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.