  1 These were the Conqueror, the Cornwall, and the Boyne, which were so damaged in the battles, that they were obliged to bear away for St. Lucia. 2 The following may serve as a specimen of these returns: State of Health of His Majesty’s Ship Alcide. Carlisle Bay, Barbadoes, 1st June, 1781.
REMARKS.During the course of last month we had one hundred and fourteen of the men, who contracted the scurvy in the late long cruise, recovered by the use of limes, which were procured at Montserrat. A pint of wine, with an equal quantity of water, made agreeable with sugar and tamarinds, is served to each patient daily. The regimen is exactly the same as mentioned last month. Since we came into port, very few have been seized with scurvy, but several complain daily of fluxes and feverish complaints, none of which seem at present to be of any consequence. Four patients have last month complained of an almost total blindness towards evening, accompanied with head-ach, vertigo, nausea, and a sense of weight about the precordia. The pupil is then extremely dilated, but contracts readily when a strong light is presented to it. Two of them had the scurvy in a high degree, one of them slightly, and the other seemed entirely free from it. I am not well acquainted with the nature or cure of this disease, which I believe is called Nyctalopia by some systematic writers. I gave those who were affected with it an emetic, which brought up a great deal of bile, and relieved the symptoms both of the head and stomach. This encouraged me to a repetition of it, which seemed also to be attended with benefit. I likewise applied blisters behind the ears, and gave bark and elixir of vitriol, with the antiscorbutic course, to those that required it. I can form no probable conjecture concerning the cause of this disease. I have observed a dilation of the pupil in scorbutic patients, and they complained of a cloud before their eyes, with imperfect vision, which disappeared as the scurvy went off. To Dr. Blane, 3 Although this hurricane, in itself and its consequences, was so destructive to the lives and health of men, yet, with regard to the inhabitants on shore, it had a surprising and unexpected effect in mending their health. I wrote an account of this hurricane to the late Dr. Hunter, who communicated it to the Royal Society, and the following passage is extracted from it: “The consequences of this general tumult of nature, on the health of man, was none of the least curious of its effects. I made much inquiry on this head, not only of the medical gentlemen who had the charge of hospitals, and of the physicians of the country, but of the inhabitants, and every one had some cure to relate either of themselves or their neighbours, in a variety of diseases. Nor could I find that either those who were in health, or those who were ill of any disease whatever suffered from it, otherwise than by its mechanical violence; but, on the contrary, that there was a general amendment of health. This is a fact, which I could neither credit, nor would venture to relate, were it not supported by so many concurring testimonies. It had a visible good effect on the acute diseases of the climate. The chronic fluxes, of which there were then some at the naval hospital, were cured or much relieved by it. But the diseases upon which it had most evident and sensible effects, were pulmonic consumptions. Some recent cases of phthisis, and even the acute state of pleurisy, was cured by it; and in the advanced and incurable state of it, the hectic fever was removed, and remarkable temporary relief afforded. A delicate lady of my acquaintance, who was ill of a pleurisy at the time, and passed more than ten hours in the open air, sitting generally several inches deep in water, found herself free of complaint next day; had no return of it; and when I saw her a few weeks after, was in much better health and looks then usual. The people observed that they had remarkably keen appetites for some time after, and the surviving part of them became uncommonly healthy; some of both sexes, whom I had left fallow and thin a few months before, looking now fresh and plump. It is very difficult to account for this, as well as every thing else in the animal oeconomy; but it was probably owing in part, at least, to the very great coldness and purity of the air from the upper regions of the atmosphere. Great agitation of mind sometimes also produces a revolution in health; and we know that the effect of external impressions in general is very different when the mind is vacant, from what it is when occupied and interested by objects, whether of pleasure and satisfaction, or of danger and suffering.” 4 In order to ascertain more exactly the degree of sickness in each month, a column was afterwards added to the form of the returns, expressing the number taken ill of the several diseases in the course of the month. 5 I was informed by Captain Caldwell, that when he commanded the Hannibal, of 50 guns, his crew was so much afflicted with the scurvy, in a passage of nine weeks from St. Helena to Crookhaven, in Ireland, that ninety-two men were confined to their hammocks in the last stage of that disease, though they had been supplied with sugar at St. Helena, and served with it on the passage. They remained three weeks at Crookhaven; at the end of which time every man was fit for duty: and though they had fresh provision, they had no fresh vegetables, so that their cure is to be ascribed to the use of lemons and oranges, which the Captain very humanely ordered to be purchased for them from on board of a foreign ship that happened to put into the same harbour. 7 They were the Formidable and Namur, of 90 guns; the Arrogant, Conqueror, Marlborough, Hercules, and Fame, of 74 guns; the Yarmouth, Repulse, ProthÉe, Anson, and Nonsuch, of 64 guns. 8 These were the Prince George, of 90; the Bedford, Canada, and Royal Oak, of 74; the America and Prudent, of 64 guns. 9 This is a term in use for the different articles of seamen’s cloathing, particularly shirts and trowsers. 10 The mortification in the shoulder, mentioned above, was somewhat singular. It happened to a man in the Yarmouth, who, after being for a week ill of a fever and flux, was one day, early in the morning, seized with a pain in the upper part of the right arm, which immediately began to mortify. He soon after became convulsed, and died the same day about two o’clock. 11 Earthquakes are frequent in the West Indies, and perhaps proceed from a weaker operation of the same cause that originally produced the islands themselves, which seem all to have been raised from the sea by subterraneous fire. There are evident vestiges of volcanoes in them all, except Barbadoes; but there are other unequivocal marks of this island having been raised from the bottom of the sea; for it is entirely formed of coral, and other sub-marine productions, of which the strata are broken, and the parts set at angles to each other, as might be expected from such a cause. There is, perhaps, at all times in the caverns of the earth, elastic vapour struggling to vent itself, and when near the surface, it may sometimes overcome the incumbent masses of matter, and produce certain convulsions of nature. In the account of the hurricane which I wrote to Dr. Hunter, I gave reasons for believing, from the testimony of the inhabitants, that hurricanes are attended with earthquakes; and if a conjecture might be advanced concerning the cause of this, it might be said, that as the atmosphere is lighter at that time, by several inches of the barometer, the elastic vapour, confined by the weight of the incumbent earth and atmosphere, being less compressed, may exert some sensible effects, producing a sort of explosion. 12 Since the publication of the first edition of this work I have been informed that this complaint is not so rare on shore as in the fleet, which may be partly owing to the greater coolness of the air at sea, and partly from the seamen not having been a sufficient length of time in the climate to be affected with this disease, as few of them had been more than two years from England. But as this affection of the liver was very common in the fleets and naval hospitals in the East Indies, it is evident that there is a great difference of the climates in this respect. It is worth remarking, that it sometimes breaks out in the West-India Islands like an epidemic. The complaint, for instance, was very little known in the island of Grenada, till about the year 1785, when it became very frequent in a particular quarter of the island; and the gentleman who sent the description of it to England alledged, that there were the most unequivocal proofs of its being contagious. It was most successfully treated by very copious bloodletting, and in exciting a salivation by mercury. See Dr. Duncan’s Medical Commentaries, Decad. 2, vol. I. 13 Dr. Lind, on the authority of Mr. Ives, surgeon to Admiral Matthews. 14 London Gazette, June, 1781. 15 This is well illustrated by the manner in which Captain Nott, of the Centaur, was killed in Fort-Royal Bay. This brave man, having carried his Ship nearer the enemy than the rest of the line, but nevertheless at a great distance, had his signal made to keep the line, and having gone into his cabin, as it is said, to examine the import of the signal, a cannon ball struck him in the groin, and it was so far spent, that it stuck in his body. It tore away a whole plank of the ship’s side, the splinters of which killed a young gentleman, the only person near him. 16 I have seen an account of the diseases of the army at St. Lucia for a whole year, kept by Mr. Everard Home, an ingenious gentleman belonging to the army hospital, and it appears, that, during ten months out of the twelve, the dysentery was the predominant disease. This seems to contradict the opinion, that the land air is more apt to occasion fevers than fluxes; but it is to be remarked, that the sickness of the soldiers on this island was not so much owing to the malignant influence of the air, the situation of the garrison being high and airy, as to the bad accommodations and provisions, together with hard labour. 17 See Essay on the Yellow Fever, by Dr. Hume, in a Collection of Essays published by Dr. D. Monro. 18 Campbell’s Lives of the Admirals, Vol. IV. 19 The late Dr. William Hunter. 21 Captain Samuel Thompson. 22 As my own stay at different ports was short, and as my own knowledge could not extend beyond that period, Dr. Farquarson, First Commissioner of Sick and Wounded Seamen, very politely gave me leave to inspect the books of the different hospitals at his office, and I collected from them the fate of all the men that were landed. 23 It is proper to mention, that the name of the disease in the hospital books being taken from the ticket sent on shore with each sick person, great accuracy is not to be expected, as this is frequently done in a careless manner. My returns were made with great exactness; and, in the latter part of the war, the hospital books may also be depended upon in this respect, the tickets, at my request, having been made out with accuracy. 24 In this, and the other tables, the smaller fractions are neglected. 26 In the year 1741, the fleet under Admiral Vernon was at Jamaica at the same time of the year; and the following is the account of the men sent to the hospital in May and June:
There was on board of this fleet about two thirds of the number of men that was on board of the fleet in 1782. I cannot ascertain how many died on board of the ships in Admiral Vernon’s fleet; but the deaths at the hospital alone are somewhat more than what happened to our fleet both on board and at the hospital. 27 I was enabled, after coming to England, to ascertain the deaths in that part of the squadron from which I happened at any time to be absent, by having leave from the Navy Board to inspect the ships’ books deposited at their office. 29 The mortality of the army in the West Indies is much greater; for it appears by the returns of the War Office, that there died in the year 1780, two thousand and thirty-six soldiers, which being calculated by the numbers on the station, and those who arrived in the convoy in March and July, the annual mortality is found to be one in four. The greatness of this mortality will appear in a still stronger light, when it is considered that those who serve in the army are the most healthy part of the community. When I was at the encampment at Coxheath in the year 1779, I was politely favoured with a sight of the returns, both of the general officers and physician, and it appeared that in an army of ten thousand and eighty-nine men, there died, from the 10th of June to the 2d of November, forty-three, exclusive of twelve who died of small pox. This being calculated, is equal to an annual mortality of one in a hundred and nine; and it was not half so much in the encampment of the former year. It appears by Mr. Simpson’s tables, that the mortality of mankind in England, from the age of twenty to forty-five, which includes the usual age of those who serve in the navy and army, is one in fifty. 32 None are comprehended but those who were killed or wounded in battles in which the whole fleet was present, this account not including those who fell in single actions in frigates or other ships. 33 It would appear, that, anciently, though the slaughter in battle was greater than in modern times, yet that disease was still more destructive than the sword. One of the oldest testimonies to this purpose is in the History of Alexander’s Expedition, by Arrian—t??? e? ?? ta?? a?a?? ?p????e?as??, ?? de ?? t?? t?a?at?? ?p?a??? ?e?e??e???, ?? p?e???? de ??s? ?p????esa?.—Arrian. Hist. Alex. Exped. 34 Upwards of three thousand were also lost at sea in ships of war belonging to the same fleets in the hurricane of October, 1780, and in the storm in September, 1782, in which the Ville de Paris and the other French prizes were lost on their passage to England. 35 The authors from whom I have borrowed have been chiefly Dr. Lind and Capt. Cook. To the former we are indebted for the most accurate observations on the health of seamen in hot climates; of the improvements made by the latter, an excellent compendium may be seen in Sir John Pringle’s Discourse before the Royal Society, on the occasion of adjudging a prize medal to Capt. Cook for his paper upon this subject. 36 In the late war sickness alone was not the cause of want of success in any instance, except in the last action in the East Indies, in which so many men were ill of the scurvy, that there were not hands enow to manage the guns. There is another fact in history, which, though not so applicable to this subject as those above recited, forcibly evinces how important a study the health of men ought to be in military affairs. When Henry V. was about to invade France, he had an army of fifty thousand men; but owing to a sickness which arose in the army, in consequence of some delays in the embarkation, their number was reduced to ten thousand at the battle of Agincourt. The disease of which they chiefly died was the dysentery. 37 It is not meant by this to insinuate that every commander is absolutely accountable for the health of his ship’s company, and censurable when they are sickly; for this may depend on his predecessor in command, or a stubborn infection may have prevailed from the original fitting out or manning of the ship which he may not have superintended. ?? ?a? ????e t? ??da ?a??te??? ???? ?a?ass??, ??dea te s???e?a?, e? ?a?` a?a ?a?te??`? e??. Dire is the ocean, dread in all its forms! Man must decay, when man contends with storms. 39 Wherever causes are obscure, superstition naturally ascribes them to some preternatural influence; and what seemed farther to have encouraged this, anciently, was, that violent epidemics occurred most frequently in camps and at sieges where great political conjunctures were likely to arise, in which superior powers were supposed to interest themselves. Thus we read in Homer of fatal diseases being sent as punishments by the gods. But the pestilential diseases so often mentioned by poets and historians as prevailing in cities and armies, were probably nothing else but fevers, produced partly perhaps by the scarcity and bad quality of provisions, but probably still more by corrupted human effluvia, which was very apt to he produced by the want of personal cleanliness, to which the mode of cloathing among the ancients would more particularly subject them, especially in camps and besieged towns. 40 If the experiments of modern philosophy are to be depended on, they go a certain way to account for the unwholesomeness of air from woods in hot climates, and in wet weather; for Dr. Ingenhousz found that the effluvia of plants in the night time, and in the shade, are more poisonous in hot than in cold weather; but though there is a salubrity in the effluvia in sunshine, the heat of the weather makes no difference with regard to this. He found also that vegetables, when wet, yield an unwholesome air. It is difficult to ascertain how far the influence of vapours from woods and marshes extend; but there is reason to think that it is to a very small distance. When the ships watered at Rock Fort, they found that if they anchored close to the shore, so as to smell the land air, the health of the men was affected; but upon removing two cables length, no inconvenience was perceived. I was informed of the following fact, in proof of the same, by the medical gentlemen who attended the army in Jamaica:—The garrison of Fort Augusta, which stands very near some marshes, to which it is to leeward when the land wind blows, was yet remarkably healthy; but it became at one time extremely sickly upon the breaking in of the sea in consequence of a high tide, whereby the water which was retained in the hollows of the fort produced a putrid moisture in the soil, exhaling a vapour offensive to the smell, and with all the noxious effects upon health commonly arising from the effluvia of marshes. 41 Dr. Hendy has lately published an ingenious treatise upon this disease. 42 See Sydenham’s Works. 44 We have a proof of this fact in particular, in the account of the jail distemper, which broke out at the Old Bailey in the year 1750. 45 See Martin’s History of the Western Islands, and Medical Communications, Vol. I. page 68. 46 There are some contagious diseases which cannot be propagated but by their own peculiar infections, as has been before observed, just as the seeds of vegetables are necessary to continue their several species; so that if the infectious poison were lost, so would the disease. Of this kind are the small pox, and the other diseases to which man is subject but once during life. There are other diseases which produce infection without having themselves proceeded from it. Of this kind are fevers and fluxes. But there is no infection of any kind, however virulent, that affects indiscriminately all persons exposed to it. If a number of persons, who never have had the small pox, are equally exposed to it, some will be seized, while others will escape, who will be affected at another time, when they happen to be more susceptible. It is doubtful how far the habit of being exposed to such specific infections renders the body insensible to them, as was said with regard to fevers; but there is another principle of the animal oeconomy laid down and illustrated by Mr. Hunter, which goes at least a certain length in explaining this variable state of the body with respect to its susceptibility of infectious diseases. This principle is, that the body cannot be affected by more than one morbid action at the same time. If a person is exposed to the small pox, for instance, while he labours under a fever, or while he is under the influence of the measles, he will not catch the first till the other has run its course. It may happen, therefore, that people escape the effect of contagion in consequence of being at the time under the influence of some other indisposition, either evident or latent: and supposing the body to be exposed to a number of noxious powers at the same time, one only could take effect. But it seems difficult to explain why some of those who are actually seized, and who have previously been to all appearance in equally good health, shall have it in a very mild degree, while in others it will be malignant and fatal. This is very remarkable with regard to the small pox, which are in some cases so slight, that they can hardly be called a disease, while in others they are so malignant, as hardly to admit of any alleviation from art. May not this, in some measure, be explained from some of the principles above mentioned, in the following manner:—The small pox, in their mildest form, are attended with little or no fever, which, therefore, is not essential to them; and when we see them attended with various forms of fever, and thereby prove fatal even in the most hale constitutions, we ought not to attribute this to any thing in the nature of the small pox, but rather to say, that they have served as an agent in exciting a fever, for which there happened to be some previous latent disposition, that would not otherwise have exerted itself, and that this disposition, or contamination, as it may be called, may have been induced by some past exposure to morbid effluvia, which either from habit, or some other circumstance, may not have been sufficiently powerful to excite the constitution to fever without some such stimulus. Any other occasional circumstance producing disturbance or irregularity in the functions of the body, may, in like manner, excite any particular kind of fever to which the body may at that time be disposed. Thus the amputation of a limb will have this effect; also exposure to cold or fatigue, and intemperance in eating or drinking. It would appear from these considerations, that there are certain circumstances, or temporary situations of constitution, which invite infection, and render its effect more certain and violent in one case than another. There are artificial methods, however, of obtruding it, as it were, upon the constitution, though not particularly disposed, or even though averse to receive it; and may not this, in some measure, account for the greater safety of some diseases when communicated by inoculation, than when caught in the natural way? But these, as well as many other facts in animal nature, do not admit of a satisfactory explanation upon any principle as yet known. Even the most common operations of the body, such as digestion and generation, when considered in their causes and modes of action, are so obscure and mysterious, as to be almost beyond the reach of rational conjecture. A little reflection will teach us the utmost modesty with regard to our knowledge of such things; for nature seems to have innumerable ways of working, particularly in the animal functions, to which neither our senses can extend, nor perhaps could our intellects comprehend them. Had we not, for instance, been endowed with the sense of sight, nothing could have led us even to suspect the existence of such a body as light; and there may be numberless other subtile and active principles pervading the universe, relative to which we have no senses, and from the knowledge of whose nature and exigence we must for ever be debarred. We have, indeed, become acquainted with electricity by an operation of reason; and animals have lately been discovered to which the electric fluid serves as a medium of sense through organs calculated to excite it, and to receive and convey its impressions. But there are few subjects we can study that are more subtle and obscure than the influence of one living body on another. There is a familiar instance of the great subtilety of animal effluvia, and also of the fineness of sense in a dog’s being able to trace his master through crowds, and at a great distance; and we can conceive that infectious matter may adhere, and be communicated in a similar manner. We have endeavoured to illustrate the great obscurity of its operation by an allusion to generation, digestion, and other animal functions, with which it is equally obscure and inexplicable. It is similar to generation in this, that its influence does not pass from one species of animal to another; for the poison of the plague, that of the small pox, that of fever, and the venereal disease, do not affect brutes47, 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 it48. 47 Hunter’s Experiments. 48 Mr. Hunter’s Lectures. 49 It is sincerely to be wished that this were adopted, and it is surprising that an article so salutary and necessary, and so difficult to be procured on foreign stations, should not have been the object of public attention, rather than a mere article of luxury, such as tobacco. But in order that it might not be a matter of choice with seamen, it would be worth while to supply them with it at prime cost, or even as a gratuity, and then they might be compelled to use it for the purpose of cleanliness. There are other articles of less importance, but being necessary to enable men upon foreign stations to keep themselves neat and clean, deserve to be made the object of public instruction. These are handkerchiefs for the neck, thread, worsted, needles, buckles, and knives. 50 At the time I am writing this, (March 8th, 1785) there has occurred a fact which proves the effect of time in generating infection. There now prevails a contagious fever in several of the hospitals in London, and, among others, in that to which I am physician. In another hospital it has been so violent, that there has been a vulgar report that the plague had broke out in it. The same fever also prevails among the poor at their own houses. The cause of it seems to be, that the cold weather has been uncommonly long and severe; for the frost began early in December, and the cold has hitherto been more like that of winter than spring. The thermometer all this month has varied from 30° to 35°. Cold is favourable to infection, by preventing ventilation; for people exclude the air in order to keep themselves warm, and the poor in particular do so on account of their bad clothing, and their not being able to afford fuel to make good fires. Heat is the great destroyer of infection, and seems to act by evaporating, and thereby dissipating it; and the effect of fires in apartments is to produce a constant change of air, thereby preventing its stagnation and corruption, and the accumulation of unwholesome effluvia. With this view, a chimney is of great use, even though no fire should be kept in it, as it serves for a ventilator. But if an aperture were to be made in an apartment merely with a view to ventilation, it should be placed in that part of the wall next the ceiling; for foul air naturally tends upwards, and the external air entering at the top of a room, would not be so apt to subject those within to the effect of cold, as it would not blow directly upon them. There would also be this advantage in jails, that apertures in this situation would not be so liable to be forced for the purpose of escape as if they were nearer the floor; and in hospitals they would be out of reach of those who, wishing to indulge in warmth, at the expence of pure air, might be induced to shut the windows. But an external communication with the air any where is of the utmost importance; and it is observable in Mr. Howard’s account of prisons, that the jail distemper was most frequently to be met with where there was no chimney. 51 It is of some consequence to attend to the materials of the seamen’s beds; for, instead of flock, they are frequently fluffed with chopped rags, which, consisting of old clothes, emit a disagreeable smell, and may even contain infection. 52 By a berth is understood the interval between two guns, or any space between decks, which is sometimes formed into a sort of apartment by means of a partition made of canvass. 53 It is remarkable that this method of purifying was practised in the most ancient times, as we learn from the following passage in Homer, where Ulysses is represented fumigating the apartments of his palace in which the suitors had been slain: ??`? d??pae???e??? p??sef? ?????t?? ?d?sse?? ??? ??~? ?? p??t?st?? e???` e?a???s? ?e?es??. O? ?fa?’. ??d’a?p???se f??? t??f?? ??????e??? ??e??e? d? ??a p?? ?a? ?????. a?ta? ?d?sse?? ?? d?e?e??se? e?a??? ?a? d?a ?a? ?????. Bring sulphur straight, and fire, the Monarch cries; She heard, and at the word obedient flies. With fire and sulphur, cure of noxious fumes, He purg’d the walls and blood-polluted rooms. This practice was probably founded in superstition, rather than the knowledge of nature. That some divine influence should be ascribed to fire was very natural, as the principal deities of the ancients were only personifications of the elements; and it is worthy of remark, that their name for sulphur signifies something divine t? ?e???, which was probably owing to its being found in those chasms of the earth, in Sicily and Italy, which were supposed to communicate with the infernal regions; for the whole Greek mythology relating to these was taken from the phÆnomena attending the subterraneous fires in those parts. It is curious farther to remark, in other instances, how facts useful to mankind, the truth of which has been confirmed in later times by the more enlightened knowledge of nature, were first suggested by some superstitious circumstance. Thus the wound received by Sarpedon could not be cured, according to the Poet, till, by divine intimation, he was desired to apply to it the rust of the spear with which it had been inflicted, in consequence of which it healed. But the weapons in those days were made of brass, so that the rust of the spear must have been the Ærugo Æris, which has been found by the experience of modern surgery to be one of the best detergents in ill-conditioned sores. It is probably, from a false analogy, founded on some such incident, that an idea prevails among the vulgar, which has become proverbial, that some part taken from the offending body is good in all external injuries. Thus some part of a mad dog is said to have a virtue in curing his bite. Herein may be seen the difference of that knowledge which is suggested by superstition, and that which is acquired by the observation of nature. 54 A loggerhead is a large round mass of iron, with a long handle to it. 55 A fact, related in Anson’s Voyage, is also strongly in proof of the same opinion. When the rich Spanish prize was taken, it was necessary to crowd the prisoners into the hold, for fear of an insurrection, which was to be dreaded from their numbers; yet, when they arrived in China, none of them had died, nor had any disease broke out. They suffered only in their looks, being wan and emaciated to a great degree. 56 It may be brought as a farther proof of a warm climate being unfavourable to every sort of infection, that though the itch is very common in ships and hospitals in Europe, I do not remember ever to have met with it in the West Indies, except in ships newly arrived from England. 57 This circumstance, in the character of the English, is only of modern date; for we learn from Erasmus, who was in England about two hundred and fifty years ago, that they were then extremely slovenly. The following passage is extracted from a letter he wrote to a physician in York, after his return to Holland:—“Conclavia sol fere strata sunt argillÂ, tum scirpis palustribus, qui subinde sic renovantur ut fundamentum maneat aliquoties annos viginti sub se fovens sputa, vomitus, mictum canum et hominum, projectam cerevisiam et piscium reliquias, aliasque sordes non nominandas.” He adds, that the windows were very ill calculated for ventilation, and imputes to the closeness and filthiness of the houses the frequent and long continued plagues with which England was infested, and particularly the sweating sickness, which, he says, seemed peculiar to this country. He mentions that his own country had been freed from the pestilence by certain changes that the State had made in the houses, in consequence of the advice of some learned man. Erasm. Lib. xxii. Epistol. 13.—It is probable that the greater number of those epidemics, called plagues, were only bad infectious fevers. What would contribute still more to the production of infection was the want of linen, which was hardly in use in those days. The disappearance, or at least the great diminution of such complaints in modern times, particularly in London, has been ascribed to the great increase in the proportion of vegetable food; but it is certainly more owing to the improvement in personal cleanliness, and to the greater spaciousness and neatness of houses. As a farther proof of this, it may be mentioned that in the charity, called the Charterhouse, in London, founded by Henry the Eighth, for the maintenance and education of poor boys, their sustenance is all animal food, as it was at the original institution, yet they are extremely healthy. The same observation applies to Winchester school, which was founded some ages before that. There are some passages in ancient history in confirmation of the same opinion. Herodotus relates, that the ancient Egyptians were the most healthy of all the nations, except the Libyans, and he imputes this to the invariableness of their weather, and the serenity of their sky. But he mentions in another part of his works, that they were also the most cleanly of all people, not only in their household utensils, but in their persons, and that their clothing was chiefly of linen, which it was one of the principal studies of their life to wash and keep clean—??ata de ???ea f??e??s? ??e? ?e?p??ta e`p?t?de???te? t??t? a??sa. Herodot. Euterp. 37.—It is remarkable that he makes no mention of the plague, though he gives a very minute account of the country from his own observation, from whence it may be naturally inferred, that it did not then exist there, though Egypt is now so subject to it, that the plague is supposed by many to be an endemial disease in it. It would appear also from another passage in this historian, that he uses the word ?????, which we translate plague in a loose sense to signify any violent acute distemper; for he relates that a great part of the army of Xerxes, in their retreat from Greece, perished by the plague ????? and dysentery, in consequence of famine. Herod. Lib. viii. cap. 115. 58 It is proper also to observe here, that those ships which are built of winter-felled timber are much drier than those built of what is summer felled; and this circumstance should have been mentioned with regard to the Montague, for the cause of her healthiness, notwithstanding her being a new ship, was probably from being built of winter-felled timber. It should, therefore, be strictly enjoined to fell the wood in winter; for those who are employed to do it have an interest in doing it in summer, on account of the value of the bark. 59 A windsail is a long cylinder of canvass, open at both ends, kept extended with hoops, and long enough to reach from the lowermost parts of the ship through all the hatchways into the open air. 60 It is not necessary that seamen should have chests, for bags or wallets answer their purpose equally well, and are much more convenient in respect of stowage. 61 Since the first edition of this work, I have met with a fact in confirmation of this principle, with regard to the cutaneous complaint called the ring-worm. This had prevailed in a private school in the neighbourhood of London, which I visited, but it had to all appearance become extinct; yet it nevertheless affected those boys who were newly sent to the school. 62 It is mentioned by Thucydides, that while the plague raged at Athens, the people were affected with no other disease; from which it would appear that those persons who would otherwise have been attacked with some particular indisposition, were seized with the plague in place of it. Vide note p. 247. 63 Part I. Book II. Chap. VI. 64 It is related by the travellers into Turkey, that the Christians save themselves from it, merely by shutting themselves up in their houses, and the inhabitants, who sleep on the open roofs of the houses, do not catch it even from those of the adjacent buildings, though the wall that separates them is of no great heighth. 65 Vide Opera Ambrosii Parei. 66 See Essay on Sea Diseases. 67 Limes, shaddocks, and perhaps all the other fruits of that class, possess the same virtues; but I have most frequently observed good effects from lemons. 68 In the course of the passage from England to the West Indies in February, 1782, the following directions for using the sour krout and melasses were given in public orders by the Admiral to the different ships of the squadron: “The allowance of sour krout made by the public boards in England, is two pounds to each man every week; and the Admiral orders that from a pound and a half to two pounds (beginning with the lesser quantity, and increasing as the men may find it palatable) be boiled with every gallon of pease on a pease day. The cooks are desired not to wash it, nor to put it into the coppers till the pease are sufficiently broken. “Half a pound is directed to be issued raw to each man on beef days, and a quarter of a pound on pork days. It is recommended that the allowance of vinegar be saved, particularly on meat days. When sour krout runs short, the pease and beef days to have the preference; when shorter still, the pease days. Melasses having been allowed in lieu of part of the oatmeal, in the proportion of eleven pounds to two gallons, the Admiral directs, that a pound of melasses be boiled with every gallon of oatmeal on Mondays, Wednesdays, and Fridays, mixing it and stirring it round with the burgoo immediately after it is drawn off. He directs that half a pound of melasses be issued with every three pounds of flour over and above the common proportion of raisins; and to prevent any abuse, it is directed that the purser’s steward pour it into the platter with the flour of which the pudding is made. The Admiral forbids the use of pease in lieu of oatmeal, as has sometimes been the practice.” These rules were suggested by Sir Charles Douglas, captain of the fleet, whose benevolence is equal to his known professional skill; and he had ascertained the utility of the preceding directions when captain of the Duke in the former part of the war. 69 In the French ships of war there is an oven large enough to supply not only all the officers and sick, but part of the crew, with soft bread every day. The advantages attending the use of flour in place of bread are so great and obvious, that the former will probably, in time, be substituted entirely for the latter. There is a proof of its being practicable to use it in place of bread in British ships of war, even with their present conveniences, communicated to me by Captain Caldwell. When he commanded the Agamemnon, of 64 guns, at New York, in the end of 1782, there happened to be no bread in store to supply that ship on her passage to the West Indies, and flour was given in place of it. The men, without any inconvenience, were able to bake it into bread for themselves, and it proved so salutary, that Captain Caldwell ascribed the uncommon degree of health which his men enjoyed to the use of the flour. The only objection that can be made to it is the greater consumption of wood occasioned by baking; but this may be obviated by adopting the grates invented by Mr. Brodie, in which the ovens are heated by the same fire with which the victuals are boiled. 70 Mr. Napeane, afterwards Under Secretary of State, was at that time purser of the Foudroyant, and acted a very benevolent and disinterested part, by being instrumental in introducing this reform in the navy victualling. 71 Half a pound of cocoa, and as much sugar, was allowed in place of a pound of butter. 72 Table, exhibiting the daily Allowance of Provisions for each Man in the Navy.
This has continued from the last century till the alterations above mentioned, all of which, except the introduction of vinegar, have been made in the three last years of this war. When the stock of small beer is exhausted, half a pint of spirits is allowed daily, diluted with four or five times its quantity of water. When wine is supplied, the daily allowance of it to a man is one pint. 73 Instead of leaving this to the management of the men themselves, it might be done with greater advantage to them by instituting short allowance in the following manner:—Let a certain proportion, suppose one third, of the salt provisions, bread, and pease, particularly the first, be stopped, and let the amount of this, for the whole crew be thrown into one estimate. Let the agent victualler pay into the purser’s hands the value of these provisions in money, at the contract price, with such a discount as will allow for the use of the money. Let the purser, in return, give him a receipt, as if for so much provisions checked. This money, being distributed in the name of short allowance, will enable the men to purchase vegetables, and the provisions will be saved for a time of want, or for a cruise. 74 The sailors in the squadron of Commodore Anson never murmured more under any of their hardships than when they were fed with fresh turtle for a length of time in the South Sea. 75 Since the first edition of this work was printed, I have met with a book published by Mr. Fletcher, a navy surgeon, in which he mentions that spices, being antiseptic bodies, might be substituted for part of the salt in curing provisions, and this would, no doubt, be an improvement in the sea victualling. The quantity of spice he proposes for every barrel of beef or pork is four ounces of black pepper, and as much allspice, and also eight ounces of nitre in powder. It may be farther alledged as an advantage of spice over salt, that it would be less apt to run into brine, which robs the meat of the greater part of its nourishment. 76 This accident happened in the Cyclops frigate in September, 1780. Mr. Gordon, the surgeon, favoured me with the following account of it: “Mr. Smith, an officer, John Barber and Anthony Wright, seamen, having eat some victuals prepared in a foul copper, complained soon after of violent gripes, giddiness, and vomiting, and they had a few loose stools. There was intense heat; the pulse was quick, full, and hard; a tremor of the hands and tongue, and wildness of the eyes. The looseness was soon succeeded by obstinate costiveness, tension of the abdomen, difficult breathing, and loss of deglutition. In the night, towards the morning, there came on insensibility, with an increase of all the symptoms, except the heat. The body was violently convulsed, with cold clammy sweats and coldness of the extremities. The abdomen subsided a short time before they died, and, before they expired, a small quantity of greenish matter, mixed with phlegm, issued from the mouths of two of them. Thirty three other men were put upon the sick list with similar symptoms in a less degree, and some of them continued on the list for five or six weeks before they perfectly recovered.” It is not said what means were attempted for the recovery of these men; but, besides emetics and milk, or oil, a dilute solution of the fixed alkali in water has been recommended against this poison. 77 I was furnished by Dr. Clephane, physician to the fleet at New York, with the following fact, as a strong proof of the excellence of this liquor: In the beginning of the war two store ships, called the Tortoise and Grampus, sailed for America under the convoy of the DÆdalus frigate. The Grampus happened to be supplied with a sufficient quantity of porter to serve the whole passage, which proved very long. The other two ships were furnished with the common allowance of spirits. The weather being unfavourable, the passage drew out to fourteen weeks, and, upon their arrival at New York, the DÆdalus sent to the hospital a hundred and twelve men; the Tortoise sixty-two; the greater part of whom were in the last stage of the scurvy. The Grampus sent only thirteen, none of whom had the scurvy. 78 We have a remarkable proof of this in comparing the fleet under the command of Admiral Byron with that under the Count d’Estaing, when they both arrived from Europe on the coast of America in the year 1778, some of the British ships having been unserviceable from the uncommon prevalence of scurvy, while the French were not affected with it. 79 See an article in Rozier’s Journal de Medicine for July, 1784, by Dr. Ingenhousz. 80 Since I came to England I have met with a pamphlet published by Mr. Henry, of Manchester, in which an ingenious method, founded on chemical principles, is proposed for separating the quick lime from water; but I fear it is too nice and complex to be brought into common practice. It would certainly be worth the trouble; but there are so many duties in a ship of war to call off the attention of the men, and they are so little accustomed to nice operations, that it would be difficult to persuade officers to attend to it and enforce it. If a sufficient quantity should not be precipitated by the air in the water, and by the accidental exposure to the atmosphere, it might be more effectually exposed to the air by Osbridge’s machine, to be described hereafter, or by a long-nozzled bellows, and if a small impregnation should be left, this is rather to be desired than avoided. 81 See Dr. Lind on the Health of Seamen. 82 The want of this apparatus may be supplied, in case of exigency, by a contrivance mentioned by Dr. Lind, consisting of a tea-kettle with the handle taken off, and inverted upon the boiler, with a gun barrel adapted to the spout, passing through a barrel of water by way of refrigeratory, or kept constantly moist with a mop. In this place I cannot help mentioning also, that in case of great extremity it has been found that the blood may be diluted, and thirst removed, by wetting the surface of the body even with sea water, the vapour of which is always fresh, and is inhaled by those pores of the skin whose natural function it is to imbibe moisture, of which there is always more or less in the common air of the atmosphere. 83 When we consider that linen was not in use among the ancient Romans, we might be apt to wonder that they were not more unhealthy; but their substitute for this was frequent bathing, which not only served to remove the sordes adhering to the surface of the body, but to air that part of the clothing which was usually in contact with the skin. The washing of the bodies of men suspected of infection upon their first entrance into a ship, has already been mentioned, and I have known some commanders who made their men frequently bathe themselves with great seeming advantage. 84 A coarse woollen stuff so called. 85 He makes the following computation of the additional expence for each man in some of the articles that have been mentioned:
87 Had I then known the salutary effects of porter and spruce beer, of which I have since been convinced, I should have proposed them as substitutes for rum. 88 The authenticity of this fact, as well as every other assertion in this work relating to the mortality in the fleet, may be proved from the ship’s books, deposited at the Navy Office. 89 I fancied that my reasoning on this subject was in a great measure new; but I lately met with the following passages in Celsus and Hippocrates, which seem to be illustrative of the same idea:—Quibus causa doloris, neque sensus ejus est, his mens laborat. Celsus, Lib. ii. cap. vii. which is nearly a translation of the following aphorism of Hippocrates:—[Greek hOkosoi poneontes ti tou sÔmatos, ta polla tÔn ponÔn ouk a sthanontai, touteoisin hÊ gnÔmÊ noseei]. Hippoc. Aphor. Lib. ii. Aphor. 6. The same principle is ingeniously explained by Mr. Hunter in his Lectures. 92 The form of administering this medicine was to add twenty drops of thebaic tincture, from half a grain to a grain of emetic tartar, and from five to ten grains of nitre, to two ounces of water or camphorated julep, of which one half was given about two hours before the common hour of rest, and the remainder at that hour. If spiritus Mindereri is preferred to the nitre, it may be given from two drachms to half an ounce for a dose, and it is better to administer it separately; for if it should not be exactly neutralized, it may decompose the antimonial, and render it inactive. 93 Since the publication of the first edition of this work, there has appeared a small tract on the treatment of low fevers, by Dr. Wall, of Oxford, and as his ingenuity and learning give him a just claim to the high rank he holds in his profession, attention is due to what he advances. The principal scope of the work is to recommend, from his own observation, the early use of opiates in those fevers, and the Doctor’s authority, as well as my own experience, convince me of the propriety of this practice in many cases occurring in this country, particularly among the lower sort of people, for whom spare diet and hard labour render evacuations less necessary than among the better sort. The inferior class of people are also more subject to this sort of fever from their houses and persons being less clean, and their apartments being worse ventilated; so that practice in these, as well as other cases, is to be varied according to the constitution and previous habits of life. 94 I first learned this, as well as many other useful and practical facts, from Mr. Farquhar, Surgeon in London, who has laid me under the greatest obligations by communicating many of his observations, derived from the most extensive experience and a truly penetrating sagacity. 95 I owe this piece of instruction, as well as many others, to Dr. Cullen’s Lectures. 96 In a review of Haslar hospital made in person by that excellent officer, Vice-admiral Barrington, in 1780, it was very judiciously proposed, among other salutary improvements, that there should be two apartments for the reception of the sick upon their first landing; one wherein they should be stripped of their dirty clothes, and another in which they should go into the warm bath, and put on the hospital dress, that they might not carry infection into the wards. 97 The following is the form of it, and it was first introduced by Mr. Whitfield, apothecary to the hospital, under the name of Bolus Sedativus:—?. Confection. Damorat. [dram]ss. Castor. Russic. pulv. [scruple]ss. Tinct. Thebaic. gtt. iv. Syr. sim. q.s. Fiat bolus sexta quaque hora sumendus. 98 Great nicety is required in all cases with regard to the times and doses of cordials; for it by no means follows that these should be in proportion to the lowness and loss of strength. This is well illustrated by Mr. Hunter in his Lectures, where he explains the distinction between the powers of the body and its actions. There must be a certain degree of strength to bear the excitement occasioned by stimulating and strengthening medicines or diet; for nothing is more pernicious, or even fatal, than that any part or function should make exertions beyond its strength; and there is the more danger in ill-timed remedies of this kind, as a state of weakness is generally a state of irritability. 101 Sailor’s fever. 103 I have in the whole of this work been extremely cautious in reasoning concerning causes, from an opinion that they are very obscure, and that the theoretical part of physic is very imperfect and fallacious. This is perhaps in no instance more remarkable than in those opinions that prevail concerning the nature and influence of bile in producing diseases. An increased secretion of bile commonly attends the feverish complaints of hot climates, and those of the hot seasons of temperate and cold climates. It is not unnatural, therefore, to impute the disease then prevailing to this redundancy of bile: but, upon considering the matter more closely, it will appear to be rather a concomitant symptom, or effect, than a cause of those fevers; for, in the first place, in those cases in which there is the greatest secretion of bile, as in the cholera morbus, there is no fever. The only danger in this disease arises from the violent irritation produced in the bowels by such an extraordinary quantity of this secretion which commonly passes downwards; though I have seen it prove fatal when it flowed into the stomach, and produced perpetual retching and excoriation of the fauces; but in this case also without any fever. Secondly, in the most fatal of all fevers, in the West Indies, there are no marks of an increased secretion of bile, but, on the contrary, a preternatural defect of it, as appears by its not being evacuated either by stool or vomiting, by the white stools which sometimes attend the yellow fever, and by its not appearing in the first passages, nor in its own receptacles after death. Perhaps also that state of the bowels which renders it so difficult to procure stools may be in part owing to the want of this natural stimulus. It is nevertheless true, that in the intermitting and remitting fevers of hot climates and seasons there is perhaps always an accumulation of bile at the beginning, and an increased secretion of it during their course. It is farther true, that this adds to the patient’s uneasiness, and aggravates the symptoms, and that the cure consists partly in the evacuation of the bile. But it is also true, that in the very worst sort of fevers in hot climates it is a favourable symptom where the secretion of the liver is restored and increased, a bilious diarrhoea being one of the most auspicious symptoms that can occur in a yellow fever; and in those that are protracted and afford hopes of recovery, there is generally a gush of bile from time to time.—We may therefore lay down the following positions: 1. That in cases in which bile is most freely and copiously secreted no fever exists, as in cholera morbus. 2. That in the worst sort of fevers there is no preternatural secretion of bile, but, on the contrary, a defect of it. 3. That nevertheless there is an uncommon quantity of bile secreted in most of the fevers of hot climates, and that part of the cure consists in evacuating it. I am extremely diffident, as I have said, in all matters depending on our supposed knowledge of the animal oeconomy; but the preceding circumstances seem to countenance the following reasoning:—The bile, according to Dr. Maclurg, who has given one of the best dissertations on its nature and properties, is composed of two parts; the gross part, which is coagulable by acids, and that part in which the bitter principle resides. The first constitutes the principal part in point of quantity, and seems to be that portion of the mass of fluids which loses the property of sound healthy blood, by a tendency to putrefaction, and is thrown out by this secretion. I will not undertake to vouch for the truth of this, but shall assume it as true in the following reasoning:—According to this theory, therefore, the greater part of the bile is what may be called the effete part of the circulating mass, or perhaps only of the red globules or gluten, the watery and saline part, which passes off by urine being the corrupted part of the serum. This part of the bile being very liable to putrefaction, the bitter part is considered by Dr. Maclurg as intended to correct this, and also to answer some good purpose in digestion. One of the effects of the bile in this operation is to extinguish acidity, whether proceeding from substances taken in, or generated in the stomach. The blood in all climates, and in all situations of life, is subject to have part of it thus corrupted, which, being separated from the common mass by the liver, is mingled and discharged with the common feces; but external heat continued for any length of time tends to augment this corruption of the fluids, and therefore to increase the secretion of bile; and it has been observed both by myself and others, that the bile found in those bodies that have been inspected after death, in consequence of fevers in hot climates, is less bitter, and not so penetrating to the fingers, being therefore deficient in the antiseptic principle. But since external heat makes no alteration in the degree of temperature of the fluids themselves, this effect must take place through the medium of the solids, in consequence of that general languor and want of energy which too much external heat induces in the functions, particularly in that power by which the living body preserves itself from putrefaction. Now if this portion of the blood, thus altered and depraved, is readily secreted and speedily thrown out, as in cholera morbus, no harm befals the constitution, nor any inconvenience but what arises from the irritation of the primÆ viÆ. But this may not take place if the body should be otherwise deranged; for the removal of this noxious matter from the mass of blood depends upon a due irritability of the blood vessels, the liver, and the bowels, whereby they are stimulated to contract, and thereby expel it. According to the principle of Mr. John Hunter, (whose deep and industrious researches into the animal oeconomy place him high in the list of those few on whom nature has bestowed real genius, and who are capable of adding something new to the stock of human knowledge,) there is in a state of health a relative habitude or mutual harmony existing between the solids and fluids, whereby they stimulate and produce actions in each other, in which the healthy state of the functions consists, whether employed in the formation of what is found, or the expulsion of what is noxious: so that where it happens that the solids have a morbid insensibility to the impressions of corrupted and acrimonious fluids, the retention of these adds still more to the general derangement. To illustrate this, it may be observed, that the stomach and bowels, when they are endowed, as it were, with their natural perception, immediately expel any preternatural accumulations of bile that may take place; but when they are insensible to this stimulus through disease, no effort is made to relieve nature till it is excited by medicine. The same reasoning may be applied to the various vessels and ducts. Thus when we see the liver gorged with bile, without any free excretion of it into the gall bladder, as I have sometimes found to be the case upon inspecting the body in some of the worst cases of fever, would it not appear that the gall ducts have lost that natural irritability whereby the bile is expelled? Or, in consequence of a depraved state of action, connected with febrile affection, may it not happen that the absorbents, which, in their natural state, only absorb particular substances, and in a given quantity, will suffer a change in this natural action, and absorb whatever happens to be applied to their orifices? In case of jaundice, the bile, which is perhaps not at all absorbed in a state of health, is taken up in large quantities, and mingled with the mass of blood, which proves a seasonable relief in the state of accumulation and distension occasioned by the obstruction. This may happen in cases of fever, not indeed as a relief to nature, but from a depraved state of irritability in the lymphatics, induced by disease. Though no increased quantity of bile, therefore, is found in the gall bladder, there may have been an increased excretion of it, a preternatural absorption having been excited. So that it may admit of a question whether the colour of the skin, in the yellow fever, is owing to this, or if the idea of it given in the text104 is more just; but in either case it seems probable that the extreme tendency to putrefaction in the whole body is owing either to the presence of bile, in consequence of absorption, or the retention of something in the blood from a defect of its secretion. This reasoning concerning the bile in hot climates may, in some sort, be illustrated by what happens to the urine in cold climates. The urine is the vehicle of an excrementitious part of the blood, of which an increased proportion is generated in certain fevers, and if it is thrown out in the form of high-coloured, turbid urine, the fever will most probably be slight and short; but if it becomes pellucid, or crude, as it is called, the general derangement will be increased, the fever will be more violent and dangerous, and the first sign of returning health will be a turbid appearance and sediment. If the reasoning in the above discussion should appear to some readers unsatisfactory, or ill connected, I can only say that if it is deserving of this character, I am willing to have it considered not only as an illustration, but an example of the nicety and fallacy of theoretical disquisitions. 105 I have been very cautious of admitting any theory into this work; but I cannot help adopting the doctrine of my much-valued master, Dr. Cullen, on this point, viz. that a great part of the symptoms of fever arise from reaction, or that effort which nature makes to overcome the morbid cause. I am happy in any opportunity of acknowledging my obligations to this learned professor, to whom the medical world in general is so much indebted, as well for the rational views of the animal oeconomy, which he teaches, as for that spirit of study and inquiry which he infuses into the minds of his pupils. 106 M. Desportes, who wrote a treatise on the diseases of St. Domingo. 107 There is a difference in the appearance of the blood when sizy, perhaps not sufficiently insisted on by practical writers; for though there should even be a very thick buff, yet, if the surface is flat, and the crassamentum tender, no great inflammation is indicated, in comparison of that state of the blood wherein the surface is cupped, the crassamentum contracted so as to afford the appearance of a large portion of serum, and where it feels firm and tenacious, though perhaps but thinly covered with buff. This is a distinction well worth attending to in practice; for it is in these last circumstances that blood-letting gives most relief, and where the patient will bear the repetition of it with most advantage. 108 See the same observation in Mr. Hume’s Essay on this Disease, published by Dr. Donald Monro. 109 The state of the stomach is very much affected by that of the external surface of the body; and it is sagaciously observed by Sydenham, that the stomach being commonly very irritable in the plague, the most effectual means of making it retain what was administered internally was to excite a sweat. 110 The red bark was brought to England in a Spanish prize in the year 1781, and a very accurate account of its medical and chemical properties was published the year after by Dr. William Saunders, of Guy’s hospital. None of it had been brought to the West Indies before the peace, so that I had no opportunity of trying it in that climate. 111 Mr. Telford related to me, that he had cured several intermittents that had baffled the bark, by means of white vitriol, whilst he was surgeon of the Yarmouth in 1779. He gave it in doses of five grains every four hours in the intermission, and was successful in every case except two, in which the patients were far advanced in the dropsy. He met with several cases of the same kind in the Alcide, in 1782, in which he was successful with the flowers of zinc, after having given large quantities of bark to no purpose. He preferred, however, the white vitriol, as being milder in its operation, and less apt to disagree with the patient’s stomach. He did not employ either of them in the recent state of the disease, nor does he assert that they are universal or infallible remedies; but only alledges, that he has experienced the most evident good effects from them in an advanced stage of the disease, and a reduced state of the patient, where the common remedy had failed. 112 Dr. Huck Saunders, whose recent loss the world has reason to regret on account of his experience and sagacity as a physician, as well as his virtues as a man, communicated to me, in conversation, some observations on the cure of obstinate intermittents, which deserve to be mentioned here. When he was physician to the army at the Havannah he cured a number of agues which had resisted the bark, by giving two ounces of the vinous tincture of rhubarb and six drams of the tincture of sena seven or eight hours before the fit. This being repeated two or three times, carried off the disease. He also informed me, that he had met with agues in England which did not yield to the bark; but, upon leaving it off, and putting the patients on a course of mercury, they were cured upon returning to the use of the bark. Arsenic has also been found to be an effectual remedy in intermittent fevers. I was informed by Dr. Huck Saunders, that when he was in North America, in the war before the last, there was an expedition undertaken against the Cherokee Indians, whose country is extremely subject to agues; and as an adequate quantity of bark would have been very cumbersome where light service was necessary, Mr. Russel, who had the medical management of the expedition, provided a great number of pills, containing each one eighth part of a grain of arsenic, by the proper use of which he was enabled to cure the intermittent fevers with which the troops were seized. I shall here mention another unusual remedy in intermitting fevers; and though I can bring only one instance in proof of its efficacy, yet this is so strong as to make it deserve farther trial. A man, on board of the Sandwich, had an obstinate intermittent which had resisted the bark, and was stopped by applying to the stomach a plaster, composed of gum plaster, epispastic plaster, and opium, in proportions which I do not now recollect. 113 Sir John Pringle on the Diseases of the Army. 114 This is elegantly expressed as follows, in Sir George Baker’s learned Dissertation on this disease:—“Primo neglectus tractatu asperior occurrebat: etenim corpus extenuatum atque confectum ut morbo fervido impar erat, ita ipsi impar curationi. Itaque optimum erat occurrere ipsis principiis atque auxilia mature prÆripere. In hoc enim corporis affectu aliquod certe in medicina opus est, haud multum in naturÆ beneficio.” 115 In Dr. Griffith’s form of his medicine for the piles, six drachms of fresh-drawn linseed oil are joined with two drachms and a half of the vinous tincture of rhubarb, and given twice a day in a draught. I commonly used oil of almonds at the hospital. This may be considered as another instance of those useful combinations of medicines, which experience alone sometimes discovers. I have found it of use also in other internal hÆmorrahages. 116 See Diseases of the Army, p. 273. 6th Edit. 117 Since coming to England, I have been informed by Dr. Garden, a learned and ingenious practitioner from South Carolina, that this medicine, in order to produce its proper effect, should be given in a very weak decoction; for that after having almost abandoned it in consequence of its failure when he gave it in strong decoctions, and in substance, he was again convinced of its efficacy by using it in a very weak decoction, a scruple being boiled in a pint of water to half a pint. 118 See page 345. A fact mentioned in Capt. Cooke’s Voyage to the North Pacific Ocean, may be also alledged in favour of this opinion. He remarks, that the Kamschadales, who were habituated to hard labour, were free from scurvy, while the Russians and Cossacks, who were in garrison in their country, and led indolent lives, were subject to it. 119 I was informed of this fact by Mr. Cairncross, an ingenious surgeon belonging to one of the battalions that served there during the siege. 120 I imagined that this was a new practice; but I find, since the first edition of this work was printed, that it has been recommended by Pere Labat in his voyage to the Antilles. 121 There is a symptom which takes place when men are beginning to recover from scurvy, (particularly when the cure is rapidly effected by the use of lemon and orange juice) upon which I have frequently reflected, but for which I have never been able to account. This consists in acute pains, which are felt in the breast and limbs, resembling rheumatic pains. I once knew the crew of a ship which was much affected with scurvy, and had about ninety men under cure by lemons and oranges, who were most of them affected with this symptom in one night, and made such a noise by crying out as to alarm the officers who were upon duty. 122 See the Medical Essays of Edinburgh. Sennertus, lib. iii. part i. sect. ii.—Haller Elem. Physiolog. lib. xix. sect. ii. 123 In the Princessa, 1781, and the Nonsuch, Prince George, and Royal Oak, in 1782. 124 Since this was first written, the melancholy tidings have arrived of another case to be added to this fatal list. It is that of the amiable and gallant Lord Robert Manners, who commanded the Resolution on the 12th of April, and having lost his leg, besides receiving a wound in his arm and breast, died of this untractable symptom on his passage to England; and though he shared a fate to be envied by every lover of true glory, his loss can never be enough deplored by his country and friends, being formed by his great virtues and accomplishments, joined to the lustre of his rank, to hold out an example of all that was good and great as a man and an officer. 125 See Kaau Boerhaave’s account of this epilepsy in a school at Harlaem, in a book, entitled Impetum faciens dictum Hippocrate per corpus consentiens (page 355.) A fact of the same kind is also related in a pamphlet, entitled Rapport des Commissaires chargÉs par le Roi de l’examen du Magnetisme Animal. 126 London Medical Observations and Inquiries, Vol. VI. 127 Medical Commentaries, Vol. III., and a Thesis printed at Edinburgh, 1784. 128 See experiments on a heated room. Philosophical Transactions, 1775, Vol. LXV. 129 That species of locked jaw, called by authors the Trismus Infantium, to which children are liable the first week after birth, is probably owing to the contact of the external air upon the skin, which is accustomed in the womb to a moist and warm medium. 130 AretÆus Cappadox says, that tetanus in general is even more apt to occur in winter than in summer. De Cauf. & Sign. Morb. Acut. lib. i. cap. vi. 131 There are several valuable practical remarks on this complaint in some of the ancient authors, especially AretÆus. Their principal means of cure consisted in the application of warm oil to the whole surface of the body, particularly of the part affected. This author also recommends clysters of warm oil, occasionally combined with a medicine called hiera, which consisted of certain spices and gums, with some purgative, such as aloes or colocynth. AretÆus Cappad. de Curat. Morb. Acut. cap. vi. Celsus, lib. iv. cap. iii. GorÆaus in vocabulum,?e?a. 132 This is a fact which does not admit of doubt; but the manner in which the effect is here produced is a matter of conjecture. It is most probably owing to the compression and tremor of the air in consequence of its resistance to the motion of the ball. We can also conceive, that, with regard to an yielding part, such as the stomach or abdomen, a body flying with great velocity may even, for a moment, displace a portion of it by passing through the same space, without any other mechanical injury than contusion, in a manner similar to what happens to two balls in the act of collision in philosophical experiments made to illustrate the nature of elasticity; or the compressed air may even, in this case, act, as it were, like a cushion, preventing the sudden impulse and contact of the ball. This explanation furnishes a reason why the parts of the body above mentioned should be more liable to be affected by accidents of this kind than the head. Perhaps this difference may also, in part, arise from the principle laid down by Mr. Hunter, that the stomach is more essential to life, and more immediately the seat of it, than the head or any other member or organ of the body, and that an injury to this part is more immediately destructive of life than any other. 133 The honourable Captain Fitzroy. 134 Colonel Markham. 135 Animals are affected by these accidents as well as men. A cow in one of the ships was killed in one of the actions in April, by a double-headed shot passing close to the small of her back. 136 HÆc formula ex Pharmacopoeia Nosocomii Sti. ThomÆ excerpta est. 137 HÆc formula ex Pharmacopoeia Nosocomii Sti. ThomÆ deprompta est. 138 Vide pag. 408. 139 Vide pag. 409. HÆc formulÆ ex Pharmacopoeia Nosocomii Sti.ThomÆ excerpta est. sed vice confectionis Damocratis hodie obsoletÆ, adhibentur confectio aromatica & opium purificatum, ratione habit ad portionem fingulorum adeo ut parem edant effectum ac in vetere formulÂ. 140 Vide pag. 456. 141 Ex auctoritate Cl. Huck Saunders. 142 Ex auctoritate Cl. Huck Saunders. 143 Ex auctoritate Cl. Lind. 144 Vide pag. 479. 145 Vide pag. 489. 146 Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo de morbis castrensibus. 147 HÆc formula ex Pharmacopoei Nosocomii Sti. ThomÆ, excerpta est. 148 Vice olei ricini dare licet olei amygdalÆ unciam unam cum tincturÆ sennÆ unci dimidiÂ. Vide Pharm. Nosoc. Sti.ThomÆ. 149 HÆc formula ex auctoritate Cl. Griffiths. In periculis a me ipso factis felicissimum successum ex hoc medicamento percepi. 150 Hoc medicamentum speciatim his hÆmorrhagiis accommodatum quÆ ex aliquo viscere lÆso vi externa exoriantur quales in nave sÆpius quam alicubi accidere solent, ex prÆcipitiis & ex corpore colliso a molimine machinarum & tormentorum.—Prodest quoque in his casibus pulvis ipecacoanhÆ compositus. 151 HÆc formula ex Pharmacopoeia Nosocomii Sti. ThomÆ deprompta est. 152 HÆc est quam proxime formula a Cl. Mead legata Nosocomio Sti. ThomÆ ubi olim munere medici functus est, & ibi ex eo tempore usque hodie feliciter in hydrope adhibita est. 153 Cl°. Huck Saunders qui dyspnoe hydropic laboravit ipse, auxilio notabili erat hoc medicamentum. In talibus malis interdum summopere prodest decoctum digitalis purpureÆ, ut medicus supra memoratus in suo casu compertus est.—Vid. Medical Transactions, Vol. III. 154 Vide Cl. Pringle in opere suo de morbis castrensibus. 155 Hujus doctrinÆ auctor est Hippocrates, quÆ restaurata est auctaque a Cl. Milman in opusculo suo de hydrope. 156 HÆc methodus medendi quÆ Æque efficax ac simplex est, primo excogitata fuit a Cl. Georgio Fordyce medico nosocomii Sti. ThomÆ, ubi & ipse felicissimo cum successu eandem expertus sum, in muneribus meis ibi fungendis. 157 Vide opus Cl. Johannis Hunter de morbo venereo. 158 Vires opii in isto morbo primo innotuerunt ex experienti Cl. Nooth, dum prÆfuit nosocomiis militaribus in America, & pro optimo remedio a peritissimis medicis & chirurgis jam habetur. 159 Non hic intelligitur ptyalismum veram esse causam qu efficitur medela morbi, sed prÆcipitur ut pro argumento sit hydrargyrum in vasa minima permeasse adeo ut effectum edat in subigendo morbo. Vide Opus Hunteri. 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