Kitabı oku: «Observations on the Diseases of Seamen», sayfa 8

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, nor do the infectious diseases of brutes affect different species of them, nor the human species. The only exception to this, that we know of, is the bite of a mad dog.
  From these facts, and also from what was formerly mentioned of contagion not affecting indiscrimately all that may be exposed to it, it would appear that some nice coincidence of circumstances is necessary to modify an animal body, so as to receive its action. There must be a sort of unison, as it were, or sympathy, betwixt different living bodies, so as to render them susceptible of each other’s influence.
  It is none of the least curious facts with regard to infection, that there are some species of it by which the body is liable to be affected only once in life. When this is considered, it is indeed conformable to what happens in the course of the disease itself; for, unless there was in the body a power of resisting it, there could be no such thing as recovery. Where the disease actually exists, the continued presence of the poison, which is also infinitely multiplied, would infallibly prove fatal in all cases, unless the living powers were to become insensible to it¹⁵⁸.


⁴⁷.

Next to want of cleanliness, the circumstances most apt to give rise to infection are, close air and crowding. A certain length of time is necessary, in order that these should have this effect, and the longer they take place, the more certainly will infection be produced, and it will be the more virulent⁴⁸.

In order to admit air freely, the ports should be kept open whenever the weather will permit this to be done. The great objection to free ventilation is the danger of exposing men to the air in cold climates. But it fortunately happens, that fire, while it is the most effectual means of counteracting the cold air, is also the best means of promoting ventilation; for wherever there is fire, there is a constant change of air taking place by means of the draught to which it gives occasion. This cannot be done with safety and convenience in all parts of the ship; but frequent fires in the lower parts of a ship will prove extremely salutary by drying up the moisture, and producing a change of air, and also in a cold climate by the warmth it produces.

The hammocks and bedding should also be aired by exposing them upon deck, especially after the ports have been long shut in consequence of bad weather. They cannot be thoroughly aired unless they are unlashed; and as this could not be conveniently done daily in men of war, it might be done from time to time by the different divisions in rotation⁴⁹. When the men come to sleep upon them after these operations, they experience the same agreeable sensations as from a change of linen; and this must conduce to health as well as pleasure, like all other natural and moderate gratifications. It may be farther remarked in favour of cleanliness, that it is not only directly conducive to health, but is naturally connected with habits of good order, sobriety, and other virtues. The most cleanly men are always the most decent and honest, and the most slovenly and dirty are the most vicious and irregular.

A ship of war must have a much greater number of men on board than what are necessary to navigate her; for, besides the marines, a great many hands are necessary to man the great guns in time of action. For this reason, there is a greater risque of the inconveniences of overcrowding than in ships intended for commerce, and therefore much greater attention is necessary with regard to ventilation and cleanliness. There is a piece of management which tends also in some measure to obviate the necessity of crowding. This is to berth the watches alternately, by which it is meant, that one half of each watch should lie on different sides, whereby they do not sleep so close, and are not so much exposed to each other’s breath and to the heat and effluvia of each other’s bodies. This has the farther advantage of preserving the trim of the ship.

What has been said of the ship and men in general, applies still more strongly to the sick, and the berth⁵⁰ assigned to them; for there is nothing so apt to increase, and even generate, contagion, as a number of sick together, unless uncommon attention is paid to cleanliness and ventilation. This is so true, that, unless where the complaint is very catching, it is best not to separate the sick; for if they are a good set of men on board, those who are confined by sickness will be better nursed and tended by their messmates than in a sick berth. But if the state of infection renders separation necessary, the best part for the accommodation of the sick, in a ship of the line, is under the forecastle in a warm climate, and on the fore part of the main deck in a cold one. When they are under the forecastle, however, they ought to occupy only one side, as they would otherwise be disturbed by the men who must pass to and from the head, and the men in health would, in this case, be exposed also to contagion. As infection is most likely to arise among the sick, attention to cleanliness and air is doubly requisite where they lie; and it has a good effect to sprinkle hot vinegar and diffuse its steams among them once or twice a day.

Thus we see that cleanliness and discipline are the indispensable and fundamental means of health, without which every other advantage and precaution is thrown away. Government never bestowed more attention and expence upon the victualling of the navy than during the late war; but it would be to little purpose to provide the most nourishing and antiscorbutic diet, the most wholesome and cordial wines, the most efficacious remedies, and the most skilful physicians and surgeons, if the men are not constrained to keep their persons sweet, their clothing and bedding clean, and their berths airy and dry. It is, therefore, upon officers more than any others that the health of the fleet depends; and I should be excused in the frequent mention I make of this, were it known how often I have been the witness of the fatal effects of the neglect of these rules.

3. Means of eradicating Infection

When, from a neglect of the means above mentioned, an infectious fever comes actually to prevail, and the infection, perhaps, adheres obstinately to the ship in spite of cleanliness, good air, and diet, and all the other means, which, if employed in due time, would have prevented it, then some measures are to be taken for eradicating this subtile poison.

The first step towards this is, to prevent the disease from spreading, and this is done by separating the sick from the healthy, and cutting off all intercourse as much as possible. For this end, it is necessary to appropriate a particular berth to contagious complaints, and not only to prevent the idle visits of men in health, but to discover and separate the persons affected with such complaints as soon as possible, both to prevent them from being caught by others, and because recent complaints are most manageable and curable. Officers might be very useful in making an early discovery of complaints, by observing those who droop and look ill in the course of duty; for seamen think it unmanly to complain, and have an aversion to be put on the sick list. I have heard of a method practised in some ships, of keeping a book on the quarter deck for the officer to mark the names of such men as might look ill, or might be missed from duty upon calling the roll, in order to afford the surgeon a means of finding out those who should be the objects of his care.

Those whose profession it is to superintend the health of the ship, would find it for their ease and interest, and should consider it as their duty, to walk over the different decks once a day, or every other day, in order to make an early discovery of those who may be taken ill. Though I have laid great stress on the duty of the commander, as the proper guardian of health, yet his assiduity will not avail unless the surgeon also does his part, by such acts of attention as I have mentioned, joined to skill in his profession.

Surgeons are, perhaps, more regarded in our service than in that of other nations; but it would be for the public benefit if they were still more respected and encouraged. To men of liberal education and sentiments, as surgeons ought to be, and generally are, the most effectual inducements for them to do their duty are flattering attentions, and a certain degree of estimation in the eyes of their officers. Liberality of manners, on the part of superiors, is the most likely means of encouraging a conscientious performance of duty in this profession; for though strict and distant behaviour may operate upon the minds of those whose functions are merely mechanical, how can it infuse that tender attention to human sufferings, and that sense of duty, which may induce a man entrusted with the health and lives of his fellow creatures to act his part with propriety and effect?

In order to prevent sickness from spreading, it is not sufficient to cut off all personal intercourse. The clothes of men are as dangerous a vehicle of infection as their persons; and it should be a strict and invariable rule in case of death from fever, flux, or small pox, to throw overboard with the body every article of clothing and bedding belonging to it.

Upon the same principle, in case of recovery from any contagious disease, as it would be too great a waste to destroy the clothes and beds, they should be smoked, and then scrubbed or washed before the men join their messes and return to duty. This precaution is the more necessary, as infection in a ship is extremely apt to be communicated by bedding, from the custom of stowing the hammocks in the netting, by which they are brought in contact with each other. This, however, is an excellent custom, as it not only clears the ship below, and serves to form a barricade on the gunwale, but tends to air the bedding; and this salutary effect should not be prevented, except in case of rain, by the coverings, called hammock-cloths, by the use of which utility is evidently sacrificed to an excess of neatness.

It sometimes happens that the number of sick in a ship is so great, that it is not possible to take proper and effectual measures on board for stopping the progress of disease. But when she can be cleared of the sick by sending them to an hospital, no pains should be spared to extirpate the remaining seeds of infection.

For this purpose, let their clothing and bedding be sent along with them; let their hammocks, utensils, and whatever else they leave behind, be smoked, and either scrubbed or washed before they are used by other men, or mixed with the ship’s stores; let the decks, sides, and beams of their berths, be well washed, scraped, smoked, and dried by fire; then let them be sprinkled with hot vinegar, and, finally, white-washed all over with quick lime.

Should any officer object to the trouble and inconvenience of all this, let him reflect for a moment how much more troublesome and inconvenient, as well as noisome and disagreeable, sickness itself proves to be; let him reflect that the efficiency of the ship, considered as a bulwark of defence, or an engine of annoyance, depends on the number of healthy hands, and that his own character is to depend on the exertions to be made by them in the day of battle, not to mention the attention due from him as a man to the sufferings of the objects themselves.

But besides these recent infections, it sometimes happens that the seeds of disease adhere to the timbers of a ship for months and years together, and can be eradicated only by a thorough cleansing and fumigation. Sweeping, washing, scraping, and airing, are not sufficient entirely to remove the subtile infectious matter; but they will assist and will prepare it to be acted upon by heat and smoke, which are the only means to be depended upon. A complete fumigation can only be performed when the ship is in dock; and I shall here transcribe a method recommended by Dr. Lind.

“It will be proper to remove every thing out of the ship, so that the hold may be swept, and, when the men have withdrawn, to light a number of charcoal fires in different parts, and to throw a handful or two of brimstone on each. The steam of these should be closely confined by shutting the ports and hatchways from morning till evening, no person in the mean time being allowed to go below, nor for some time after opening the ports and hatchways, that the steam may be dispersed.

“In order to purify the men’s clothes, it would farther be proper to fumigate the hulk into which they are removed with tobacco once or twice a week while their ship is in dock, the men remaining below as long as they can bear it.

“The clothes and hammocks of the men should be exposed in the hulk to the smoke of the tobacco, and those which are more particularly suspected may be hung up the ship, and exposed to the steam of the charcoal and brimstone.

“The ship having been already fumigated with tobacco, it will be sufficient to use the fumigation of charcoal and brimstone above described for three days, and, after the last day’s fumigation, the inside of the ship should be well washed with boiling vinegar, and, before the men return on board, all the decks should be scraped and washed.”

When a ship is at sea, these precautions cannot be taken so completely; but if infection is present, or is suspected, then cleansing and fumigating may be practised in a less degree. I have known a ship at sea fumigated with gunpowder kneaded with vinegar, so as to prevent it from exploding, and to make it burn slowly with a spattering flame. Flowers of sulphur⁵¹, with about an eighth part of nitre, will answer still better. A quantity of these is placed in each interval of the guns between decks, every person being turned up, and the ports and hatches shut till they are consumed, and till the smoke has dispersed. It has also been recommended to burn resinous bodies, such as the woods of fir, spruce, and juniper, as the smoke of these is more salutary. Upon the same principle, the effluvium of tar is thought wholesome; and the cables that are coiled in the lower parts of a ship being soaked with tar, like most of the other ropes of a ship, probably conduce to the health of a place otherwise dank and unwholesome. Fumigation may also be performed by means of tar, either by throwing it on red-hot irons, or a wood fire, which may be carried about between decks in a pot or moveable grate, or over some cannon balls in a tub, or by immersing a red-hot loggerhead⁵² in a bucket of tar. If this is done in the place occupied by the sick, it will have a still better effect; and it will be of service to them to be removed for a short time under the half deck or forecastle till this or other means of purification are put in practice. In whatever manner fumigation is performed, it will be of service to spread out the clothes and bedding of the men, or to hang them upon lines, that they may be exposed to the heat and smoke.

It will also be of great service to make the men expose their frowsy clothes to the sun and wind. If a strong infection is suspected, and it cannot be afforded to destroy the clothes, the best means of eradicating the poison is to hang them for a length of time over pots of burning brimstone in a large cask standing endways, with small apertures to admit air enough for the brimstone to burn.

Fire in every shape is to be considered as the principal agent of purification, by its heat and the ventilation it occasions, perhaps, still more than its smoke. It has already been repeatedly inculcated, that the great enemies of infection are ventilation and heat. I have mentioned smoke and the effluvia of balsamic bodies, but these are not to be depended on; and it is the more necessary to mention this, as the attention bestowed on more trifling means may divert the mind from a proper regard to what is more essential. It is mentioned by the benevolent Mr Howard, that it is the custom in some parts abroad to scatter fresh branches of pine or spruce in the hospitals, in order to purify the air; but, trusting to this, they neglect the admission of fresh air, which is the only effectual method of sweetening the air.