Kitabı oku: «Observations on the Diseases of Seamen», sayfa 7

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 hundred²⁷ 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 hospitals²⁸. 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 twenty²⁹. 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 appears³⁰, 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, 1780³¹. 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 enemy³², in three years and three months, in the fleets and hospitals with which I was connected:

Примечание 1³³

Примечание 2³⁴

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 books³⁵ 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 1757³⁶.

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.