Half a pound of cocoa, and as much sugar, was allowed in place of
a pound of butter.

[72] TABLE, exhibiting the daily Allowance of Provisions for each Man
in the Navy.

  ---------+---------+------+----------------------------------------+---------
           | Biscuit.| Beer.| Beef.| Pork.| Pease.| Oatmeal.| Butter.| Cheese.
           | lbs.    |galls.| lbs. | lbs. | Pint. |  Pint.  |  ozs.  |  ozs.
  ---------+---------+------+------+------+-------+---------+--------+---------
  Sunday   |    1    |   1  |      |   1  | half  |         |        |
  Monday   |    1    |   1  |      |      |       |    1    |    2   |    4
  Tuesday  |    1    |   1  |   2  |      |       |         |        |
  Wednesday|    1    |   1  |      |      | half  |    1    |    2   |    4
  Thursday |    1    |   1  |      |   1  | half  |         |        |
  Friday   |    1    |   1  |      |      | half  |    1    |    2   |    4
  Saturday |    1    |   1  |   2  |      |       |         |        |
  ---------+---------+------+------+------+-------+---------+--------+---------

This has continued from the last century till the alterations above
mentioned, all of which, except the introduction of vinegar, have been
made in the three last years of this war. When the stock of small beer
is exhausted, half a pint of spirits is allowed daily, diluted with
four or five times its quantity of water. When wine is supplied, the
daily allowance of it to a man is one pint.

[73] Instead of leaving this to the management of the men themselves,
it might be done with greater advantage to them by instituting short
allowance in the following manner:--Let a certain proportion, suppose
one third, of the salt provisions, bread, and pease, particularly the
first, be stopped, and let the amount of this, for the whole crew
be thrown into one estimate. Let the agent victualler pay into the
purser’s hands the value of these provisions in money, at the contract
price, with such a discount as will allow for the use of the money. Let
the purser, in return, give him a receipt, as if for so much provisions
checked. This money, being distributed in the name of short allowance,
will enable the men to purchase vegetables, and the provisions will be
saved for a time of want, or for a cruise.

[74] The sailors in the squadron of Commodore Anson never murmured more
under any of their hardships than when they were fed with fresh turtle
for a length of time in the South Sea.

[75] Since the first edition of this work was printed, I have met with
a book published by Mr. Fletcher, a navy surgeon, in which he mentions
that spices, being antiseptic bodies, might be substituted for part
of the salt in curing provisions, and this would, no doubt, be an
improvement in the sea victualling. The quantity of spice he proposes
for every barrel of beef or pork is four ounces of black pepper, and
as much allspice, and also eight ounces of nitre in powder. It may be
farther alledged as an advantage of spice over salt, that it would be
less apt to run into brine, which robs the meat of the greater part of
its nourishment.

[76] This accident happened in the Cyclops frigate in September, 1780.
Mr. Gordon, the surgeon, favoured me with the following account of it:

“Mr. Smith, an officer, John Barber and Anthony Wright, seamen, having
eat some victuals prepared in a foul copper, complained soon after
of violent gripes, giddiness, and vomiting, and they had a few loose
stools. There was intense heat; the pulse was quick, full, and hard; a
tremor of the hands and tongue, and wildness of the eyes. The looseness
was soon succeeded by obstinate costiveness, tension of the abdomen,
difficult breathing, and loss of deglutition. In the night, towards
the morning, there came on insensibility, with an increase of all the
symptoms, except the heat. The body was violently convulsed, with cold
clammy sweats and coldness of the extremities. The abdomen subsided a
short time before they died, and, before they expired, a small quantity
of greenish matter, mixed with phlegm, issued from the mouths of two of
them.

Thirty three other men were put upon the sick list with similar
symptoms in a less degree, and some of them continued on the list for
five or six weeks before they perfectly recovered.”

It is not said what means were attempted for the recovery of these men;
but, besides emetics and milk, or oil, a dilute solution of the fixed
alkali in water has been recommended against this poison.

[77] I was furnished by Dr. Clephane, physician to the fleet at New
York, with the following fact, as a strong proof of the excellence of
this liquor:

In the beginning of the war two store ships, called the Tortoise and
Grampus, sailed for America under the convoy of the Dædalus frigate.
The Grampus happened to be supplied with a sufficient quantity of
porter to serve the whole passage, which proved very long. The other
two ships were furnished with the common allowance of spirits. The
weather being unfavourable, the passage drew out to fourteen weeks,
and, upon their arrival at New York, the Dædalus sent to the hospital
a hundred and twelve men; the Tortoise sixty-two; the greater part
of whom were in the last stage of the scurvy. The Grampus sent only
thirteen, none of whom had the scurvy.

[78] We have a remarkable proof of this in comparing the fleet under
the command of Admiral Byron with that under the Count d’Estaing, when
they both arrived from Europe on the coast of America in the year 1778,
some of the British ships having been unserviceable from the uncommon
prevalence of scurvy, while the French were not affected with it.

[79] See an article in Rozier’s Journal de Medicine for July, 1784, by
Dr. Ingenhousz.

[80] Since I came to England I have met with a pamphlet published by
Mr. Henry, of Manchester, in which an ingenious method, founded on
chemical principles, is proposed for separating the quick lime from
water; but I fear it is too nice and complex to be brought into common
practice. It would certainly be worth the trouble; but there are so
many duties in a ship of war to call off the attention of the men, and
they are so little accustomed to nice operations, that it would be
difficult to persuade officers to attend to it and enforce it. If a
sufficient quantity should not be precipitated by the air in the water,
and by the accidental exposure to the atmosphere, it might be more
effectually exposed to the air by Osbridge’s machine, to be described
hereafter, or by a long-nozzled bellows, and if a small impregnation
should be left, this is rather to be desired than avoided.

[81] See Dr. Lind on the Health of Seamen.

[82] The want of this apparatus may be supplied, in case of exigency,
by a contrivance mentioned by Dr. Lind, consisting of a tea-kettle with
the handle taken off, and inverted upon the boiler, with a gun barrel
adapted to the spout, passing through a barrel of water by way of
refrigeratory, or kept constantly moist with a mop.

In this place I cannot help mentioning also, that in case of great
extremity it has been found that the blood may be diluted, and thirst
removed, by wetting the surface of the body even with sea water, the
vapour of which is always fresh, and is inhaled by those pores of the
skin whose natural function it is to imbibe moisture, of which there is
always more or less in the common air of the atmosphere.

[83] When we consider that linen was not in use among the ancient
Romans, we might be apt to wonder that they were not more unhealthy;
but their substitute for this was frequent bathing, which not only
served to remove the _sordes_ adhering to the surface of the body, but
to air that part of the clothing which was usually in contact with
the skin. The washing of the bodies of men suspected of infection
upon their first entrance into a ship, has already been mentioned,
and I have known some commanders who made their men frequently bathe
themselves with great seeming advantage.

[84] A coarse woollen stuff so called.

[85] He makes the following computation of the additional expence for
each man in some of the articles that have been mentioned:

                                           £. _s._ _d._
  For 3 handkerchiefs, at 1s. 6d.           0   4   6
  12 pounds of sope, at 6d.                 0   6   0
  1 knife, at 1s.                           0   1   0
  1 pair of buckles, at 9d.                 0   0   9
                                          -------------
                                            0  12   3

  Suppose 3 shirts a year, the difference   0   2   3
  3 pair of trowsers, ditto                 0   2   3
  1 milled cap                              0   2   0
                                           ----------
                                 Total   £. 0  18   9


[86] See Part I.

[87] Had I then known the salutary effects of porter and spruce beer,
of which I have since been convinced, I should have proposed them as
substitutes for rum.

[88] The authenticity of this fact, as well as every other assertion in
this work relating to the mortality in the fleet, may be proved from
the ship’s books, deposited at the Navy Office.

[89] I fancied that my reasoning on this subject was in a great measure
new; but I lately met with the following passages in Celsus and
Hippocrates, which seem to be illustrative of the same idea:--Quibus
causa doloris, neque sensus ejus est, his mens laborat. Celsus, Lib.
ii. cap. vii. which is nearly a translation of the following aphorism
of Hippocrates:--[Greek hOkosoi poneontes ti tou sômatos, ta polla tôn
ponôn ouk a sthanontai, touteoisin hê gnômê noseei]. Hippoc. Aphor.
Lib. ii. Aphor. 6.

The same principle is ingeniously explained by Mr. Hunter in his
Lectures.

[90] See page 181.

[91] See pages 125 and 126.

[92] The form of administering this medicine was to add twenty drops of
thebaic tincture, from half a grain to a grain of emetic tartar, and
from five to ten grains of nitre, to two ounces of water or camphorated
julep, of which one half was given about two hours before the common
hour of rest, and the remainder at that hour. If spiritus Mindereri is
preferred to the nitre, it may be given from two drachms to half an
ounce for a dose, and it is better to administer it separately; for if
it should not be exactly neutralized, it may decompose the antimonial,
and render it inactive.

[93] Since the publication of the first edition of this work, there has
appeared a small tract on the treatment of low fevers, by Dr. Wall,
of Oxford, and as his ingenuity and learning give him a just claim to
the high rank he holds in his profession, attention is due to what he
advances. The principal scope of the work is to recommend, from his own
observation, the early use of opiates in those fevers, and the Doctor’s
authority, as well as my own experience, convince me of the propriety
of this practice in many cases occurring in this country, particularly
among the lower sort of people, for whom spare diet and hard labour
render evacuations less necessary than among the better sort. The
inferior class of people are also more subject to this sort of fever
from their houses and persons being less clean, and their apartments
being worse ventilated; so that practice in these, as well as other
cases, is to be varied according to the constitution and previous
habits of life.

[94] I first learned this, as well as many other useful and practical
facts, from Mr. Farquhar, Surgeon in London, who has laid me under the
greatest obligations by communicating many of his observations, derived
from the most extensive experience and a truly penetrating sagacity.

[95] I owe this piece of instruction, as well as many others, to Dr.
Cullen’s Lectures.

[96] In a review of Haslar hospital made in person by that excellent
officer, Vice-admiral Barrington, in 1780, it was very judiciously
proposed, among other salutary improvements, that there should be two
apartments for the reception of the sick upon their first landing; one
wherein they should be stripped of their dirty clothes, and another in
which they should go into the warm bath, and put on the hospital dress,
that they might not carry infection into the wards.

[97] The following is the form of it, and it was first introduced by
Mr. Whitfield, apothecary to the hospital, under the name of Bolus
Sedativus:--℞. Confection. Damorat. [dram]ss. Castor. Russic. pulv.
[scruple]ss. Tinct. Thebaic. g^{tt.} iv. Syr. sim. q.s. Fiat bolus
sexta quaque hora sumendus.

[98] Great nicety is required in all cases with regard to the times
and doses of cordials; for it by no means follows that these should
be in proportion to the lowness and loss of strength. This is well
illustrated by Mr. Hunter in his Lectures, where he explains the
distinction between the powers of the body and its _actions_. There
must be a certain degree of strength to bear the excitement occasioned
by stimulating and strengthening medicines or diet; for nothing is
more pernicious, or even fatal, than that any part or function should
make exertions beyond its strength; and there is the more danger in
ill-timed remedies of this kind, as a state of weakness is generally a
state of irritability.

[99] See a method proposed for obviating this, page 358.

[100] Page 381 et seq.

[101] Sailor’s fever.

[102] See pages 161, 181, and 380-1.

[103] I have in the whole of this work been extremely cautious in
reasoning concerning causes, from an opinion that they are very
obscure, and that the theoretical part of physic is very imperfect
and fallacious. This is perhaps in no instance more remarkable than
in those opinions that prevail concerning the nature and influence of
bile in producing diseases. An increased secretion of bile commonly
attends the feverish complaints of hot climates, and those of the
hot seasons of temperate and cold climates. It is not unnatural,
therefore, to impute the disease then prevailing to this redundancy of
bile: but, upon considering the matter more closely, it will appear
to be rather a concomitant symptom, or effect, than a cause of those
fevers; for, in the first place, in those cases in which there is
the greatest secretion of bile, as in the _cholera morbus_, there is
no fever. The only danger in this disease arises from the violent
irritation produced in the bowels by such an extraordinary quantity of
this secretion which commonly passes downwards; though I have seen it
prove fatal when it flowed into the stomach, and produced perpetual
retching and excoriation of the fauces; but in this case also without
any fever. Secondly, in the most fatal of all fevers, in the West
Indies, there are no marks of an increased secretion of bile, but,
on the contrary, a preternatural defect of it, as appears by its not
being evacuated either by stool or vomiting, by the white stools which
sometimes attend the yellow fever, and by its not appearing in the
first passages, nor in its own receptacles after death. Perhaps also
that state of the bowels which renders it so difficult to procure
stools may be in part owing to the want of this natural stimulus. It
is nevertheless true, that in the intermitting and remitting fevers of
hot climates and seasons there is perhaps always an accumulation of
bile at the beginning, and an increased secretion of it during their
course. It is farther true, that this adds to the patient’s uneasiness,
and aggravates the symptoms, and that the cure consists partly in the
evacuation of the bile. But it is also true, that in the very worst
sort of fevers in hot climates it is a favourable symptom where the
secretion of the liver is restored and increased, a bilious diarrhœa
being one of the most auspicious symptoms that can occur in a yellow
fever; and in those that are protracted and afford hopes of recovery,
there is generally a gush of bile from time to time.--We may therefore
lay down the following positions: 1. That in cases in which bile is
most freely and copiously secreted no fever exists, as in _cholera
morbus_. 2. That in the worst sort of fevers there is no preternatural
secretion of bile, but, on the contrary, a defect of it. 3. That
nevertheless there is an uncommon quantity of bile secreted in most
of the fevers of hot climates, and that part of the cure consists in
evacuating it.

I am extremely diffident, as I have said, in all matters depending
on our supposed knowledge of the animal œconomy; but the preceding
circumstances seem to countenance the following reasoning:--The bile,
according to Dr. Maclurg, who has given one of the best dissertations
on its nature and properties, is composed of two parts; the gross
part, which is coagulable by acids, and that part in which the
bitter principle resides. The first constitutes the principal part
in point of quantity, and seems to be that portion of the mass of
fluids which loses the property of sound healthy blood, by a tendency
to putrefaction, and is thrown out by this secretion. I will not
undertake to vouch for the truth of this, but shall assume it as true
in the following reasoning:--According to this theory, therefore, the
greater part of the bile is what may be called the effete part of
the circulating mass, or perhaps only of the red globules or gluten,
the watery and saline part, which passes off by urine being the
corrupted part of the serum. This part of the bile being very liable to
putrefaction, the bitter part is considered by Dr. Maclurg as intended
to correct this, and also to answer some good purpose in digestion.
One of the effects of the bile in this operation is to extinguish
acidity, whether proceeding from substances taken in, or generated in
the stomach. The blood in all climates, and in all situations of life,
is subject to have part of it thus corrupted, which, being separated
from the common mass by the liver, is mingled and discharged with
the common _feces_; but external heat continued for any length of
time tends to augment this corruption of the fluids, and therefore
to increase the secretion of bile; and it has been observed both by
myself and others, that the bile found in those bodies that have been
inspected after death, in consequence of fevers in hot climates, is
less bitter, and not so penetrating to the fingers, being therefore
deficient in the antiseptic principle. But since external heat makes
no alteration in the degree of temperature of the fluids themselves,
this effect must take place through the medium of the solids, in
consequence of that general languor and want of energy which too much
external heat induces in the functions, particularly in that power
by which the living body preserves itself from putrefaction. Now if
this portion of the blood, thus altered and depraved, is readily
secreted and speedily thrown out, as in _cholera morbus_, no harm
befals the constitution, nor any inconvenience but what arises from
the irritation of the _primæ viæ_. But this may not take place if the
body should be otherwise deranged; for the removal of this noxious
matter from the mass of blood depends upon a due irritability of the
blood vessels, the liver, and the bowels, whereby they are stimulated
to contract, and thereby expel it. According to the principle of Mr.
John Hunter, (whose deep and industrious researches into the animal
œconomy place him high in the list of those few on whom nature has
bestowed real genius, and who are capable of adding something new to
the stock of human knowledge,) there is in a state of health a relative
habitude or mutual harmony existing between the solids and fluids,
whereby they stimulate and produce actions in each other, in which
the healthy state of the functions consists, whether employed in the
formation of what is found, or the expulsion of what is noxious: so
that where it happens that the solids have a morbid insensibility to
the impressions of corrupted and acrimonious fluids, the retention
of these adds still more to the general derangement. To illustrate
this, it may be observed, that the stomach and bowels, when they are
endowed, as it were, with their natural perception, immediately expel
any preternatural accumulations of bile that may take place; but when
they are insensible to this stimulus through disease, no effort is made
to relieve nature till it is excited by medicine. The same reasoning
may be applied to the various vessels and ducts. Thus when we see the
liver gorged with bile, without any free excretion of it into the gall
bladder, as I have sometimes found to be the case upon inspecting the
body in some of the worst cases of fever, would it not appear that the
gall ducts have lost that natural irritability whereby the bile is
expelled? Or, in consequence of a depraved state of action, connected
with febrile affection, may it not happen that the absorbents, which,
in their natural state, only absorb particular substances, and in a
given quantity, will suffer a change in this natural action, and absorb
whatever happens to be applied to their orifices? In case of jaundice,
the bile, which is perhaps not at all absorbed in a state of health, is
taken up in large quantities, and mingled with the mass of blood, which
proves a seasonable relief in the state of accumulation and distension
occasioned by the obstruction. This may happen in cases of fever, not
indeed as a relief to nature, but from a depraved state of irritability
in the lymphatics, induced by disease. Though no increased quantity
of bile, therefore, is found in the gall bladder, there may have been
an increased excretion of it, a preternatural absorption having been
excited. So that it may admit of a question whether the colour of the
skin, in the yellow fever, is owing to this, or if the idea of it given
in the text[104] is more just; but in either case it seems probable
that the extreme tendency to putrefaction in the whole body is owing
either to the presence of bile, in consequence of absorption, or the
retention of something in the blood from a defect of its secretion.

This reasoning concerning the bile in hot climates may, in some sort,
be illustrated by what happens to the urine in cold climates. The
urine is the vehicle of an excrementitious part of the blood, of which
an increased proportion is generated in certain fevers, and if it is
thrown out in the form of high-coloured, turbid urine, the fever will
most probably be slight and short; but if it becomes pellucid, or
_crude_, as it is called, the general derangement will be increased,
the fever will be more violent and dangerous, and the first sign of
returning health will be a turbid appearance and sediment.

If the reasoning in the above discussion should appear to some readers
unsatisfactory, or ill connected, I can only say that if it is
deserving of this character, I am willing to have it considered not
only as an illustration, but an example of the nicety and fallacy of
theoretical disquisitions.

[104] See page 437-8.

[105] I have been very cautious of admitting any theory into this work;
but I cannot help adopting the doctrine of my much-valued master, Dr.
Cullen, on this point, viz. that a great part of the symptoms of fever
arise from reaction, or that effort which nature makes to overcome
the morbid cause. I am happy in any opportunity of acknowledging my
obligations to this learned professor, to whom the medical world in
general is so much indebted, as well for the rational views of the
animal œconomy, which he teaches, as for that spirit of study and
inquiry which he infuses into the minds of his pupils.

[106] M. Desportes, who wrote a treatise on the diseases of St. Domingo.

[107] There is a difference in the appearance of the blood when sizy,
perhaps not sufficiently insisted on by practical writers; for though
there should even be a very thick buff, yet, if the surface is flat,
and the _crassamentum_ tender, no great inflammation is indicated, in
comparison of that state of the blood wherein the surface is cupped,
the _crassamentum_ contracted so as to afford the appearance of a large
portion of _serum_, and where it feels firm and tenacious, though
perhaps but thinly covered with buff. This is a distinction well worth
attending to in practice; for it is in these last circumstances that
blood-letting gives most relief, and where the patient will bear the
repetition of it with most advantage.

[108] See the same observation in Mr. Hume’s Essay on this Disease,
published by Dr. Donald Monro.

[109] The state of the stomach is very much affected by that of the
external surface of the body; and it is sagaciously observed by
Sydenham, that the stomach being commonly very irritable in the plague,
the most effectual means of making it retain what was administered
internally was to excite a sweat.

[110] The red bark was brought to England in a Spanish prize in the
year 1781, and a very accurate account of its medical and chemical
properties was published the year after by Dr. William Saunders, of
Guy’s hospital. None of it had been brought to the West Indies before
the peace, so that I had no opportunity of trying it in that climate.

[111] Mr. Telford related to me, that he had cured several
intermittents that had baffled the bark, by means of white vitriol,
whilst he was surgeon of the Yarmouth in 1779. He gave it in doses of
five grains every four hours in the intermission, and was successful in
every case except two, in which the patients were far advanced in the
dropsy.

He met with several cases of the same kind in the Alcide, in 1782,
in which he was successful with the flowers of zinc, after having
given large quantities of bark to no purpose. He preferred, however,
the white vitriol, as being milder in its operation, and less apt to
disagree with the patient’s stomach.

He did not employ either of them in the recent state of the disease,
nor does he assert that they are universal or infallible remedies; but
only alledges, that he has experienced the most evident good effects
from them in an advanced stage of the disease, and a reduced state of
the patient, where the common remedy had failed.

[112] Dr. Huck Saunders, whose recent loss the world has reason to
regret on account of his experience and sagacity as a physician, as
well as his virtues as a man, communicated to me, in conversation, some
observations on the cure of obstinate intermittents, which deserve to
be mentioned here. When he was physician to the army at the Havannah
he cured a number of agues which had resisted the bark, by giving two
ounces of the vinous tincture of rhubarb and six drams of the tincture
of sena seven or eight hours before the fit. This being repeated two or
three times, carried off the disease. He also informed me, that he had
met with agues in England which did not yield to the bark; but, upon
leaving it off, and putting the patients on a course of mercury, they
were cured upon returning to the use of the bark.

Arsenic has also been found to be an effectual remedy in intermittent
fevers. I was informed by Dr. Huck Saunders, that when he was in North
America, in the war before the last, there was an expedition undertaken
against the Cherokee Indians, whose country is extremely subject
to agues; and as an adequate quantity of bark would have been very
cumbersome where light service was necessary, Mr. Russel, who had the
medical management of the expedition, provided a great number of pills,
containing each one eighth part of a grain of arsenic, by the proper
use of which he was enabled to cure the intermittent fevers with which
the troops were seized.

I shall here mention another unusual remedy in intermitting fevers;
and though I can bring only one instance in proof of its efficacy, yet
this is so strong as to make it deserve farther trial. A man, on board
of the Sandwich, had an obstinate intermittent which had resisted the
bark, and was stopped by applying to the stomach a plaster, composed of
gum plaster, epispastic plaster, and opium, in proportions which I do
not now recollect.

[113] Sir John Pringle on the Diseases of the Army.

[114] This is elegantly expressed as follows, in Sir George Baker’s
learned Dissertation on this disease:--“Primo neglectus tractatu
asperior occurrebat: etenim corpus extenuatum atque confectum ut morbo
fervido impar erat, ita ipsi impar curationi. Itaque optimum erat
occurrere ipsis principiis atque auxilia mature præripere. In hoc enim
corporis affectu aliquod certe in medicina opus est, haud multum in
naturæ beneficio.”

[115] In Dr. Griffith’s form of his medicine for the piles, six drachms
of fresh-drawn linseed oil are joined with two drachms and a half of
the vinous tincture of rhubarb, and given twice a day in a draught. I
commonly used oil of almonds at the hospital. This may be considered
as another instance of those useful combinations of medicines, which
experience alone sometimes discovers. I have found it of use also in
other internal hæmorrahages.

[116] See Diseases of the Army, p. 273. 6th Edit.

[117] Since coming to England, I have been informed by Dr. Garden,
a learned and ingenious practitioner from South Carolina, that this
medicine, in order to produce its proper effect, should be given in
a very weak decoction; for that after having almost abandoned it in
consequence of its failure when he gave it in strong decoctions, and
in substance, he was again convinced of its efficacy by using it in a
very weak decoction, a scruple being boiled in a pint of water to half
a pint.

[118] See page 345. A fact mentioned in Capt. Cooke’s Voyage to the
North Pacific Ocean, may be also alledged in favour of this opinion.
He remarks, that the Kamschadales, who were habituated to hard labour,
were free from scurvy, while the Russians and Cossacks, who were in
garrison in their country, and led indolent lives, were subject to it.

[119] I was informed of this fact by Mr. Cairncross, an ingenious
surgeon belonging to one of the battalions that served there during the
siege.

[120] I imagined that this was a new practice; but I find, since the
first edition of this work was printed, that it has been recommended by
Pere Labat in his voyage to the Antilles.

[121] There is a symptom which takes place when men are beginning to
recover from scurvy, (particularly when the cure is rapidly effected
by the use of lemon and orange juice) upon which I have frequently
reflected, but for which I have never been able to account. This
consists in acute pains, which are felt in the breast and limbs,
resembling rheumatic pains. I once knew the crew of a ship which was
much affected with scurvy, and had about ninety men under cure by
lemons and oranges, who were most of them affected with this symptom in
one night, and made such a noise by crying out as to alarm the officers
who were upon duty.

[122] See the Medical Essays of Edinburgh. Sennertus, lib. iii. part i.
sect. ii.--Haller Elem. Physiolog. lib. xix. sect. ii.

[123] In the Princessa, 1781, and the Nonsuch, Prince George, and Royal
Oak, in 1782.

[124] Since this was first written, the melancholy tidings have
arrived of another case to be added to this fatal list. It is that
of the amiable and gallant Lord Robert Manners, who commanded the
Resolution on the 12th of April, and having lost his leg, besides
receiving a wound in his arm and breast, died of this untractable
symptom on his passage to England; and though he shared a fate to be
envied by every lover of true glory, his loss can never be enough
deplored by his country and friends, being formed by his great virtues
and accomplishments, joined to the lustre of his rank, to hold out an
example of all that was good and great as a man and an officer.

[125] See Kaau Boerhaave’s account of this epilepsy in a school at
Harlaem, in a book, entitled Impetum faciens dictum Hippocrate per
corpus consentiens (page 355.) A fact of the same kind is also related
in a pamphlet, entitled Rapport des Commissaires chargés par le Roi de
l’examen du Magnetisme Animal.

[126] London Medical Observations and Inquiries, Vol. VI.

[127] Medical Commentaries, Vol. III., and a Thesis printed at
Edinburgh, 1784.

[128] See experiments on a heated room. Philosophical Transactions,
1775, Vol. LXV.

[129] That species of locked jaw, called by authors the _Trismus
Infantium_, to which children are liable the first week after birth, is
probably owing to the contact of the external air upon the skin, which
is accustomed in the womb to a moist and warm medium.

[130] Aretæus Cappadox says, that tetanus in general is even more apt
to occur in winter than in summer. De Cauf. & Sign. Morb. Acut. lib. i.
cap. vi.

[131] There are several valuable practical remarks on this complaint in
some of the ancient authors, especially Aretæus. Their principal means
of cure consisted in the application of warm oil to the whole surface
of the body, particularly of the part affected. This author also
recommends clysters of warm oil, occasionally combined with a medicine
called _hiera_, which consisted of certain spices and gums, with some
purgative, such as aloes or colocynth. Aretæus Cappad. de Curat. Morb.
Acut. cap. vi. Celsus, lib. iv. cap. iii. Goræaus in vocabulum,ἱερα.

[132] This is a fact which does not admit of doubt; but the manner in
which the effect is here produced is a matter of conjecture. It is most
probably owing to the compression and tremor of the air in consequence
of its resistance to the motion of the ball. We can also conceive,
that, with regard to an yielding part, such as the stomach or abdomen,
a body flying with great velocity may even, for a moment, displace a
portion of it by passing through the same space, without any other
mechanical injury than contusion, in a manner similar to what happens
to two balls in the act of collision in philosophical experiments made
to illustrate the nature of elasticity; or the compressed air may
even, in this case, act, as it were, like a cushion, preventing the
sudden impulse and contact of the ball. This explanation furnishes
a reason why the parts of the body above mentioned should be more
liable to be affected by accidents of this kind than the head. Perhaps
this difference may also, in part, arise from the principle laid down
by Mr. Hunter, that the stomach is more essential to life, and more
immediately the seat of it, than the head or any other member or organ
of the body, and that an injury to this part is more immediately
destructive of life than any other.

[133] The honourable Captain Fitzroy.

[134] Colonel Markham.

[135] Animals are affected by these accidents as well as men. A cow
in one of the ships was killed in one of the actions in April, by a
double-headed shot passing close to the small of her back.

[136] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ excerpta est.

[137] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.

[138] Vide pag. 408.

[139] Vide pag. 409. Hæc formulæ ex Pharmacopœia Nosocomii Sti.Thomæ
excerpta est. sed vice confectionis Damocratis hodie obsoletæ,
adhibentur confectio aromatica & opium purificatum, ratione habitâ ad
portionem fingulorum adeo ut parem edant effectum ac in vetere formulâ.

[140] Vide pag. 456.

[141] Ex auctoritate Cl. Huck Saunders.

[142] Ex auctoritate Cl. Huck Saunders.

[143] Ex auctoritate Cl. Lind.

[144] Vide pag. 479.

[145] Vide pag. 489.

[146] Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo de
morbis castrensibus.

[147] Hæc formula ex Pharmacopœiâ Nosocomii Sti. Thomæ, excerpta est.

[148] Vice olei ricini dare licet olei amygdalæ unciam unam cum
tincturæ sennæ unciâ dimidiâ. Vide Pharm. Nosoc. Sti.Thomæ.

[149] Hæc formula ex auctoritate Cl. Griffiths. In periculis a me ipso
factis felicissimum successum ex hoc medicamento percepi.

[150] Hoc medicamentum speciatim his hæmorrhagiis accommodatum quæ ex
aliquo viscere læso vi externa exoriantur quales in nave sæpius quam
alicubi accidere solent, ex præcipitiis & ex corpore colliso a molimine
machinarum & tormentorum.--Prodest quoque in his casibus pulvis
ipecacoanhæ compositus.

[151] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.

[152] Hæc est quam proxime formula a Cl. Mead legata Nosocomio Sti.
Thomæ ubi olim munere medici functus est, & ibi ex eo tempore usque
hodie feliciter in hydrope adhibita est.

[153] Cl°. Huck Saunders qui dyspnœâ hydropicâ laboravit ipse, auxilio
notabili erat hoc medicamentum. In talibus malis interdum summopere
prodest decoctum digitalis purpureæ, ut medicus supra memoratus in suo
casu compertus est.--Vid. Medical Transactions, Vol. III.

[154] Vide Cl. Pringle in opere suo de morbis castrensibus.

[155] Hujus doctrinæ auctor est Hippocrates, quæ restaurata est
auctaque a Cl. Milman in opusculo suo de hydrope.

[156] Hæc methodus medendi quæ æque efficax ac simplex est, primo
excogitata fuit a Cl. Georgio Fordyce medico nosocomii Sti. Thomæ, ubi
& ipse felicissimo cum successu eandem expertus sum, in muneribus meis
ibi fungendis.

[157] Vide opus Cl. Johannis Hunter de morbo venereo.

[158] Vires opii in isto morbo primo innotuerunt ex experientiâ Cl.
Nooth, dum præfuit nosocomiis militaribus in America, & pro optimo
remedio a peritissimis medicis & chirurgis jam habetur.

[159] Non hic intelligitur ptyalismum veram esse causam quâ efficitur
medela morbi, sed præcipitur ut pro argumento sit hydrargyrum in vasa
minima permeasse adeo ut effectum edat in subigendo morbo. Vide Opus
Hunteri.


[Transcriber's Note:

Inconsistent spelling and hyphenation are as in the original.]