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. | |
|---|---|---|---|---|
| NEARLY | ONE IN | |||
| Fevers | 224 | 29 | 8 | |
| Fluxes | 17 | 6 | 3 | |
| Scurvy | 50 | 5 | 10 | |
| Ulcers | 25 | 10 | 2½ | |
| Other Complaints | 46 | 8 | 6 | |
| 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.