The Preservation of the Health of Seamen
We have received with attention the opinion of a constant correspondent, to collect into one point of view some of the principal opinions of Medical Writers, respecting the preservation of the health of Seamen ; and we hope by this means to make such opinions more known and considered. It may also be an advantage to such medical men in the Service, as have not opportunity of possessing many volumes, thus to receive new or valuable information.
Medical advice, when on board, cannot always be obtained ; the illness of the officer who presides in that department, with a variety of other causes, may often arise to prevent the possibility of deriving advice from the accustomed quarter. We wish therefore by these occasional extracts to call the attention of naval officers themselves, more towards a subject, with which every one should in some measure be acquainted;— "All men," says Hippocrates, "ought to know the science of medicine ; I consider a knowledge of it as the Messmate of Wisdom."
In the Biographical Memoir of the late Captain Buckoll, our readers will remember that his death is mentioned as owing to an intermitting fever, frequent on the coast of Africa. Dr. Robertson, physician to the Royal Hospital at Greenwich, published, in the year 1792, Observations on Fevers, and other Diseases which occur on Voyages to Africa and the West Indies. The original work appeared many years ago under the title of, A Physical Journal. The last edition of his valuable work is inscribed to James Bogle French, Esq. chairman to the Committee of Merchants trading to Africa.
Dr. Robertson particularly dwells on that kind of fever to which Captain Buckoll fell a victim : on some future opportunity we purpose giving our readers his observations on it, with the method of cure ; and shall at present insert what
he styles the postscript to the volume, containing observations on Bark being used as a preventive from sickness on the Coast of Africa, with reasons offered for the necessity of supplying his Majesty’s ships, employed on foreign service, with Bark, after the same manner that they are supplied with elixir of vitriol, or Dr. James’s powders.
From the preceding Journal, it appears that the remitting fever was never epidemical on board of his Majesty's Ship Rainbow, but on the first voyage ; and that they only were seized with it then, one case excepted, who had been employed on shore duty, and of whom very few escaped being more or less ill. But in what manner the noxious exhalations, which are emitted from swamps covered with impenetrable woods and shrubs, which contain putrid vegetables, corrupted fish and insects, together with the assistance of heavy dews — operate upon the human body to produce fevers, only bare conjectures can be formed. To know that arcanum, would certainly be matter of great satisfaction to the curious, though perhaps the knowledge thereof could impart far less advantage to us, than would the discovery of a method to prevent the poisonous qualities of such exhalations from injuring those people, who must necessarily be exposed to them, as the companies of his Majesty's ships employed on the unhealthy coast of Africa, are. A discovery of that nature is perhaps thought too trivial to merit general attention ; but it is of no less consequence to his Majesty's Service, than the preservation of Seamen's lives ; the loss of which, whatever may be supposed to the contrary, or how indifferently soever it may be esteemed, is certainly a real national loss ; and therefore, whoever heartily endeavours to prevent it, merits the regard of the Public.
Dr. Lind is the only person who can be said to have laboured strenuously or successfully in the prophylactick part of medicine, for the benefit of his Majesty's Navy in particular. His essay on the most effectual means of preserving the health of Seamen and his treatise on the diseases which are incident to Europeans in hot climates, were wrote principally for that purpose ; though, too little regard is paid to the excellent instructions which they contain, both by surgeons and others. For notwithstanding that he has so highly condemned the dangerous practice of suffering the men to sleep ashore from their ships, on the dangerous or very sickly part of the coast of Africa, and even though the fatal effects of that custom are woefully experienced on board of his Majesty's Ships, it is not yet exploded.
Without suffering the men to lie ashore, they will be in too great danger of sickness from doing their duty there by day ; and as very
little time is taken up in landing them every morning, and getting them on board again in the evening, the Service will thereby, strictly speaking, be more forwarded, instead of being retarded ; because the dangers to which their health is exposed, chiefly from sleeping ashore in the night, will then be certainly avoided.
The situation of our watering party at Sierra Leona, the first voyage, and the weather, together with the situation of our people the night that they lay ashore at St. Thomas's, soon after, are particularly taken notice of in The Journal. What an abominable place is the island of St. Thomas for men to lie ashore at, if there be a possibility of preventing it, when out of fifty and odd men, that were only ashore one night, in a house with several large fires, few of them escaped without sickness ! Apprehending the consequence that would ensue there from, and imagining that a large dose of the tincture of bark might at least be comfortable to them, I sent next, morning a sufficient quantity of Huxham's Tincture for each of them, which was carefully distributed by my mate, in a glass of wine that Captain Collingwood allowed them. No person by the bye could have expressed more uneasiness for their situation than he did, although it was not in his power to have prevented it. When they came on board, many of them were exceedingly dejected, and complained ; but they were unanimously of opinion, that the tincture of bark, and wine, had been of very great service to them.
Reflecting therefore on that circumstance, I thought that a dose of a strong wine tincture of the bark, given to the men every morning, before they were to be sent ashore on duty upon the coast of Africa might be very serviceable in preventing their getting fevers, I communicated to Captain Collingwood, the following voyage, my intention of prosecuting that scheme, if he approved of it ; and would, in case there should be a necessity, give orders for their taking the tincture. I intimated to him, at the same time, in what manner it might be introduced on board of his Majesty's Ships employed on that service afterwards, through his assistance, if it succeeded in the Rainbow. He readily concurred with me to make a trial of it, and assured me if it did succeed, that he would use his utmost endeavours to get such a salutary measure introduced on board of his Majesty's Ships employed on that coast. I then commenced a correspondence * with him upon the subject ; and he was pleased to direct Captain Robertson, Commander of his Majesty's sloop Dispatch, by a letter, to advise Mr. Perry, the surgeon under his command, to adopt the same scheme and at the end of the voyage to get his report of its effects in writing
* It continued afterwards, until the Rainbow arrived at Spithead from her last voyage.
and transmit it to him ; which, together with my report of its effects on board of the Rainbow, he sent up to the Secretary of the Admiralty as well as all the letters, and copies of letters which were wrote upon the subject, inclosed in one, wherein he recommended the scheme to their Lordships, and requested that they would be pleased to allow us for our expence in making the tincture, as soon as the ship arrived in England.
In their Lordships answer to Captain Collingwood, they were pleased ,to inform him, that they had sent the reports of the surgeons upon the subject to the Commissioners for Sick and Hurt, to know their opinion of it ; and desired them to call upon the surgeons for their accounts of the expence which they had been at in making the tincture. The Sick and Hurt Board accordingly wrote to us separately ; and in my answer to them, I inserted the formula of the tincture, which was lbvi. cert. peruv. in crass pulv. rad. gentian. incis. lbii. rad. serpent. cont. lbi. put into a quarter cask of wine — but we sailed again for the coast, without my hearing any more from them. I therefore persisted in my own scheme, only adding cort. per. lbi. a proportionable quantity of the rad. & aurant. parv. lbii. to the quarter cask of wine, the last voyage, more than I had done the preceding one : and when we returned to England, I gave Captain Collingwood a report of its effects, which he sent, with the different letters on the subject, and one of his own to the same purport as the one he had sent before to the Secretary of the Admiralty ; who informed him by their Lordships' directions, that they had ordered the Commissioners for the Sick and Hurt to repay the surgeons their expences for making the tincture, and to send them their opinion of the matter. But previous thereto, that board thought proper to consult the physicians of the different hospitals, and some of the most eminent physicians in town, thereon, who were unanimous in their opinion.—They afterwards acquainted their Lordships, that the happiest effects might be expected from giving the bark, as a preventive from sickness, to the men who might be sent ashore on duty upon the Coast of Africa ; but that instead of a tincture, they had recommended a drachm of the powder, with a gill of wine to be given every morning and evening.
In consequence of which, the Lords of the Admiralty were pleased to order Bark and Wine to be purchased at the Government's expence, and to be sent on board of his Majesty's ships the Pallas and Weasel, the two ships which were sent to the Coast this year, with directions to the commander of the Pallas concerning it; and likewise ordered the Commissioners for Sick and Hurt, to send such directions to the respective surgeons, as they thought proper, with regard to administering
them ; and to direct them to keep a particular account of the effects thereof, and transmit the same to them when the ships returned to England. So that I have at last the pleasure of seeing that scheme, which in all probability will be the means of preserving many lives to his Majesty, established by their Lordships’ authority, through the assistance of Captain Collingwood, and the candour of the Commissioners for Sick and Hurt, who have since repaid me for my expences.
In discoursing with Dr. Lind on the matter upon our arrival in England, after I had first made trial of it, he informed me that he had for the like purpose recommended, in his Essay on the most effectual means of preserving the health of Seamen, a bark bitter ; and on my telling the Doctor that I never had seen that valuable essay, he showed me therein the article mentioned, and was so obliging, as to insist on my accepting of the copy of the Essay — which I acknowledge is not the only favour that he has conferred on me. I own too, that I was a good deal pleased to find, that I had adopted that proposition of the doctor’s, without knowing that it was one of his. Before I formed my scheme, I knew that the people on the coast of Africa, as well as the officers and gentlemen on board of his Majesty's ships, took a little tincture of the bark, either in a glass of wine or water every forenoon, as a stomachic ; but I never heard of its being given to the ship's company as a preventative from sickness. Therefore, as I succeeded in perfecting it * by the method and assistance which I have mentioned, I hope it will prove an inducement to my brethren, for introducing improvements of greater moment on board of his Majesty's ships, for the health of the seamen ; and I hope that my desire of propagating such an useful remedy, will plead an excuse for my having been so particular on that head.
Peruvian Bark is essentially necessary in curing various diseases of all climates, particularly of hot ones ; the consumption thereby is so great, and the price thereof consequently so high, that the surgeons of his Majesty's Navy not being able to purchase a sufficient quantity to serve the purposes for which it is really wanted on foreign service, lose many of their patients lives, which they could otherwise preserve.
* See the success with which it was attended, mentioned in the Monthly Review.
I am sorry to say that this was my case in 1769, upon the Coast of Africa, in the Weasel, and that it was Mr. Curry's likewise, surgeon of that same Sloop, and upon the very same station, in 1774. Notwithstanding we had each of us more than thrice the quantity which is put up in the medicine chest for foreign service, it was not half sufficient for the number of patients we had. Mine were thirty-two bad cases of the remitting fever, besides a number of other cases wherein I did and would have prescribed the bark more freely ; and upon a medium, every one of those thirty-two cases would have required ten ounces, which in all would have been 20 lb.— and bark at Apothecaries' Hall, on a moderate calculation, is twelve shillings and sixpence per lb. and was lately at the enormous price of seventeen shillings and eight-pence there ; so that 20 lb. would have stood me in twelve pounds ten shillings, above one fifth of my pay : and, at least, I might allow 4 lb. more, for other uses, which in all, would have cost fifteen pounds, the fourth part nearly, of my annual pay, for one article of medicine only.
At the end of my Journal for that sloop, I represented to the Commissioners for Sick and Hurt, the distress that I was in for want of Bark, with the consequences which attended it ; and entreated them that they might be pleased for the good of his Majesty's Service, to use their endeavours to get all his Majesty's ships, employed in hot climates, supplied with it, after the manner that they are supplied with elixir of vitriol, or James's Powders.
As I received no answer from that Board, I set on foot a plan for the surgeons petitioning the Admiralty, to allow Bark for his Majesty's ships employed on foreign service, after either of the ways which I have mentioned, or as they should think proper ; but unluckily, being ordered to sea before I could get it completed, the matter dropped in my absence, and has not since been renewed.
I would therefore, with all deference, beg leave to recommend it to the most serious consideration and attention of the present Commissioners for Sick and Hurt ; the effecting of which, will not only be a task suitable to the known humanity of these gentlemen, but will in like manner evidence their study to promote the real benefit of his Majesty's Service in their department
But it may be urged, that my plea for requesting this expensive innovation, is only grounded on two instances which occurred upon the coast of Africa ; and that his Majesty's Ships employed there now, are furnished with means for preventing sickness from shore duty, whereon the principal danger of contracting sickness there depends.
* The predecessors of the present Commissioners ; but they did not think proper to take the least notice of the matter.
I grant it. Yet the time of these ships, after they leave that coast, continuing in a hot climate, where the people are always liable to bad fevers and other sickness, is very considerable; and that therefore, they ought to be better prepared against such evils than the surgeons are capable from their circumstances, to prepare themselves.
Should this argument be deemed insignificant, I beg leave to furnish them with a far more fatal instance than either of the two which I have mentioned, of the want of bark in the army, as well as in a large fleet of his Majesty's ships during the late war, at the reduction of Havannah ; when thousands, I may venture to affirm, were lost for want of bark chiefly. A period therefore, which, for the mortality both of seamen and soldiers, will be memorable throughout his Majesty's dominions, for many ages. There was a general want of that precious medicine, both in the fleet and the army, when they were very sickly, until providentially, a capture of a large quantity thereof, was made in one of the enemies' ships, which was carefully divided between the fleet and the army.
I shall now leave this important matter before the Sick and Hurt Board, for the Commissioners to reflect on as they think proper, alter presuming to say, that if they do procure his Majesty's ships which are employed in hot climates, to be supplied with bark, after either of the ways which I have taken the liberty to mention, or as they themselves think fit, at the Government's expence, it will be a certain method of preserving annually to his Majesty, many valuable lives, which otherwise will be lost. No expence whatever, in my opinion, can justly be put in competition with the preservation of the lives of his Majesty's seamen or subjects.
I beg leave to acquaint my brethren, in the mean time, that Doctor James Hossack, physician to the Royal Hospital at Greenwich, who surveys our medicine chests, and the lists of supplies which we write to Apothecaries Hall for, is not only so obliging as to order double the quantity of bark to be put in our chests, to what is specified in the old established printed form of supplies, and a proportionable less quantity of other articles of medicines, which are seldom wanted, but also indulges the surgeons with any medicines of their own, that they apply for, instead of those mentioned in the printed invoice. Though, unless they amount in value to the sum which is established for us to lay out for medicines, according to the rate of the ship we are in, they may expect that he will order such an addition of other articles, which are most suitable for the station that the ships are going upon, as will make up that sum.
By this means therefore, until we are supplied with bark at the Government’s expence, which I sincerely hope will be soon, they
may provide themselves with a greater quantity of bark, and of the other most useful articles of medicine, in place of those which are lest useful, without putting themselves to any extraordinary expence, which many of them perhaps have done hitherto, from their not knowing this circumstance.
I must also do Doctor Hossack (whose friendship I have been favoured with for some years) the justice to declare, that it was chiefly owing to his persuasion, that my Journal and Observations would hereafter be serviceable to surgeons who have never yet been in a hot climate, particularly on the coast of Africa, when they go there, that I was prevailed upon to offer them to the public.
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The last edition *, lately published, of Dr. Blane’s Observations on the Diseases of Seamen with corrections and additions, is a most valuable work for all nautical men. This gentleman was appointed Physician to the Fleet, under the command of Lord Rodney, in the beginning of the year, 1780 ; whilst in the West Indies, whenever the fleet was in port. Dr. Blane daily superintended and visited the hospitals, of which there was one at almost every island on the station : from his own accurate observations, and the assistance of surgeons of the Fleet, be has amassed a number of well-established facts, and arranged them in a methodical manner, so as to prove a groundwork for investigation. The peace in the spring of the year 1783 terminated this physician’s enquiries, and prevented him from following up some practical researches.
Since the first materials for this work were collected, now sixteen years ago, Dr. Blane was for twelve year's physician to St. Thomas's Hospital ; and from his resignation of that office, in 1795, has continued one of the commissioners of sick and wounded seamen. Besides reviewing and correcting the subjects formerly treated of, he has added two new chapters, one on ulcers (in which they are proved to be contagious), the other on casualties. - The volume is divided into three parts.-
Part I. Book i. contains the
* Printed for Murray and Highley, in one vol. 8vo. The first edition was printed in 1785, the second in 1790,
medical history of Lord Rodney's fleet from March 1780 until August 1781.
Book 2. Continuation of the same, from August 1781, until the conclusion of the war in April 1783.
Book 3. Of the numbers and mortality of different diseases sent to hospitals, with a general view of the whole mortality during the war.
Part II. Of the causes of sickness in fleets, and the means of prevention.
Chap. 1. Of air.
Chap. 2. Of aliment.
Chap. 3. Of exercise and fatigue.
Part III. Description and treatment of the diseases most frequently occurring at sea.
Chap, 1. Of fevers.
Chap. 2. Of fluxes.
Chap. 3. Of scurvy.
Chap. 4, Of ulcers.
Chap. 5. Of various casualties.
Chap, 6. Of the wounds received in the actions of April 1782.
Appendix. Pharmacopoeia therapeutica nautis accommodata. Letters on the yellow fever, quarantine, &c. Dr. Blane dedicates his work to the Duke of Clarence.
I had conceived that melasses *, being a vegetable sweet, must have been a very powerful antiscorbutic ; but the greatest part of the last reinforcement of seven ships came from England furnished with this as an article of victualling, as a substitute for a certain proportion of oatmeal, which was withheld agreeably to a late very judicious order of the Admiralty. But though I am persuaded that this article of diet mitigated the disease, it was very far from preventing it ; and the Princessa in particular, which suffered most from the scurvy, was well supplied with it.
There is reason to think that it is not in the vegetable sweet alone that the antiscorbutic principle resides, but in this in conjunction with the natural mucilage, such as exists in the malt. I suspect likewise that the change which the essence undergoes in its preparation, tends also to rob it of some of its original virtue. But the melasses are still farther altered by being deprived of the natural mucilage by means of quick lime, with which all sugar is clarified in the boilers. Dr. Hendy, of Barbadoes, to whom I have been obliged for several remarks informed me, that the liquor, before it undergoes this operation, has been found by him to produce the most salutary effects in the scurvy ; but as this cannot be had at sea, we had no opportunity of comparing it with other antiscorbutics. It is certain also that the medical effects of the native sweet juices are, in other respects, very different from what they arc in their refined state; for manna, wort,
* Melasses were first introduced Into the Foudroyant about the year 1780.
and the native juice of the sugar cane are purgative ; whereas sugar itself is not at all so. This affords a presumption that they may be also different in their antiscorbutic quality; and there is reason to think, from experience, that the more natural the state in which any vegetable is, the greater its antiscorbutic quality. Vegetables, in the form of sallads are more powerful than when prepared by fire ; and I knew for certain, that the rob of lemons and oranges is not to be compared to the fresh fruit. Raw potatoes have been used with advantage in the fleet, particularly by Mr, Smith, of the Triton, who made the scorbutic men eat them, sliced with vinegar, with great benefit. This accords also with what Dr. Mertans *, of Vienna, has lately communicated to the Royal Society of London.
Table shewmg the Number of Men admitted and who have died at Haslar and Plymouth Hospitals, from the year 1755 to the year 1797, distinguished according to the Periods of Peace and War.
|From 1755 till 1763, both years included
||1 in 18.6
||1 in 15.3
|From 1764 till 1777, both years included
||1 in 31.2
||1 in 25.6
|From 1778 till 1782, both years included
||1 in 16.7
||1 in 24.9
|From 1783 till 1792, both years included
||1 in 21.6
||1 in 19.2
|From 1793 till 1797, both years included
||1 in 14.3
||1 in 24.7
It appears, then, from the annexed table, that during the late and the present wars, there has been less mortality at Plymouth than at Haslar. These two institutions are equally well supplied with accommodations, diet, and attendance. They are both kept in a state of the most perfect cleanliness and good order, so that in all points they are justly considered as models of what hospitals ought to be, and are perhaps inferior to none in every advantage attainable by such institutions. It is presumable, therefore, that the difference of mortality is
* See Philosoph. Tranact. vol. 68.
† The records of the office from which this abstract has been taken, are wanting from August 1757 till February 1759, and from May 1761 till April 1762. This, however, does not affect the proportional number of admissions and deaths, and the relative state of the two hospitals.
‡ Forty-one deaths reported in the returns of Plymouth for 1796 are not included, being men sent dead on shore for interment from the Amphion frigate, which blew up while at anchor in the Sound. Those who die on board of their ships, both at Portsmouth and Plymouth, arc buried at the hospitals and included in the returns of dead ; but as all the cases of danger are usually sent to the hospitals, the number of those who die on board is usually but small, and though the affects somewhat the general rate of mortality, as stated above, it does not alter the relative proportion of it at these two places.
owing to the difference in point of air. Plymouth has some advantage in respect to climate, being considerably warmer in winter, which is of great advantage to those more particularly, who are affected with pulmonic complaints, who constitute a considerable proportion of the sick, It is also situated on a drier soil. But the chief difference in these two hospitals consists in the size and distribution of the buildings. Haslar hospital consists of one great center building. and four pavilions running backwards from each comer of it. These are placed in pairs, standing parallel and very close to each other lengthwise, so as to intercept the free course of the air. It is calculated to hold with ease eighteen hundred men. Plymouth hospital consists of twelve separate similar and equal buildings, ranged in a large square, with wide intervals between each. Of these twelve, however, ten only are occupied by the sick. It is calculated to hold with ease twelve hundred men. M. Tenon, a French physician, who by his king's order had made a comparative review of most of the hospitals in Europe, with a view to the reformation of those in Paris, and visited this one in 1787, gives the preference to it over all others, in regard to the judicious construction and distribution of the buildings. The wards in both hospitals are nearly of the same dimensions, and there is an allowance of about eight hundred cubic feet for each patient, in the wards where the sick and wounded are so ill as to be confined. Less space is allowed for convalescent and chronic cases. The superior salubrity of Plymouth, therefore, in so far as regards the building, seems to consist in there being fewer apartments under the same roof, so that there is a smaller mass of foul air to be carried off, and in the several buildings not screening each other from the free current of the external air.
It is difficult for those whose researches and reflections have not led them to consider this subject, to conceive the great influence of even a small difference in the purity of the air breathed by those who labour under sickness and wounds. This is still more difficult to conceive, when it is observed how little these varieties affect people in health. One of the most striking proofs of this is the great difference in the success of the treatment of compound fractures, and other violent injuries, in private houses, from what it is at an hospital. The superior effect of the air of the country over that of the town, in restoring the sick and convalescent, is another fact which ought to be deeply impressed on the minds of those who plan edifices and conduct institutions for the reception of the sick and wounded, in order to serve as an illustration of the value of fresh air. *
* See Diseases of the Army by Sir John Pringle, to whom the world is much indebted for placing this subject in a strong and instructive point of view, by representing Hospitals themselves when ill aired, to be one of the principal causes of mortality, and a great source of infection.
But the most remarkable point of comparison exhibited in this table, is that of the late war with France, which lasted five years, with the five by-past years of the present war. It appears that in these two hospitals alone, there were upwards of twenty seven thousand more patients admitted in the former than the latter period, though a † greater naval force is now kept up than was ever known in this country, and a greater proportion of it on home service than in the late war. The principal causes of this seem to be;-
- 1st. That the navy at the commencement of this war was manned with less impressing than on the like occasion in former wars. The foul air produced by the crowding, and bad accommodation attending the methods of securing impressed men, previous to their distribution, has already been stated as the principal cause of the general infection prevailing in the beginning of wars.
- 2dly. The greater observance of cleanliness and dryness, and the stricter enforcement of discipline, in consequence of the conviction now entertained by officers, of the indispensable necessity of these to the health of the men under their command.
- 3dly. The general use of lemon juice, so judiciously and liberally allowed to ships at sea for the three last years.
- 4thly. The late increase of encouragement to surgeons, and the operation of the regulations established and put in force by the medical board of the navy.
In consequence of the great diminution of sick at Haslar hospital, and the general and steady state of health of the navy, not only at home but on foreign stations, there has just now (August 1798) a reduction been made of one third of the establishment there. This is in itself a considerable saving, but the saving in the maintenance of the sick, and replacing those who die or become unserviceable, is still more considerable, not to speak of advantages of still higher moment. And at this crisis, when every one must see and feel, that our hourly security, and perhaps our existence, depends on the unremitting exertions and judicious management of our naval force, it cannot but constitute the most pleasing matter of contemplation to the nation at large, as well as to the Government, and particularly that branch of it which presides over the navy, to behold at once the great interests of humanity, of national defence, and public economy thus effectually promoted.
The greater rate of mortality in this than in former wars at both hospitals, seems chiefly to be owing to the better selection of the sick, more cases of a slighter nature being now cured on board, in consequence of the additional means afforded to surgeons of doing so, and perhaps, a striker attention at hospitals respecting admissions, their general discipline having been of late improved.
† The number of seamen and marines now voted by Parliament is 120,000. The greatest number in the late war was 110,00, and in the preceding war 88,000.
Source : Naval Chronicle, Vol. 2
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