The purest water is apt to spoil by producing a putrid glare upon the inner surface of the cask which contains it. There is a great difference in this respect between a new cask, especially if made of moist wood, and that cask which has been hardened and seasoned by age and use. Several contrivances have been proposed for preparing the vessels that hold the water; but none have been found by experience so effectual as letting them stand for some time full of sea water; and it is a great advantage of this method, that it is so easily practicable.
It is in few places we meet with water such as that of Bristol, which, in clean vessels, may be kept for any length of time. We may consider all water kept in wooden vessels as more or less liable to putrefaction; but there is a substance, which is neither rare nor costly, that effectually preserves it sweet. This is quick lime, with which every ship should be provided, in order to put a pint of it into each butt when it is filled. It has the advantage of not being injurious to health; but, on the contrary, is rather friendly to the bowels, tending to prevent and check fluxes. In the year 1779 several ships of the line arrived in the West Indies from England, and they were all afflicted with the flux, except the Stirling Castle, which was the only ship in which quick lime was put into the water. Nor does it spoil the water for any culinary purpose. Its action in preventing putrefaction consists, in part at least, in destroying vegetable and animal life. An addition of putrescent matter is produced in water by the generation of small insects; and the glare that collects on the sides of casks, and also what collects on the surface of the water, is a species of vegetation of the order called by naturalists algæ79. Quick lime is a poison to this species of vegetable life as well as to insects: but upon whatever principle it depends, the property of it in preserving water sweet is so well ascertained, that it is inexcusable ever to neglect the use of it.
Quick lime is equally efficacious for this purpose, whether slacked or unslacked; and though the latter form is more convenient for stowage, by having less weight and bulk, yet the other is to be preferred for the sake of safety; for if water should by chance reach the unslacked lime, a great degree of heat is thereby produced, which has been known to give occasion to the most formidable accidents.
The only other objection I know of to the use of quick lime is, that it converts the water into a lime water, rendering it thereby disagreeable to the palate and stomach: but the quantity necessary to preserve it makes but a very weak lime water; for part of the lime is precipitated by the mephitic air, or the aerial acid, as it is otherwise called, of which there is some contained in the water. The accidental exposure to the atmosphere, which also abounds with this sort of air, tends farther to lessen the acrimony of the quick lime80.
There are other substances which have been found useful in correcting bad water. Alum and cream of tartar, as antiseptic bodies, have been employed for this purpose. Vinegar and the vegetable acid juices and fruits, such as tamarinds, may be used occasionally to take off the putrid offensive taste which may have arisen in case the use of quick lime has been neglected. In the fleet under Sir Charles Saunders, the water of the river St. Lawrence having been found to produce fluxes, this quality was removed by throwing four pounds of burnt biscuit into each cask before it was used. But there is nothing so effectual, and subject to so few inconveniences, as quick lime.
The next method to be mentioned of purifying water is filtration, which not only separates the gross impurities, but removes the putrid smell and taste. It is performed with a dripping stone, which is a convenient contrivance for officers, but cannot furnish a supply for a whole ship’s company.
When the water of wells or brooks is found loaded with mud, the following expeditious method of filtration, described by Dr. Lind, has been practised with success:—Let a quantity of clean sand or gravel be put into a barrel placed on one end, without the head, so as to fill one half or more of it, and let another barrel, with both ends knocked out, of a much smaller size, (or let it be an open cylinder of any kind) be placed erect in the middle of it, and almost filled with sand or gravel. If the impure water be poured into the small barrel or cylinder, it will rise up through the sand of both barrels, and appear pure above the sand of the large one in the interval between it and the small one.
But when water is offensive in consequence of being long kept, the most effectual and expeditious method of sweetening it is by exposing it to the air in as divided a state as possible. Boiling will not expel the putrid effluvia contained in water; but such is the attraction of air for this offensive matter, that the water need only be thoroughly exposed to it to be rendered quite sweet. This is best done by a machine invented by Mr. Osbridge, a lieutenant of the navy. It consists of a hand pump, which is inserted in a scuttle made at the top of a cask, and by means of it the water, being raised a few feet, falls through several sheets of tin pierced like cullenders, and placed horizontally in a half cylinder of the same metal. The purpose of it is to reduce the water into numberless drops, which being exposed in this form to the open air, is deprived of its offensive quality. The same method will serve to separate the superfluous quick lime in the water. It is a machine very deservedly in common use, and the working of it is a moderate and salutary exercise to men in fair weather.
The following contrivance will be found to afford a sufficient supply of sweet water to particular messes, and may be considered as an artificial and more expeditious sort of dripping stone.—Let the narrow mouth of a large funnel be filled with a bit of sponge, over which let there be a layer of clean gravel or sand covered with a piece of flannel, and over the whole another layer of sand. Muddy or offensive water being poured upon this, runs or drops out clear; and care must be taken to change the sand, sponge, &c. frequently, as they will become loaded with the impurities of the water81.
There should be in every ship an apparatus for distilling water in case of distress. This consists merely of a head and worm adapted to the common boiler, and distillation may go on while the victuals are boiling. More than eight gallons of excellent fresh water may be drawn off in an hour from the copper of the smallest ship of war82. I refer for a more particular account of all this to the works of Dr. Lind, who was the original inventor and recommender of this method.
This invention seems to have escaped others so long, from the idea that the desideratum in freshening sea water was some substance to be added to it while under distillation. No such substance is necessary, and, the more simple the mode of distillation, the fresher the water will prove.
Rain water at sea is always pure and wholesome, and may be saved occasionally by means of a sail or awning.
Nature has made man so defenceless, that even the rudest nations, in the hottest climates, in general, adopt some sort of covering to guard themselves from the weather. We may affirm, that clothing is the most artificial circumstance in the life of man; and there is none, of which the errors subject him to more inconvenience and hardship. Insensible perspiration is performed by the pores of the skin, and being one of the most important functions of the body, the suppression of it seems to be one of the principal causes, or at least one of the most frequent attendants on feverish and inflammatory complaints; and one of the most common causes of this suppression is the application of cold to the skin.
In order to keep up perspiration, it is necessary that the orifices of the pores of the skin should be bathed, as it were, in the vapour already secreted from them; and clothing seems to act in confining this, as well as in preventing the escape of the natural heat and the access of the external air. Though the air should not be cold, it will check perspiration by carrying off this vapour and drying the skin. In the warmest climates exposure of the skin to the external air is unsafe; for it not only produces a feverish and uneasy sensation at the time, but occasions the most dangerous internal disorders. In consequence of the great sensibility and sympathy of the body, and from the pores of the skin being open in a warm climate, exposure is in some respects even more dangerous than in a cold one. Nothing is more apt to bring on the locked jaw and tetanus than sleeping in the open air; and it was observed in Jamaica, that when it was the custom to wear cotton and linen clothes, the dry belly-ache was much more common than now that it is the custom to wear woollen cloth.
We know besides, that the pores of the skin can absorb not only the moisture that floats in the atmosphere, but a variety of foreign bodies, whether noxious or medicinal, which may be applied to their orifices; and as the air is in certain places loaded with noxious matter, may not clothing be considered as a filter, as it were, to separate the impurities of the air before it comes in contact with the surface of the body?
It is therefore every where of the utmost consequence that sufficient and suitable clothing should be provided.
It would certainly be for the benefit of the service that an uniform should be established for the common men as well as for the officers. This would oblige them at all times to have in their possession a quantity of decent apparel, subject to the inspection of their superiors. It would also be less easy to dispose of their clothes for money without detection, and desertion would also thereby be rendered more difficult.
It is of great consequence that the purser should lay in a sufficient stock of clothing and bedding suited to the climate for which the ship is destined, in order that there may be a sufficient supply after having been on a distant station for a certain length of time. I have known men suffer the greatest inconvenience and hardship, and infectious diseases kept up, from the neglect of this.
The greatest evil connected with clothing is the infection generated by wearing it too long without shifting; for to this cause we have attributed the jail, hospital, or ship fever. The great importance of cleanliness appeared when we were treating of infection, from whence we may judge of what consequence it is that men should be provided with a shift of linen, as that part of the clothing which is in contact with the skin is most likely to harbour infection83.
As clothing is not the gift of nature, being left to man’s own reason, it is subject to caprice, and thereby productive of inconvenience and disease. The necessity of it depends very much upon habit, like every thing else relating to the human body, and therefore sudden and unseasonable changes of apparel are very unsafe to health. It is also found that a partial exposure of the body is more pernicious than a general exposure. If I were writing for the more delicate part of the world, I should illustrate this by the danger of exposing the feet alone to cold or wet. It is seldom that seamen are susceptible to so great a degree, for their hardy and exposed life steels them against such impressions. But there is another circumstance which renders it of the utmost consequence to defend the feet against external injury. It frequently happens, that, without any visible symptoms of scurvy, the constitutions of seamen are such, that, upon the least scratch being received on the feet or legs, a large spreading incurable ulcer arises; which sometimes ends in the loss of a limb; but at any rate disables them from duty till a cure can be effected by the use of a fresh and vegetable diet, or a change of climate. Next to acute diseases and scurvy, this is the most destructive complaint incident to a sea life, particularly in a hot climate; and I have known great numbers of good men thereby lost to the service. It is, therefore, of the utmost consequence that men should not only be supplied with shoes, but be obliged to wear them, which is found to require a degree of compulsion; for in the West Indies it is observed that seamen always wish to go barefooted.
Since the first edition of this work was published, I have been favoured with several valuable remarks on this subject, by Captain Caldwell, an officer of great humanity and experience. Among other remarks, he observes, that the different articles of clothing supplied to sailors are, in general, too slight, and of too small a size, which renders them expensive and inconvenient to large men. The trowsers, he observes, should be much thicker, and larger, as the least shower goes through them; and, in a cold climate, those made of fear-nought84, which do not cost more than the others, should also be allowed. What a situation are men in when topsails are reefing in the winter season while it rains, when cold and wet, with their trowsers sticking to them, (which would not be the case if they were of flannel) and it is not practicable that they should have change of clothing for every time they are obliged to be wet? Thick, double-milled caps are much wanted in bad weather to cover the head and ears. Dutch caps do not keep out the weather, and will not stay on the head. It is commonly remarked that the men who wear the thickest linen shirts are the most healthy.
Men, upon first entering into the service, are allowed the advance of two months wages, in order to provide necessaries: but this, inadequate as it is for a long voyage, is not extended to pressed men. It is also argued against making large stoppages in seamen’s wages; that, by diminishing what they have to receive when paid off, a discouragement is thereby given to the service. But as we see men deserting from men of war when several years wages are due to them, the most reasonable and effectual encouragement seems to be to render their lives as comfortable and healthy as possible.
But why might not most of the articles mentioned be supplied gratuitously? In favour of which Captain Caldwell makes use of an argument frequently inculcated in this work, viz. that so much advantage would accrue to Government by preserving the health and lives of men, and so much would be saved in hospitals, as would much more than reimburse the extraordinary expence85.
It commonly happens in a ship of war that a great proportion of the hands is landsmen; for, besides the men required to navigate the ship, a great number is necessary to fight the guns, as well as for other duties, and their health may be affected by the want of exercise.
It has been observed before, that one use of frequent reviews and musters in a numerous crew is, to call forth men that would otherwise be overlooked, to oblige them to come into the open air, to keep themselves clean, and to prevent them from indulging in filth and laziness. It is observed, that seamen are in general less subject to scurvy than marines and landsmen, which seems to be owing to the greater activity of their life and alacrity of their minds.
There is an essay on the causes of the pestilence, by an anonymous author, published at Edinburgh in 1759, in which this disease is said to be entirely the offspring of idleness, and he illustrates this by its being more apt to arise in besieged towns than any other situation; and he alledges that a false alarm of the plague will actually produce it by throwing people idle, as was the case, he affirms, when the plague was last at Messina.
There are always numbers who have been pressed into the service, to whom a sea life is new, and who are therefore prone to indolence, low spirits, and self-neglect. Men of this description are by far the most apt to fall into the scurvy; and next to the quality of the food, there is nothing contributes more to promote the scurvy than such a disposition. It is indeed both a cause and a symptom of this disease, and therefore idleness and skulking should be rigidly discouraged, unless the complaint is so far advanced as to render it cruel and even impossible to force men to take exercise.
The Conqueror, of 74 guns, one of our squadron in the last year of the war, was an instance of a ship in which only the prime seamen were attacked with the scurvy, and this is to be accounted for upon the same principle, for it proceeded from their having been exempted from the duty of pumping, in which the inferior classes of men were constantly employed, owing to the leaky state of the ship.
As low spirits and indolence have such an unfavourable effect upon health, it would be wise, as well as benevolent, to promote whatever produces jollity, contentment, and good humour, so far as is consistent with sobriety and regularity. There are certain rough sports which are now almost in disuse; and whoever would revive and encourage them, would perform a useful office to the service.
A sea life frequently demands violent temporary exertions, from the uncertainty of the weather, and other incidents; so that men are more exposed to extreme fatigue and sudden calls of duty in this than in any other situation of life. Nothing tends more to shorten life than excessive bodily labour and watching; and it is for this reason that seamen in general are short lived, and that their countenance and general appearance make them appear older than they really are by several years. This is remarkably the case when a seaman comes to be upwards of forty and it has been mentioned before, that a person not acquainted with this circumstance will make a mistake of ten years in guessing at the age of a seaman from his looks.
Fatigue being therefore frequently the means of bringing on disease and breaking the constitution, as much tenderness is due to men as is consistent with the necessary duties of service. This is a circumstance in which young officers are apt to forget themselves; and they should take care how they call all hands wantonly, and oblige men to make exertions beyond their strength, especially as this will be submitted to more readily by sailors than any other set of men, from the generous alacrity of their nature.
It would be well if it could be rendered convenient at all times, except in cases of danger or emergency, to put the men at three watches instead of watch and watch. By the former arrangement they have eight hours sleep and rest; by the latter only four hours are allowed, which is not sufficient for refreshment, nor is there time for them to get dry, in case they have been exposed to wet.
It would be a good rule to have as few men as possible out of bed in the night-time, unless where active service renders it necessary; for, if unoccupied, they lie about the decks, fall asleep, and catch cold. In such situations, might not all the topmen but one remain on the forecastle, where they might take exercise, which they could not do aloft? I am indebted for this remark to the Rev. Mr. Ramsay, who joins to a great knowledge of the sea service a warm and disinterested zeal for its prosperity, and has been so good in several other instances as to communicate to me the results of his experience and observation.
The good effects resulting from the indulgent treatment of men are, that it encourages them to enter into the service, and to do their duty with cheerfulness and resolution. There is something more daunting to the mind of man to see his companions suffering under oppression and languishing in disease, or perishing miserably from sores or sickness, than in the terrors of fire and sword, which, as we have seen, make the least part of the calamities of war. The good treatment of seamen, in so far as it regards their health, is by no means incompatible with strict discipline. Indeed strictness and even severity is necessary with seamen; for it is observed with regard to men who are used to arbitrary government, that they cannot bear indulgence and relaxation. But the steady enforcement of discipline and regularity is so far from being akin to cruelty, that it tends to prevent both sickness and the commission of crimes, consequently rendering the infliction of punishment less frequent and necessary. The chief excellence in the character of an officer seems to consist in uniting strict discipline with indulgence and humanity.
The subject of the preceding remarks has been the prevention of diseases and it has appeared that the means of this are not so much in the province of the medical profession as of those who are entrusted with the direction of the navy in a civil or military capacity; and that with regard to cure and recovery also, a great deal depends upon them, by their having it in their power to make a suitable provision of proper diet and cordials. The great importance of the subject will plead my excuse for again calling to mind, that such attentions are not only dictated by humanity, but would be the greatest wisdom in an œconomical and national light, considering how expensive it is to replace men and to support invalids, not to mention that it is upon the health and lives of men that every public exertion essentially depends, and upon which may depend not only the character of officers, but the national character in the day of battle.
It must be confessed, that though there is still room for improvement, the navy is now on a better footing with regard to the health and comfort of seamen than it appears to have been in former times. The victuals were in general in the late war of excellent quality; the civil branch has shewn in many instances a readiness to adopt the means and to furnish the articles that were recommended for the health of the men86; and most of the commanders whom I have the honour to know are humane, attentive, and intelligent.
To conclude; there is no situation of life in which there is room for more virtues, more conduct and address, than that of a sea officer. The men are thrown upon his humanity and attention in more views than one: they are subject to a more arbitrary exertion of power than the constitution of the date authorities in civil life, Englishmen giving up into his hands, from considerations of public expediency, that which they hold most dear, and of which they are most jealous, their LIBERTY. It is the character of seamen to be thoughtless and neglectful of their own interest and welfare, requiring to be tended like children; but from their bravery, utility, and other good qualities, they seem entitled to a degree of parental tenderness and attention from the state they protect and the officers they obey.
In order to exhibit a concise view of the most material observations contained in this part of the Work, a Memorial, delivered to the Board of Admiralty in October, 1781, is here subjoined.
Proposing Means for preventing the Sickness and Mortality prevailing among His Majesty’s Seamen in the West Indies.
I have for the two last years attended a squadron, consisting seldom of less than twenty ships of the line, in quality of physician to the fleet at Barbadoes and the Leeward Islands. I received, by the order of the Commander in Chief, a monthly return from the surgeon of each ship, setting forth the diseases, deaths, and other circumstances of the respective ships companies. I also superintended the hospital of the place where the fleet happened to lie when in port. These advantages have afforded me an intimate knowledge of the nature and causes of the sickness and mortality among the seamen, both on board of their ships and in hospitals.
It appears by my returns, that there died in the course of the twelve months preceding July last, on board of ships, seven hundred and fifteen seamen and marines, of whom only fifty-nine died in battle and of wounds. There died in the same time in hospitals eight hundred and sixty-two: so that out of twelve thousand one hundred and nine men, which is the sum total of the complement of twenty ships of the line, there have perished in one year one thousand five hundred and seventy-seven, that is nearly every seventh man.
There were also sent to England in the same year, three hundred and fifty men, disabled by lameness and chronic complaints, the greater part of whom will be for ever lost to the service.
The degree of sickness is very different at different times; but it appears by the returns, that, at a medium, there has been one man in fifteen on the sick list.
Having employed all the attention of which I was capable to find out the causes of this sickness and mortality, in order, if possible, to point out the means of prevention, I flatter myself with being able to assign the most general causes, and to propose some effectual remedies.
When it is considered that sickness is almost entirely confined to ships of two and three decks, and that some of these are as healthy as frigates and merchant ships, though in the same circumstances of service with others that are extremely sickly, we are led from hence to infer, that sickness is not in its own nature unavoidable, and we are encouraged to hope, that the attainment of general health is within the compass of human management.
I humbly and earnestly solicit attention to some of the most material observations and conclusions which have occurred in the course of a service, which, though short, has been extensive; and whatever is here proposed has this recommendation, that it is easily practicable, and is no addition to the public charges.
First, I hardly ever knew a ship’s company become sickly which was well regulated in point of cleanliness and dryness. It is the custom in some ships to divide the crew into squads or divisions under the inspection of respective officers, who make a weekly review of their persons and clothing, and are answerable for the cleanliness and regularity of their several allotments. This ought to be an indispensable duty in ships of two or three decks; and when it has been practised, and at the same time ventilation, cleanliness, and dryness below and between decks, have been attended to, I have never known seamen more unhealthy than other men. The neglect of such attentions is a never-failing cause of sickness.
I would, therefore, with all becoming deference, suggest, that such a regulation, instead of being left to the discretion of officers, should be made a part of the public instructions. From some commanders, who already practise these rules, the advantage of them comes to be known; and would not a public sanction not only render them general and permanent, but facilitate the duty of the officer, by making such a regulation appear a matter of legal necessity, instead of his own arbitrary act?
Secondly, Scurvy is one of the principal diseases with which seamen are afflicted, and this may be infallibly prevented, or cured, by vegetables and fruit, particularly oranges, lemons, or limes. These might be supplied by employing one or more small vessels to collect them at different islands, and such an expedient would prevent much sickness, and save many lives. I am well convinced that more men would be saved by such a purveyance of fruit and vegetables, than could be raised by double the expence and trouble employed on the imprest service; so that policy, as well as humanity, concur in recommending it. Every fifty oranges or lemons might be considered as a hand to the fleet, inasmuch as the health, and perhaps the life, of a man would thereby be saved.
Thirdly, The use of wine, in place of rum, has been found extremely conducive to health. In the course of my observation I have met with the most unquestionable proofs of the benefit that would arise from this substitution. It is a farther reason for such a change, that good rum is seldom or never supplied in the West Indies.
Fourthly, The necessaries provided for the sick by the present establishment are not at all adequate, especially on a distant station, where the supply is not regular, and the quantity at best is such as can contribute but little to their comfort and recovery. An ample provision might be made for the sick, without any additional expence, in the following manner:
It is a rule in the service, that though men are sick, their ordinary allowance of salt meat and other victuals is nevertheless served out, and is either used by the other seamen, who stand in no need of it, or is wasted. Now, if the pursers were instructed to provide themselves with certain species of necessaries, such as Madeira wine, sugar, rice, and dried fruits, to serve to the sick, in place of rum, and the common provisions of the ship, such a regulation would be productive of the very best effects, in recovering the health, and preserving the lives of those men who have the misfortune to be taken ill in a situation necessarily destitute of most of the comforts that can alleviate their sufferings. I cannot help here applauding a late regulation, by which melasses are substituted for part of the oatmeal; for the quantity of the latter heretofore legally allowed was so much greater than what was necessary, that one half of it has commonly been wasted.
It is to be observed, in general, with regard to the West Indies, that ships on service are to be considered, in a great measure, in the light of ships constantly at sea; for, excepting the island of Barbadoes, there is no other port in which fresh meat and vegetables can be procured in any quantity, and therefore sour krout, melasses, and such other articles of antiscorbutic diet as can be supplied on board, are absolutely necessary. Fleets could hardly exist here, were it not that a warm climate is naturally more unfavourable to the scurvy than a cold one.
Fifthly, Though the health of a ship’s company depends chiefly on diet, and that discipline and order which is the business of officers, yet much depends also on the medical art, particularly in the West Indies; and as surgeons frequently cannot do justice to the men without wronging themselves, in a country where the price of every thing is exorbitant, and medicines often unsound, Government would find its account in supplying gratuitously some of the most costly articles, particularly Peruvian bark in a fresh state, from time to time, from England.
Sixthly, It is now the general custom to send every sick person on shore to an hospital, where there is frequently worse air and worse accommodation than on board, from overcrowding the apartments. Contagious diseases, though not so common as in Europe, are here often mixed with those that are not so, whereby numbers are infected and carried off; and, besides this, the land air is infinitely more unwholesome in the West Indies than the air at sea or in a road. The scurvy is perhaps not at all contagious, nor is it very difficult of cure; but a number of cases of it terminate fatally from the flux or fever, caught either by contagion in hospitals, by the noxious influence of land vapours, or by intemperance. I beg leave, therefore, humbly to suggest, that as few sick as possible of any disease, but what is contagious, be sent to hospitals, and that some method be established for the supply of vegetables and other refreshments to the sick on board of their ships.
Seventhly, Crowding, filth, and the mixture of diseases, are the great causes of mortality in hospitals. There should be a space of five hundred cubic feet allowed for each man; and in general the sick had better remain on board than be crowded beyond that degree; or relief should be provided to the hospital by an hospital ship, which, for reasons already given, is preferable to any accommodation on shore; and such an institution would be more particularly proper for the reception of convalescent men.
I would beg leave, therefore, earnestly to recommend that cleanliness, the separation of diseases, and a competent space, be regularly enjoined and strictly enforced in hospitals; and in order to make this more practicable in the great scale of service now going on, I would farther propose that hospital ships be established for the reception of the sick or recovering. I know from extensive experience and close observation, that these circumstances are more essential than even medicine and diet.
These are a few remarks extracted from a series of observations, and derived from great opportunities of experience. Many other remarks would suggest themselves; but I purposely confine myself to what is highly important, and easily practicable, with little or no addition to the public expence. Some of the improvements recommended are indeed an immediate, and all of them will be an eventual, saving to the public.
The alterations that have been proposed are,
1st, The establishment of a certain method and discipline, in order to secure regularity and cleanliness among the men, and to render the ships clean and dry.
2dly, The supply of fruit and other vegetables for the cure of the scurvy.
3dly, The substitution of wine87 for rum.
4thly, The provision of an adequate quantity of necessaries for the sick.
5thly, The gratuitous supply of certain medicines.
6thly, The curing of certain diseases on board instead of sending them to hospitals; and,
Lastly, The preventing of filth, crowding, and the mixture of diseases in hospitals, by proper regulations, and by establishing hospital ships.
I beg leave again to call to mind, that 1518 deaths from disease, besides 350 invalids, in 12,109 men, in the course of one year, is an alarming waste of British seamen, being a number that would man three of His Majesty’s ships of the line; and what I advance is from a real conviction that a due attention to the above-mentioned propositions would save more than two thirds of the seamen that would otherwise die in that climate. It was to set this in a proper light that I requested leave to quit my duty during the absence of the greater part of the squadron in the hurricane months; and should any thing I propose meet with public approbation, and be carried into effect, I should esteem it a recompence far above any other gratification I can derive from the service.
London,
October 13, 1781.
To the Right Hon. the Lords Commissioners
of the Admiralty.
Next year the following Supplement to the preceding Memorial was sent to the Board of Admiralty:
Since my return to my duty on this station, additional experience has afforded me farther practical confirmation of the utility of the former proposals.
The great squadron employed on this station has, by the attention of the Commissioners of Victualling, and also of the Commander in Chief, been supplied with most of the articles recommended, in such quantities as to prove their efficacy; and indeed the small degree of mortality in comparison of former times, is a sufficient demonstration of this.
I beg leave to give an instance in the Formidable of the great and salutary effects of the proposed improvements. This ship left England, furnished not only with sour krout and melasses, in common with most others in the squadron, but what was peculiar to herself was, an entire supply of good wine in place of spirits; and an experiment has been made in this instance, under my own eye, to ascertain what degree of health it was possible to attain in a great ship in this climate. With the above advantages, together with good discipline and medical care, no man88 died of disease from December, 1781, to May, 1782, and only thirteen were sent to hospitals, whose complaints were small pox and ulcers. In the months of May and June last, when at Jamaica, there died of disease in this ship, three men, and seventeen were sent to the hospital, most of whom had contracted their sickness on board of French prizes.
In the rest of the fleet the health was in proportion to the wine and other refreshments, and the cleanliness, good order, and discipline observed.
In the squadron I attended the last five months, which seldom consisted, during the last three months of that time, of less than forty ships of the line, there have died of disease about 350 men, and about 1000 have been sent to hospitals; a degree of sickness and mortality which, though not greater than what frequently prevails in Europe, I am persuaded would have been still less, had the improvements proposed been complied with in a manner more extensive and complete, and had the general rules of discipline and cleanliness been kept up with due and equal strictness throughout the fleet.
This last article, which, being the most important, I have placed first in the preceding memorial, it is only in the power of supreme authority to enforce; and my additional experience and observation have so far confirmed me in the opinion of the utility of this, as well as the other articles, that I hope to be again pardoned for repeating my humble and earnest solicitations that these regulations may be farther extended and enforced.
Formidable,
At Port Royal, Jamaica,
July 16, 1782.
PART III.
It was mentioned in the Introduction to this work, that though my opportunities of experience were extensive, several obstacles had prevented me from making observations so accurately as could have been wished. These were chiefly the bad accommodation of the sick at some of the hospitals, and the shortness of our stay at any one place, which seldom exceeded six weeks or two months, and prevented me from completing such observations as I have happened to be engaged in. But having practised among great numbers, observations necessarily arose from the comparison of so many cases; and amidst the variety of situations connected with the emergencies and hardships of war, nature is seen in certain portions and under certain trials which are not met with in common life. I shall therefore describe the diseases such as they occurred, and shall add such remarks on practice as I could ascertain.
The following observations shall be confined chiefly to what I have called the sea epidemics, viz. Fevers, Fluxes, and the Scurvy.
Though it is impossible to refer every particular case of fever to a distinct class, on account of the mixed and anomalous symptoms that arise, yet there are certain distinguishing features which afford sufficient ground for dividing them into different kinds, and such a division will at least serve to facilitate description, and to afford room for laying down the outlines of practice.
The fevers which occurred most frequently on board of ships, and at naval hospitals belonging to the fleet in which I was employed, were the infectious ship fever, (which is the same with the jail and hospital fever) the bilious remitting fever, and the malignant yellow fever.
This does not occur so frequently in hot as in cold climates, both because it is the disease of ships newly fitted out, which they seldom are in the West Indies, and because there is something in the warmth of a climate which prevents the production of contagion, as has been formerly remarked. But as great fleets arrived from time to time in the West Indies from Europe, with numbers of men labouring under this fever, there were sufficient opportunities of making observations upon it.
It has been so well described by Sir John Pringle, Dr. Lind, and other writers, that it is unnecessary to enter into a minute detail of all its different appearances in its several stages; and I shall content myself with recounting some of the most distinguishing symptoms, and with marking the peculiarities that arose from the influence of the climate.
This fever is extremely various in its symptoms and in its degree of malignity and fatality. We are told in some of the histories of the jail distemper, that, upon its first attack, few escaped that were seized with it; but that afterwards it grew more mild; and it has been already observed, that the contagious poison of fever differs from that of small pox and other specific infections, by varying in its degrees of virulence.
There are, however, certain characteristic symptoms pretty constant in this fever in all its forms.
One of the most remarkable of these is a greater degree of muscular debility than what takes place in other fevers, and it deserves to be mentioned first, as being one of the most constant. It is also a tolerably true index of the degree of malignity, the danger being in proportion to this symptom. In the more advanced stages of the fever, a tremor of the hands, and of the tongue when put out, is a constant symptom, and seems to be connected with this weak state of the muscular fibres. I have seen, however, extreme debility without tremor in cases too of the greatest danger, and it was observable in these that there was little or no delirium.
Another striking character of this fever is the delirium of a particular kind which usually attends it. Sensation and reason are here in a state uncommonly depraved; and it is in this sort of fever oftener than any other that we find a total deprivation of them in the symptom called coma. The delirium is seldom of a wild, ungovernable kind, such as occurs in inflammatory continued fevers, in the violent paroxysms of intermitting and remitting fevers, or in inflammations of the brain. It is, however, connected with great suffering; and this consists in anguish rather than pain, shewing itself by outward tremor, agitation, and what is called the floccorum collectio; also by sighing, mumbling, and moaning, symptoms always indicating danger.
Delirium is a symptom, to the nature and appearances of which I have been particularly attentive, in consequence of a painful and diligent attendance upon some cases in which I was particularly interested from friendship and affection, and in which this was a remarkable symptom. It seems chiefly to consist in a false reference of our sensations, whether external or internal; and this is in no sort of fever more evident than in this. When any painful impression, for instance, is made by an external body, the patient, if in a state of delirium, does not refer it justly to the part affected; but the general agitation and incoherence of sentiments will be aggravated for the time. I have known a degree of heat applied to the extremities sufficient to blister them, yet the part did not shrink, though the raving and general uneasiness were increased. In like manner, with regard to internal sensations, when an irritation is excited to expel the urine or feces, the mind does not recognize it as such, but from a sense of uneasiness, probably mistaken for something else, an effort is made to relieve nature, which is done without a proper consciousness, and certain symptoms are produced which are well-known marks of danger in this fever. In watching those who have been under the influence of delirium, I have observed it increase when any particular want of nature urged, and this would continue for some time, the patient being incapable of procuring himself immediate relief on account of the false reference of sensation that has been mentioned; but he would become calm after voiding the urine or feces, or after receiving something to drink, according to the particular want that was present at the time. So great is the disorder in the common course of sensation in this fever, that a person ill of it has been even unconscious of inflammations of vital parts, which, in the natural state of the nerves, would have excited the most acute pain, and would have been distinctly referred to the part affected, but were not discovered nor suspected till inspection after death89. I remember one case in which there were found large erosions, and even holes in the intestines, without any preceding complaint that could have led to suspect such an appearance. It would appear that the motions excited in the brain and nerves in such cases, instead of producing the sensations naturally belonging to them, serve to excite disagreeable emotions of a different kind, in which delirium consists. It seems to be from the same depraved state of sensation, that when a phthisical person is seized with this sort of fever, his cough is for the time suspended. I have seen the same circumstance occur in a maniacal case. From a like cause it sometimes happens in dangerous cases of fever, that in the height of delirium the epiglottis loses its natural irritability, so that liquids in the act of swallowing are apt to get into the windpipe, so as to excite coughing and threaten suffocation, as I have observed in some cases that came under my care.
All these different forms of delirium are signs of a body extremely disordered in its functions, and forbode great danger.
The next symptom I shall mention as most characteristic of this sort of fever is, the spots known by the name of petechiæ and vibices, which, though far from being constant, are, perhaps, more peculiar to it than any other symptom. They occur only in the latter stages of the disease, and in cases of considerable danger. The common opinion concerning their cause is, that the blood is in such a dissolved state, that the red part of it is effused into the cellular membrane. The appearance in such bodies as I have inspected, seems to favour this opinion; for there was hardly any coagulation of the blood in the great vessels, and instead of those firm substances, called polypi, in the heart, there were only soft grumous bodies, which were so tender in their consistence, that, upon being handled, they, as it were, dissolved. Since the improved method of treating these fevers has been generally adopted, this symptom seldom occurs; for in most cases it may be called an artificial symptom, chiefly arising from close apartments and the heat of bed clothes.
It may be considered as a peculiarity of this fever, that it is more indefinite in its crisis than most others. In continued fevers of the inflammatory kind, there are frequent attempts at remission, there are certain periodical exacerbations, and there is generally a distinct crisis marked by a freedom of the secretions and turbid urine: but in the fever of which we are treating, though the patient is generally somewhat worse towards the evening and during the night, its course is more equable, and the transition from sickness to health is insensible and gradual, being seldom marked with any perceptible crisis.
The symptom next to be taken notice of, though a minute one, is very constant and characteristic in this sort of fever. It is a peculiar heat in the skin, communicated to the hand of another person. It is usual to grasp the wrist of the patient after feeling his pulse, in order to examine the state of the skin in point of heat and moisture; and in doing this a glow of heat is impressed on the palm of the hand, which lasts for some hours, if one should neglect so long to wash the hands. I have never met with this symptom in any of the sporadic fevers of England, though I am informed it sometimes occurs in these.
The fever we are treating of differs also from the sporadic nervous fever of England, and from most others of the continued kind, in being attended with a more copious secretion of bile, which, when thrown up, is generally green, or, as it is otherwise called, of a porraceous colour. This symptom takes place in all climates; but is more remarkable in a hot climate, as might be expected.
These are the chief characteristic symptoms of this fever. I shall next point out such modifications of it as occurred in the West Indies from the influence of climate.
In the first place, when this fever prevailed on board of any ship that arrived from a northern climate, it was soon after succeeded by, or, as it were, converted into, a dysentery; for those ships that arrived either from England or North America with the greatest stock of feverish infection, were the most subject to fluxes, after being two or three months in the West Indies. This was formerly made use of as an argument, to prove that the dysentery proceeds from the same cause with fever, taking a different determination, from circumstances of climate and constitution.
Secondly, It sometimes happens that men, under the influence of this infection, are more apt than others to be affected with symptoms peculiar to the climate upon their first arrival. A very striking instance of this has been mentioned in the case of men that were pressed into the Formidable at New York, some of whom had the common ship fever on the passage; others, upon our arrival at Barbadoes, were seized with the yellow fever, and were the only men in the fleet who had it at that time. There was another instance in the recruits brought from England by the Anson, who were seized with a fever on board of the Royal Oak; and in this fever the skin and eyes were yellow, though without any symptoms of malignancy90.
Thirdly, It happened in some ships91 that the infection was kept up for several months after arriving in the climate, from a neglect of cleanliness, or the want of an opportunity of removing those who were infected to an hospital. It did not in these take a dysenteric turn, as in most of the other ships, but differed from the ship fever of colder climates, as above described, in some particulars, which I shall here enumerate. All the symptoms were milder: it was more protracted, and less dangerous. In the beginning there was but little difference, only the symptoms were less violent; but in the succeeding period of the disease the pulse deviated very little from the natural standard, and the skin felt cold and clammy. The tongue was white; and this did not seem so much owing to any fur covering it, as to its being itself of a pale, lifeless colour, as well as the face, and it appeared larger in size than natural. The teeth were clogged with a white fur. Those affected with this fever were subject to faintings, and had a constant uncomfortable languor and listlessness. Most of them had a deep-seated pain in the occiput, and an oppression at the stomach, but without any inclination to vomit. The unfavourable symptoms were coma, delirium and a yellowness of the skin. I never remember to have seen petechiæ in any of them. The favourable symptoms were a warm moisture, or a miliary eruption on the skin, and a gentle diarrhœa, which, however, if neglected, was in danger of degenerating into an incurable flux. A great number were seized with this fever in the Alcide, in July, 1783, and what is remarkable, most of them had the tape worm, as I was informed by Mr. Telford, the surgeon of that ship, who frequently obliged me with valuable remarks; and he observed also, that it was evidently infectious, and that the skin communicated the same disagreeable feeling to the hand as was mentioned above.
Though the inflammatory fever does not often occur in hot climates, yet, as it is of great consequence to distinguish it in all cases from the infectious fever of which we are treating, it may not be improper, nor uninstructive, here to point out the most remarkable differences. There is more resemblance in their symptoms, especially towards the beginning, than might at first be supposed; and as it is very material to avoid error with regard to the practice, which, in these two sorts of fevers, ought to be very different, and even opposite, I have taken particular pains to discriminate them.
The continued inflammatory fever is very uncommon in the West Indies; but in the form in which I have met with it in North America and England, there are cases in which the blood is sizy during the whole course of the disease, even without local affection, though, in general, there is more or less rheumatism, or pulmonic inflammation. The symptoms which chiefly distinguish such cases from the fever before described are, a greater degree of muscular strength, a more violent delirium, pale urine, a more parched tongue and skin, greater heat and thirst, and a pulse more frequent and strong, with a particular sharpness. There is another symptom sometimes occurring, which I consider as strongly characteristic of a fever of an inflammatory nature. This is a watery diarrhœa, without fæces and without gripes, the stools consisting chiefly of the drink as it was taken in. There seems here to be a suspension of the power of absorption as well as secretion in the bowels, in consequence of a general spasm on the extreme vessels; for there is hardly even bile or mucus in the stools. There is also a particular appearance of the mouth connected with this type of fever, which is better learned by the eye than by description. It consists chiefly in a want of moisture on the lips, and a dryness and shining appearance of the teeth. With these symptoms, it will be found that the patient will bear the lancet in very advanced stages of the disease. These fevers seldom occur but in a sporadic way, unless when there is some peculiarity of season, as at New York in autumn, 1782. They are also more frequent among the better than the lower sort of people.
By comparing these symptoms with those of the infectious fever above described, there will appear an obvious difference in their nature, and evident reasons for varying their treatment.
When the body is thrown into disorder by an attack of fever, the first step to be taken is to clear the stomach and bowels of their crude and acrid contents, consisting either of the food imperfectly digested, or the depraved natural secretions. So great is the disturbance produced by such offending matter, that, when nature is freed from this embarrassment, the functions of the body are frequently by this alone restored to their proper exercise, and a remission produced. It seems probable also, that this evacuation proves salutary not only by removing the morbid stimulus, but by preventing the absorption of corrupted or ill-concocted juices into the mass of blood, which would tend still farther to derange the functions of life. But perhaps the circumstance that first suggested the utility of evacuating the stomach, as the first step in the cure of fevers, was the nausea so common in the beginning of them, which may be considered as a natural indication of this practice. It farther appears rational, that, as acute diseases generally come on suddenly, and find the body in a state of repletion from the recent ingesta, the most obvious means of relief should be to free the bowels, and particularly the stomach, from what is foreign and oppressive to it. It seems also probable, that the nausea and the act of vomiting have a salutary effect independent of evacuation; for I have seen relief produced from these when nothing was evacuated. Such, indeed, is the great and universal influence and sympathy of the stomach, that the operation of vomiting affects every fibre of the body, and has been known to resolve tumours in the most distant parts. An early administration of an emetic is therefore the first step to be taken in the treatment of this as well as most other fevers.
If it is given in small divided doses, it will most probably evacuate the bowels downwards; and the most convenient form for this purpose is a solution of emetic tartar. If it should not have this effect, some brisk purgative medicine should be given soon after the operation of it.
I mention these evacuations before blood letting; for though this ought to be first in those cases in which it is proper, it is here seldom necessary, and we may pronounce it to be a remedy very ill adapted to this sort of fever, particularly in a hot climate. It sometimes happens, however, that there is violent head-ach, pain of the back and limbs, with a throbbing pulse; and these symptoms may in the very beginning not only justify, but require the losing some blood before the administration of the emetic or purgative.
The next means of relief I shall mention, and also the most probable means of cutting short the disease, is to excite universal sweat. This being an imitation of nature, is founded on reason as well as experience; for it is by sweating that the fit of an intermittent is relieved and terminated; and continued fevers in general, if not always, begin with a fit of the same kind. A dry skin, accompanied with heat, is one of the most constant as well as troublesome and uneasy symptoms in all fevers; and it would appear from the peculiar heat of the skin in this sort of fever, that there is either a more than common acrimony of the matter of perspiration, or something peculiar in the mode of circulation on the surface of the body. Sweating does not seem to operate entirely by the evacuation of acrimony, for no relief is procured by it if it is partial; and it is evident from a number of facts that the state of the brain and viscera depends on that of the external surface of the body; for a free state of the pores of the skin, provided it is general, tends more than any other circumstance to relieve internal pain, and also to take off delirium. The good effect of sweating seems, therefore, chiefly to depend on a general relaxed state of the small vessels on the surface of the body; and it ought to be effected, if possible, by gentle, soothing means, and not by such regimen and medicines as heat the body and accelerate the circulation. This intention is best answered in the beginning by moderate doses of antimonial medicines, and either James’s powder or tartar emetic may be employed. The first is a more certain sudorific, being less apt than the other to run off by the bowels; and its effect will be still more certain, if accompanied with a mild opiate, rendered diaphoretic by Spiritus Mindereri, which will both prevent the antimonial from acting roughly, and will determine its operation to the skin. A sweat kept up by these means, together with plentiful warm dilution, from twelve to twenty-four hours, is the most probable means of bringing about a complete remission of the fever; and in this case a fresh accession is to be prevented by the immediate administration of the bark.
These are the means proper for stopping the fever in the beginning, or tending to render its future progress more safe; and though, with this view, free evacuations have been recommended, yet, if the fever should go on, great caution is necessary in this respect in the future treatment, debility being the symptom chiefly to be guarded against. Purgatives may, indeed, be occasionally necessary, in consequence of accumulations of bile taking place; but, in general, the evacuations by stool should not be more frequent than in health; and some of the cases which were most unmanageable and fatal, were those in which there was a spontaneous diarrhœa. With regard to blood letting, it is always hurtful after the first two days, unless some inflammatory affection of a vital part should arise.
The natural evacuation, which may with most safety and advantage be solicited and encouraged in this disease, is, that by perspiration; and it is observable, that in those cases for which nature does most, there is a universal warm sweat, which has generally a very offensive smell, and seems to be a salutary effort of the constitution to cure the disease. Where this takes place, little medical assistance is necessary, except to keep it up chiefly by warm dilution; and there is no circumstance in which the judgement of a physician is shewn more than in discerning those cases in which his chief business is to look on, where nature, being equal to the task, ought not to be disturbed by the active and officious interposition of art. We should not, however, aim at producing a profuse sweat, except with a view to effect a remission immediately after the first evacuations. In the course of the disease, it is only necessary to keep up a gentle moisture or softness of the skin.
The head being particularly affected in this sort of fever, the patient is extremely restless and delirious, especially at night; and there is a medicine which has a most pleasing effect in procuring both rest and perspiration. This is a combination of an opiate with an antimonial medicine, which was administered in the evening with great success; and the sudorific effect is rendered more certain by the addition of some saline neutral, especially Spiritus Mindereri92. I tried pure opiates in the early stage of this, fever, but found them not to answer; though in the low93 fevers of England, and in the advanced stages and convalescent state of this fever, they are extremely safe and useful. Pure laudanum is also given by Dr. Lind, at Haslar, with great success in the height of the disease; but in the West Indies there is a greater tendency to acrid excretions, and the effect of pure opium in causing a retention of these, seems to be the cause of its disagreeing in that climate in the first stage of this fever.
It may here be observed, that the addition of a little neutral salt alone will sometimes so qualify the operation of opium, as to prevent its bad effects, such as the increase of febrile heat and delirium, and the stupor and head-ach which, when given alone, it frequently induces the following day. I have generally employed nitre with this intention; but this does not seem so well adapted to this disease as some other neutral salts, as it tends too much to lower the powers of life.
But with a view to perspiration, the Spiritus Mindereri is the most effectual neutral medicine when conjoined with an opiate, and there is not, perhaps, a more safe and pleasing diaphoretic known than a combination of it with syrup of poppies94. There is some neutral salt in Dover’s powder, and this has more effect than could be expected from so small a quantity of an inert medicine; for I know from trials of my own, as well as those of others, that ipecacuanha and opium given together, in the proportions prescribed in that powder, will not have the same effect as when joined with the neutral salt. This is an instance of those useful combinations of medicines which can be discovered only by experience, but which every physician ought gladly to adopt in practice upon good testimony and fair trial, though he may not be able to account for their effects, nor to explain their mode of operation.
There is nothing more important than plentiful warm dilution; and the infusion of sauge, or any such light aromatic, is rather more proper than farinaceous decoctions, or any compositions in which there is wine or spirits. Success in this, as well as other diseases, depends on attention to nursing as much as upon medicine; for what would it avail here to administer medicines for promoting perspiration, unless they were assisted with fluids to allay thirst, to dilute the acrimony in the first passages and in the vessels, and to furnish the materials of free perspiration?
But however desirable it may be to procure sweat, this is not to be attempted by close rooms and bed clothes, nor by hot medicines, such as volatile salts, serpentary, spirituous tinctures, or aromatics. These, according to the testimony of Sydenham, tend to increase the heat and delirium, and to produce petechiæ, miliary eruptions, or local inflammations. In the intervals of the anodyne diaphoretic above described, Spiritus Mindereri and small doses of camphor, with proper dilution, may be safely employed to procure a soft skin.
The only other means I shall mention with this view is, the application of warm moisture to the surface of the body, which may be done by soaking the feet and hands in warm water, or by fomenting the feet and legs with stupes95. These operations have the effect of bringing on a general relaxation on the skin, thereby taking off febrile agitation and delirium, and inducing sleep. I sometimes, with seeming benefit, ordered cataplasms to be applied to the feet, merely of the emollient kind, without mustard or any other acrid substance, being intended to relax, and not to stimulate.
In the use of pediluvia and fomentations, there is a difference worth attending to between the practice in this fever, and that in the inflammatory fever before described, for they are as hurtful in the latter as they are beneficial in the former. I have observed, in general, that they have a bad effect in all cases where there is sizy blood, particularly where the breast is affected.
Delirium is one of the most constant and alarming symptoms in this disease, and the removing of it depends much upon the attendants as well as the physician. It has been said before, that it depended on a false apprehension of the impressions or natural sensations. When a person, for example, labours under delirium, and is affected with thirst, the minds is either so agitated with other objects, that this sensation is overlooked, or, instead of producing a craving for drink, it excites some other disagreeable emotion in consequence of the disordered state of sensorium. This last seems to be probable from the cessation of delirium, which will take place upon any natural want being satisfied; I have seen a temporary stop put to the patients raving by making him drink, or upon his discharging his urine or feces; for he is then unconscious of thirst and other natural wants, is therefore ignorant of the means of satisfying them; and when he does so, he fancies he is about something else which is the subject of his delirious thoughts. This observation leads to a material practical purpose; for it follows from it, that unremitting attention should be given to the patient’s feelings and all his possible wants, as those natural notices and instinctive cravings which occur in health are now wanting, in consequence of the depraved state of sensation.
Most of the remarks that have hitherto been made apply to the earlier stages of the disease. The principal remedies applicable in the more advanced stages are, blisters, Peruvian bark, opium, and wine.
I have found what Dr. Lind says concerning the efficacy of blisters confirmed by my own experience, especially in those fevers in which there was great delirium, coma, and head-ach; but I have not experience enough to say whether they were as useful in the beginning of the disease in the West Indies as he found them to be in England.
The men that were brought from the ships to the hospitals were affected with the disease in various stages; but as we had in general a very inaccurate history of the several cases, the method of treatment upon their first admission was pretty nearly the same in all; and it consisted, in the first place, in washing their face, hands, feet, and legs, with warm water and vinegar, from which they derived the greatest comfort, being commonly very dirty. There ought to be a 96warm bath at every naval hospital kept in constant readiness; for there are so few conveniences on board of a ship for preserving bodily cleanliness among the sick, that the surface of the body becomes loaded with filth, so that the operation of the warm bath could not fail to be highly comfortable and salutary as the first step to their cure when brought on shore. We had generally very indistinct information about the state of their bowels, as well as other circumstances, on account of their delirium; but it was at any rate useful, or at least safe, to give them a clyster. They were enjoined plentiful dilution; and if they were low, some wine and water was allowed. In the evening, the anodyne diaphoretic medicine was administered, and a blister applied to some part of the body. In consequence of this method, we seldom failed to find the patients better next morning; and it was tried in such numbers, that the efficacy of it was sufficiently ascertained. It happened in some cases, that these means were omitted, and a comparison of these with the others served to ascertain the true efficacy of the medicines; the stationary state of the symptoms, when the disease was thus left to itself, sufficiently proving the propriety of the treatment above described.