Observations on the Diseases of Seamen. Sir Gilbert Blane
to form a proper estimate of the real efficacy of different remedies and modes of treatment.
But besides this difficulty belonging to the nature of the subject, there were others connected with the nature of the service; for the hospitals were at times so inadequate in point of size, and so ill provided with necessary articles and accommodations, particularly during the first part of my attendance, that my principal care was to remedy these defects by proper superintendence and representation.
A due attention to air, diet, and cleanliness, is not only more essential than mere medical treatment, but the sick cannot be considered as fit subjects for evincing the powers of medicine till they are properly provided for in these respects. These inconveniences were owing, in a great measure, to the unusual extent of the service; for there was a much greater naval force in those seas, at this period, than was ever before known, and there was of course a proportional want of accommodation for the sick. Towards the end of the war these difficulties were much obviated, so that a fairer field of observation presented itself.
Another obstacle to my practical inquiries was, that the fleets I belonged to seldom remained more than six weeks or two months at any one place, so that any series of observations that might have been instituted was interrupted, and I was in a great degree deprived of the fruits of them, by not seeing the event of cases under my management.
The peace in the spring of the year 1783 put an end to all my inquiries, and particularly prevented me from following out some practical researches. I have ventured, however, in one part of this work, to give the result of my experience in some diseases, more especially such as are peculiar to the climate and mode of life.
Upon the whole, I have, in the following work, humbly attempted to follow what I conceive to be the only true method of cultivating any practical art, that is, to collect and compare a great number of facts. A few individual cases are not to be relied on as a foundation of general reasoning, the deductions from them being inconclusive and fallacious, and they are liable to be turned and glossed, according as the mind of the observer may he biassed by a favourite prepossession or hypothesis. It has been my study to exhibit a rigid transcript of truth and nature upon a large scale, and to take the average of numberless particular facts, to serve as a groundwork for observation; and I have endeavoured to analyse and collate these facts, by throwing the monthly returns that were made to me into the form of Tables, as the most certain and compendious way for finding their general result. If the materials are not sufficiently ample, or if the method should be found faulty and imperfect, let it be remembered, that I had no example to go by in this field of observation. It is to be regretted, that ages have passed without any attempts being made to transmit regular records of this kind to posterity. It would not only be extremely curious, as a piece of natural knowledge, but would conduce greatly to medical improvement and public utility, were we possessed of such information concerning the causes and nature of the diseases prevailing at sea, in various circumstances of weather, climate, and diet, in remote ages and countries, or even in our own age and country, as might enable us to compare them with present facts, and to ascertain more precisely the means of preventing and removing such diseases.
The favourable reception which the first edition of this work has met with, renders it necessary to offer another to the Public; and though no new opportunities have occurred of making additional observations in the naval service I have endeavoured, during the last two years, from a pretty extensive experience in a large hospital, and from private practice, to add some new information on some practical points; and I hope this edition will be found throughout more full and correct than the former.
The method I propose to follow in this work, is, First, to deliver the history of the different voyages and expeditions, so far as relates to health, giving an account of the prevalence and nature of the diseases and mortality on board of ships and in hospitals.
Secondly, To deduce, from observations founded on these facts, and also from the former experience of others, the causes of sickness in fleets, and the means of prevention.
Thirdly, To deliver some practical observations on the cure of the most common diseases incident to fleets, particularly in hot climates.
OBSERVATIONS.
PART I.
BOOK I.
Comprehending the Medical History of the Fleet, from March, 1780, till August, 1781.
CHAP. I.
Containing an Account of the Health of the Fleet from March, 1780, till July following.——Five Ships of the Line arrive at Barbadoes from Europe in March—Join a large Squadron then on that Station—Their Health compared—Engagements with the Enemy in April and May producing Hardship and Exposure, but little Increase of Sickness—Method of collecting the Returns of the Surgeons—Influence of Situation upon Health in Harbours—Course of the Seasons, and Temperature of the West Indies—The Fleet reinforced in June and July with Ships from England and North America—Their Health.
During the war, which broke out with France in 1778, and with Spain in 1779, the West Indies was the principal seat of naval operations, and much greater fleets were then employed in that quarter of the world than in any former period.
Though there had been a great squadron on the Caribbee station during the greater part of 1779, no physician was appointed to it till the beginning of the next year, when I arrived there in that character with my friend and protector, Lord Rodney.
There were then sixteen ships of the line on that station, most of which had been upwards of twelve months in the climate; and they were reinforced at this time by five more from England.
The squadron which we found on the station was then extremely healthy, and in several of the ships there was not a man unfit for duty. We were told, however, that they had all been subject to sickness, particularly to the dysentery, soon after their arrival in that climate. Of the five with which the fleet was at this time reinforced, all but the Intrepid left England at Christmas, making part of the squadron which effected the first relief of Gibraltar, under the command of Lord Rodney, who continued his route to the West Indies, in order to take the command on the Windward station, where he arrived on the 16th of March. The Intrepid had arrived with a convoy the day before. These five ships were all pretty healthy on their passage, except the Sandwich and Terrible, in which a fever prevailed; but they had almost recovered from it before they arrived in the West Indies. A dysentery broke out in April in all the ships newly arrived, and it prevailed to the greatest degree in those which had been most affected with fevers in Europe, namely, in the Terrible and Intrepid. The Sandwich and Ajax were also affected, though in a less degree; but the Montagu, though this was her first voyage, and though she was just off the stocks, had been the most healthy of any of them from the time of leaving England, and continued so during all this campaign. I have not observed that new ships are more unhealthy than others, unless they are built of ill-seasoned timber; and they have this advantage, that there is no previous infection adhering to them. What may have contributed also to the superior health of the Montagu, was the precaution that was taken when this ship was first manned and fitted out, of stripping and washing the men that were brought from the guardship to complete the crew.
The Intrepid, while in England, had been afflicted with fevers to a most uncommon degree; for, being one of the fleet in the Channel cruise the year before, almost the whole crew either died at sea, or were sent to the hospital upon arriving at Portsmouth. This ship, after refitting, was pretty healthy for a little time; but, probably from the operation of the old adhering infection, she became extremely sickly immediately after joining our fleet, and sent two hundred men to the hospital the first two months after arriving in the West Indies. Most of these were ill of the dysentery.
The Pegasus frigate arrived with the ships from Gibraltar, and we have here