Читать книгу Observations on the Diseases of Seamen - Sir Gilbert Blane - Страница 4

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Having been appointed by Lord Rodney Physician to the Fleet under his command, in the beginning of the year 1780, I determined to avail myself, to the utmost of my abilities, of the advantages which this field of observation afforded. This I was led to do, in order to satisfy my own mind as a matter of duty, as well as to find out, if possible, the means of bettering the condition of a class of men, who are the bulwark of the state, but whose lot is hardship and disease, above that of all others.

A fleet, consisting seldom of less than twenty ships of the line of battle, and sometimes exceeding forty, which I attended in the different scenes of active service in that distant and unhealthy region, for more than three years, has afforded me opportunities of making observations upon a large scale.

My object has been prevention as much as cure; and as the former must more particularly depend on a knowledge of the external causes of disease, I have collected and arranged all the facts upon this subject that came within my reach, considering these as the only grounds from whence the remote causes of health and sickness could be deduced.

When I entered upon my employment, the Commander in Chief gave an order, that every surgeon in the fleet should send me a monthly return, stating the degree of prevalence of different diseases, the mortality, and whatever else related to the health of the respective ships. This was done with a view to enable me to regulate the reception of men into hospitals, so that each ship might have a due proportion of relief, according to the degree of sickness on board, taking care at the same time that the hospitals should not be overcrowded; and also to acquaint the Commander in Chief, from time to time, of the state of sickness, or the predominance of particular diseases, in order to recommend such articles of diet, or other means, as might tend to cure them, or to check their progress. These returns have served also in this work as a method of collecting a multitude of well-established facts, tending to ascertain the causes and course of disease.

While the fleet was in port, I also superintended and visited daily the hospitals, of which there is one at almost every island on the station; and having kept an account of the different kinds of disease that were admitted, and of their mortality, I have in this way likewise been furnished with a number of facts that may throw light on the history of human maladies.

Nevertheless, I do not boast of having made great discoveries; and every person of a correct judgement must be aware how difficult it is to ascertain truths, and to draw fair and solid inferences, on medical subjects. I have attempted little more than to amass, from my own observation, and by the assistance of the surgeons of the fleet, a number of well-established facts, and to arrange them in such a methodical manner, as to prove a groundwork for investigation; and I am persuaded that others, of more sagacity and enlarged knowledge than myself, may be able to deduce from them, observations that may have escaped me especially if these new, but imperfect, attempts should come to be compared with similar ones that may be made by other observers in other climates, and in other circumstances of service.

I met with several obstacles in instituting inquiries, purely medical, to the extent I could have wished. There is, in the first place, from the nature of the subject, a great difficulty attending all practical inquiries in medicine; for, in order to ascertain truth, in a manner that is satisfactory to a mind habituated to chaste investigation, there must be a series of patient and attentive observations upon a great number of cases, and the different trials must be varied, weighed, and compared, in order 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.