Observations on the Diseases of Seamen

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 care37?

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 sixty38.

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 heaven39; 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

All the diseases incident to a fleet, except the scurvy, are more apt to arise in a harbour than at sea, and particularly the violent fevers peculiar to hot climates. There are generally woods and marshes adjacent to the anchoring places in the West Indies, and the men are exposed to the bad air proceeding from thence, either in consequence of the ship’s riding to leeward of them, or of people’s going on shore on the duties of wooding and watering. Instances of this, without number, might be adduced from the accounts of voyages to all the tropical countries. Our fatal expeditions to the Bastimentos, and to Carthagena, in former wars, are striking proofs of it; and we have seen the same effects, though in a much less degree, while the fleet was at Jamaica in 1782.

I have known a hundred yards in a road make a difference in the health of a ship at anchor, by her being under the lee of marshes in one situation, and not in the other40. Where people at land are so situated, as not to be exposed to the air of woods and marshes, but only to the sea air, they are equally healthy as at sea. There was a remarkable instance of this on a small island, called Pidgeon Island, formerly described, where forty men were employed in making a battery, and they were there from June to December, which includes the most unhealthy time of the year, without a man dying, and with very little sickness among them, though they worked hard, lived on salt provisions, and had their habitations entirely destroyed by the hurricane. During this time near one half of the garrison of St. Lucia died, though in circumstances similar in every respect, except the air of the place, which blew from woods and marshes.

The duties of wooding and watering are so unwholesome, that negroes, if possible, should be hired to perform them. In general, however, the employing of seamen in filling water and cutting wood is unavoidable, but it should be so managed as not to allow them, on any account, to stay on shore all night; for, besides that the air is then more unwholesome, men, when asleep, are more susceptible of any harm, either from the cold or the impurity of air, than when awake and employed.

As the service necessarily requires that men should be on shore more or less, however unwholesome the air may be, means are to be used to prevent its pernicious impressions on the body. Certain internal medicines, such as bitters, aromatics, and small quantities of spirituous liquors, tend to preserve the body from its bad effects. Of the bitters, Peruvian bark is, perhaps, the best; and there is a well-affected instance of its efficacy in the account given by Mr. Robertson of a voyage in the Rainbow to the coast of Africa; and by the same means Count Bonneval and his suite escaped sickness in the camps in Hungary, while half of the army were cut off by fevers. In consequence of Mr. Robertson’s representation of the effects of bark in curing and preventing the fevers of that climate, the ships of war fitted out for the coast of Guinea have been supplied with it gratuitously, and Government would find its account in extending this bounty to all the tropical stations.

We have seen, in the former part of this work, that the fever produced by the impure air of marshes may not appear for many days after the noxious principle, whatever it is, has been imbibed; men having been sometimes seized with it more than a week after they had been at sea. It naturally occurs, therefore, that something may be done in the intermediate time to prevent the effects of this bad air; and nothing is more adviseable than to take some doses of Peruvian bark, after clearing the bowels by a purgative. Some facts, related in the first part of this work, show that an interval of ten days or a fortnight may elapse between the imbibing of the poison and its taking effect. And, in order to guard against the diseases of this climate in general, it would be more proper to take some large doses of bark once in either of these periods, than to make a constant practice of taking a little, as I have known some people do, by which they may also render their body in some measure insensible to its good effects. I knew a physician of some eminence in the West Indies, who always enjoyed uninterrupted health, and he imputed it to his taking from half an ounce to an ounce of bark every change and full of the moon, as he thought that fevers of the intermitting and remitting kind, were more apt to occur at these periods. Whether this idea be well founded or not, the practice is proper, upon the other principle that has been mentioned, and the phases of the moon will at least serve as an aid to the memory.

The spices of the country, such as capsicum and ginger, for which nature has given the inhabitants of the torrid zone an appetite, have also been found powerful in fortifying the body against the influence of noxious air. Either these, or the bark, or similar substances, of a bitter and aromatic nature, given in a glass of spirits to men going upon unwholesome duty, have been found to have a powerful effect in preventing them from catching the fevers of the climate. The practice may be thought too troublesome in the hurry of service in a great fleet; and I in general avoid mentioning any thing but what is easily practicable, and highly important to the body of seamen at large; but such a precaution may be of service at least to officers, or to a ship’s company, when service is easy, or on a small scale.

But besides the poisonous effluvia of woods and marshes, the sensible qualities of the air are also to be attended to. If I were required to fix on the circumstances most pernicious to Europeans, particularly those newly arrived in the West Indies, I would say, that they are too much bodily exercise in the sun, and sleeping in the open air; and the practices most hurtful next to these are, intemperance in drinking, and bad hours. The sickness and mortality among new comers may, in general, be imputed to some one of these causes. It is in favour of this opinion that women are not subject to the same violent fevers as the other sex, which is probably owing to their not giving into the above-mentioned irregularities.

The last direction I shall mention with regard to the preservation of health in a harbour is, that the ship should be made to ride with a spring on the cable, that the side may be turned to the wind, whereby a free ventilation will be produced, and the foul air from the head, which is the most offensive part, will not be carried all over the decks, as it must be when the ship rides head to wind.

Having little experience of my own with regard to diseases at sea in cold climates, I cannot recommend any particular precautions; but Dr. Lind thinks that garlick infused in spirits is one of the best preservatives against the bad effects of cold and wet. The French ships of war are furnished with great quantities of garlick as an article of victualling, and its effects seem to be very salutary. It would appear, that substances of this kind are very conducive to health in hot climates also. I was informed by Capt. Caldwell, that, when he commanded a sloop of war on the coast of Guinea, he was supplied with a large quantity of shalots by a Portuguese about the time he left the coast, and his men were remarkably healthy on the passage to the West Indies, while the other ships in company, who wanted this supply, were very sickly.

But besides the obvious and sensible qualities of the air above mentioned, there are certain obscure properties which we do not understand, and which we find difficult to investigate; for there are diseases prevailing in certain places which seem to depend on some latent state of the air. Of this kind is the complaint of the liver, so common in the East Indies, yet almost entirely unknown in the West Indies; and in the West Indies there are certain diseases which prevail in one island and not in another; such as the elephantiasis41 of Barbadoes, which is an affection of the lymphatics peculiar to that island. In the climates of Europe there are also certain obscure conditions of the air that favour one epidemic more than another, and in some years more than others42. All this is very mysterious to us; and although we could detect these properties of the air, we probably could not prevent their bad effects, since man must every where breathe the air, whatever its qualities may be.

SECT. II.

Of Foul Air from the Neglect of Cleanliness in Men’s Persons – Infection

Nature has wisely so contrived our senses and instincts, that the neglect of cleanliness renders a person loathsome and offensive to himself and others, thereby guarding against those fatal diseases that arise from bodily filth. The noxious air we speak of is generated by men keeping the same clothes too long in contact with the body, while they are at the same time confined and crowded in small and ill-ventilated apartments. Such is the origin of the jail fever, otherwise called the ship and hospital fever; and it seems to be with reason that Dr. Cullen ascribes the low, nervous fever of Britain to a similar origin, being caused, as he thinks, by an infection of a milder kind, arising in the clothes and houses of the poor, who, from slovenliness or indigence, neglect to change their linen, and air their houses.

Man is evidently more subject to disease than any other species of the animal creation, owing partly to the natural feebleness of his frame, but still more perhaps to the artificial modes of life which his reason leads him to adopt. There is no circumstance of this kind by which health is more affected than by clothing. Some of the most fatal and pestilential diseases are produced and communicated by it; for we see that the greater number of fevers, particularly those of the low and malignant sort, may be traced to the want of personal cleanliness.

There are few subjects more mysterious and difficult of investigation than this of infection. The origin of specific contagions, such as the small pox and the venereal disease, seems to be almost beyond the reach of a conjecture; and why all the contagions we know, excepting that of the bite of a mad dog, should be confined to one species of animal, their effects not being communicable to any other, is equally unaccountable. Why is the body incapable of being affected more than once by certain morbid poisons; and whence comes the striking and curious differences of susceptibility to infection in different individuals at the same time, and of the same individual at different times?

It would appear that the infection of fever, which we are chiefly to consider here, does not, like some of the diseases above mentioned, depend on the continued propagation of a certain poison, but that it may spontaneously arise from a concurrence of circumstances, producing a long stagnation of the effluvia of the body on the clothes, for want of clean linen, while people are excluded from the free air, as in jails, hospitals, or ships.

In order, therefore, to preserve the crews of ships from such diseases, means should be taken not only to prevent the introduction of infection already existing, but to prevent the generation of it on board.

1. Means of preventing the Introduction of Infection

War being a state of violence and confusion, in which the hurry and emergency of service may be such as to render it impossible to put in practice all the rules which might be laid down concerning the preservation of health, yet it is necessary that those who direct the navy, either in a civil or military capacity, should be aware of the causes of sickness and mortality, in order to guard against them as far as is practicable. From an indolent acquiescence in this idea of the hardships and inconveniences of war being unavoidable, I have known neglect to arise in the conduct of officers with regard to those under their command, as if it was not the duty of a commander to employ his utmost attention to alleviate the misfortunes and mitigate the sufferings of his fellow creatures; and we have seen that much more of the calamities of war arise from disease than from the sword. The like excuse might be framed for the neglect of stores and arms, which, the hurry of service might equally expose to injury. We see, indeed, infinite pains taken to prevent cordage from rotting, and arms from rusting; but however precious these may be as the necessary resources of war, it will not be disputed that the lives of men are still more so; yet, though there is the additional inducement of humanity to watch over the health of men, I do not think that this, in general, is studied with a degree of attention equal to what is bestowed on some inanimate objects.

Ships of war are exposed to infection chiefly by receiving such men as have been raised by pressing, who are frequently confined in guardships, under such circumstances of bad air and bodily filth as tend to generate the most virulent infection. The service also requires sometimes that men be received from jails, and they are either criminals delivered over by the civil jurisdiction of the country, or captives who have been restored by the enemy after a course of confinement in their prisons. It may happen too, as we have seen43, that the enemy, who are made prisoners at sea, may have infection about them, and will communicate it the more readily that they are strangers.

There are few fevers but what are infectious at some stage or other of the disease; but it is not necessary that fever should actually exist in order to create infection. In the most violent and pestilential fevers, such as have sometimes originated in the jails of England, the persons who communicated them were not affected with it themselves44. Infection, like some other poisons, does not affect those who are accustomed to it, and therefore those who are in the habit of being exposed to it frequently escape its bad effects, especially if it is gradually applied, as must be the case with those about whose persons it is generated. For the like reason, physicians and nurses are less susceptible than others; and strangers, who are accustomed to a pure air, are the most susceptible of any. It is observed by Dr. Short, that contagious epidemics are more frequent and fatal in the country than in London, and this may probably be accounted for on the same principle; for every person in a great town is exposed to the breath and effluvia of others, and to a variety of putrid exhalations, which are unavoidable where multitudes inhabit together; but they are so used to them, that they are not affected by them; whereas in the country, where people are less accustomed to each other’s company, and less used to impure air in general, they are the more readily affected when infection is introduced among them. It may even admit of a doubt if any society of men, living together, are entirely free from morbid contagion. It certainly sometimes happens, that a ship, with a long-established crew, shall be very healthy; yet, if strangers are introduced among them, who are also healthy, sickness will be mutually produced. This principle in the human constitution, by which the presence of strangers affects it, is well illustrated by a fact45, founded on the best testimony, that, in one of the small western islands of Scotland, which is so remote, that the inhabitants are frequently without any communication with strangers for several months together; they become so susceptible, in consequence of this long interruption of intercourse, that they are seized with a catarrh when strangers of any description come among them. It was said before, that cleanliness was founded on a natural aversion to what is unseemly and offensive in the persons of others; and there seems also to be implanted in human nature, for the same purpose, an instinctive horror at strangers, as is visible in young children and uncultivated people. In the early ages of Rome, one word signified both a stranger and an enemy46.