Observations on the Diseases of Seamen

Observations on the Diseases of Seamen
Gilbert Blane

Observations on the Diseases of Seamen

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.

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 - 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.], 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 - 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.REMARKSDuring 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.] 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 (#TABLE_I).) by way of specimen, and the proportional result of them for fourteen months is set down in another table, (Table II (#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.