Observations on the Diseases of Seamen

In this state of the disease, the articles of lesser powers, such as malt and melasses, may be of service by preventing its farther progress, or the appearance of actual symptoms, and by restoring the constitution.

In some of the early stages of this disease the effervescing mixture of acids with fixed alkali may probably also be of use. I never could perceive any sensible benefit in those cases in which I tried it, though some of the gentlemen of the fleet reported to me that they thought it of service.

There is no article of the Materia Medica yet known that possesses any considerable power over this disease without the assistance of proper diet. With this assistance, however, it is found, that whatever tends to increase the fluid secretions, hastens very much the recovery of the scorbutic patient. I have observed a very striking instance of this in the effects of a spontaneous diarrhoea; for I have seen those hard livid swellings on the legs, that form one of the most constant symptoms of this disease, almost disappear, and the hams, from being contracted, become flexible in the course of twelve hours after the purging came on. I have endeavoured to imitate this with purgatives, but never with the same effects as the natural looseness. A free flow of urine is also found to promote the recovery, and vinegar of squills is one of the most effectual medicines in this intention. It is likewise of singular service to excite sweat; for an obstruction of perspiration seems to be one of the principal constituents of the disease. The goose skin, which is an early and constant symptom of this disease, seems to be owing to a constriction of the exhaling vessels. Dover’s powder has been employed with advantage as a sudorific, with decoction of the woods drank warm, and plentiful warm dilution. Camphor, combined with nitre, has been found one of the best remedies, and it acts both as a diaphoretic and diuretic.

Such external applications as relax the skin are found also to forward the cure. The contraction of the hams and the livid hardness of the calves of the legs are relieved by emollient cataplasms. Burying the legs in the earth, which has a sensible good effect, seems to act on the same principle, for it makes the parts sweat profusely.

There can be no doubt that in the scurvy there takes place in certain parts of the body a stagnation of the humours in the small vessels, particularly of the lower extremities, and that it is to this circumstance that the livid hardness of the fleshy parts of the legs is owing. The effect of medicine in removing this, must be to restore the action of those torpid vessels, so as to bring the stagnated fluids again into circulation[118 - There is a symptom which takes place when men are beginning to recover from scurvy, (particularly when the cure is rapidly effected by the use of lemon and orange juice) upon which I have frequently reflected, but for which I have never been able to account. This consists in acute pains, which are felt in the breast and limbs, resembling rheumatic pains. I once knew the crew of a ship which was much affected with scurvy, and had about ninety men under cure by lemons and oranges, who were most of them affected with this symptom in one night, and made such a noise by crying out as to alarm the officers who were upon duty.] Purgatives seem to act upon it as they do in the dropsy, by exciting absorption. The irritation of the bowels and their increased secretion thus affecting the minute vessels in all parts of the body, is the result of that sympathy or balance established between every part of the system, in order to support the harmony and effect the purposes of the animal œconomy.

It has long appeared to me, that the scurvy is owing rather to a defect of nourishment than to a vitiated state of it. In fact, that sort of food which is supposed most commonly to induce the scurvy, is, in most cases, not putrid, but is in an unnatural and depraved state by being drained of its juices, which run off in brine; and perhaps some of the more subtile and nutritious parts are wasted by evaporation. It is not found that salt of itself has any effect in inducing the scurvy, and indeed it can be induced under a state of diet in which there is no salt, as we know from some instances quoted by Dr. Lind; and some cases are related by Dr. Monro and Dr. Milman, in the Medical Transactions, which are in proof of the same opinion. But the case most in point to prove that it depends on a defect of aliment, is that of Dr. Stark, who, by way of experiment on himself, reduced his diet to the least quantity he could subsist upon, and was thereupon affected with the symptoms of the sea scurvy. I have also known some symptoms of it arise in old people in consequence of long abstinence, owing to the want of appetite.

It would appear that the aliment we take in acts in two ways in increasing the vigour of the body. First, by assimilation, whereby it affords the matter of which the solids of the body are made, in order to carry on growth in youth; and to repair the waste of parts in adult age. A very small quantity of matter is necessary for these purposes; and as a proof of it, we see people supported equally well with very different quantities and qualities of food. Secondly, Food is necessary as a stimulus, either by a power it has of soothing the nerves of the stomach, and the other surfaces to which it is applied, or by its volume in distending the intestines and blood vessels. It is upon this principle that luxury renders the great quantities of food we take in necessary; and those species of food which satisfy most by their stimulus are by no means such as are the most nutritious. It is also upon this principle, that in cases of accidental hardship from want of food, or in barren and inclement countries where food is scarce, the body is supported, in some measure, by what contains little or no nutritious matter, such as pure water, or the bark of trees powdered and kneaded into a sort of bread, as we are told of the inhabitants of Lapland.

There are other familiar and well-established facts, which prove, that either from the influence of disease, from habits of life, or the nature of particular animals, life can go on for a length of time with little or no aliment. This is the case in fevers, in sea-sickness, in certain singular cases that have been recorded[119 - See the Medical Essays of Edinburgh. Sennertus, lib. iii. part i. sect. ii. – Haller Elem. Physiolog. lib. xix. sect. ii.], in torpid animals, and in animals of cold blood. Though a man in health will die if deprived of food for a very few days, it does not follow that this is owing to the want of matter to repair the waste of the body. The craving for food, and the faintness from long abstinence, arise from the want of the accustomed stimulus, especially in those who are used to live well; and a person feels himself most refreshed by food and drink when newly taken in, and before it can be applied to the purpose of nutrition.

As there is a continual waste and decay, however, both of our fluids and solids, some degree of reparation is absolutely necessary, especially to animals of warm blood; and such ingesta as would give the stimulus of food, without being possessed of any nutritious principle, would indeed continue life for a certain time; but disease would ensue. The provision used at sea answers, in a great measure, to this description; for unless the powers of digestion and assimilation are remarkably strong, salt beef and biscuit, which have been long kept, do not contain much more nourishment than saw-dust, or the bark of a tree, and the disease induced by this diet is the scurvy.

The nature and symptoms of the scurvy countenance this opinion: for as the means of renewing the animal matter of our bodies is withdrawn under this course of diet, nature, in consequence of an accommodating principle, observes a sort of frugality, and the animal œconomy adopts such measures as may be productive of the least possible waste and corruption of the fluids. Accordingly all the secretions become scanty; and, in particular, one of the first symptoms of this disease is a suppression of perspiration, as appears by the goose-skin that attends it. There is a paucity of urine. There is also a great languor in the circulation, which may be considered either as a means adopted by nature to prevent that vitiated and effete state of the fluids which a brisker action might induce; or it may happen from a want of that due supply of nourishment necessary to produce a vigorous action of all the functions.

We have a proof of this general languor not only from the great aversion to motion, and the great disposition to syncope, but from the inspection of the dead body, from which it appears that the whole circulating system, being more flaccid and less elastic, is subject to preternatural distention. The heart is accordingly found enlarged in bulk, the size of the cavities being increased; and in the extremities, where the circulation is naturally most languid, the small vessels carrying the colourless part of the blood, are so far enlarged as to admit the red part of it, as appears by the livid colour; and where this is the case, these vessels being unable to carry on the circulation, a stagnation ensues, as is evident in those livid appearances most common about the calves of the leg, which feel like a hard cake. I have examined those parts in the dead subject, and found a want of fluidity in the contents of the vessels, but could not discover any thing like eechymosis; from which I concluded that the colour was owing to an error loci, and the hardness to stagnation and coagulation of the fluids, and a want of action of the vessels.

The incurable state of ulcers, so common in this disease, is also what we might expect from the defect of fresh assimilated juices; for where a breach is made, either by nature or accident, in the solids, particularly of the extremities, the proper suppuration is prevented by the depraved state both of the fluids and vessels; and we cannot expect that renewal of solid parts in which healing consists, where both the instruments and materials of its formation are so defective.

I shall conclude what I have to say on this subject, by shortly considering whether or not this disease is ever contagious.

There is something in the nature and history of the scurvy that would lead us at once to pronounce that it is not infectious; for the external causes on which it depends are so obvious, and seem so adequate to account for its appearance and prevalence upon certain occasions, as at first sight to exclude every other external cause.

But it seems extremely unphilosophical to deny the reality or possibility of any thing in Nature, from our supposed knowledge of the means and causes she employs, particularly in a branch of science so obscure as the animal œconomy. Could we, therefore, prove the point as a matter of fact, it would be in vain to deny it, from our fancied acquaintance with Nature’s modes of operation.

The facts which give a suspicion of the scurvy being infectious are, 1st, What is related by Dr. Lind, that the sea scurvy spread at one time from the naval hospital to the people of the adjacent country. 2dly, There occurred several instances, in the first part of this work, of this disease prevailing to a much greater degree in some[120 - In the Princessa, 1781, and the Nonsuch, Prince George, and Royal Oak, in 1782.] particular ships than others, though upon the most accurate inquiry there was found no difference in the diet, or any other external or predisposing cause adequate to account for this. We can conceive, that those ships having accidentally a few men, whose constitutions were remarkably predisposed to this disease, might catch it earlier than in other ships, and communicate it to the rest of the crew.

The only practical inference that would lie from the establishment of this fact would be, that when the disease begins first to appear, the men affected should be separated from the rest; and this is a good practice, whether this opinion is true or not; for such men ought to be put in one mess, in order that they all may live upon the same antiscorbutic articles of diet, and that they may more easily be debarred from the use of their common provisions, of which this disease does not make them lose the relish.

CHAP. IV.

Of the Wounds received in the Actions of April, 1782

Loss in the Battle and from Wounds – Fatality of the locked Jaw – Treatment of it – Some Ships more subject to it than others – Different from other Cases of Tetanus – It is not cured by the Removal of the Part – It may come on after the Part is cured – Effect of Climate in producing it – Accidents from the Wind of a Ball – Accidents from the Explosion of Gunpowder – Means of preventing them – General Observations on Sores and Wounds.

Though surgery was not properly in my department, yet, having had a fair opportunity of collecting facts concerning this branch of practice, I thought it my duty to pay some attention to it.

The whole number of men wounded in the actions of April, 1782, amounted to eight hundred and ten.

Of these, sixty died on board before the end of the month, five in the course of the following month, and two in June.

There were ninety-seven wounded men sent to the hospital at Port Royal, of whom there had died twenty-one when the fleet left Jamaica on the 17th of July.

So that the whole loss of men in the battles of April, and their consequences, is as follows:

Of those who died on board, fifteen[121 - Since this was first written, the melancholy tidings have arrived of another case to be added to this fatal list. It is that of the amiable and gallant Lord Robert Manners, who commanded the Resolution on the 12th of April, and having lost his leg, besides receiving a wound in his arm and breast, died of this untractable symptom on his passage to England; and though he shared a fate to be envied by every lover of true glory, his loss can never be enough deplored by his country and friends, being formed by his great virtues and accomplishments, joined to the lustre of his rank, to hold out an example of all that was good and great as a man and an officer.] were carried off with the Symptoms of the locked jaw; but of those sent to the hospital, only one. The reason that so few in proportion were affected with it in the hospital may have been, that none of the wounded were landed till near the end of the third week after the principal action. The danger of this symptom was then, in a great measure, past, though I have known it to take place in every period from the second or third day till the fourth week.

Only three men in the whole fleet recovered from this alarming complaint; and as it is interesting to know every thing relating to so desperate a symptom, I shall give a short account of each.

The first was a seaman of the Montagu, who had his thigh wounded by a splinter which carried away part of the integuments and membrana adiposa, and lacerated in a small degree the vastus externus muscle. The wound did extremely well till the 23d day, when the jaw became almost entirely fixed, and the whole muscles of the wounded side were thrown into frequent spasms. Mr. Young, the surgeon, who was always anxious and assiduous in his duty, consulted with me, and we had immediate recourse to the warm bath, which gave a degree of instantaneous relief, and was repeated twice a day for half an hour. He was sensibly better every time; in nine days was entirely free of the symptom, and continued afterwards to do well. The only other means taken for this man’s recovery, besides what were used with the other wounded men, were from three to five grains of opium, which he took every day, in divided doses.

The next was a seaman of thirty years of age, belonging to the Magnificent, who had the humerus broken and shattered by a splinter which entered the deltoid muscle. Several large portions of bone were extracted, and the artery was laid bare on the inside. On the fifth day there came on a large ichorous discharge, with a low quick pulse and depressed spirits, and the jaws began to close, with pain and stricture on both sides about the articulation of the lower jaw. He had every day since the accident taken half an ounce of Peruvian bark, combined with opium or rhubarb, according as it made him loose or costive. This was continued, and the part externally was kept constantly moist all round with volatile liniment, to which a fourth part of tinctura thebaica was added. Next day the jaw was almost entirely fixed, so that it was with difficulty that a little wine and water could be introduced with a spoon. Mr. Harris, the surgeon, now wisely determining to do something vigorous in this unpromising situation, beat up twelve ounces of opium moistened to the consistence of a cataplasm with the thebaic tincture, and applied one half to each side of the jaw. The patient this day swallowed a pint of the bark decoction with half an ounce of nitre, and took a diaphoretic draught of twenty drops of thebaic tincture and thirty of antimonial wine. He had also the smoke of tobacco thrown up his nostrils.

On the third day after the attack he could open his mouth half an inch. The cataplasms were taken off, beat up afresh with the tincture, and applied anew. The bark and other medicines were continued. On the fourth day the stricture and pain of the jaw went entirely off, but the cataplasm and volatile liniment were applied for three days longer. The wound produced a laudable discharge, every symptom became favourable, and he continued to recover.

The only other person who recovered from this symptom was a man in the Bedford. Several died of it on board of this ship; and as the same means of relief were skilfully employed in all the cases by Mr. Wickes, the surgeon, the success seemed owing more to something favourable in the man’s constitution, than any thing peculiar in the treatment, which consisted in the administration of the warm bath, opium and camphor, with mercurial friction on the jaw.

This accident affected some ships remarkably more than others, particularly the Barfleur and Bedford, though their wounds had nothing peculiar, nor were in a greater proportion than in the rest of the fleet. Four were carried off by it in each of these ships. It has formerly been observed, that great ships acquire peculiar habits, or dispositions, which incline the constitutions of the men to one disease more than another. This complaint took a run in some particular ships last year also after the battle of the Chesapeak; and I have known it prevail in some particular hospitals more than others. In the present instance, it may have been owing either to something peculiar in the constitution, or air of the ships; or we can conceive it to be owing to some sort of nervous sympathy, just as the epilepsy[122 - See Kaau Boerhaave’s account of this epilepsy in a school at Harlaem, in a book, entitled Impetum faciens dictum Hippocrate per corpus consentiens (page 355.) A fact of the same kind is also related in a pamphlet, entitled Rapport des Commissaires chargés par le Roi de l’examen du Magnetisme Animal.] has been known to spread from one boy to another, at a school, in consequence of imitation, dread, horror, or some such delicate nervous or mental affection. We have in yawning an example of a spasmodic affection spreading from one person to another. If this is the case in the locked jaw, those affected by it should be removed from the presence of the other wounded men, lest the idea of the sufferings of others should be so fixed in their mind, or so impress them with the fear of the like, as to invite the attack of the same complaint.

Though the locked jaw, in consequence of wounds, resembles frequently in its symptoms the tetanus which arises without any external accident, yet there are many cases of the former which differ materially from the violent symptoms of the other, as described by authors. In most cases of the locked jaw from wounds the spasms are not so general, so violent, nor attended with such exquisite pain. It sometimes happens that the convulsive twitchings are even accompanied with a sort of pleasure, as in the case of a lieutenant of the Montagu, whose case was related to me by Mr. Young, the surgeon of that ship, a man of skill and observation in his profession, and upon whose fidelity and accuracy I could perfectly rely. This officer had been wounded in the elbow at the battle of St. Christopher’s by a splinter, whereby the capsular ligament of the joint was injured. On the ninth day, symptoms of the locked jaw came on, and soon after the whole muscles of the wounded side were affected with frequent convulsive twitchings, which, as he himself said, afforded a pleasant sensation, exciting laughing like an agreeable titillation. He died on the fourth day after it came on, and had no pain to the last.

The locked jaw from accident differs also from other cases of tetanus, in respect to its cure; for the latter has been successfully treated by cold bathing, as is related by Dr Wright[123 - London Medical Observations and Inquiries, Vol. VI.] and Dr. Cochrane[124 - Medical Commentaries, Vol. III., and a Thesis printed at Edinburgh, 1784.]; but it is acknowledged by the latter that this treatment did not answer when the complaint proceeded from a wound.

It is to be remarked, that the locked jaw did not take place in those cases in which the wounds had a foul and gangrenous appearance more than others; for those that digested and cicatrized favourably, were equally apt to be affected by it; and though amputations are most liable to this symptom, the slightest injuries, even a scratch, will sometimes bring it on.

It would be difficult, therefore, to establish any particular treatment that would tend to prevent accidents of this kind; but Mr. Bassan, surgeon of the Arrogant, one of the line-of-battle ships engaged on the 12th of April, mixed laudanum with the dressings of all the wounds, and no locked jaw occurred.

In the Bedford there occurred a curious circumstance concerning this complaint. In one of the cases that proved fatal, the symptoms did not come on till the wound was so far healed that all dressing had been laid aside.

Mr. Wood, surgeon of the hospital at Jamaica, informed me, that in cases of the locked jaw from injuries to small members, such as fingers, he had tried the effect of amputating the part after the symptoms had come on, but without any effect in putting a stop to them.

Would it not appear, from the two last mentioned facts, that this symptom is not kept up, nor even takes place in the first instance, from an immediate present irritation, but that the constitution comes to be so modified, or receives such an impulse, as it were, that the complaint runs its course independent of the presence of that stimulus which excites it?

It would be difficult to assign a satisfactory reason why this accident is more frequent in hot than in cold climates. The effect of external heat upon the living body is not to raise its temperature even when the heat of the air exceeds that of the body[125 - See experiments on a heated room. Philosophical Transactions, 1775, Vol. LXV.]; so that we are to seek for the effects of it in some of those affections peculiar to animal life. And as the outward temperature of the air does not affect the general mass of the body, all the effects produced by it must depend on impressions made on the external surface of the body and lungs; and the skin, which may be considered as a large expanded tissue of nervous fibres endowed with universal sympathy and great sensibility, affects every organ and every function of the body, according to the state of the air in contact with it, whether cold or hot, moist or dry, pure or vitiated. This sympathetic sensibility of the skin is chiefly affected by the state of the perspiring pores on its surface; for it is only when these are open that the impression of the air on the skin produces catarrhs, rheumatisms, and internal inflammations in cold climates; and the external temperature in hot climates being such as to keep the pores almost always open, this seems to be a principal reason of that universal irritability prevailing there, and of the general sympathy that prevails between every part, particularly as connected with the organs of perspiration[126 - That species of locked jaw, called by authors the Trismus Infantium, to which children are liable the first week after birth, is probably owing to the contact of the external air upon the skin, which is accustomed in the womb to a moist and warm medium.]. This readiness of one part to be affected by another in hot climates is well illustrated by the sudden translation of certain diseases. I have seen, for instance, a catarrh cease, and be converted, as it were, into a diarrhœa, and this as quickly disappearing, a pain in the foot would arise, like an attack of the gout. All this would happen in the space of a few hours.

But, in cold climates, wounds are by no means exempt from the locked jaw; for it sometimes occurs in England, where I have seen it even in the winter season[127 - Aretæus Cappadox says, that tetanus in general is even more apt to occur in winter than in summer. De Cauf. & Sign. Morb. Acut. lib. i. cap. vi.].

Since my return to England I have received some new and useful information on this subject in conversing with Dr. Warren, physician to the King; and as any observations derived from so much acknowledged skill and sagacity must be valuable, I shall here relate what he was so kind as to communicate to me.

This eminent physician, in attending a case in which he was nearly interested, and in which his endeavours were rewarded with success, found the greatest benefit from opium and the warm bath. The opium was given in the form of tincture, in moderate, but pretty frequent, doses. The bath was composed of milk and water, and the addition of milk was, no doubt, an improvement; for there is something in this as well as oil extremely soothing to the human nerves. Dr. Warren had intended to make trial of a bath of oil in case this had failed. He mentioned the following observation, with regard to the external application of oil, which could only have been suggested by that anxious attention that was paid to the case. It was found, that the uneasiness arising from the spasm was allayed by constantly drawing a feather wetted with oil over the temples, which had an evident effect in lulling the pain and spasm; for when this operation was left off, there was an immediate recurrence of these symptoms[128 - There are several valuable practical remarks on this complaint in some of the ancient authors, especially Aretæus. Their principal means of cure consisted in the application of warm oil to the whole surface of the body, particularly of the part affected. This author also recommends clysters of warm oil, occasionally combined with a medicine called hiera, which consisted of certain spices and gums, with some purgative, such as aloes or colocynth. Aretæus Cappad. de Curat. Morb. Acut. cap. vi. Celsus, lib. iv. cap. iii. Goræaus in vocabulum,ἱερα.].

It would appear, therefore, from this as well as the former cases, that opium and the warm bath are the only remedies yet known which are of service in this complaint, and much will depend on the judicious management of them. The method of administering the opium, recommended by Dr. Warren, seems to be the most judicious, especially in constitutions not habituated to this medicine.

There is a certain medium in giving opium, by which its best effects are obtained, for in an under dose it will produce disturbance instead of rest; and when it is given in large quantities it frequently defeats the very end for which it is given, by throwing the body into convulsions which terminate in death. The rule for judging of the proper limits of this dose is, by its effect in inducing that stupor or insensibility which renders the senses incapable of irritation; for in this, as well as in every other case of disease, the cure seems ultimately to be the work of nature, the effect of medicine being only a secondary operation, by which it removes some obstacle to the natural efforts of the constitution. Though a dose of opium greater than ordinary is required to produce this insensibility in cases of spasm, and though the constitution in that situation will bear more, yet even here it may be given to excess; and by beginning with small quantities, and giving it in frequent rather than large doses, the constitution will thereby be better reconciled to it, and it will also with more convenience admit of that gradual increase which is peculiarly necessary with this medicine. These ideas were suggested to me by Dr. Warren; and it may be farther added, in recommendation of his method, that the liquid form is preferable to the solid, as the effects of it will sooner be seen, and a better judgement can be formed how far it is proper to push it.

Great attention is also necessary in regulating the heat of the bath; for if it is not sufficiently warm, it will not have the effect of producing a due relaxation; and if it should be too hot, it will stimulate too much, and will have the farther inconvenience of making the patient very faint in a short time. It cannot be well regulated without a thermometer, and 93° upon Fahrenheit’s scale is perhaps the best temperature. I have kept a patient in a bath of that heat for six hours, which he could not have endured for half an hour had the heat been three or four degrees higher.

The circumstance next in consequence, in the cure of this complaint, is the keeping up a moisture on the skin, and guarding the surface of the body from the access of the air. This is particularly necessary with regard to the part itself, which should be constantly enveloped in warm, anodyne, and emollient applications. The good effects of this is particularly exemplified in the case which recovered under the care of Mr. Harris, who gave the diaphoretic medicine, composed of antimonial wine and laudanum, and applied the anodyne cataplasm to the external fauces. It was remarked, that the locked jaw was most incident to those wounded men who lay in parts of the hospital where they were exposed to a current of air; and the cases of tetanus that most usually occur in the West Indies, independent of wounds, are those of slaves who fall asleep in the night-time in the open air.

Since the first edition of this work, there has appeared an Essay on the Locked Jaw by Dr. Rush, physician to the American army in the late war, in which he recommends, from his own observation, Peruvian bark, wine, and blisters, and to dress the wounds with mercurial ointment, in the cure of this complaint. From some trials I have since made of the bark in St. Thomas’s hospital, I have reason to think well of it as a remedy in this disease.

There is a singular species of accident to which engagements at sea are liable, the WIND OF A BALL, as it is called. If a cannon ball in its flight passes close to any part of the body, it renders it livid and numb for some time[129 - This is a fact which does not admit of doubt; but the manner in which the effect is here produced is a matter of conjecture. It is most probably owing to the compression and tremor of the air in consequence of its resistance to the motion of the ball. We can also conceive, that, with regard to an yielding part, such as the stomach or abdomen, a body flying with great velocity may even, for a moment, displace a portion of it by passing through the same space, without any other mechanical injury than contusion, in a manner similar to what happens to two balls in the act of collision in philosophical experiments made to illustrate the nature of elasticity; or the compressed air may even, in this case, act, as it were, like a cushion, preventing the sudden impulse and contact of the ball. This explanation furnishes a reason why the parts of the body above mentioned should be more liable to be affected by accidents of this kind than the head. Perhaps this difference may also, in part, arise from the principle laid down by Mr. Hunter, that the stomach is more essential to life, and more immediately the seat of it, than the head or any other member or organ of the body, and that an injury to this part is more immediately destructive of life than any other.]. It is most dangerous when it approaches the stomach; and there was an instance of a man in the last battle, who, upon a ball passing close to his stomach, dropped down dead instantaneously, without the least visible marks of injury. Another, in consequence of a ball passing close to his belly, remained without sense or motion for some time, and a large livid tumor arose on the part, but he recovered. I attended a man at the hospital at Barbadoes, who had the buttons of his trowsers carried off by a cannon ball, without its having touched the body. The pubis was livid and swelled for some time after: he suffered exquisite pain from strangury, which seemed to proceed from a paralysis of the bladder, for he voided no water without a catheter for near three months, after which time he recovered. I know a brave young officer[130 - The honourable Captain Fitzroy.] in the army, who had his epaulette carried off by a cannon ball at Charlestown, in consequence of which the shoulder and adjacent parts of the neck were affected for some time. A like accident happened to a marine officer in one of the late engagements; but in neither of these was the head materially affected, nor is it so apt to be affected in this way as the stomach. I never knew death the consequence of the wind of a ball on the head; though an officer[131 - Colonel Markham.] in the Sultan, at the battle of Grenada, was so stunned by a shot passing near his temple, as to be insensible for some time, but he recovered entirely in a few hours[132 - Animals are affected by these accidents as well as men. A cow in one of the ships was killed in one of the actions in April, by a double-headed shot passing close to the small of her back.].

The class of wounds most peculiar to a sea engagement are scorches from the accidental explosion of gunpowder; and in most of the campaigns in which I have served they have been very frequent and fatal. Few accidents, however, of this kind happened in the late engagements; so that we had but little experience of this sort of wounds in April, 1782. But on former occasions they were very frequent, and the best application to the burnt parts was found to be linseed oil, which some of the surgeons mixed with lime water, others with cerusse, and both compositions answered well. Opium was found of great use in alleviating pain and procuring rest, care being taken to guard against costiveness by the use of clysters. In the battles of 1780 and 1781, one-fourth part of the whole killed and wounded was from this sort of accident; but on the 9th and 12th of April, 1782, only two accidental explosions of gunpowder happened in the whole fleet, by one of which one life was lost, by the other, two. This difference was owing partly to greater experience and habits of caution acquired in the course of the war, and partly to certain improved methods in working the artillery introduced by Sir Charles Douglas, which, like all his other valuable improvements, tend to give facility and expedition, as well as to save the lives of men. The circumstances which tend to prevent explosions are, 1st, The wetting of the wads, which prevents their inflaming and blowing back when they fight the weather side of the ship; a circumstance which, without this precaution, gives occasion to a number of accidents by the burning parts catching the loose powder, or setting fire to the cartridges. 2dly, The use of goose-quill tubes and small priming boxes, made of tin, instead of the large horns formerly in use, whereby great quantities of powder were scattered about and exposed to accidental fire. 3dly, The use of locks, which was practised with great success in several ships, and was found to make the operation both more safe and more expeditious.