Observations on the Diseases of Seamen

TABLE I

ABSTRACT of RETURNS,

1st June, 1781

Transcriber’s keys:

A Complement.

B Sick and Wounded on Board.

C Sent to the Hospital in the course of last Month.

D Dead on Board in the course of last Month.

The main body of the fleet lay at Barbadoes till the 6th of June, and the men had recruited extremely by their stay there; for vegetables, fruit, and other refreshments, can be procured at an easier rate, and in much greater plenty, at this island, than any other on the station.

The fleet arrived at St. Lucia the next day after it sailed from Barbadoes, and remained there till the 18th of June. The whole of this month was showery at this island, though it is not accounted the common rainy season; for more rain falls here than at any of the other islands at that time in our possession, being the most mountainous, as well as the most woody and uncultivated, of them all. These rains produced some increase of sickness, but very little, when compared to what took place at the same time in the army on shore, and in the ships refitting at the Carenage. There died about this time from fifty to fifty-five men every week in an army of not quite two thousand men.

The difference in point of health between the Carenage (which, as the word implies, is the place where ships go to be hove down, or otherwise repaired) and Gros-Islet Bay, where the main body of the fleet lay, affords a striking proof of the effects of situation. The Carenage is a land-locked creek, with a marsh adjacent to it, whereas the other is a road open to the fine air of the sea, the only land sheltering it to windward being a small, dry island, consisting of one hill, of half a league in circumference, and some of the cliffs of the main island of St. Lucia.

The increase of sickness here was farther prevented by the men having little labour to perform on shore, nor any haunts to encourage intemperance, a vice which the Admiral endeavoured still more effectually to prevent, by ordering all the rum stills in the neighbourhood to be destroyed.

It may be proper here to introduce a general account of the seasons and temperature of the West Indies, as there will be frequent occasion hereafter to make allusions to them. With regard to the heat, though the range of the temperature is very small, in comparison of what it is in Europe, the variations follow the same seasons; for July and August are the hottest months, and December and January the coolest. This we would naturally expect, as our plantations lie all in the northern hemisphere, between the 10th and 20th degree of N. latitude, and therefore bear the same relation as Europe does to the sun’s annual course. The hurricanes happen in the same season in which the periodical rains chiefly fall, that is, in the months of August, September, and October, which are called the hurricane months, and this is also the most unhealthy season. The time of the year which is most apt to be rainy, next to this, is from the middle of May to the middle or end of June, but this is not invariable. The lowest I ever observed the thermometer was at 69°; it stands very commonly at 72° at sunrise, in the cool season, rising to 78° or 79° in the middle of the day. In the hot season, the common range is from 76° to 83°. It seldom exceeds this in the shade at sea; and the greatest height at which I ever observed it in the shade at land was 87°. This is far short of the extremes of heat which they experience at certain seasons on the continent of North America, even very far north. In Pennsylvania and New York, the thermometer, I have been assured, rises frequently above 90°. It does so commonly enough in the East Indies; but I believe it never was known to rise so high in the West Indies, so that the heat, comparatively speaking, may be called moderate and steady.

The comparative mortality in June is small, owing to the fleet’s having been cleared of all the bad cases at Barbadoes before it sailed from thence. Though the proportion of sick in July is less, that of the mortality is greater, (see Table II (#TABLE_II).) which seems to be owing to this circumstance, that the cases taken ill during the rainy weather of June did not terminate fatally till the succeeding month.

In the course of this summer the fleet was reinforced by several ships of the line from England. The Triumph arrived in May, without any sick on board; but a flux prevailed a few weeks afterwards, without any evident cause, except the influence of the climate, and the exposure and fatigues during the operations of May. The disease, however, soon subsided, and the ship being kept in excellent order and discipline, continued healthy during all the remaining time in which she served with us.

In June, the Russel, of 74 guns, arrived from North America, and the Shrewsbury, a ship of the same rate, from England. The former left England in 1778, but was obliged to put back by stress of weather and sickness, and upon arriving afterwards on the coast of America, was extremely afflicted both with fevers and the scurvy. These were removed to the hospital, and this ship had become free of all sickness before sailing for the West Indies, except that a few of the men were seized with fevers, and she remained healthy after arriving there, not suffering from any regular attack of sickness, such as affected the ships in general from Europe. The Shrewsbury left England healthy, but was soon attacked with a fever and flux, which continued to prevail till the end of the year.

The fever in these two ships resembled rather the low ship fever of Europe than the bilious one peculiar to the climate. This last, indeed, seldom or never prevails to a great degree on board of a ship, unless it has been caught on the watering duty, or from some other exposure to the air of the land. I have, however, known a few instances of bilious fevers in men who never had been on shore from the time they left England; I have even known men of the same description attacked with intermittent fevers, which are supposed to depend still more on land air. This is perhaps owing either to the quantity of water in a great ship, part of which is always more or less putrid, or to the fresh-cut wood of the country taken on board for fuel, the steam of all which must resemble a good deal the effluvia of woods and marshes, which are supposed to give rise to intermittents.

In the beginning of July our fleet was reinforced with the Culloden, Egmont, and Centaur, all of 74 guns. In the end of the same month we were joined by the Alcide and Torbay, of the same rate, and also directly from England. The fleet was at this time at St. Christopher’s, having arrived there on the 22d of the month, with a large convoy from England, which had joined it at St. Lucia, under protection of the Thunderer and Berwick, two ships of the line, which being bound to Jamaica, I do not reckon as belonging to our fleet.

TABLE II

Shewing the proportional Sickness and Mortality, in relation to the whole Numbers on board, for fourteen Months.

Transcriber’s keys: A Proportion of Sick and Wounded on board on the First of the Month. B Proportion of Sick and Wounded sent to the Hospital in the Course of the Month. C Proportion of Deaths on board in the Course of the Month.

CHAP. II

Account of the Health of the Fleet from August, 1780, till December following. – The Fleet divided – The principal Squadron goes to North America – Fluctuation between Fevers and Fluxes – The Alcide and Torbay the most sickly Ships – Health mended by the Climate and Diet in North America – Hurricane in the West Indies – Sufferings in consequence of it – Fevers the chief Disease.

The hurricane months approaching, the season for active operations in the West Indies was now over. The whole force of the enemy, consisting of thirty-fix French and Spanish ships of the line, having gone to St. Domingo in the end of July, ten sail of the line were detached after them from our station, for the protection of Jamaica. The Admiral sailed for North America in August, with eleven ships of the line, leaving six for the protection of the islands.

There was little alteration in the general state of the sick during the voyage to America, and indeed we found no diminution of the West-India heat, which at this season is at the greatest height, until we came to the 33° of N. latitude.

The only material alteration in point of health was in the Alcide and Torbay, which had arrived from England with a few men ill of fevers; but in the course of this voyage these two ships became as unhealthy as any that ever came under my observation. There was a greater number of sick on board of them than all the fleet besides, and it increased to such a degree, that upon their arrival at New York, which was in the middle of September, after a passage of three weeks, near one half of their men were unfit for duty. In the Alcide it was a fever that raged; in the Torbay it was a dysentery; and the unusual degree of sickness and mortality which appears in the Table for the month of September, was owing to the very sickly state of these two ships.

TABLE III

Shewing the Number of Fevers and Fluxes on board on the First of each Month, and the Number sent to the Hospital in the Course of the Month.

Key: B On board. H Sent to the Hospital.

We shall hereafter see reason for supposing that fever and dysentery proceed from the same cause; and as both these ships arrived from England in a similar state with regard to health, fevers would probably have been the prevailing disease in both; but a part of the 87th regiment, then serving as marines in the fleet, was put on board of the Torbay at St. Christopher’s, and some of them being ill of the dysentery, gave this turn to the disease which afterwards prevailed on board. I have formed a Table to shew the fluctuating state of these two diseases, and this was one of my first and most imperfect attempts towards a medical history of the fleet in a methodical way. (Table III (#TABLE_III).)

There was but little sickness in the rest of this squadron, except in the Terrible, where the dysentery prevailed a good deal. None of the ships of the line which we found in the West Indies, upon our arrival there, were now in company, except the Yarmouth, and this was the most healthy of all the ships that went to North America.

The health of the fleet was very much recruited by its short stay in America; for the men were supplied with fresh meat and spruce beer, and they enjoyed the two finest months of the year in that temperate climate. The squadron left New York in the middle of November, and though dispersed by a violent storm, all the ships arrived safe in the West Indies before the middle of December.

In October the fleet had attained such a degree of health, that though the calculation in the Table is made from five of the most sickly ships, no death happened in this month on board of any of them. In November the mortality was also inconsiderable, though the ships left in the West Indies are included in the calculation; which, had it been made upon those only that went to North America, the deaths would have been no more than one in seven hundred and eleven in this month, which is rather less than that of any other month in the Table.

The amendment in health, in consequence of the change of climate, was most remarkable in the Terrible, which, by the time she left America, had entirely got rid of the violent dysentery that had prevailed for some time on board. This sudden change in the health of this ship was evidently owing to the great attention of the Captain to cleanliness and discipline, and no less to the assiduity and abilities of the Surgeon. The Alcide still continued sickly, though not so much so as the Torbay. The former had sailed on a cruise in October, and having met with very rough weather, the sick list was thereby increased. The dysentery now prevailed in that ship, as well as fevers, and those men chiefly were attacked with fevers who were ill of the scurvy, or recovering from it. This was not very common; and there were several other remarkable particulars with regard to the fevers in this ship; for her men were not only uncommonly subject to this disease, both in America and the West Indies, but to all the various forms of it; the low, infectious, ship fever of Europe, the bilious remitting, and the malignant yellow fever of hot climates. It would appear from this, as well as other instances, that a ship may assume, as it were, a particular constitution, or a tendency to some particular disease, for a length of time, and this depending on some lurking and adhering infection, or the manner in which she may have been victualled, watered, disciplined, or manned.

The great benefit derived to the health of the fleet, from the change of climate, as well as other reasons, justified the Admiral in going to North America; and there was the more merit in this measure, as it was undertaken without precedent, and without instruction. Upon our return we found there was great good fortune in it, as well as wisdom; for there had happened on the 10th of October a more violent hurricane than any in the memory of man, and the ravage it made both by sea and land is, perhaps, unparallelled in history. Several of the ships of the line were exposed to it; but though they suffered extremely, and were in the utmost danger, none were lost. Two of them happened to be at Antigua, which was out of the track of this hurricane, as it extended only from the 12th to the 15th degree of N. latitude; so that the only islands that suffered by it were Barbadoes, St. Lucia, St. Vincent, and Martinico. – Four frigates, and as many sloops of war, either foundered or were wrecked, and about one thousand seamen perished in them. One of the buildings of the hospital at Barbadoes was entirely demolished by the impetuosity of the sea, which, having risen to a great height, dashed a ship against it, and twenty-three seamen were buried in the ruins[3 - Although this hurricane, in itself and its consequences, was so destructive to the lives and health of men, yet, with regard to the inhabitants on shore, it had a surprising and unexpected effect in mending their health. I wrote an account of this hurricane to the late Dr. Hunter, who communicated it to the Royal Society, and the following passage is extracted from it:“The consequences of this general tumult of nature, on the health of man, was none of the least curious of its effects. I made much inquiry on this head, not only of the medical gentlemen who had the charge of hospitals, and of the physicians of the country, but of the inhabitants, and every one had some cure to relate either of themselves or their neighbours, in a variety of diseases. Nor could I find that either those who were in health, or those who were ill of any disease whatever suffered from it, otherwise than by its mechanical violence; but, on the contrary, that there was a general amendment of health. This is a fact, which I could neither credit, nor would venture to relate, were it not supported by so many concurring testimonies. It had a visible good effect on the acute diseases of the climate. The chronic fluxes, of which there were then some at the naval hospital, were cured or much relieved by it. But the diseases upon which it had most evident and sensible effects, were pulmonic consumptions. Some recent cases of phthisis, and even the acute state of pleurisy, was cured by it; and in the advanced and incurable state of it, the hectic fever was removed, and remarkable temporary relief afforded. A delicate lady of my acquaintance, who was ill of a pleurisy at the time, and passed more than ten hours in the open air, sitting generally several inches deep in water, found herself free of complaint next day; had no return of it; and when I saw her a few weeks after, was in much better health and looks then usual. The people observed that they had remarkably keen appetites for some time after, and the surviving part of them became uncommonly healthy; some of both sexes, whom I had left fallow and thin a few months before, looking now fresh and plump.It is very difficult to account for this, as well as every thing else in the animal œconomy; but it was probably owing in part, at least, to the very great coldness and purity of the air from the upper regions of the atmosphere. Great agitation of mind sometimes also produces a revolution in health; and we know that the effect of external impressions in general is very different when the mind is vacant, from what it is when occupied and interested by objects, whether of pleasure and satisfaction, or of danger and suffering.”].

The Montague suffered most on this occasion, and was also most subject to sickness and mortality, brought on in consequence of the great fatigue and hardships of the men in bringing her into port and refitting her; for the ship was almost torn to pieces both in the rigging and hull, and the bedding and other necessaries and conveniencies were entirely destroyed. The fever that prevailed on board at this time was of the most malignant kind known in this climate; and the worst cases arose in watering, and the other necessary duties on shore, from which the men would sometimes return frantic, and die in a few hours. There was a party of soldiers on board; and as they were not called upon to perform any duties on shore, they had but little sickness in companion of the sailors.

The other ships having suffered less from the storm, were also less sickly, as it was not necessary for them to remain so long in the unhealthy Carenage to repair.

The only disease that prevailed at this time, in these two ships, was fevers, there being few or no fluxes, though they had been so frequent in the former part of the year. Though fevers and fluxes depend on the same general causes, yet when these causes exist in a higher degree, it would appear that they are more apt to produce fevers. Thus the exhalations of the earth from marshes are more apt to produce fevers; and mere excesses of heat and cold, or moisture, are more apt to produce fluxes; just as in Europe a catarrh, which may be considered as a local febrile affection, as well as a dysentery, will be excited by exposure to cold or damp, without any specific bad quality in the air.

The Ajax and Montague are the only two ships of those left in the West Indies, which are included in the estimate of sickness and mortality in November and December, and they bear a very great proportion to the whole; for out of forty-four that died in fourteen ships of the line in November, twenty died in the Montague, and five in the Ajax; and out of forty-three, the whole number of deaths in December in twenty-one ships of the line, ten were of the Montague, and eleven of the Ajax.

CHAP. III

Account of the Health of the Fleet from January, 1781, till July, 1781, both Months included. – Arrival of seven Ships of the Line from England – Increase of Sickness in consequence of a Descent on St. Vincent’s – Long Cruise to windward of Martinico – Great Prevalence of Scurvy – Difference of Health in different Ships – New Ships not more unhealthy than others – Why Frigates are more healthy than Ships of the Line – Remarkable Cure of Scurvy in two Ships – Essence of Malt – Vegetables most antiscorbutic in their natural State – Advantage of supplying Refreshments on board of Ships in preference to Hospitals.

We are now come to that period in which our fleet was reinforced with seven ships of the line, which arrived at Barbadoes from England on the 5th of January, 1781, under the command of Lord Hood. This addition, with two which had arrived in November, made the force upon this station again amount to twenty-one ships of the line.

TABLE IV

Shewing the Number of each Disease on board on the First of each Month, the Numbers sent to the Hospital, and Dead, in the Course of the Month

KEY:

B On board.

H Sent to the Hospital.

D Dead.

N. B. Where the Spaces are marked thus, §, no Return was made.

The whole fleet was tolerably healthy during this month, the season being dry and cool; there was, however, a small increase of sickness at this time, and it was owing to a descent made on St. Vincent’s in December. The soldiers, (of whom there was still a regiment on board of the fleet) the marines, and some of the seamen, had been on shore for one night only; but many of them having lain on the ground, some having been intoxicated, or having eaten to excess of sugar-cane and fruit, caught fevers and fluxes, which increased the proportion of diseases and deaths the following months, as appears by the Table.