Observations on the Diseases of Seamen

I shall give another example of the same kind in the hospital at Jamaica, when our fleet went there after the battle of the 12th of April. All the men accounted for here were landed from the fleet under Lord Rodney in May, June, and July, 1782[26 - In the year 1741, the fleet under Admiral Vernon was at Jamaica at the same time of the year; and the following is the account of the men sent to the hospital in May and June:There was on board of this fleet about two thirds of the number of men that was on board of the fleet in 1782. I cannot ascertain how many died on board of the ships in Admiral Vernon’s fleet; but the deaths at the hospital alone are somewhat more than what happened to our fleet both on board and at the hospital.].

This uncommon degree of mortality was not owing to the bad air of the place, for Port Royal is naturally as healthy as most parts in that climate; nor was it owing to bad accommodations, or to neglect of any kind; but is imputable entirely to this circumstance, that the hospital being extremely small, those only were sent to it who were very ill. There were at this time upwards of forty ships of the line at Jamaica, and an hospital, containing only three hundred beds, could afford but a very inadequate relief. Some officers are unwilling that any man should die on board of their ships, for fear of dispiriting the others; and many were sent to the hospital, in the most desperate stage of sickness, that they might there die.

There cannot be a stronger proof than this of the fallacy of judging of the success of practice by the proportion of the deaths; for the sick on this occasion were better accommodated, better provided for in every respect, and as regularly attended, as at any other period of my service in the West Indies, yet the mortality was greater than at any other time.

Having given instances of the common rate of mortality in hospitals in Europe and the West Indies, I shall next give examples of the success we had in North America, when the fleet was there in the autumns of 1780 and 1782.

Account of the Sick landed at New York from the West-India Fleet, consisting of eleven Ships of the Line, in Autumn, 1780.

Account of the Sick landed at New York from the West-India Fleet, consisting of twenty-six Ships of the Line, in Autumn, 1782.

The difference of mortality here, from what occurred in the West Indies, is partly imputable to climate, and partly to the smaller number of acute diseases. In the two accounts last stated, the difference in favour of the latter seemed chiefly to arise from the superior attention to the sick, and the better treatment of them. It was mentioned before, that in autumn, 1782, at New York, they were better supplied, both at hospitals and on board of their ships, with every thing that could be wished, and that on this occasion almost every scheme I had proposed was realised. The extraordinary success in the scurvy was owing to the great quantities of vegetables that were supplied; for several fields of cabbages had been planted in the neighbourhood of the hospital for the use of the sick. This was owing to the humane attention of Admiral Digby, who had also caused cows to be purchased to supply the hospital with milk. Cleanliness, and the separation of diseases, were also strictly attended to; and I am persuaded that many of the scorbutic men were saved by keeping them separated from the fevers and fluxes; for it has been observed, that men ill of the scurvy, or recovering from it, are very apt to be infected, particularly with the flux.

It appears, that the disease in which climate makes the greatest difference is the flux. It was observable, that though the dysentery at this time was more fatal on board of the ships at New York than in the West Indies, yet it was less so at the hospital. The cause of this seems to be, that the acute state of this disease, of which men die on board before there is time to remove them to an hospital, is more fatal in a cold climate; but when it becomes more protracted, which is the case with most of the cases sent to hospitals, they then do much better in a cold than in a hot climate.

I shall here subjoin an account of the numbers that were admitted, and died, during the whole war, at the hospitals of the different parts at which the fleets I was connected with touched.

I have been able to calculate the numbers of deaths from disease in this great fleet, both on board and at hospitals, during the period of my own service, which was three years and three months, and they amounted to three thousand two hundred[27 - I was enabled, after coming to England, to ascertain the deaths in that part of the squadron from which I happened at any time to be absent, by having leave from the Navy Board to inspect the ships’ books deposited at their office.] independent of those that were killed and died of wounds.

There died of disease in the fleet I belonged to, from July, 1780, to July, 1781, about one man in eight, including both those who died on board and at hospitals[28 - See Appendix to Part II (#APPENDIX_TO_PART_II).]. But the annual mortality in the West-India fleet, during the last year of the war, that is, from March, 1782, to March, 1783, was not quite one in twenty[29 - The mortality of the army in the West Indies is much greater; for it appears by the returns of the War Office, that there died in the year 1780, two thousand and thirty-six soldiers, which being calculated by the numbers on the station, and those who arrived in the convoy in March and July, the annual mortality is found to be one in four. The greatness of this mortality will appear in a still stronger light, when it is considered that those who serve in the army are the most healthy part of the community. When I was at the encampment at Coxheath in the year 1779, I was politely favoured with a sight of the returns, both of the general officers and physician, and it appeared that in an army of ten thousand and eighty-nine men, there died, from the 10th of June to the 2d of November, forty-three, exclusive of twelve who died of small pox. This being calculated, is equal to an annual mortality of one in a hundred and nine; and it was not half so much in the encampment of the former year. It appears by Mr. Simpson’s tables, that the mortality of mankind in England, from the age of twenty to forty-five, which includes the usual age of those who serve in the navy and army, is one in fifty.]. This difference was partly owing to the general increase of health in fleets as a war advances, partly to some improvements in victualling, and partly to better accommodations as well as regulations in what related to the care of the sick.

Though the mortality in fleets in the West Indies is, upon the whole, greater than in Europe, yet it has so happened, that, in the late war, the fleet at home has, at particular periods, been considerably more sickly than that in the West Indies was at any one time. I was informed by Dr. Lind, that, when the grand fleet arrived at Portsmouth in November, 1779, a tenth part of all the men were sent to the hospital. It appears[30 - See Table II (#TABLE_II).], that in the years 1780 and 1781, a period at which the fleet in the West Indies was most sickly, the medium of the numbers on the sick list was one in fifteen, and many of these were very slight complaints; whereas, in the fleet alluded to in England, the diseases were mostly fevers, and so ill as actually to be sent to the hospital. It appears likewise, that there was the greatest proportion of sick in our fleet when it was on the coast of America in September, 1780[31 - See Table II (#TABLE_II).]. This difference is owing to the greater prevalence of the ship fever, and of the scurvy, in a cold than in a hot climate.

With regard to the mortality at hospitals, the comparison is greatly in favour of those in England. This is owing to the greater regularity, and the better accommodation and diet, which an hospital at home admits of, as well as to the difference of climate. It has also been mentioned, that, on most occasions, the hospitals I attended abroad were so limited as to contain only the worst cases, in consequence of which there would of course be a greater proportional mortality than in the great hospitals of England.

The following is an account of the whole loss of lives from disease, and by the enemy[32 - None are comprehended but those who were killed or wounded in battles in which the whole fleet was present, this account not including those who fell in single actions in frigates or other ships.], in three years and three months, in the fleets and hospitals with which I was connected:

Примечание 1[33 - It would appear, that, anciently, though the slaughter in battle was greater than in modern times, yet that disease was still more destructive than the sword. One of the oldest testimonies to this purpose is in the History of Alexander’s Expedition, by Arrian – τους μεν ἐν ταῖς μαχαις ἀπολωλεκασιν, ὁι δε ἐκ των τραυματων ἀπομαχοι γεγενημενοι, ὁι πλειοῦς δε νοσω ἀπολωλεσαν. – Arrian. Hist. Alex. Exped.Lib. v. cap. 26.]

Примечание 2[34 - Upwards of three thousand were also lost at sea in ships of war belonging to the same fleets in the hurricane of October, 1780, and in the storm in September, 1782, in which the Ville de Paris and the other French prizes were lost on their passage to England.]

PART II.

of the

CAUSES of SICKNESS in FLEETS, and the

MEANS of PREVENTION

INTRODUCTION

In the year 1780 I printed a small treatise for the use of the fleet, containing general rules for the prevention of sickness; and this part of the work is chiefly taken from it.

My own opportunities of experience, as exhibited in the preceding Part, have been sufficiently extensive to suggest many observations on this subject; but as my object is utility, rather than the praise of originality, I shall not confine myself to these. Great part of what is to be advanced is taken from books[35 - The authors from whom I have borrowed have been chiefly Dr. Lind and Capt. Cook. To the former we are indebted for the most accurate observations on the health of seamen in hot climates; of the improvements made by the latter, an excellent compendium may be seen in Sir John Pringle’s Discourse before the Royal Society, on the occasion of adjudging a prize medal to Capt. Cook for his paper upon this subject.] and conversation, as well as my own experience, my design being to exhibit a concise view of all the discoveries on this subject that have come to my knowledge. I have assumed nothing, however, from mere report or testimony, having had opportunities, from my own observations, of verifying or disproving the assertions of others.

More may be done towards the preservation of the health and lives of seamen than is commonly imagined; and it is a matter not only of humanity and duty, but of interest and policy.

Towards the forming of a seaman a sort of education is necessary, consisting in an habitual practice in the exercise of his profession from an early period of life; so that if our stock of mariners should come to be exhausted or diminished, this would be a loss that could not be repaired by the most flourishing state of the public finances; for money would avail nothing to the public defence without a sufficient number of able and healthy men, which are the real resources of a state, and the true sinews of war.

In this view, as well as from the peculiar dependence of Britain on her navy, this order of men is truly inestimable; and even considering men merely as a commodity, it could be made evident, in an œconomical and political view, independent of moral considerations, that the lives and health of men might be preserved at much less expence and trouble than what are necessary to repair the ravages of disease.

It would be endless to enumerate the accounts furnished by history of the losses and disappointments to the public service from the prevalence of disease in fleets. Sir Richard Hawkins, who lived in the beginning of the last century, mentions, that in twenty years he had known of ten thousand men who had perished by the scurvy. Commodore Anson, in the course of his voyage of circumnavigation, lost more than four fifths of his men chiefly by that disease. History supplies us with many instances of naval expeditions that have been entirely frustrated by the force of disease alone: that under Count Mansfeldt in 1624; that under the Duke of Buckingham the year after; that under Sir Francis Wheeler in 1693; that to Carthagena in 1741; that of the French under D’Anville in 1746; and that of the same nation to Louisbourg in 1757[36 - In the late war sickness alone was not the cause of want of success in any instance, except in the last action in the East Indies, in which so many men were ill of the scurvy, that there were not hands enow to manage the guns.There is another fact in history, which, though not so applicable to this subject as those above recited, forcibly evinces how important a study the health of men ought to be in military affairs. When Henry V. was about to invade France, he had an army of fifty thousand men; but owing to a sickness which arose in the army, in consequence of some delays in the embarkation, their number was reduced to ten thousand at the battle of Agincourt. The disease of which they chiefly died was the dysentery.Rapin.].

That the health of a ship’s company depends in a great measure upon means within our power, is strongly evinced by this, that different ships in the same situation of service enjoy very different degrees of health. Every one who has served in a great fleet must have remarked, that out of ships with the same complement of men, who have been the same length of time at sea, and have been victualled and watered in the same manner, some are extremely sickly, while others are free from disease. Is it not naturally to be inferred from hence, that the health of men at sea depends in a great measure upon circumstances within the power of officers, and, indeed, upon their exertions, much more than medical care[37 - It is not meant by this to insinuate that every commander is absolutely accountable for the health of his ship’s company, and censurable when they are sickly; for this may depend on his predecessor in command, or a stubborn infection may have prevailed from the original fitting out or manning of the ship which he may not have superintended.]?

It has appeared in the preceding part of this work, that the diseases most prevalent among seamen are fevers, fluxes, and the scurvy. These are indeed some of the most fatal that can attack the human body; but there is a numerous tribe of complaints, which are also some of the most severe scourges of human nature, from which they are in a manner entirely exempt. – These are the diseases to which the indolent and luxurious are subject, and which so far embitter their life as to render their portion of worldly enjoyment nearly on a level with that of the poor and laborious. The diseases alluded to are chiefly the gout, stomach complaints, hypochondriac and other nervous disorders. In all countries it is the better sort of people that are most subject to these; for they are owing to the want of bodily exercise, to the great indulgence of the senses, and a greater keenness and delicacy in the passions and sentiments of the mind. Man being formed by nature for active life, it is necessary to his enjoying health that his muscular powers should be exercised, and that his senses should be habituated to a certain strength of impression. Animal and vegetable nature may be aptly enough compared to each other in this respect; for a tree or plant brought up in a greater degree of shelter and shade than what is suitable to its nature, will be puny and sickly; it will neither attain its natural growth nor strength of fibre, nor will it be able to bear the influence of the weather, nor the natural vicissitudes of heat and cold to which it may be exposed.

It is to be remarked, however, that exercise and temperance may be carried to excess, and that in these there is a certain salutary medium; for when labour and abstinence amount to hardship, they are equally pernicious as indulgence and indolence. This is strongly exemplified in seamen; for, in consequence of what they undergo, they are in general short lived, and have their constitutions worn out ten years before the rest of the laborious part of mankind. A seaman, at the age of forty-five, if shewn to a person not accustomed to be among them, would be taken by his looks to be fifty-five, or even on the borders of sixty[38 - Οὐ γαρ ἐγωγέ τι οῗδα κακώτερον ἄλλο θαλάσσης,Ανδεά τε συγχεῦαι, εἰ καὶ μάλα καρτερὸς εἴη.ΟΜΗΡ. ΟΔΥΣ. Θ.Dire is the ocean, dread in all its forms!Man must decay, when man contends with storms.Pope.].

The most common chronic complaints which a long course of fatigue, exposure to the weather, and other hardships, tend to bring on, are pulmonary consumptions, rheumatisms, and dropsies. It is also to be considered, that these complaints, particularly the last, are farther fomented by hard drinking, which is a common vice among this class of men, and they are led to indulge in it by the rigorous and irregular course of duty incident to their mode of life.

With regard to gout, indigestion, hypochondriac complaints, and low spirits, there is something in hard labour of every kind that tends to avert them, and particularly in that rough mode of it peculiar to a sea life. There is also something in the harsh sensations from the objects which seamen are in use to see, hear, and handle, which so modifies their constitutions and hardens their nerves as to make them little liable to what may be called the diseases of excessive refinement, such as those above mentioned. I have, indeed, met with such diseases at naval hospitals; but I always remarked that they were in landsmen who had been pressed, and who had been bred to sedentary and indolent occupations.

The diseases above enumerated, as well as most other chronic complaints, being the offspring of indolence and luxury, while fevers and feverish complaints fall equally on all ranks and descriptions of men, it was a saying of some of the ancients, that acute diseases were sent from heaven[39 - Wherever causes are obscure, superstition naturally ascribes them to some preternatural influence; and what seemed farther to have encouraged this, anciently, was, that violent epidemics occurred most frequently in camps and at sieges where great political conjunctures were likely to arise, in which superior powers were supposed to interest themselves. Thus we read in Homer of fatal diseases being sent as punishments by the gods. But the pestilential diseases so often mentioned by poets and historians as prevailing in cities and armies, were probably nothing else but fevers, produced partly perhaps by the scarcity and bad quality of provisions, but probably still more by corrupted human effluvia, which was very apt to he produced by the want of personal cleanliness, to which the mode of cloathing among the ancients would more particularly subject them, especially in camps and besieged towns.]; whereas chronic diseases were of man’s own creation. But I shall endeavour in the course of this work to evince, that, with regard to seamen at least, acute diseases are as much artificial as any others, being the offspring of mismanagement and neglect; with this difference, that they are imputable not so much to the misconduct of the sufferers themselves, as of those under whose protection they are placed.

If I were to add any other complaint to the three already mentioned, as most prevalent, and peculiar to a sea life, it would be those foul and incurable ulcers which are so apt to arise at sea, particularly in a hot climate. The slightest scratch, or the smallest pimple, more especially on the lower extremities, is apt to spread, and to become an incurable ulcer, so as to end in the loss of a limb. The nature of the diet, and the malignant influence of the climate, both conspire in producing them.

The diseases most frequent and prevalent at sea have this advantage, that they are more the subjects of prevention than most others, because they depend upon remote causes that are assignable, and which increase and diminish according to certain circumstances, which are in a great measure within our power.

The prevention of diseases is an object as much deserving our attention as their cure; for the art of physic is at best but fallible, and sickness, under the best medical management, is productive of great inconvenience, and is attended with more or less mortality. The means of prevention are also more within our power than those of cure; for it is more in human art to remove contagion, to alter a man’s food and cloathing, to command what exercise he is to use and what air he is to breathe, than it is to produce any given change in the internal operations of the body. What we know concerning prevention is also more certain and satisfactory, in as much as it is easier to investigate the external causes that affect health than to develope the secret springs of the animal œconomy.

This part of the work, therefore, is chiefly addressed to those who direct the navy either in a civil or military capacity; for the general health of ships depends so much upon the victualling and manning in the first instance, and, afterwards, on the degree of discipline and order which are kept up, that I am persuaded that a certain degree of attention on their part would almost entirely eradicate disease from our fleets.

Several remarks in this part of the work will be found so obvious, that it might seem superfluous to mention them. But it has been my intention to omit nothing that I have heard of or observed as a matter of ascertained utility, and, I believe, the most experienced will find either something new, or what they had not before sufficiently attended to. Though the design of it is that of being extensively useful, yet my trouble would be compensated, should it prove the means of health and comfort to a single ship’s company; nay, I should not repent my labour, could I enjoy the conscious certainty of its being the means of saving the life of one brave and good man.

The prevention of disease has relation only to the external causes that affect health, and I shall consider these under the four heads of

I. AIR,

II. ALIMENT,

III. EXERCISE,

IV. CLOATHING.

CHAP. I.

AIR

Under this head I shall not only consider the natural state of the air of the atmosphere in point of heat and cold, moisture and dryness, purity and corruption, but also the different artificial impregnations of it from the holds or other parts of a ship, or from the persons of men who have been neglected in point of cleanliness.

The common air of the atmosphere at sea is purer than on shore, which gives to a sea life a very great advantage over a life at land. This advantage is still greater in the tropical regions, where the land air, especially such as proceeds from woods and marshes, is so fatal, and where the heat is also considerably less at sea than on shore. But this superior purity of the air at sea is more than counterbalanced by the artificial means of propagating diseases on board of a ship. Since a sea life, however, has this great natural advantage to health, the causes of disease peculiar to it are chargeable rather to the mismanagement of men than to any thing unavoidable in nature; and we are from this encouraged to exert our endeavours in removing them.

The effects of land air, however, are not to be neglected by those who are studious of preserving the health of a ship’s company, for seamen are exposed to it in various ways while they are in harbour; and this is what we shall first treat of.

SECT. I.

Of the noxious Effects of Land Air in particular Situations