Observations on the Diseases of Seamen

IN HYDROPEPULVIS HYDRAGOGUS

℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana quindecim, pulveris zinziberis grana quinque. Misce fiat pulvis, fumatur alternis diebus.

MISTURA DIURETICA

℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias duas, kali præparati drachmam unam. Misce. Hauriamur unciæ tres bis die.151Vice infusi gentianæ licet adhibere infusum absynthii.

TINCTURA SCILLÆ. Pharm. Lond

Sumatur drachma una bis die ex haustu potûs communis.

PILULA EX ELATERIO

℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur in pilulas sex. Sumatur una bis die.

152Ægro licet, imo prodest hoc morbo laboranti bibere ad libitum ex liquore aliquo siti extinguendæ accommodato, veluti aquâ hordei cum crystallis tartari.

IN ERYSIPELATE

153℞. Pulveris corticis Peruviani drachmam unam. Sumatur omni horâ vel interpositis duabus vel tribus horis.

IN MORBO VENEREO1. IN GONORRHOEA

Hauriatur ad libitum infusum lini, vel decoctum hordei cum gummi arabici drachmis sex in singulis libris.

Sumantur calomelanos grana duo quotidie per viginti circiter dies.

154℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati granum unum. Misce. Injiciatur pauxillum in urethram bis vel ter die.

IN GONORRHOEA BENIGNA

℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ guttas triginti. Misce. Sumatur bis die.

2. IN ULCUSCULIS

In initio feliciter adhibetur causticum.

℞. Calomelanos drachmam dimidiam, conservæ rosæ quantum satis sit. Contunde in massam & divide in pilulas triginta. Sumatur una quotidie, vel interdum dimidia ter die, ut cieatur ptyalismus modicus. Perstet æger in usu medicamenti hujus per dies acto postquam sanata fuerint ulcuscula.

Pro medicamento topico, utile erit inspergere ulcusculum cum pulvere hydrargyri nitrati.

3. IN BUBONE

Illinatur artus lateris affecti infra inguen cum unguenti ex hydrargyro drachmâ dimidiâ quotidie.

Si abierit bubo in ulcus mali moris omittatur pro tempore usus hydrargyri & sumatur quotidie 155opii purificati granum unum primo semel, dein bis, denique ter die vel etiam sæpius, & pulveris corticis Peruviani drachma una ter quaterve die. – Interdum conducit sumere pulveris sarsæparillæ drachmas duas ter die, vel extracti cicutæ grana tria ter die, augendo paullatim usque ad grana decem.

4. IN VERA LUE, anginâ scilicet osteocopiis, exostosibus & defædatione cutis

Illinantur membra quotidie cum unguenti ex hydrargyro drachmis duabus quotidie usque dum cieatur ptyalismus156 per dies triginta ad minimum vel donec evanuerint symptomata. – Interdum vice litûs adhibere conveniat vel calomelanos granum unum ter die, vel pilularum ex hydrargyro grana quinque bis die, vel

℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram unam. Fiat solutio, & sumatur uncia dimidia bis die. In ulceribus tonsillarum pernotabili est auxilio suffitum ex cinnabare in fauces inhalare semel vel bis quotidie.

Si ulcera mali moris exorta fuerint in quavis corporis parte, eadem, ut jam de bubone dictum est, fiant.

IN SCORBUTO MARINO

Sumat æger quotidie succi limonum unciam unam ter quaterve die.

℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi melasses dicti libras sedecim pondere, extracti pini uncias octo pondere, spumæ vel fæcis cerevisiæ libras duas mensurâ. Misce & agita valide cum baculo, dein sinatur abire in fermentationem, ut fiat cerevisia, deinde servetur in vase clauso. Ut diutius servari potest, proderit admiscere spiritûs vini tenuis Gallici, vel qui rum dicitur, libras duas aut tres. Si infirma fuerint viscera adjicere juvabit vel lupuli vel summitatum absinthii vel quassiæ, vel zinziberis quantum satis sit. Hauriat æger libras duas quotidie.

℞. Farinæ avenaceæ libras tres, aquæ puræ congios quatuor. Misce. Macera donec liquor fiat acidulus, dein effunde dimidium & adjiciatur par copia aquæ puræ, & coque ad idoneam spissitudinem, ut cogatur in pulmentum. Sit pro victu assiduo cum vini & sacchari non purificati, vel syrupi melasses dicti quantum sufficiat ad gratum saporem conciliandum.

Ad alvum solvendam commode adhiberi potest electuarium eccoproticum cum crystallis tartari. Vid. p. 556.

THE END

1

These were the Conqueror, the Cornwall, and the Boyne, which were so damaged in the battles, that they were obliged to bear away for St. Lucia.

2

The following may serve as a specimen of these returns:

State of Health of His Majesty’s Ship Alcide. Carlisle Bay, Barbadoes, 1st June, 1781.

REMARKS

During the course of last month we had one hundred and fourteen of the men, who contracted the scurvy in the late long cruise, recovered by the use of limes, which were procured at Montserrat. A pint of wine, with an equal quantity of water, made agreeable with sugar and tamarinds, is served to each patient daily. The regimen is exactly the same as mentioned last month.

Since we came into port, very few have been seized with scurvy, but several complain daily of fluxes and feverish complaints, none of which seem at present to be of any consequence.

Four patients have last month complained of an almost total blindness towards evening, accompanied with head-ach, vertigo, nausea, and a sense of weight about the precordia. The pupil is then extremely dilated, but contracts readily when a strong light is presented to it. Two of them had the scurvy in a high degree, one of them slightly, and the other seemed entirely free from it. I am not well acquainted with the nature or cure of this disease, which I believe is called Nyctalopia by some systematic writers.

I gave those who were affected with it an emetic, which brought up a great deal of bile, and relieved the symptoms both of the head and stomach. This encouraged me to a repetition of it, which seemed also to be attended with benefit. I likewise applied blisters behind the ears, and gave bark and elixir of vitriol, with the antiscorbutic course, to those that required it.

I can form no probable conjecture concerning the cause of this disease. I have observed a dilation of the pupil in scorbutic patients, and they complained of a cloud before their eyes, with imperfect vision, which disappeared as the scurvy went off.

WILLIAM TELFORD.

To Dr. Blane,

Physician to the Fleet.

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.”

4

In order to ascertain more exactly the degree of sickness in each month, a column was afterwards added to the form of the returns, expressing the number taken ill of the several diseases in the course of the month.

5

I was informed by Captain Caldwell, that when he commanded the Hannibal, of 50 guns, his crew was so much afflicted with the scurvy, in a passage of nine weeks from St. Helena to Crookhaven, in Ireland, that ninety-two men were confined to their hammocks in the last stage of that disease, though they had been supplied with sugar at St. Helena, and served with it on the passage. They remained three weeks at Crookhaven; at the end of which time every man was fit for duty: and though they had fresh provision, they had no fresh vegetables, so that their cure is to be ascribed to the use of lemons and oranges, which the Captain very humanely ordered to be purchased for them from on board of a foreign ship that happened to put into the same harbour.

6

See Appendix to Part II.

7

They were the Formidable and Namur, of 90 guns; the Arrogant, Conqueror, Marlborough, Hercules, and Fame, of 74 guns; the Yarmouth, Repulse, Prothée, Anson, and Nonsuch, of 64 guns.

8

These were the Prince George, of 90; the Bedford, Canada, and Royal Oak, of 74; the America and Prudent, of 64 guns.

9

This is a term in use for the different articles of seamen’s cloathing, particularly shirts and trowsers.

10

The mortification in the shoulder, mentioned above, was somewhat singular. It happened to a man in the Yarmouth, who, after being for a week ill of a fever and flux, was one day, early in the morning, seized with a pain in the upper part of the right arm, which immediately began to mortify. He soon after became convulsed, and died the same day about two o’clock.

11

Earthquakes are frequent in the West Indies, and perhaps proceed from a weaker operation of the same cause that originally produced the islands themselves, which seem all to have been raised from the sea by subterraneous fire. There are evident vestiges of volcanoes in them all, except Barbadoes; but there are other unequivocal marks of this island having been raised from the bottom of the sea; for it is entirely formed of coral, and other sub-marine productions, of which the strata are broken, and the parts set at angles to each other, as might be expected from such a cause. There is, perhaps, at all times in the caverns of the earth, elastic vapour struggling to vent itself, and when near the surface, it may sometimes overcome the incumbent masses of matter, and produce certain convulsions of nature. In the account of the hurricane which I wrote to Dr. Hunter, I gave reasons for believing, from the testimony of the inhabitants, that hurricanes are attended with earthquakes; and if a conjecture might be advanced concerning the cause of this, it might be said, that as the atmosphere is lighter at that time, by several inches of the barometer, the elastic vapour, confined by the weight of the incumbent earth and atmosphere, being less compressed, may exert some sensible effects, producing a sort of explosion.

12

Since the publication of the first edition of this work I have been informed that this complaint is not so rare on shore as in the fleet, which may be partly owing to the greater coolness of the air at sea, and partly from the seamen not having been a sufficient length of time in the climate to be affected with this disease, as few of them had been more than two years from England. But as this affection of the liver was very common in the fleets and naval hospitals in the East Indies, it is evident that there is a great difference of the climates in this respect. It is worth remarking, that it sometimes breaks out in the West-India Islands like an epidemic. The complaint, for instance, was very little known in the island of Grenada, till about the year 1785, when it became very frequent in a particular quarter of the island; and the gentleman who sent the description of it to England alledged, that there were the most unequivocal proofs of its being contagious. It was most successfully treated by very copious bloodletting, and in exciting a salivation by mercury. See Dr. Duncan’s Medical Commentaries, Decad. 2, vol. I.

13

Dr. Lind, on the authority of Mr. Ives, surgeon to Admiral Matthews.

14

London Gazette, June, 1781.

15

This is well illustrated by the manner in which Captain Nott, of the Centaur, was killed in Fort-Royal Bay. This brave man, having carried his Ship nearer the enemy than the rest of the line, but nevertheless at a great distance, had his signal made to keep the line, and having gone into his cabin, as it is said, to examine the import of the signal, a cannon ball struck him in the groin, and it was so far spent, that it stuck in his body. It tore away a whole plank of the ship’s side, the splinters of which killed a young gentleman, the only person near him.

16

I have seen an account of the diseases of the army at St. Lucia for a whole year, kept by Mr. Everard Home, an ingenious gentleman belonging to the army hospital, and it appears, that, during ten months out of the twelve, the dysentery was the predominant disease. This seems to contradict the opinion, that the land air is more apt to occasion fevers than fluxes; but it is to be remarked, that the sickness of the soldiers on this island was not so much owing to the malignant influence of the air, the situation of the garrison being high and airy, as to the bad accommodations and provisions, together with hard labour.

17

See Essay on the Yellow Fever, by Dr. Hume, in a Collection of Essays published by Dr. D. Monro.

18

Campbell’s Lives of the Admirals, Vol. IV.

19

The late Dr. William Hunter.

20

See Appendix to Part II.

21

Captain Samuel Thompson.

22

As my own stay at different ports was short, and as my own knowledge could not extend beyond that period, Dr. Farquarson, First Commissioner of Sick and Wounded Seamen, very politely gave me leave to inspect the books of the different hospitals at his office, and I collected from them the fate of all the men that were landed.

23

It is proper to mention, that the name of the disease in the hospital books being taken from the ticket sent on shore with each sick person, great accuracy is not to be expected, as this is frequently done in a careless manner. My returns were made with great exactness; and, in the latter part of the war, the hospital books may also be depended upon in this respect, the tickets, at my request, having been made out with accuracy.

24

In this, and the other tables, the smaller fractions are neglected.

25

See the last chapter of Part III.

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.

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.

28

See Appendix to Part II.

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.

30

See Table II.

31

See Table II.

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.

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.

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.

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.

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.

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.

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.

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.

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.

41

Dr. Hendy has lately published an ingenious treatise upon this disease.

42

See Sydenham’s Works.

43

See Part I. Book II. Chap. VI.

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.