Observations on the Diseases of Seamen

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 - 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.]. 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 - Dr. Hendy has lately published an ingenious treatise upon this disease.] 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 - See Sydenham’s Works.]. 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 - See Part I. Book II. Chap. VI (#BOOK_II_CHAP_VI).], 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 - 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.]. 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 - See Martin’s History of the Western Islands, and Medical Communications, Vol. I. page 68.], 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 - 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[157 - Hunter’s Experiments.], 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[158 - Mr. Hunter’s Lectures.].].

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 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[47 - 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.].

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[48 - 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.].

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[49 - 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.]. 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[50 - 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.] 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.