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.