3 nNHMvnwn«»H8fflnnu»HH WWBSTCESfflSKJWSr | Jt-^1- 1*M ~<-|min..>i-(;ii - SCAkUli .V 1INH Hoot.'. AI KAN V. N y NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service A TREATISE CONTAINING A PLAN FOR THE INTERNAL ORGANIZATION AND GOVERNMENT OF MARINE HOSPITALS wjum Mwf«ar.i« 0tjummmtnmm IN THE UNITED STATES: TOGETHER WITH A SCHEME FOR AMENDING AND SYSTEMATIZING THE MEDICAL DEPARTMENT OF THE NAVY. BY WILLIAM P. C. BARTON, A. M. M.D. MEMBER OF THE AMERICAN PHILOSOPHICAL SOCD3TY, AND A SURGEON IN THE NAVY OF THE UNITED STATES. «____----Si quid novisti rectius istis, Tjv£'DlC■ \L, / ^"S Candidus imperti: si non, his utere mecum." Hor. Epist. vi. Ub.». // •"/: PHILADELPHIA: PRINTED FOR THE AUTHOR. SOLD BY EDWARD PARKER, NO. 178, MARKET-STREET, AND PHILIP H. NICKLIN, NO. 151, CHESNUT-STREET. 1814. DISTRICT OF PENNSYLVANIA, town: Be it remembered, That on the ninth day of February, in the thirty- eighth year of the independence of the United States of America, A. D 1814, William P. C. Barton, of the said district, hath deposited in this olhCe the Title of a Book, the right whereof he claims as author, in the word* following, to wit: "A Treatise containing a plan for the internal organization and govern- ment of Marine Hospitals in the United States: together with a scheme for amending and systematizing the medical department of the navy. By William P. C Barton, A. M. M D. Member of the American Phi- losophical Society, and a surgeon in the navy of the United States. " —— Si quid novisti rectius istis, Candidus imperti: si non, his utere mecum." Hor. Epist. vi. lib. i. In conformity to the act of the congress of the United States, intituled, " An act for the encouragement of learning, by securing the copies of Maps, Charts and Books, to the autliors and proprietors of such copies during the times therein mentioned."—And also to the act, entitled, " An act supple- mentary to an act, entitled, ' An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and propri- etors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching histo- ~:~~' *>rw1 «ther prints." D. CALDWELL, Clerk of the District of Pennsylvania. TO the FLAG-OFFICERS, CAPTAINS, AND SURGEONS, 7 IN THE NAVY OF THE UNITED STATES: A NAVY, rendered glorious by the brilliancy of its ! achievements, and which has added lustre to the \ nation—giving dignity and importance to its character abroad : A NAVY, to the seamen of which, by their prowess i and their victories—the skilful, the valorous, \ and the httherto unconquered, naval sons of Britain, are forced to yield the palm of supe- riority : A NAVY, thus eminently distinguished even in in- fancy—and which has conquered its way to pub- lick favour and estimation : THIS ATTEMPT TO PROMOTE ITS INTERESTS, IS MOST RESPECTFULLY DEDICATED BY THE AUTHOR. RECOMMENDATORY LETTERS. " Having perused Dr. W. P. C. Barton's < Treatise on the internal organization and government of Marine Hospitals in the United States/ I have found it to con- tain much useful information on the subject, and so far as I am competent to decide on the merits of such a production, I consider it eminently calculated for the purposes for which it is intended. John Syng Dorsey, m. d. Adjunct Professor of Surgery in the University of Pennsylvania) and one of the surgeons of the Pennsylvania Hospital. Philadelphia, Feb. 6, 1814. DEAR SIR, I have examined with the attention my time would admit, your " Treatise containing a plan for the inter- nal organization and government of Marine Hospitals, &c." which you had the goodness to transmit to me ; and I do but justice to my feelings, when I assure you, I have not met with any work better calculated, in my opinion, to subserve the interests of the community, in the benefit it is intended to produce, to one of the most respectable and important of its classes. Sincerely hoping your philanthropic views, may meet with the success they most assuredly deserve, I am, very truely, Your friend and servant, John Redman Coxe, m. d. Professor of Chemistry in the University of Pennsylvania Dr. W. P. C. Barton. Philadelphia, February 16, 1814. Vi RECOMMENDATORY LETTERS. " I have read the manuscript copy of a work which has been submitted to me, entitled < A Treatise con- taining a plan for the internal organization and govern- ment of Marine Hospitals in the United States, and a scheme for amending and systematizing the medical department of the navy;' and am entirely satisfied that there is no where to be found the same extent of infor- mation, on the subject of which it treats, in so narrow a compass. It will no doubt, if published, be a very acceptable present to the medical characters who are engaged in the publick service of the United States. N. Chapman, m. d. Professor of Materia Medica, in the University of Pennsylvania. Philadelphia, Feb. 15, 1814. " Having perused, although hastily, ' A Treatise containing a plan for the internal organization and government of Marine Hospitals in the United States, &c. &c.' by W. P. C. Barton, M. D. &c—From the fund of information on the subject it contains, I con- sider that its publication may prove eminently bene- ficial in directing and aiding the humane exertions of the practitioner employed in that department, and also in meliorating the situation, as well as preserving and restoring the health, of the useful class of men placed under his professional care. Thomas C. James, m. d. Professor of Midwifery in the University of Pennsylvania, and one of the physicians of the Pennsylvania Hospital Philadelphia, Feb. 14, 1814. "1 have read a Treatise written by Dr. W. P. C. Barton, on the internal organization and government RECOMMENDATORY LETTERS. VH of Marine Hospitals in the United States, &c. &c. This work is replete with information highly interest- ing, not only to the persons to whom it is particularly addressed, but to all others, who know and wish to alleviate the miseries of seamen. The author, by collecting and condensing into one view, the result of preceding experience in the organi- zation of marine hospitals in Europe, has rendered an essential service to his country. Joseph Hartshorne, m. d. One of the surgeons of the Pennsylvania Hospital Philadelphia, Feb. 13, 1814. " A Treatise on the internal organization and government of Marine Hospitals, &c. &c. by Wm. P. C. Barton, M. D. contains a fund of information on this subject, which, as far as I am competent to offer an opinion, is likely to prove acceptable to those interested in making the requisite provisions for a long neglected portion of the community, who have high claims on the generosity and gratitude of their coun- try. Thomas T. Hewson, Physician and Surgeon—One of the Surgeons of the Pennsylvania Aims-House. Philadelphia, Feb. 16, 1814. " I am of opinion, that Dr. W. P. C. Barton's work, entitled ' A Treatise containing a plan for the inter- nal organization and government of Marine Hospitals in the United States, and a scheme for amending and systematizing the medical department of the navy'— viii recommendatory letters. is calculated to be very useful in the medical depart- ment of the United States' naval service. Benjamin Smith Barton, m. d. Professor of the Theory and Practice of Medicine, and of Natural History and Botany, in the University of Penn- sylvania, and one of the Physicians of the Pennsylvania Hospital. Philadelphia, Feb. id, 1814. ,^ PREFACE. IS EARLY three years ago, a law was passed by congress, relative to the establishment of Marine Hospitals in the United States. When at Washing;- ton in July 1811, the secretary of the navy, Mr. Hamilton, requested me to throw together on paper such ideas as I entertained, respecting the proper and systematick mode of conducting institutions of this nature, as well as any such suggestions for the in- ternal organization of the household, as might seem to me consistent with economy and health. Mr. Hamil- ton informed me that he was required by an article of the marine hospital law, to prepare by the next meet- ing of congress, a report, on the police and domestick arrangements of such hospitals, which would exhibit a digested plan for the accomplishment of both; but that, conceiving the subject to be properly the province of medical men to treat of, and not being himself one, he felt incompetent to the just consideration of it,— and that therefore he was induced to apply to such as belonged to the faculty to assist him. The outlines of the plan proposed in the following pages, were accordingly thrown together, with such A X PREFACE. order and system as the limited time I had to devote to the subject, amidst the pressure of my professional duties on ship-board, permitted. The report containing them, which was chiefly writ- ten during a tempestuous passage from Norfolk to New-York, in the Hornet sloop of war, with the ever to be lamented captain Lawrence,* and under the disadvantages too of sea-sickness and acute mental affliction from the recent loss of a friend, a brother— was certainly less perfectly digested, and more care- lessly treated, than the importance of the subject de- manded. But imperfect as it necessarily was under such unpropitious circumstances, I thought it my duty to transmit it to the secretary by the specified time. This was therefore done. Subsequent and more ma- ture consideration of the subject, has enabled me to render the memorial more worthy of the attention of those persons, for whom it was first designed, at the instance of Mr. Hamilton, viz. the commissioners of the Marine Hospital Fund. With considerable addi- tions, and I hope also with some emendations not en- tirely unimportant—the original plan sent to the secre- tary is now presented in the form of a treatise, to the commissioners of the marine hospital fund, and the surgeons in the navy. * At the mention of the name of a man dear to every American, and whose patriotism and valour are deeply registered in our memories, I hope I shall be excused in giving way to an impulse of feeling, by declaring- that in sickness and in sorrow I found in this magnanimous hero, acorn- forter who administered the sweetest solace with even feminine tenderness 8uch w.ere the softer virtues of a man who was gigantick and valorous in war! preface. xi The second part of the work contains some miscel- laneous observations on the medical department of the navy. 1 have attempted to devise a more systema- tick plan for conducting it—and have ventured to pro- pose a scheme for checking the abuses which grow out of its present loose administration. The motives that induced me to notice this subject are these: Hav- ing entered the navy as a surgeon when very young, and having been ordered to one of the largest ships* in it, with a complement of 430 men, stationed in a warm and variable climate—I soon found myself not a little embarrassed by the perplexities that I daily met with in my practice on board. The unhealthiness of the climate, operating upon a variety of different constitutions in an entirely new crew; the change of diet and mode of life; the necessary and unavoidable exposure of boats' crews to the fervid rays of a verti- cal sun, as well as to the damp and heavy dews of night, and at all times to the insalubrious exhalations of marsh miasma—all combined to generate such perpetual sickness, that the frigate might almost have been called a hospital-ship—the average number on the daily sick-list, of fevers and fluxes, being about 40. In this situation, on board of a ship just refitted, com- missioned, and equipped, I found myself without half the comforts and necessaries for the sick that the hos- pital department should have been supplied with; yet this department had been reported as replenished with every requisite article for a cruise of two years, and • The frigate United States. Xll PREFACE, together with the medicine chest, had cost the govern- ment fifteen hundred dollars. There were neither beds for the sick, sheets, pillows, pillowcases, nor night- eaps—nor was there a sufficiency of wine, brandy, chocolate, or sugar; and that portion which the store- room contained of these articles, was neither pure nor jfit for sick men. The medicine chest was overloaded with the useful, and choked up with many useless and damaged articles. Such was the state of the medical de- partment of this ship! Upon a representation of it how- ever to her commander, Com. Decatur, he generously allowed me all the necessaries I stood in need of, and thus enabled me to administer those comforts to my patients, which they so much required. What would have been my situation, had the ship immediately pro- ceeded to sea, for a cruise of eight or ten months, upon my joining her, and before 1 had an opportunity of examining into the condition of the medicine and store chests.....which might have been the case, these having been reported as sufficiently furnished? What the consequence would have been must be obvious! The other ships were not better furnished than the one of which I am speaking—and I perpetually heard of complaints on this score. What was the cause of these abuses?—The want of a regular board of medical commissioners, whose pe- culiar province it should be, to order the proper pro- portions and quantities of medicine, comforts, and ne- cessaries, for the publick ships, and who should have PREFACE. .Xlii no interest, directly or indirectly, individually or col- lectively—in the furnishing of articles thus ordered. As I was at that time a perfect novice in the routine of ship duty, and having then but recently left the Pennsylvania Hospital, an institution in which order, system, and punctuality, render the practice of medi- cine a pleasure, I was overwhelmed with the difficul- ties I had to encounter in the performance of profes- sional duties, where every species of inconvenience • and disadvantage that can be imagined was opposed to the exertions of the surgeon. My feelings revolted from the idea of continuing in such a perplexing and distressing situation—-and I became disgusted with the unavailing toil attendant upon ship-practice. I communicated my sentiments on this subject unre- servedly to my lamented friend, the late captain Wm„ Henry Allen,* then first lieutenant of the ship. I ventured even at that early period of my naval service^ to condemn the flagrant irregularities and abuses, that I could not but believe existed to a ruinous extent. In my conversations with him I often declared, that if * This gallant officer and accomplished gentleman, died at Mill-Prison Hospital, Plymouth, (England) in the twenty-ninth year of his age, of a wound received in the action between his vessel, the Argus, and the British brig Pelican, of superiour force. In him were united the valour of the hero, the virtues of a philantrophist, and the polished mind and manners of a gentleman. He inherited from nature a person elegant and commanding, rendered still more engaging by a happy union of manliness with the graces. He was eminently remarkable for three things: his devotedness to his profession—the constancy and faithfulness of his attachments—and the sensibility and refinement of his mind. His urbanity, his disinterest- edness, conspicuous in every action ; his noble generosity, caused him to be beloved by many,—but by none more ardently than the friend who now offers this feeble, but heart-felt tribute to his memory. ♦ XIV PREFACE. such was always the deplorable condition of sick men on ship-board, I wished not longer to be their medical attendant; for my feelings were every moment in the day subjected to harassment and pain, from contem- plating afflictions I was unable to relieve, for the mere want of comforts so easily procured on shore. He encouraged me, however, to persevere, and at the same time that he lamented with me the want of a superin- tending medical board, he tendered an offer of his as- sistance in making any arrangements compatible with the internal economy of the ship, that I might deem calculated to meliorate the condition of the sick. I soon found that their situation was susceptible of much relief, even on ship-board—and I was not long con- cluding, that if proper steps were taken to furnish the ships with sick-necessaries of a proper kind, the prac- tice of medicine and surgery in the navy, could be rendered not only more beneficial to the sick, but less offensive to the humane feelings of the medical officer. I never lost sight of the opinion I had conceived, that the errours of the medical department of the navy might be easily corrected, and its abuses abolished. During the term of my sea-duty, I had many oppor- tunities of seeing other irregularities in this department, and the disastrous consequences attending them. These irregularities and abuses are those, the means of correcting and abolishing which, I have endea- voured to point out. If the propositions and sugges- tions exhibited in the few pages on these heads, that follow the treatise on marine hospitals, be thought PREFACE. XV i worthy of adoption: and if, when executed, they shall be found calculated to achieve the object they have in view—I shall esteem the five years I have devoted to the naval service, not passed in vain. Or if the exposition that I have made of the abuses in the medi- cal department shall elicit from an abler and more experienced hand, any more feasible or efficient plan for accomplishing the reform and system I have had in view—my labours will be amply remunerated. I have been long enough in the navy to have its interests much at heart, even if I did not believe (which I cer- tainly do) that its existence is vitally important to our national prosperity and honour. Whatever, therefore, my humble endeavours shall effect towards reforming and systematizing that department, without the effi- cient and able administration of which, the lives of thousands may be jeopardized or lost—whether this be by means that 1 have here proposed, or by inviting the attention of others to the subject—will afford me the liveliest gratification. The labour is arduous, but it is not the toil of Sisyphus: " Dimidium facti, qui ccepit habet." Prune-street, Philadelphia, February 1, 1814. I ADVERTISEMENT. Since the Author of the following pages commenc- ed the practice of medicine in this city, he has of course been much out of the way of learning the state of that department of the navy to which he belonged. Accident discovered to him a circumstance, which had no little agency in causing a publication of this work. An officer of the navy passedthrough this city two months ago, and in the course of some conversation relative to the medical department, stated some improvements about to be made in it, recently suggested by one or two sur- geons who had lately entered the service. To his sur- prise, and not a little to his mortification, the Author found his name in no way connected with a mention of these improvements, although they had absolutely been suggested by him better than three years ago, and some of them jive years back. The knowledge of this cir- cumstance determined him to assert his prior claim to the improvements hinted at. With this view he has published copies of his official letters to the secretary of the navy, and some of the captains of the service, with their original dates. If there be any credit due for the amendments allud- ed to, it is but just that he who suffered not a little in feelings and in fortune, by exposing the abuses which required them—should receive it. If there be none— why should his name be kept out of view P Sic vos nonvobis, &c. A. * index. Dedication, Recommendatory letters. Preface, Advertisement, Page. iii v ix xvii PART FIRST. SECTION I. Observations on the necessity for the establishment of na- val hospitals in the United States, .... SECTION II. Sketch of some of the marine hospitals of Europe, Royal hospital for seamen at Greenwich, The chest at Chatham, a charity for wounded seamen, Royal hospital at Haslar, near Portsmouth, Royal hospital at Plymouth, Chelsea hospital, ..... Emperor Napoleon's hospital at L'Orient, ------------------,----------Cherbourg, Forton-prison hospital, near Portsmouth, Royal hospital at Deal, .... ------------at Yarmouth, Isle of Wight, .------------at Paignton, Royal navy-yards, . ... SECTION III. General remarks on the establishment and administration of naval hospitals in the United States, SECTION IV. Of the proper situation and construction of navy hospitals, Of the offices and rooms appertaining to an hospital, SECTION V. Of the structure of wards, .... Of water-closets and tub-rooms, ... 8 9 16 17 18 19 21 22 ib. ib. ib. 23 ib. 23 27 29 31 xx index. Page. SECTION VI. Of the construction of bedsteads, and their arrangement in the wards, ........34 Regulations on these subjects, appertaining to the French military service,....." . • 35 SECTION VII. Of dress, bedding, Sec........38 Regulations on these points, in the French military hospitals, 39 SECTION VIII. Of the ablution and purification of the hospital bedding and apparel,.........43 Regulations respecting these processes, in the French mi- litary service,........44 SECTION IX. Of the ventilation of wards, . . . . . . 47 SECTION X. Of the method of warming hospitals, . . . . 52 Description of the American chimneyplace-stove, . 55 Plate of the same, and explanations, .... 60 SECTION XI. Of the diet,.........62 Sick-ration for a seaman in the French naval hospitals and ships, .........64 Mode of victualling the patients, See. in the Pennsylvania hospital,.........ib. Scheme of diet for the U. S. marine hospitals, . . 66 Regulations of the French military hospitals with regard to diet,..........68 SECTION XII. Of the introduction of patients into the hospital, . . 70 SECTION XIII. Of the officers of the hospital, 80 INDEX. XXI Page. SECTION XIV. Of the governour, . . . . i . . . 81 SECTION XV. Of the physician,........82 Form of a prescription-bill for U. S. naval hospitals, . 84 SECTION XVI. Of the surgeon, . •...... 85 SECTION XVII. Of the dispenser,........86 SECTION XVIII. Of the lieutenants,...... . 87 SECTION XIX. Of the physician's assistant, . . . . ■ ; • 88 SECTION XX. Of the surgeon's assistants, . . . • • 89 _ SECTION XXI. Of the assistant-dispenser, or hospital-mate, . . . 91 SECTION XXII. Of the duty of the agent, . . . • . . 92 SECTION XXIII. Of the chaplain,..... . . 94 SECTION XXIV. Of the steward, ........ 95 SECTION XXV. Of the deputy-steward, steward's clerk, and ward-master, 97 SECTION XXVI. Of the matron, . . ...-.".' 99 4 xxn index. Page. SECTION XXVII. Of the nurses and orderly-men,.....10° SECTION XXVIII. Of the guard,........101 SECTION XXIX. Rules and regulations for the government of the patients and pensioners, and the preservation of order and quiet- ness in the hospital, ......• 102 SECTION XXX. Miscellaneous rules and regulations respecting the internal police of the hospital, . . . • • . 107 SECTION XXXI. Mr. Latrobe's report on marine hospitals, . . . Ill SECTION XXXII. An account of the Pennsylvania hospital, . . . 121 SECTION XXXIII. Hints and propositions to the managers of that institution, for the better ventilation of the wards, and improving some of the internal arrangements, . . . . 131 PART SECOND. A scheme for amending and systematizing the medical de- partment of the navy,......135 SECTION I. Introduction,....... 137 SECTION II. Of the introduction of lemon-acid into the navy, . 145 Letter from Dr. Gray, of Haslar hospital, England, on the subject of the lemon-juice, &c. ... 151 INDEX. xxiii Page. Letter from capt. Porter, of the Essex frigate, on the le- mon-juice, ........ 156 Letter from commodore Rodgers, of the President frigate, on the lemon-juice, . . . . . . . 160 SECTION III. Of the mode of furnishing the medicine and store-chests, 162 Of the establishment of a board of medical commissioners, 165 Table of the necessary proportions of medicines, Sec. for a ship of the first rate,......168 ------of the proportions of bedding, lemon-juice, Sec. for ditto,.........169 ------ of the proportions of medicines, Sec. for a ship of the second rate, . . . . ■ . . - • 170 ■------of the proportions of bedding, lemon-juice, Sec. for ditto,.........171 ------of the necessary proportions of medicines, Sec. for a ship of the third rate, . . . . • . 172 ------of the proportions of bedding, lemon-juice, Sec. for ditto,.........173 .------ of the proportions of medicines, Sec. for a ship of the fourth rate,........174 ------of the proportions of bedding, lemon-juice, &c. for ditto,.........175 ______of the proportions of medicines, &c. for a ship of the fifth rate, ........176 ______of the proportions of bedding, lemon-juice, Sec. for ditto,.........177 ______of the proportions of medicines, Sec. for a ship of the sixth rate, . . ~ • • • ■ 178 ______of the proportions of bedding, lemon-juice, Sec. for ditto,.........1^9 ------of the proportions of medicines, Sec. for a sloop, 180 .______of the proportions of bedding, lemon-juice, Sec. for ditto,.........181 ------of the proportions of medicines, Sec. for a cutter, 182 .______of the proportions of bedding, lemon-juice, Sec. for ditto,.........183 XXI v INDEX. Page. SECTION IV. Of the mode of furnishing surgical instruments to Mir navy, 184 Of the number and kind of instruments necessary for a sur- 186 geon,.........f Of the number and kind of instruments, for a surgeon s- mate,....... .188 SECTION V. Of the mode of making expenditure returns of medicines, Sec...........189 Blank tables for these returns, . • • • • 192 SECTION VI. On the propriety of abolishing the surgeons' five-dollar per- quisite from the navy, . . - • • • 198 SECTION VII. Of the duties of a surgeon and a surgeon's-mate in the na- vy, on ship-board, . . . . • • • 201 Form of a blank printed sick-report, .... 202 Form of a semi-annual sick-return, .... 204 Detail of the duties and offices of a surgeon's-mate in the navy, ......... 206 SECTION VIII. Of the expediency of augmenting the pay of navy svirgeons and surgeon's-mates, ...... 208 Regulations for pay, Sec. of the medical officers in the Bri- tish navy, . . • • ■ • • • 210 SECTION IX. Of the propriety of establishing the rank of navy surgeons, 213 SECTION X. Of the expediency of altering the present ration, . 215 Rations of the French service for a workman, . . ib. .----- when on a cruize, . . . . . . 216 ------ of the sick at sea, . . . . . . 217 ------ of the artillerv,......ib, INDEX. XXV Page. Rations of prisoners of war,.....217 ------ of a galley-slave in prison, . . . . ib. ------ of a galley-slave, at work, . . . . 218 ------ of a galley-slave, without work, ... ib. ------ of galley-slaves, invalids, . . . . ib. ------- of a seaman in the British navy, . . . 219 Scheme of diet by Mr. Turnbull, a surgeon of the British navy,.........220 Ration of a seaman in the American navy, . . . 221 Scheme of diet for promoting and preserving the health and morals of seamen in the United States' naval service, by William P. C. Barton,......226 SECTION XI. On the ventilation and warming of ships, . . . 227 SECTION XII. On the the impropriety of frequently wet-scrubbing the decks in the winter season, ..... 229 Letter from Dr. Gray, one of the physicians of the royal hospital at Haslar, (England,) on some of the usages in the British navy,.......232 SECTION XIII. Of the impropriety of shipping men for the U. S. naval ser- vice, without a previous examination of them by a sur- geon or a surgeon's-mate,.....233 SECTION XIV. Miscellaneous observations on the internal arrangements of ships, and some necessary regulations in their govern- ment, .........237 Conclusion,........241 APPENDIX. List of surgeons in the navy of the United States, . 243 List of surgeons'-mates in the same, .244 A *# ERRATA. Page xiii, line 5 of the note, for "philantrophist" read philanthropist. Page xiv, line 4 from the top, for " harassment" read embarrassment. Page 8, line 12 from the bottom, for " conduction " read direction. 23, first litre after Section III. for " administra" read administration. 25, line 1, for "but" read and. 25, line 14 from the top, for " deposit" read deposite. 29, line 12 from the bottom, ditto. 35, line 14 from the top, ditto. 65, line 5 from the bottom, for " is " read are. same line, for " object" read objects. 103, line 7 from the bottom, for " enteries " read entries. 121, line 6 from the bottom, for " entitles" read entitle. 166, line 8 of the text from the bottom, for " hospital" read hospitals. 190, line 11 from the top, for " is" readiww. 219, in the note to the ration-bill, (of some few copies,) second line, insert one-half before the word "pint." PART FIRST. A PLAN FOR THE INTERNAL ORGANIZATION AND GOVERNMENT OF MARINE HOSPITALS IN THE UNITED STATES, « k>* A PLAN FOR THE INTERNAL ORGANIZATION AND ADMINISTRATION OF MARINE HOSPITALS, IN THE UNITED STATES. SECTION I. Observations on the necessity for the establishment of such Institutions in the United States. ON the 26ih of February, 1811, a law was pass- ed in Congress, for establishing Marine Hospitals in the United States. This law required, that the mo- ney accruing from the execution of an act for the relief of sick and disabled seamen, should be paid to the se- cretary of the navy, the secretary of the treasury, and the secretary of war, for the time being, who were by this law appointed a board of commissioners, to be styled " Commissioners of Navy Hospitals." This money, together with the sum of 50,000 dollars, ap- propriated by the same law, (of 26th Feb.) out of the unexpended balance of the marine hospital fund, was to be paid to these commissioners, and was to consti B A OBSERVATIONS ON tute a fund for navy hospitals. This fund was to be augmented also, by all the fines imposed on navy offi- cers, seamen, and marines, which were required to be paid to the commissioners of navy hospitals. The commissioners were moreover authorised and required by this law, to procure a suitable place, or places, proper for navy hospitals, and, if the necessary buildings could not be obtained with the site, they were empowered to have such erected, with a due re- gard to economy, giving preference to such plans, as with most convenience and least cost, would admit ot such subsequent additions as the funds would allow, and circumstances require. The commissioners were required also, at one of the establishments, to provide a permanent asylum for dis- abled and decrepit navy officers, seamen, and ma- rines. For the purpose of conducting these hospitals, the law authorised and required the secretary of the navy, to prepare the necessary rules and regulations for the government of the institutions contemplated, and to re- port the same to the succeeding session of Congress. It was likewise enacted, that when any navy offi- cer, seaman, or marine, was admitted into any one of these navy hopitals, the institution should be allowed one ration per day during his continuance therein, which was to be deducted from the account of the United States with such officer, seamau, or marine ; as also when any officer, seaman, or marine, entitled to a pen- sion, was admitted into any navy hospital, such pen- sion, during his continuance in the institution, was to be paid to the commissioners of navy hospitals, and deducted from the account of such pensioner. The objects of this law then were, to authorise the establishment of one or more marine hospitals, and to MARINE HOSPITALS. 3 provide a fund for the purpose of defraying the neces- sary expenses of their erection and subsequent opera- tion. The method by which the fund contemplated was to be raised, was undoubtedly calculated to achieve eve- ry purpose designed by the law. It was founded in e(luity, and embraced in its operation such sources as could not fail to produce an influx into the hospital re- venue, of very considerable amount. Though two years have elapsed since the passing of this law, the end it was intended to effect has never yet been accomplished. The talents of that able en- gineer, Mr. Latrobe, were employed by the secretary of the navy,* for the designing of an architectural plan of the buildings to be erected. This plan was admirably calculated for the erection of permanent and conveni- ent edifices, to which, from time to time, as exigencies might require, or the hospital fund admit, additions might be made, so that when the whole was completed, it would present one entire and perfect building. In this plan he had exceedingly well combined the requi- site economy, so far as compatible with the ultimate object of the law, with that simplicity, elegance, and convenience, which characterize all the works of this master architect. This plan met with the warmest ap- probation of the secretary of the navy, but was object- ed to by the other two commissioners, for those qualifi- cations which ought to have entitled it to their favoura- ble opinion, viz. its permanency and stability. The business therefore fell through, and the whole plan proved abortive. The time however, lias arrived, when we must view the establishment of extensive navy hospitals, as an * Mr. Hamilton, 4 OBSERVATIONS ON event by no means remote or improbable, but m fact as necessarily connected with the augmentation of the na- vy, and the preservation of the health and lives of the officers and seamen who compose it. An extensive and energetick naval establishment, cannot possibly be conducted without the institution of publick marine hospitals for sick and hurt officers, sea- men, and marines ; and asylums connected with them, for superannuated or decrepit pensioners of the service. We have no such institution.s at this time, in any part of the United States. The very inconsiderable esta- blishments in some of our sea-port towns, limited in extent, and unsystematically organized, deserve not the appellation of hospitals. In some of these there are medical officers, whose ability and experience would certainly enable them to superintend and govern very extensive establishments, if the appropriations by Congress for the building of such hospitals, were ade- quate to defray the expense of them. The spirit of exertion and enterprise then of these surgeons, would, if unrestrained by the necessity of such circumscribed expenditure in their operations, redound very much to the interest and welfare of the service. Every naval station in the United States, presents a noble site for the erection of marine hospitals. Those of St. Marys and Norfolk, on the southern coast; the central ones of Philadelphia and New-York ; and those of New-London, Newport, and Boston, on the northern coast, are peculiarly well adapted for hospital establishments. The liberality and munificence of a government cannot find more worthy objects of their favour, than that class of its citizens who voluntarily ex- pose their lives and fortunes to the most imminent perils and afflicting accidents—for the safeguard, the protec- tion, and defence, of the honour and prosperity of our MARINE HOSPITALS. 3 country. And when we view the present want of ex* sensive institutions for the care of sick sailors, we can- not but hope, that the imperious necessity for their establishment, will, before long, elicit the attention of Congress : particularly when we advert to the known impolicy of such deficiencies. They are impolitick, be- cause it is natural to suppose, that men will be deterred from entering a service, in which no sufficient pro- vision is made for alleviating the distresses it is liable to produce. ^ Nothing causes seamen to discover alacrity, promp- titude, and faithfulness, in the performance of their se- vere and arduous duties, or contributes more to recon- cile them to the comfortlessness, the hazardous chances and accidents, to which they are constantly liable in the service—than a certainty of being attended humane- ly and ably, by the superintendants of a medical de- partment replete with every comfort and convenience for the sick and afflicted. Every one who has had an opportunity of mixing with seamen on ship-board, must be aware of this fact. While, on the other hand, the neglects, irregularities, or inability, of the medical officers, never fail to create discontentment and dis- gust. In the petition to the lords commissioners of the admiralty, made by the delegates of the English fleet at Spithead, in the ever memorable mutiny that prevailed in his Rritannick majesty's navy in the year 1797^ when the command of the whole fleet was usurp- ed by the seamen, in consequence of what they deem- ed their grievances, one of the principal articles refer- red to the neglect of their sick on board the ships, and the embezzlement of such necessaries and comforts as were allotted by government to their use. This alarm- ing mutiny could not be quelled, until these grievances were absolutely relieved ; and it was deemed prudent 6 OBSERVATIONS ON and expedient to issue new orders and instructions from the office of sick and wounded seamen, respect- ing the medical department, the strict observance of which was required of the surgeons. Indeed, V have myself seen, among a number of sick seamen with whom I was left in charge at the navy yard of this place, where they were necessarily huddled into a mi- serable house, scarce large enough to accommodate the eighth part of their number—a spirit of impatience, and even of revolt, in those who were able to discover it, that was calculated to contrive the most serious injury for the service. So wretched was the hovel, and so destitute of every necessary comfort for sick persons, in the charge of which I was left with thirty patients, (although a surgeon had been between five and six years on this station) that every man who gathered suf- ficient strength, and was successful in getting an op- portunity to effect his escape, absconded immediately. The replies of these men, when I addressed them respecting the desertion of their comrades, were strong- ly expressive of their wearisomeness and impatience of such disgraceful accommodations; and their disgust and sense of grievance were uttered in terms, that convinced me the intention to desert was not confined to a few of them.* * In justice to the present secretary of the navy, I must observe, that at this period he had but recently come into office, and upon my representation of the sick-quarters as above detailed, and stating the necessity of some bet- ter accommodations, he immediately aceeded to my request, and wrote to commodore Murray on the subject. In mentioning thus publicly the dis graceful accommodations for the sick that appertained to this station, on Mr. Jones's accession to office, I am desirous that the blame or neglect should at- tach to the persons properly chargeable with them, and to exonerate such as were in no way connected with either. With this view I deem it proper to in sert the two following letters. Philadelphia, May 22d, 1813. Sir, The embarrassment under which I labour with respect to the accommoda- I MARINE HOSPITALS. 7 These circumstances sufficiently prove the expedi- ency of establishing proper and convenient hospitals, at every naval station of importance in the United States. Convinced as I am, that without them, our na- vy cannot prosper, I sincerely hope that Congress will tion of a number of sick now under my care at the navy yard, has induced me, with the concurrence and advice of commodore Murray, to address you on the subject. There are now in the very small building appropriated to the reception of sick, and which is calculated to accommodate witli convenience only about eight patients, twenty-four sick sailors, who will probably be unfit for duty for some weeks. They are very much crowded in this small building, and I much fear, that this circumstance, in such a warm season, may be productive of disease. My object in writing is to suggest the necessity of some tempo- rary arrangement, not only for the better accommodation of the men now sick, but for the reception of others who may become so. The plan of this arrangement, of course, is left to your decision; but I would mention, that probably a suitable house in the vicinity of the navy yard might be rented for a month or two, until some more permanent ac- commodations could be provided. Commodore Murray declines entering upon any measure of this nature with- out your instructions, and as I am at present exceedingly at a loss to accom- modate these patients as comfortably as their diseases require, I beg the fa- vour of your attention to the subject, when a leisure hour is at your disposal. I am, sir, most respectfully, your obedient servant, WILLIAM P. C. BARTON. The Hon. Wm. Jones, Esq. Sec'ry of the Navy, Washington. Navy Department, May 26,1813. Sir, I have received a letter from surgeon Barton, on the subject of the sick in the navy yard at Philadelphia. I wish you to examine into the situadon of the hospital with a view to the comfortable accommodation of the sick on that station; and if you deem it necessary, you will direct a convenient frame building to be erected on as reasonable terms as possible, in some con- venient part of the yard, as remote from the ship-yard as may be, and in the interim, if it appears to you necessary for the good of the present sick, you will rent some convenient building in the vicinity, until that in the yard shall be ready to receive them. Respectfully, your obedient servant, W. JONES. Alexander Murray, Esq. Commanding N. Officer, Philadelphia. A frame building was accordingly erected for an hospital. 8 OBSERVATIONS ON speedily devise some plan, for raising and augmenting a sufficient fund to defray the expenses of erecting and conducting grand naval hospitals, at the stations, at least, of St. Marys, Norfolk, Philadelphia, New- York, Newport or New-London, and Boston. With such an event in view, I have thrown together such rules and regulations for their organization and government, as will, I trust, facilitate the accomplish- ment of the end to be answered by such institutions. SECTION II. Sketch of some of the Marine Hospitals of Europe. As much difficulty occurs respecting the general economy of these establishments, and the proper and sufficient salaries to be allowed to the respective offi- cers belonging to them, I will, previously to entering into a consideration of the minutiae of arrangement, ex- hibit a brief sketch of the extent of some of the most important foreign naval hospitals, together with an enumeration of the officers appointed for the govern- ment and conduction of them, and the salaries apper- taining to their stations. A comparison then of the plan of any hospital or hospitals about to be erected in the United States, with the magnitude and internal police of transatlantic institutions of a similar nature, which have been long in effective operation, will tend to facilitate the design- ing of proper plans for the organization of those con- templated at home. As to a minute and accurate description of the architec- tural plans of these different European establishments, I am unable to afford it—my observations and inquiries MARINE HOSPITALS. 9 having extended no farther than to their internal orga-> nization—in fact, to essentials. It is the business of the engineer to furnish such arrangements in the plans for his buildings, as will be productive of the healthi- ness of the wards, their airiness, and their proper ex- posure to the influence of the winds, &c. I have ob- served one thing, however, in which they are all alike: The buildings generally compose one grand body and two wings, so constructed, as to leave an area of considerable extent between them—the open side fac- ing that quarter from which the milder winds generally blow. They are all placed on situations in the vicinity of rivers which have a ready communication with the sea. This is to the English hospitals an object of great importance, since the continual state of naval warfare the British are engaged in, renders these sick establishments the receptacles of many wounded men, who after actions are sent home to them by a water conveyance. The first great naval institution is the Royal Hospi- tal for Seamen, at Greenwich. This hospital is situat- ed about five miles from London-bridge, on the south- ern bank of the river Thames. It consists of four distinct piles of building. The first, called King Charles' Building, contains fifteen different wards, some larger and some smaller, but the whole calculat- ed to accommodate 332 persons. The second, or King William's Building, is divid- ed into eleven different wards, which are likewise of various dimensions, but which contain in the aggre- gate, 559 persons. The third, or Queen Anne's Build- ing, is divided into twenty-four wards, large and small, and accommodates 437 persons. The fourth, or Queen Mary's Building, contains thirteen wards of 10 OBSERVATIONS ON different dimensions, most of them very large, and ac- commodates 1120 persons. The number of beds then in King Charles' Build- ing is, ...••* 332 in King William's ditto, 559 in Queen Anne's ditto, 437 in Queen Mary's ditto, 1120 Total, 2448 All these wards are appropriately and separately named. In queen Mary's building there is a commodious chapel, and in different parts of the great fabric, apart- ments are provided of a convenient nature, for the go- vernour and principal officers; and wards are properly fitted up for pensioners and nurses. These, together with officers' families, inferiour officers, and servants resident within the walls, amount to above 3000 per- sons. The infirmary is a quadrangular brick building, di- vided into two principal parts ; one for patients under the care of the physician, and the other for such as require the attendance of the surgeon. Each part is two stories high, containing a double row of rooms, be- ing altogether in number 64, calculated to accommo- date 256 patients. Each room has a chimney-place, with an aperture near the ceiling for the purpose of ventilation, and will hold conveniently four patients. This building likewise contains a chapel, apartments for a physician, a surgeon, an apothecary, with their respective assistants; and for the matron. Contiguous to this building is another, containing hot and cold baths for the use of helpless pensioners. The school-room is contained in a spacious building MARINE HOSPITALS. 11 near the hospital, and is capable of holding 200 boys. It has a fine Tuscan colonade of great extent, which is intended for a shelter for the boys, and a play-place in bad weather. In the two stories above, are dormitories fitted up with hammocks for the boys to sleep in. The establishment of officers, pensioners, is as fol- lows : Salaries per ann. L. s. sterling. A master and governoui 'f 1000 A lieutenant governour, . 400 Four captains, . 272 each. Eight lieutenants, . . 136 10 each. A treasurer and receiver general, 200 A secretary, . 160 An auditor, . 100 Two chaplains, . 130 each. A physician, . 10 per da A steward, • « 160 A surgeon and two assistants, 203 10 his assistants^ , 50 each. A clerk of the checque, . 160 A surveyor, • 200 A clerk of the works, . 5 per da An apothecary and one assistant, 93 10 assistant, 40 Three matrons, • • 40 each. A school-master, . 150 An organist, • • 60 A butler, . 25 Inferiour Officers, 8[c. Governour's clerk, . . 70 Deputy treasurer, . ■* 100 IS OBSERVATIONS ON Salaries per ami. L. *. sterling- Two treasurer's clerks, , 50 each. Secretary's deputy, . 60 His clerk, . 50 Assistant to the clerk of the works, 90 Servant to surgeon, . 30 1st steward's clerk, . 70 2d and 3d ditto, . 50 4th ditto, . 50 Clerk to clerk of the checque, one of, 70 2d, 3d, 4th, ditto, . 50 each. Master brewer, . 60 Butler's mates, two, . 15 each. Messenger, . 30 Cook of the east kitchen, . 40 Cook's mates, two, , 15 each. Cook of the west kitchen, . 30 His mates, two, . 15 each. Scullery man, . 20 His mates, two, • 15 each. Porters, two, 9 15 each. Barber, , 12 The governour and treasurer are appointed by royal patent. The rest of the officers by the board of admi- ralty, except the surveyor, the two receivers of the hos- pitals' estates in the north, and the clerk of the works, who are appointed by the general court of commis- sioners ; the school-master and messenger, by the board of directors; and all the clerks by their respec- tive superiors. The number of pensioners maintained in the hospi- tal at this time amounts to 2460. Every boatswain is allowed 2s. 6d. every mate Is. 6d, and every private Is. per week, for pocket money. MARINE HOSPITALS. 13 They are allowed for two years, one suit of blue clothes, a hat, three pairs of blue yarn hose, three pairs of shoes, four shirts, and a great coat, if neces- sary. Their diet consists of one loaf of bread of 16 ounces, and two quarts of beer, every day ; one pound of mutton, on Sundays and Tuesdays ; one pound of beef, on Mondays, Thursdays, and Saturdays ; and pease-soup, cheese, and butter, on Wednesdays and Fridays. Such persons as desire to be admitted as pension ers, are obliged to make application to the admiralty of- fice ten days, or more, previous to the examination day, which is the first Thursday in every month, where they receive letters directed to the proper officer at the navy office, for certificates of their time of service in the na- vy. These certificates are to be sent to the admiralty before the day of examination. The surgeon of the hospital attends the examination of the board, and such candidates as are deemed proper objects for pension- ers, are recorded as such, and are to be sent to the hospital as the vacancies occur. The out-pensioners, amounting at this time to up- wards of 3,200, receive yearly allowances of *7l. 10/. 141, and 18/. according to their length of service, or the peculiar nature of their cases. They are appointed in the manner of in door pensioners. After their appoint- ment, they are required to take their warrants to the treasurer's office in the hospital, where a ticket is de- livered to them, by which they are empowered to re- ceive their pension by quarterly payments, either there, or, if they live at a distance, from the collectors of the customs, or excise, in consequence of certificates signed and transmitted by the treasurer, and attested by the steward, or clerk of the checque. There are, besides these out-pensioners^ 14 OBSERVATION'S ON Sterling. Z pc »nn-each 10 captains, at .. . 80 15 commanders, at . . 65 50 lieutenants, at 50 who are also officers out-pensioners of this hospital. There are 149 nurses, who must all be widows of seamen, and under the age of 45 years at the time of admission. They are required to take out certificates of their husbands' service in the navy, in the same mode as pensioners, and produce certificates of their age and marriage to the board of admiralty, (on the day of examination,) by whom they are appointed. Their allowances are as follows : Wages each, 11/. per ann.: those who attend the sick are paid 16/. 4 s.: such as are employed to look after the helpless pen- sioners, 14/. 14 s. : and such as are in the service of the boys, 16/. 4 s. per ann. Provisions and bedding are furnished them the same as other pensioners, and a gray gown and petticoat yearly. When superannuat- ed, they are allowed 20 /. a year. The establishment of boys consists of 200. It is intended for the maintenance and education of sons of seamen, and is solely under the management of the di- rectors, who nominate, in rotation, the boys for admis- sion. Prior to this, however, it must be made to ap- pear by proper certificates, that they are sons of sea- men between ten and twelve years of age, objects of charity, of sound body and mind, and able to read. They are educated in reading, writing, and naviga- tion ; and after three years residence in the hospital, are bound out for seven years, to the sea-service only. For the better improvement of their talents, and that they may become able seamen and good artists, they once a year bring specimens of their performances be- fore the directors, when four of them are allowed MARINE HOSPITALS. 15 the following premiums, according to their respective merit, viz. For the best projected map or chart, a Had- ley's quadrant, . . • • 1st prize. For the best drawings after nature, the same,......2d prize. For the next best, a case of mathematical instruments, .... 3d prize. For the next best, Robertson's treatise on navigation,.....4th prize. Their clothing is a blue cloth jacket and breeches, and blue serge waistcoat, with leather breeches, to wear on week-days 5 checked shirts, and black velvet stocks, a small round hat, and blue worsted stockings. When bound out for sea-service, a boy is furnished with two suits of clothes, a hat, two pairs of shoes, three pairs of worsted stockings, three checked shirts, two black silk handkerchiefs, and a worsted night- cap ; a flock-bed and pillow, two blankets, a coverlet, and two checked pillow-biers ; and such religious and nautical books and instruments as are judged proper. Their diet consists of fourteen ounces of bread, two ounces of cheese, and a quart of small beer, a day ; with half a pound of mutton for dinner, on Sundays, Saturdays, and the same quantity of beef on Thurs- days ; rice-milk on Mondays; plumb-pudding on Wednesdays ; and pease-soup on Fridays ; with an ounce of butter on Mondays, Wednesdays, and Fri- days. Their meat is roasted on Sundays; and on this and the other meat days, potatoes are allowed them. All strangers who visit Greenwich hospital pay two- pence each, and this income, which is not inconsidera- ble, is appropriated to the fund for the mathematical 16 OBSERVATIONS ON school. For the better support of this magnificent hospital, every seaman in the royal navy, and in the merchant service, pays six-pence per month, stopped out of their pay, and delivered at the six-penny re- ceiver's office on Tower Hill. On this account, a sea- man who can produce an authentick certificate of his being disabled and unfit for service by defending any ship belonging to his majesty's British subjects, or in taking any ship from the enemy, may be admitted into this hospital, and receive the same benefit, as if he had been in his majesty's immediate service. Out of all that is given for showing the great hall, which is a most magnificent apartment, only three- pence in the shilling is allowed to the person who ex- hibits it. The rest makes a fund for the yearly main- tenance of not less than twenty boys, the sons of mari- ners either slain or disabled in the service of their country. The chest at Chatham, a charity instituted for the benefit of wounded seamen, was removed from thence to Greenwich. It is placed under the management of four superiors, viz. first lord of the admiralty—comp- troller of the navy—governour, and auditor of Green- wich hospital—a secretary—and five directors, viz. Salaries. L per ann Lieutenant governour of Greeenwich hos- pital, ...... 100 Two captains,.....80 each. Two lieutenants, .... 60 each. An accountant, a surgeon, and assistant, ditto, and clerks. The vacancies of directors are filled up by the superiors. The Royal Naval Asylum is removed from Pad- dington-Green to Greenwich, and a superb building is MARINE HOSPITALS. 17 now erecting in the Park for the accommodation of the objects of this charity, who are to be the children of such British sailors and mariners as have served in the roy- al navy. There are to be admitted 800 boys, and 200 girls. The boys between the years of five and twelve, and the girls between the years of five aud ten. The principal officers are as follow : Governour, Auditor, Surgeon, Steward, Matron, and clerks. The whole of this institution is in the patronage and under the direction of twenty-six governours, of whom his royal highness, the duke of Cumberland, is presi- dent. The royal hospital at Haslar, near Portsmouth, is si- tuated on the water's side, opposite Spithead, the great rendezvous of the British fleet; and about a mile and an half from the town of Portsmouth, and a quarter of a mile from Gosport. It consists of an immense pile of brick buildings, composing a grand front, and two wings of great ex- tent running at right-angles from the front, forming a very spacious area within. In the centre of this area is the chapel, a neat and appropriate building. There are numerous other buildings appertaining to this extensive establishment, within the walls, for the accommodation of the officers oe the hospital, for store-rooms, &c. &c. There is a water-carriage, by means of a small creek or canal, from Spithead-roads, up to the door of the receiving-room, for the easy and tranquil convey- ance of wounded and sick seamen. The different buildings are divided into a great number of wards, all large, airy, and convenient. Each ward contains sixteen patients, and there is a distance of five feet be- tween the beds. This institution is conducted by the following of- ficers : 18 OBSERVATIONS ON 500 each. 6 per day. 5 per day. 350 per ann. 350 300 300 A governour, Who must be a post-cap- tain, with a yearly salary of 80Q Two physicians, who must belong to the navy, with a salary, one of 766 10 The other, with a salary of Three surgeons, with One assistant-surgeon, Two hospital-mates, One steward, One agent, . . One dispenser, One chaplain Besides numberless inferiour officers and servants. This hospital is calculated to accommodate 1500 pa- tients ; but on an emergency, it will very well contain 2000. When there are a great many patients in the hospital, each physician is allowed one assistant for every hundred men he may have under his charge; and each surgeon, two assistants fo every hundred men. This hospital is one of the two grand depots for medical stores, utensils, comforts, &c. &c. furnished to the ships of war. The royal hospital at Plymouth, is likewise a spa- cious and stupendous collection of fine buildings. It consists of ten distinct piles of structure, in stone, all conveniently arranged, so as to admit the free passage of air into every ward in the hospital. It is delightfully situated about half way between the towns of Plymouth and Plymouth-dock, at a small town called Stone-house. It has, as well as Haslar hospital, a water-carriage from Plymouth-sound, so that the sick and hurt seamen can be safely landed at the door of the receiving-room, without any danger ac* cruing from motion. MARINE HOSPITALS, 19 Salaries as at Haslar. This establishment is pretty nearly similar in its in- ternal economy and arrangements, to that at Haslar. It is the second grand depot for medicines and medical stores, &c. for the English naval shipping. It is divided in a number of wards, containing each fourteen patients, and the beds so arranged, that there are five and a quarter feet of space between each bed. The wards are all well ventilated, and the hospital contains from 800 to 1200 patients. It is governed by the following officers : A governour, (post captain,) 3 lieutenants, 2 physicians and 2 assistants, 2 surgeons and 3 assistants, 1 dispenser, 1 agent, 1 steward, 1 chaplain, Together with other petty-officers, servants, &c. I ought not to omit to mention, that both these hos~ pitals are furnished with fine vapour, hot, and cold baths, for officers and men; and each with a commodi- ous room for performing operations in. Chelsea Hospital. There is a royal hospital at Chelsea, a fine village situated on the northern banks of the river Thames, a mile westward of Westminster, for the support of wounded and decrepit soldiers of the crown. It consists of a vast range of buildings, that form three large squares. The expenses of this establish- ment are defrayed by the poundage deducted from the army; deficiencies being made up by parliament. 20 OBSERVATIONS ON It is governed by the following officers-commission- ers, who are ten in number, viz. The president of the council. First lord of the treasury. Two secretaries of state. Paymaster general of land forces. Secretary at war. Two comptrollers of the army. The governour and lieutenant-governour. Military Officers. Salaries per ann. General—governour, . . L 500 General—lieutenant-governour, 400 Major,..... 250 Adjutant, .... 100 The treasurer is the paymaster-gene- ral for the time being, to the land- forces. His deputy, ... not known. His clerk, .... do. Two chaplains, . . . 100 each. Secretary and register, 1 Salaries not Two clerks, 3 known. Magistrate to attest the invalids 7 and out-pensioners, 5 Physician, .... 100 Surgeon, . . . 100 Two mates, Apothecary, Comptroller, v _ ? , Salaries not Steward, >» , ^ \ f known. 1 russ-maker, White wardrobe-keeper, Comptroller of the coal yard, MARINE HOSPITALS, 21 Organist, -% Clerk of the works, Master-lamp-lighter, Master-butler, £» Salaries not known. Master-cook, Second-cook, Under-cooks, two, &c. &c. The present number of pensioners of Chelsea hos- pital amounts to 503, who are all provided with clothes, diet, washing, lodging, firing, &c. and have one day's pay, in every week, for spending-money. There are at present 12,000 out-pensioners, who have each a yearly stipend of 12/. for the purpose of their support. The candidates for admission into Chelsea, are re- quired to bring certificates from their superior offi- cers, that they have been maimed or disabled in the service of the crown, or that they have served the crown twenty years ; which must be proved by an in- spection of the muster-rolls. Besides the sum paid annually out of the poundage of the army for the support of this hospital, one day's pay of every officer and private, is deducted each year, and appropriated to the funds of the hospital. This deduction brings in annually, in time of war, a reve- nue of 13 or 14,000/. sterling. The emperor Napoleon's marine hospital at the city of L'Orient, is one of his best naval establishments, though it is small. It is under the general superinten- dance of the military Prefect of the city, who is a kind of civil officer likewise. It is attended by one physician, three surgeons, and three assistant-surgeons. These all belong to the marine establishment, and are named, the surgeon, chi- 22 OBSERVATIONS ON rurgien-major; and the assistant-surgeons, seconds- chirurgiens. There are other assistants equivalent to hospital-mates. The assistant is termed aide-chirur- gien, and one always is attached to a marine hospital in France. The emperor's marine hospital at Cherbourg, is ex- actly a miniature imitation of the English hospitals at Plymouth and Haslar. Its officers are the same in number and name as those belonging to the naval hos- pital at L'Orient. There are other hospitals of smaller note in the Bri- tish naval establishments, than those already specified, which it may not be improper to notice briefly here, with a view to exhibit the number of medical and other officers thought necessary for their operation. Forton-prison hospital, is intended for the accom- modation of French prisoners of war. Its officers (medical) belong to the navy. This hospital is situat- ed near to the town of Portsmouth ; it has a surgeon, a dispenser, four hospital-mates, a clerk, a steward, and a matron. The royal naval hospital at Deal, has a governour (a lieutenant of navy) a physician, a surgeon, an agent, a dispenser, and a clerk. The salary of the governour is, L 375 per ann, of the physician, - 650 of the surgeon, - 550 of the agent, - 290 of the dispenser, - 290 of the clerk, - 156 The royal hospital at Yarmouth, in the Isle of Wight, has a governour (a lieutenant) a physician, a surgeon, and a dispenser. The salaries are the same as at Deal. This hospital, though small, is as well organized as any I had an opportunity of vi- MARINE .HOSPITALS. 23 siting. I was informed there, that when any number of sick was admitted into the hospital, an assistant- surgeon was ordered to attend likewise. At Paignton, there is a surgeon, who is agent—a dispenser, who is assistant-surgeon—an under-stew- ard, a chaplain, and a matron. In the royal navy-yards, a surgeon is stationed, who is likewise a physician. Those stationed at the royal yards of Depford, Woolwich, Chatham, Sheerness, Portsmouth, and Plymouth, as well as those in the yards at Jamaica, Halifax, and the East-Indies, have all an additional sum besides their pay, though not so much as the surgeons of hospitals. SECTION III. General remarks on the establishment and administra- of Naval Hospitals in the United States. In the establishment and organization of marine hospitals in the United States, two objects of impor- tance present themselves to our consideration. First, the accommodation of the sick to be received in them, with the necessary comforts and conveniences for their condition, and with the ablest professional attendance : and, secondly, the accomplishment of these ends, compatibly with the grand desideratum—economy. With a design to the realization of these objects, I have in the following pages, proposed such regulations as I deemed most likely to contribute to the end in view; and I have endeavoured to prove the necessity, that both a physician and a surgeon should be attach- ed to every naval hospital of any considerable com- pass. I cannot conceive, that the duty of a well regu- lated, judiciously organized, and extensive institution 24 OBSERVATIONS ON for the relief of sick and wounded seamen, can be ad- vantageously conducted without these two profession- al men at the heads of their respective department?. aided by a sufficient number of medical and chirurri- cal assistants. For the accomplishment of the second object, I have proposed such regulations in the departments of the dispenser and the agent, for furnishing not only the hospitals, but the United States vessels of war, with their necessary medicines, &c. &c. as will, I think, be productive of a great saving in the medical department of the navy, without incurring in the busi- ness of the agent and dispenser, a much greater ex- pense than will necessarily attend their operations for the hospital. It has been proposed by Turnbull, an English na- val surgeon of eminence, that lectures on anatomy, surgery, and clinical practice, should be read in the grand naval hospitals of Haslar and Plymouth, to a class of naval medical students, by the physicians and surgeons of these hospitals. As these persons are ge- nerally officers who have served for a considerable time in the naVy, he naturally concludes, that they are peculiarly well qualified to instruct those about to en- ter on the same career. He intended, by this plan, to render these hospitals schools of naval surgery ; and proposed that all candidates for situations in the medi- cal department of the navy, should have attended the practice and lectures of the hospitals, or one of them. at least two years previous to his receiving an ap- pointment in the navy. The object was, that young men should enter the medical sea-service, in which they sometimes hold very important and responsible si- tuations, not mere tyros in their business, but, on the contrary, well versed in what may be denominated MARINE HOSPITALS* 25 naval medicine and sea-surgery ; but intimately ac- quainted with the nature and treatment of those dis- eases which are incidental to a sea-faring life. The proposition of this able writer on naval medicine, ap- pears to me an extremely judicious one, and produc- tive, if executed, of all the ends, the accomplishment of which is contemplated. How far it may be ser- viceable in suggesting a hint for the arrangements in the medical department of our hospitals, I leave to the judgment of the naval commissioners to deter- mine. Marine hospitals in the United States, should, if they be of the extent contemplated in the following pages, contain the grand store-rooms for the deposit of all articles used in the medical department of the na- vy ; and in so far as any of these articles can be pre- pared or manufactured in the dispenser's or other de- partments of the hospital, it should be done. Thus will the business of the dispenser and the agent, not only be carried on with the greatest economy, for the uses of the hospital, but rendered subservient to other important purposes, and productive of a considerable saving to the government. The profits of the apothecary and the grocer, which are enormous on all articles vended by them in small or retailed quantities, will be saved, on all commodities, drugs, &c. consumed in the hospitals and publick ships. The general administration of marine hospitals should be of a military nature. The subordination among the higher officers, should be the same which appertains to the naval service ; and all misdemean- ors of any consequence which they may commit, should be cognizable before a court-martial, and the offenders punished as the court should decide. Slight offences and irregularities of these officers, might be 26 OBSERVATIONS ON brought under the cognizance of the officer highest m authority in the institution ; and the offending person subjected to such punishment or penalty as he might dei ii expedient to impose or exact. The salaries of the different officers should be as li- beral as is consistent with a due regard to economy. The medical officers, particularly, should be allowed such ample compensation, that they would have no inducement, nor be subjected to the necessity of re- sorting to private practice, in order to support them- selves or their families. All business extraneous to the duties of the hospital, tends to estrange the officer from a rigid attention to the benefit of the publick ser- vice. All the officers of the institution should be furnish- ed with houses or apartments within the limits of the hospital, sufficiently commodious for their residence. When the appointment of medical men to these insti- tutions is made, as in the British service, a reward for merit and long service at sea, an inducement will be held forth to professional men of talents and ability, to enter and continue in the service. The respectable footing on which surgeons and phy- sicians in the British navy are now placed, together with an adherence to the just principle of advance- ment to hospitals, according to merit and term of sea- duty, has induced many of the first medical men of England and Scotland to devote their time to the ser- vice of their country. MARINE HOSPITALS. 27 SECTION IV. Of the proper situation and construction of JS/avy Hospitals. In warm climates and in temperate latitudes, a dry and airy place, at a good distance from marshes or large and thick woods, and out of the reach of winds that blow over such places, should be chosen. If pos- sible, it should be on an elevation, protected from the inclement winds ; fronting the south or west, and hav- ing a good command of water. Much depends upon erecting hospitals in proper situations, as regards heal- thiness ; and the accounts of British naval writers are replete with instances of the fatal effects of establish- ing hospitals in damp or marshy situations. If conve- nient, there should be a water-carriage up to the re- ceiving door, (afterward to be mentioned) for the pur- pose of conveying patients without motion from ships to the hospital. This would set forth the propriety of erecting the hospitals in the neighbourhood of rivers, which communicate with the sea by a ready convey- ance, and whose borders are not judged unhealthy. This, however, is a consideration which must be in- fluenced by circumstances, of which the engineer em- ployed to draw the plans of the hospital, is the most proper judge. Back of the buildings there should be extensive and open courts. These should be appropriated to the rj of such of the patients to walk in, as are able to take exercise. Connected with these there should be a co- vered walk, which might be used in bad weather, or as a shelter from the fervid rays of the sun in sum- mer. These courts and walks should be furnished 28 OBSERVATIONS ON with benches. Kitchengardens should be connected with the hospitals, for the purpose of raising the vege- tables consumed in them, where the ground belonging to the establishments will admit of them. The privies should be as far removed from the hos- pital as convenient, and ought to be constructed with the greatest care, otherwise they will be apt to become nuisances. They seldom fail of proving so to hospi- tals, or camps, when they are not so contrived that their contents can be carried off by a drain, and the foul air arising from them be conveyed to such a height in the atmosphere, as to prevent the possibility of con- taminating the surrounding air. When the pit is very deep, the danger from this cause is less; and when a drain is formed for the purpose of carrying off the soil, the air in the vicinity of such privies is seldom so much infected, as when this contrivance is not attend- ed to, or is impracticable. When these conveniences can be erected over natural or artificial rivulets, of a pretty rapid current, and which communicate with, or enter into creeks or rivers by a channel uninterrupted or broken by rocks or other hindrances, the plan of constructing them so as to profit by these streams of water, is infinitely preferable to that of digging pits. When, however, circumstances render this last me- thod the only practicable one, and when the extent of the buildings requires many privies, as is the case in large hospitals, they should be connected together, but subdivided, with a separate access to each, and contrived so that the soil may fall into one drain or pit of extensive compass, which should be kept continual- ly full of water. At the top of this pit should be a co- vered drain, communicating with a stream of water. Hot lime should be thrown in as often as may be deem- ed necessary. This dissolves the soil sufficiently to ad- MARINE HOSPITALS. 29 mit its passing out through the drain at the top, as the water rises in the pit. From the top of the pit, a vent, or tunnel, should be carried to a considerable height above the roof of the privies, to carry off the foul air, and dissipate it in the atmosphere at such a distance above the surface of the ground, that it may not be offensive. The number of rooms or offices appertaining to an hospital, and necessary to its health and convenience, are as follow : Dry and large airy cellars. A bake-house. A kitchen, and scullery adjoining it. A larder; (two or more, if the hospital be extensive.) Three laundries : 1. A wash-house for washing foul-blankets, woollen-clothes, and the like ; 2. another for cleansing the foul linen and bandages of the hospital; and, 3. a drying-room heated by a stove, or flues underneath, from the cellar—and, adjoining and communicating with it, an ironing and mangling-room. A receiving-clothes-room, for depositing the clothes belonging to the patients. An hospital clothes-room, for the deposit of clean hospital apparel, bed-clothes, mattresses, pillows, &c. A receiving-room, in which the patients are to be examiued by the physician or surgeon, previous to their admission into the wards of the hospital. A dressing-room, adjoining it, in which the patients are cleaned and dressed before they enter the wards they may be assigned to. Warm, cold, and vapour baths, for patients; and distinct apartments containing the same for officers. Store-rooms for the hospital furniture, utensils, &c. »" OBSERVATIONS O.N not actually in use; and for the preservation of medicines, necessaries, &c. to be furnished to the ships of war. Wards for the sick, and water-closets adjoining tbem. A refectory. A laboratory. An apothecary's shop, or dispenser's apartment. An operation-room. A dissecting-room. A dead-house, for the laying out of the dead. This should be a small building separate, and at some distance from, the main building, into which the patients that may die should immediately be re- moved, from the wards. A chapel-room, for sacred worship. A council-room, for transacting the publick business of the hospital. Lodging-rooms for the governour, lieutenants, phy- sician, surgeon, and their assistants. Ditto, for the dispenser and his assistant, the stew- ard, and all the subordinate officers and servants belonging to the institution. Different arrangements may be made for lessening the number of these offices, when the hospital is small: and in such case, the operations appertaining to the different rooms, can best be accommodated one with another, when the exact extent of the hospital h known. The plans for the minute and particular structure of these offices, it is the province of the architect to de- vise. I will, however, make two general observations: first, that the economy of fuel, both by the use of steam and soup-digesters, should be consulted in the con- struction of trio kitchen : 2dly, that the larders should MARINE HOSPITALS. 31 be so planned, that they cannot become too moist, which would cause the provisions to spoil; and that the ravages of rats, mice, and vermin in them, may be prevented. For these purposes the floors should be covered with a thick coat of mortar. SECTION V. Of the structure of wards. As the sick wards of an hospital are the most im- portant parts of the building, we should profit by the best experience in constructing them. Their healthful- ness and convenience depend originally on three cir- cumstances, viz. their judicious position as respects exposure to sun, light, and air; their proper and effi- cient ventilation ; and their capableness of being heat- ed in the winter season, to an equable and unvarying temperature. With a view to the first object, the wards should be airy, and, if long, should contain two or three open chimney-places. The windows and doors should be close, and those on the north and east sides of the build- ing, protected from the inclement winds by an arcade,. or some other similar structure. There ought to be separate buildings containing wards for the venereal patients, and those afflicted Avith fluxes, infectious fevers, and the like. By means of these wards being detached from the main build- ing, and a separate set of nurses and attendants ap- pointed to wait on them, all danger from contamina- tion will effectually be prevented. The wards should be kept pure and clean, by a re- moval of all things calculated to vender them other- 32 OBSERVATIONS ON wise. Each one should have a water-closet adjoining it, and the patients should be compelled to make use of this, if they be able to leave their beds to go to it. Or there might be one water closet constructed on each floor of the building, to which the patients of that story should repair. Mr. Latrobe has proposed, iustead of water-closets, the construction of a small apartment on each floor of the hospital, which he has denominated a tub-room. The design of this room is, to contain a number of conve- nient vessels for the use of such patients as are able to walk from their wards; and also a large vessel or tub, into which the contents of the smaller ones, as well as those of the utensils used by patients who are not in a condition to repair to the tub-room, are to be emptied. This tub is then to be lowered by a rope at an early hour every morning, and late at night, or, if judged expedient, only at night, into a cart or wheel-barrow, and removed to the pit of a privy, or other proper place in the yard. If I mistake not, when I conversed with Mr. Latrobe on this subject, the reason he gave me for the substitution of these tub-rooms for water- closets, was, that the disagreeableness of the latter, arising from their unpleasant smell, would be obviated by this contrivance. Though, with the highest opi- nion of the ingenuity and skill of my old master, in matters of this nature, I should be very much dis- posed to accede to the feasibility of any scheme of his devising, even should it be in seeming opposition to my experience of its usefulness ; yet I cannot, in this case, subscribe to the plan of this very able architect; first, because I bear fresh in my memory, a fact related to me by the surgeon of the royal military barracks between Cowes and Newport, in the Isle of Wight. When I passed through his sick-quarters with him, I MARINE HOSPITALS. 33 found five cases of true typhus gravior, confined very ill, to their bunks. Upon my inquiring of him whe- ther that disease was prevalent among the troops then stationed there, he informed me that it was not; that on the contrary, they were generally healthy; that these men belonged to the highland-regiment, and were, from being long accustomed to the peculiar dress of that regiment, possessed of sound and robust con- stitutions ; and that he had reason to believe their dis- ease was induced by the infected air of the closet- room, which adjoined the apartment in which this mess of five men was quartered. This room was appropri- ated to a purpose similar to that of Mr. Latrobe's tub- rooms ; and the surgeon assured me it was generally kept clean. This one fact is sufficient of itself, to make me hesi- tate about conceding to the usefulness or healthfulness of the tub-rooms, as they are at present planned. But it does not stand alone. The mischief resulting from an exposure to the odour of faeces, or any other foetid or offensive matters, is well known to all persons in the habit of visiting wards of an hospital or sick rooms. In the second place, I would remark, that if proper care and attention be bestowed on the construction of water-closets, they may be kept perfectly pure and healthful, and entirely free from the offensiveness, which indeed is too frequently connected with them. In most of the larger inns of England, the water-clo- sets are made under the main roof. But they are so carefully constructed, that no person could tell that any such offices were in the building. I have lodged in a room adjoining one of these closets, and could perceive nothing whatever offensive proceeding from it. If Mr. Latrobe's plan be adopted, I think it ought to be improved in this way. Let the room or rooms be 34 OBSERVATIONS ON contained in a small building detached from the main edifice, and communicating with the entries of this, by means of a corridor. This building should have a tunnel from the apex of its roof, carried to a considera- ble distance above it. Tub-rooms, thus contrived, instead of being made in the main building and the vicinity of wards, would be not only useful, but could be employed under circumstances where the introduc- tion of water into the second and third stories of the hospital, for water-closets, would be difficult or im- practicable.* SECTION VI. Of the construction of the Bedsteads, and their ar- rangement in the Wards. The spaces allowed for the beds, very much depend upon the loftiness or lowness of the ceilings, and vary with the variations in the height of these. If they be moderately high, (that is, about ten or twelve feet) eight, or eight and an half feet square;—or, if more lof- ty, (say about fifteen feet,) eight feet by seven ought to be allowed for every bed. But let the height of the ceiling be ever so great beyond fifteen feet, the mi- nimum of space that can with safety be allotted to a single bed, is six feet square. This will allow of a small table or chair being placed between each bed, for the use of the patient, and will leave sufficient room for the passage of the physician or attendants at each side of the bed. If the beds be arranged on each side of a ward, with a passage between their foot-part, that is, through the middle of the room, this thorough- fare should not be less than twelve feet wide, and, if * During my residence in the Pennsylvania hospital, I had frequently oc- casion to regret the want of some such contrivance as this. Should this pas- sage meet the eye of any of the managers of that institution, I hope they will not deem the hint unworthy of their notice. MARINE HOSPITALS. 35 the size of the ward will admit it, it would be advisa- ble to leave it fifteen or eighteen feet iu width. The bed-steads, whatever their construction may be, should be elevated at a considerable distance above the floor, that is, as high as is compatible with the con- venience of the patient in getting in and out of bed. This arrangement contributes very much to the clean- liness of the wards, and, indeed, the beds themselves, and is at the same time more consistent with the free circulation of air throughout the apartments, than the plan of placing the bedsteads scarcely fifteen inches above the floor. The propriety of elevating them will be obvious, when we advert to the circumstance of the under part of the bedstead being the place of deposit, in violation of every regulation to the contrary, not on- ly of spitting-boxes, and pots-de-chambre, but also of dirty shoes and boots, foul clothing, &c. belonging to the patients. When the view underneath the bed- steads is clear, the nurses and orderly-men will have no excuse for permitting the patients to lumber the floor with these unseemly articles. The bedsteads should be six feet in length, and not less than three in width, nor more than four. They should be constructed with a foot-board about seven inches above the sacking-bottom, or cross-panes, and a head-board at least eighteen or twenty-four inches in height. In the French service* all these arrangements are established by edicts of the emperor, and it would be well for us to imitate the nice attention to economy and health with which they are devised, and the pre- cision and strictness with which the execution of them is enjoined. The following are the regulations respecting the di- mensions of bedsteads, and their arrangement in the 36 OBSERVATIONS ON wards, which appertain to the military hospitals oi France. For the bed of a single person, the bedstead must be of the following dimensions. metre, centimetres. Inward lenghth, - - - - 1 94 Breadth, . _ . - 0 97 Stanchions. Height of the head, - - - 1 W Height of the foot, ... 0 73 Thickness at the head and foot, 0 8 Breadth of each face or pane, - 0 23 Thickness of ditto, ditto, - - 0 23 The four panes are fixed in the stanchions by te- nons, mortices, and pegs. The pane of the head may be only half the breadth of the other two ; but it must be surmounted by a head- board of a plain plank, rising as far as the shelf, under which it ought to be so tight, that the head-board of the same thickness as the shelf, ought to form a pane joined with tongue and plough. Shelves. metre, millimetres. Breadth, o 175 Thickness, . . 0 12 Those shelves nailed on the stanchions of the head, have two edges of 54 millimetres, and are supported by two square pieces or brackets. The panes of the bedsteads are raised at 400 mil- limetres above the ground, and each lateral pane bears up a bracket of 27 millimetres, which is strongly nail- ed to receive six planks to form the bottom. The betlsteads are made with oak-wood, except the MARINE HOSPITALS. 37 bottom-boards, which are the only ones allowed to be sap-wood. In countries where the oak-wood is too dear, any other kind of wood may be employed, pro- vided it be hard. In every ward, the single beds must be two feet asunder ; the double beds two feet and an half apart. When the ceilings are less than ten feet in height, the double beds must not be less than three feet apart. At all times, each row of beds must be distant at least two metres ; and if circumstances should render it neces- sary to alter this arrangement, it should not continue otherwise longer than twenty-four hours. Whatever be the size of the wards, it is positively prohibited to establish a row of beds in the middle. No patient is to be put in a double bed, when the phy- sician has ordered a single bed for him. The permanent and temporary hospitals of the inte- riour, generally use complete furniture for the bed- stead, consisting of a straw-bed, a mattress, and a blanket. Bedsteads, or couches, are used in the permanent hospitals. Their number is not regulated by the size of the hospital, but the number of sick to be accommo- dated. In the temporary and permanent hospitals, each bed is furnished with three pairs of sheets ; and each pa- tient is allowed four shirts, four night-caps, two wool- len caps, a great-coat, and two blankets, for the win- ter. Each bed must have a small table at its head, for the convenience of the patient; also, a small moveable board, for putting his plate of food on. There must be two bathing-tubs in a permanent hos- pital, for every hundred of wounded or sick soldiers ; one, for every fifty of those infected with the itch; and 38 OBSERVATIONS ON one, for every twenty-five affected with the venereal disease. If they be made of wood, they must be paint- ed and varnished inside and outside. Each patient must be provided with a plate, a por- ringer, a middle-sized pitcher for his common drink, a larger one for his ptisan, and a pot-de-chambre. Those who require them, may likewise be furnished with a basin and a taper. The cloths which are used for spitting, must be changed every day. Such patients as are too ill to leave their beds, are to be supplied with close-stool-chairs, which are to be changed as often as necessary. They must always contain some clean water. The seat must be well cleaned after use, and now and then be rubbed with oil, to prevent it from absorbing the moisture, and thus becoming damp. Near to each ward there should be a fountain-tub or bucket, with a stop-cock, which must be filled eve- ry morning early with clean water. This arrange- ment is to enable the patients to wash their faces and hands as often as requisite. SECTION VII. Of Dress, Bedding, §V. The hospital should be abundantly stocked with shirts, trowsers, and jackets, of raven's duck, and sheets and pillowcases of cotton. There should likewise be a great number of caps ; all of these articles should have the words U. S. Naval Hospital, printed on them with large types and printers' ink, which very well stands frequent washing. Each patient should be furnished with a suit of hospital apparel and a cap, upon his entering the house 5 his own clothes, which MARINE HOSPITALS. 39 should be deposited in the clothes-room, as mention- ed under another head, are to be delivered to him up- on his leaving the hospital; and care should be taken that he does not purloin an\ hospital-clothes. I have seen seven hundred patients in an English hospital, all dressed alike, from the hospital-wardrobe. This plan contributes very much to the health, cleanliness, and comfort of the patients, and also to the neat ap- pearance of the establishment. The beds should be mattresses of hair, or good flock. They should be kept dry and clean; for the accomplishment of which purpose, they should be oc- casionally opened and examined, as mentioned in ano- ther place. The sheets, pillowcases, and coverlets, should all be marked in the same manner as the cloth- ing ; and great care should be taken by the nurses to keep them clean and dry. The table-linen, towels, &c. &c. should likewise be marked in the same manner. This plan will prevent thefts, or at least lead to the detection of any thing sto- len from the hospital. In the royal hospitals in England, all the articles just specified, have a stamp of what is properly styled,* " the king's cross," and vulgarly, " deviVs bit," put on them, in addition to the name of the hospital. Thi? plan effectually prohibits thefts ; for all persons in. whose possession any articles are found, bearing a stamp of the king's cross, if they are unable to give a- satisfactory account of the manner in which such things came into their possession, are liable to trans- portation, by a law to that effect. It would be well to have some particular mark of this nature, to identify, and prohibit the theft of, all U. S. hospital articles. The regulations in the French hospitals, respecting beds, bedding, and dress, are as follow ; 40 OBSERVATIONS ON The square measure of a straw-bed for a single per- son, ought to be 4 metres 75 centimetres, so that being filled up with 20 or 25 kilogrammes of straw, it may present the same dimensions both in length and breadth as the bedstead inwardly. The square measure of the mattress, for a single per- son, is 4 met. 52 centim. so that, when furnished with wool and hair, it may present the same dimensions as above. The bolster must be 9 deciin. 7 centim. in circumfer- ence, and as much in length ; its making up, as well as that of the mattress, is the same as for a bedstead for two persons. The weight of the bolster must be 2 kilo. 44 decagrammes, and the mattress 12 kilo. 23 deca. both together 30 pounds, including the linen-cloth. Blankets must be 2 m. 54 or 59 cen. in length, by I m. 78 e. in breadth. They should be made up with wool of a good qua- lity, long, evenly spun, without any mixture of thread, or defective matter, and especially that known by the name of avalies (wool taken from a sheep that has been killed). The contexture must be well twisted and tight, so as to suffer at the fullery but little shrinking. They must be furnished with a sufficient quantity of substantial wool, in short, conformable to the pattern agreed upon by the minister, and to which ought to be affixed the seal of the central directory of the hospitals. The mark of the provider is interwo- ven in the woof. They must be paid for by the weight, and weighed quite dry, without any ropes or pack-cloth—no more than five can be put on the scale. If the weight be under 3 kilogrammes for each blanket, they must be rejected. If over 3 kilo. 400 gram, they may be admit- u«l, but only paid at the rate of the last weight. MARINE HOSPITALS. 41 The breadth of the sheets for a single person must be about 1 m. 80 c. and it cannot be less than 1 m. 67 c. The length must be 2 m. 90 c. For beds for two persons, the bedstead, raised above the ground, 4decim. must be 1 m. 30 c. in breadth, by lm. 94c. in inwrard length. The dimensions above stated for the panes and shelves of the bedsteads for one person, vary according to the proportions. The square measure of the straw-bed for two per- sons, ought to be at least 5 m. 75 c. so that being filled up with 25 or 30 kilogr. of straw, it may have the same dimensions both in length and breadth as the bedstead inwardly. The square measure of the mattress for two persons, must be 5 m. 52 c. so that when furnished with wool and hair, it may have the same dimensions as the bed- stead. The mattress ought to be filled up with one half wool, and one half hair, or one third of the one and two thirds of the other, and weigh 14 kilogrammes 10 decagrammes. The bolster must be 1 metre 29 centimetres in length, by 9 decimetres 7 centimetres in circumfer- ence, filled up with wool and hair like the mattress, and weigh 2 kilogrammes 90 decagrammes, altoge- ther with the mattress, including the linen-cloth. The quality of the blankets is the same as for a bed for one person; they are received in the same man- ner ; the weight must be not less than 3£ kilogrammes, nor over 4 kilogrammes; they must be 2 metres 60 centimetres in length, by 2 metres 11 centimetres in breadth. The sheets for the beds for two persons, must be 2 metres 9 decimetres in length, by 2 metres 11 to 16 centimetres in breadth. 6 42 OBSERVATIONS ON When it is impossible to get blankets in sufficient quantity for the supply of hospitals, counterpanes made up for that purpose, may be used in their stead. During the winter, the use of counterpanes should be combined with that of blankets, so that a blanket is always used jointly with a counterpane. Shirts must be, in the back part from the neck, 3 feet 2 inches in length; in the fore-part, also from the neck. 2 feet 10 inches in length. Each part must be of the same breadth, which cannot be less than 78 or 89 centimetres. The opening of each side must be 14 inches high, measured on the fore-part. The sleeves must be 20 inches in length, not includ- ing the gusset, by 8 or 9 inches in breadth, without amadis (wrist-band,); the neck of the shirt must be 2h inches high, by 14 inches in length. Of the totality of the shirts, the 25th part must be quite open in the fore-part and sleeves, with the neces- sary number of strings to tie them; they are intended for the wounded. The night-caps must be knitted, 10 inches high, and 12 inches wide. The cauls* of night-caps must be cut round on the top, and, when folded, they must be 16 inches high, by one foot in breadth. The capot (cloak) made with common cloth or knit- ted stuff, must be 4 feet long, not including the collar, about 7 feet wide at the lower part, 4 feet at the mid- dle ; the collar 2 inches high, and 18 inches long. There must be in the hospitals, for itchy and vene- real patients, pantaloons of brown linen, to be changed every ten days. The surgeons' aprons must be white linen: those • Linen caps or hoods, which go over the night-caps. MARINE HOSPITALS. 43 of the apothecaries, dyed linen ; those of the overseers of the infirmary, unbleached linen; for evp,ry chief physician and surgeon, a frock of brown lineu. The dimensions of each apron must be 96 entime- tres long, without including the bib, 119 millimetres broad, and of one breadth; the bib, measured by the middle, must be made with the same linen, and 30 centimetres high, by 60 centimetres in breadth, at the bottom. Every apron must be furnished with a poc- ket or bag, made with the same linen, 25 centimetres high, by 40 centimetres broad, and also with two tape strings. The waistcoats and pantaloons of the overseers of the infirmary, must be, for summer, unbleached linen, strong and well woven; for winter, calmuck, or lin- sey-woolsey. The waistcoats must have an uniform collar, that the overseers of the infirmary may be the more easily known. Besides the effects before pointed out, the ware- houses ought to be sufficiently provided with all the utensils necessary for the use of the patients. SECTION VIII. Of the Ablution and Purification of the Hospital Bed- ding and Apparel. Though the operation of washing clothes is simple, and well known to the women who are employed in the laundries;, yet a deal of mischief often arises in an hospital, from a neglect to attend to this necessary pu- rification, as often as requisite. As the foul linen, &c. of an hospital is daily produced, the accumulation of it should be prevented, by having the laundries in con- 44 OBSERVATIONS OK tinual operation. Foul clothes should be sent imme- diately from the wards, to a place where they may be aired before they are washed. They should be per- fectly dried, and again aired, before they are returned into the clothes-room. It is not uncommon to neglect the washing of blankets, if not altogether, at least for a long time. This is an improper and a dangerous oversight. Whether they be made of wool or cotton, (such as are now furnished to the hospital department of our army,) they should be regularly washed and carefully dried. Bed-sacks, mattress-covers, and even sacking-bottoms, should also be washed occasionally; at least once or twice during the year. Foul bandages should not be kept one moment longer than necessary in the wards, after they are removed from ulcers, &c. They should be immediately sent to the laundry, and thrown into water to soak, previously to being washed. The process of mangling should be used for all the larger articles, such as sheets, pillowcases, and the like. Besides being less laborious than ironing, it is peculiarly well adapted for the smoothing of sheets, imparting to them a glazed softness very agreeable to the skin of a sick person. Ironing of course must be employed for the smaller articles, as shirts, night-caps, &c. The following are the regulations of the French mi- litary service, respecting the ablution of "Ihe effects of the hospital, and their rules for purification of arti- cles supposed to be infected. ^ The articles of the hospital mentioned below, un- dergo a purifying process, every spring an| fall. The great-coats and blankets are to be frequently beaten, brushed, and fumigated; and every six months they are to be washed. The woollens are not to be put into the fuller, except when it is necessary for MARINE HOSPITALS. 45 their purification, which is principally after sickness deemed contagious. The woollen-caps, jackets, and pantaloons, must be washed as often as they may require it, to be cleanly. The mattresses and pillows are to be beaten twice in the year, or oftener, if deemed proper. The wrap- pers, or sacks, must be washed before they are again used. When the straw of the straw-bed is broken or bruis- ed, it must be renewed; and when the physician, in concert with the commissary of war, thinks it necessa- ry, the bed-straw of a dead man must be renewed. The sheets, the shirts, and the caps, must be renew- ed every five days. But the physician may order them more frequently changed, if he thinks proper. The chief-overseer is to distribute to the overseers, the body and bed linen, destined for the sick, and is to see that the foul linen be punctually and correctly returned. He is accountable for them to the stew- ard. The foul linen is to be taken into the garrets and aired, till it can be washed. The washing is generally done out of the hospital, and is contracted for by the piece or dozen, by the steward. In case no contract is made, the inspector examines the accounts. When circumstances render it necessary to take in washerwomen and seamstresses to mend the linen, &c. they are to be paid by the day, at the common price, which is fixed by the inspector and the commissary of war; and they are to find themselves. The steward must deliver out the clothes to be wash- ed, as often as the renewal of them takes place. He is to have them returned clean into the hospital, as soon as possible afterward. 46 OBSERVATIONS ON The clothes and linen of the venereal patients, and ihose affected with cutaneous diseases, are to be wash- ed separately. The shirts which the sick persons bring with them into the hospital, are to be washed, so that they may have them clean to put on when they leave it. The clothes of men with contagious cutaneous dis- eases, are to be purified by fumigating them with sul- phur. The kettles, copper pans, and other utensils belong- ing to the hospital kitchen, and the apothecary-shop, must be cleaned every day ; and when they require it, should be coated over again with tin in the inside. The bathing-tubs must be washed and rinsed every day after they have been used by the patients. The pitchers, porringers, and other utensils belong- ing to the wards, must be washed and rinsed, morning and evening. Where a contagious disease has prevailed in the hospital for so long a time as to damage any of the ef- fects used by the patients, they must be burnt or puri- fied by airing them for a few days, or in any other pro- per manner. The blankets should be put into the fuller; the sacks of the straw-beds and mattresses into a strong ley. The wool should be washed, carded, and dried in the sun. The feathers of pillows, &c. should be beaten, and if they have any bad smell, must be ex- posed to the heat of an oven of about forty or fifty de- grees. The bedsteads must be taken to pieces, and well washed with a sponge soaked in a strong decoc- tion of tobacco or lime, and not set up again until they are dried in the sun. MARINE HOSPITALS. 47 SECTION IX. Of the Ventilation of Wards. As the health of the patients, the comfort of their at- tendants, and the uninterrupted ascent of the smoke in the chimnies of an hospital, depend so much on the proper mode of ventilating the wards and other apart- ments, this subject has claimed much of the attention of physicians and architects. Various are the plans that have been devised for maintaining a free circula- tion of fresh air through the rooms, so as to receive the benefit of such ventilation, without the inconvenience and even danger arising from the admission of cold or partial streams of air. to the patients and inhabitants. Ventilation may be effected by horizontal tubes carried along the ceilings of the several wards, galleries, lob- bies, or other apartments communicating at different places with the open air. When the fire-places are not in use, the lower part may be shut up, and an opening made into the flue, near the ceiling, as a ventilator. It has also been the practice to remove a pane of glass from the upper sash of one or more windows, and fill up the space with a tin ventilator. This plan admits of the passage of fresh air, but I apprehend not in suf- ficient quantities for wards containing many sick peo- ple. Mr. Whitehurst proposed the use of an air-duct, three or four feet long, to be fixed in any corner of a room remote from the fire-place, and communicating with the external air through the wall. The diameter of this duct he recommends to be five or six inches. The air admitted through this aperture, will ascend perpendicularly to the ceiling, and be gradually dif- fused through the room, with the air of which it will mix, and soon acquire its temperature. The inhabi- 4$ OBSERVATIONS ON tants of the room are not sensible of any coldness while this process is going on, for it will not even disturb the flame of a candle. He mentions particularly, the ne- cessity for perforating the wall for the air-duct, at a distance from the fire ; for if the current of fresh air be admitted in its vicinity, it will take the. nearest course to the chimney, and of consequence, though this will act well, the circulation through the room will be par- tial. The air in the parts of the room remote from the air-duct, would then remain quiescent, and of course would not be so fit for respiration. If there be two chimnies in the ward, and the doors and windows be air-tight, then such a duct becomes absolutely necessary ; and in such case the dimensions of the duct must be increased. The reason of this ne- cessity is obvious; for if a fire be made in one of the chimnies, this fire will burn well, and the ascent of the smoke will be rapid and complete, because this chim- ney takes in its draught the air which passes down the one out of use. But if it should now be necessary to make fire in the other also, the smoke will not ascend in this at all, since a current of air is constantly rushing down this chimney to supply the fire in the other. The same thing of course will happen reversely ; for if the fire be previously made in the second chimney, then the smoke will not rise in the first. If the plan of Mr. Whitehurst be adopted, I would propose that the air- duct be made to perforate the wall so as to form an an- gle with its perpendicular elevation, that is, in a direc- tion from the outside of the wall towards the ceiling; so that the air would be directed obliquely against it, and of course it would more effectually be prevented from inconveniencing the inhabitants, by making a cur- rent through the room. Or, what would perhaps be still better, let the current that passes through this air- MARINE HOSPITALS. 49 duct, be broken by an elbow in the duct, (as in a stove- pipe,) the arm of which should be pointed directly up- ward towards the ceiling. If this be done, the air will strike perpendicularly against the ceiling, which cannot happen in Mr. Whitehurst's plan. Another plan recommended by Mr. Whitehurst, and one which he says stood the test of experiment in many instances, is as follows : He left an open space between the up- per part of the architrave surrounding the door, and the wall, on each side of the door, and an open space also between the casing and the lintel. In this con- struction of the door-cases, the air descends between the architrave and the wall on the outside of the door, and ascends between the architrave and the wall on the inside of the room. The current of air thus ad- mitted from without, is forced up against the ceiling, and is dissipated through the room, without being felt by its inhabitants, as it gradually acquires, before it reaches them, the temperature of the surrounding air. Mr. Whitehurst says that this mode of ventilation af- forded a free exit for the smoke of candles; prevented the air of the room from becoming stagnant; rendered small apartments as pleasant and healthful as larger ones; and effectually prevented the smoke from de- scending the chimney of such small rooms, when the doors were shut. This able architect proposes, when it is not convenient to make an opening in the wall for the introduction of an air-duct, this mode of ventilation, viz. by " admitting air between the folding of the sash- frame, by means of cutting away about an eighth of au inch from the frame, leaving the whole substance at each style. This is only practicable," he continues, " when there are shutters on the outside, and not on the inside of the window. For by inside shutters the current of air upwards is obstructed; whence it rushes through H 50 OBSERVATION'S ON the crevices in various directions, and produces un- pleasant effects." Mr. Willan mentions that the wards of St. Thomas's Hospital, in London, were all f°rm^r- ly ventilated in a mode analogous to this, by Mr. Whitehurst, viz. in this manner: " In every second window, about an inch and an half of each frame, m the bottom of the upper sash, is cut away. A pane of glass nearly two feet in width, is set across the win- dow, resting upon the top of the upper sash, and fas- tened to it by hinges. The frame can be moved on the hinges, so as to make a greater or less angle with the window ; and by that means admit more or less air at pleasure. The air which enters between the sashes, being directed by the pane towards the ceiling, is dif- fused through the ward without any perceptible cur- rent." When I visited St. Thomas's Hospital, in the beginning of 1811, there were but two wards ventila- ted in this manner, and those up stairs. The general ventilation of the wards was kept up by the tin venti- lators in the window-sashes. Monro recommended a permanent plan for ven- tilating the wards of hospitals. He proposed that a hole should be cut in the ceiling of the ward, and communicating with the chimney of the upper ward, above the fire place, by means of a wooden tube, hav- ing its opening into the lower ward, furnished with a plug which can be removed at pleasure. The princi- ple of ventilation in this plan is, that the foul air is lighter than the pure, consequently will rise to the up- per part of the ceiling, and find its exit through the tube into the chimney above. This arrangement I have seen in St. George's Hospital in London. Some of the wards of that institution are furnished with these ven- tilators, and they are found to answer the purpose Very well. I think it would be a good plan to have a small MARINE HOSPITALS. 51 Venetian blind in the upper part of every door of a ward communicating with entries or galleries, through which there is a continual circulation of fresh air. This opening might be furnished with a shutter, by which it could be closed at pleasure. Some of the wards of the Pennsylvania Hospital are ventilated by means of an opening into the ftue of the chimnies, near the ceiling, about four inches square. The west end of the building, which consists princi- pally of cells for lunaticks, is remarkably well venti- lated. An opening is made from the upper part of each cell in the north and south walls, which commu- nicates with the chimney flue, and a free circula- tion of fresh air is kept up through the different stories, by means of two or three lattice-openings between the floor of one entry and the ceiling of the one below. This mode of ventilation is preserved in each story of the west building. It is principally owing to this structure, that the air of that portion of the hospital is constantly so pure, notwithstanding the many squalid and offensive tricks practised by the fatuous maniacs in their cells, and which, without this admirable venti- lation, would stifle every one who came within the sphere of its influence. There is but one objection that has been urged to this contrivance, and that is the ready communication of sound which it affords, from one story to another. This, however, is an objection of trivial import, compared to the indispensible advan- tage of a free circulation of fresh air in the apartments so continually liable to be offensive, from the habitation of the miserable beings who dwell in them. Upon the whole, I think that mode of ventilation might be adopt- ed in other than maniacal apartments, with advantage. In hospitals not intended for the reception of lunaticks, the inconvenience of affording a ready passage for 52 OBSERVATIONS ON noise and vociferation from one story to another, wouu not be felt. Such lattice-ventilations therefore, I would recommend for the lobbies or entries of the naval hos- pitals. Different fumigations have been recommended by the writers on this subject, for purifying the wards of hos- pitals- They are so various and so diverse, that I Shall not attempt even the enumeration of them, much less commence a discussion of their respective merits. I leave the choice of them to the discretion and judg- ment of the physician and surgeon who may be attach- ed to the hospitals, whose province it is to attend to such minutiae. The plan however most to be depend- ed on is, I think, that which prevents the introduction of foul and infected articles into the wards, and great care and attention in keeping them clean and well aired. SECTION X. Of the method of warming Hospitals. As there is no part of the internal economy of hospi- tals more important, so there is none which admits of more diversity of opinions respecting the best and most healthful mode of accomplishing its object, than the heating of wards during cold weather. While many contend that the use of stoves is pernicious, others de- clare that a large ward with high ceilings, cannot be heated to such an agreeable and constant temperature as the patients require, by means of open fire-places. I shall not pretend to enter into the merits of either of these modes. In fact, I believe them both capable, with proper regulations and precautions, of answering the same good purpose. If the economy of fuel be con- sulted, stoves are undoubtedly the best means of heat- ,\ MARINE HOSPITALS. 53 ing the rooms and galleries, or entries ; and if a proper ventilation is attended to, the injury resulting from the close and intense heat arising from hot iron, is prevent- ed. If the common ten-plate stoves be employed, they should be furnished with sand-baths. This contrivance prevents the use of the top of the stove for improper pur- poses, such as the putting of candlesticks, provisions, and other greasy articles upon it. The smell and va- pour arising from the melting of such things upon the stove, is exceedingly unpleasant, oppressive, and un- healthful; and I believe is more generally the cause of the injury resulting from the use of close-stoves, than the warm air produced by heated iron. Count Ruraford remarks, that "there is frequently an oppressiveness in the air of a room heated by a Ger- man stove, of which those who are not much accus- tomed to living in those rooms seldom fail to complain, and indeed with much reason; but this oppressiveness does not arise from the air of the room being injured by the respiration and perspiration of those who inhabit it; it arises from a very different cause,—from a fault in the construction of German stoves in general; but which may be easily and most completely remedied, as I shall show more fully in another place. In the meantime, I would just observe here, with regard to these stoves, that as they are often made of iron, and as this metal is a very good conductor of heat, some part of the stove in contact with the air of the room be- comes so hot as to calcine, or rather to roast, the dust which lights upon it; which never can fail to produce a very disagreeable effect upon the air of the room. And even when the stove is constructed of pantiles, or pottery-ware, if any part of it in contact with the air of the room is suffered to become very hot, which seldom fails to be the case in Germau stoves constructed on the 54 OBSERVATIONS ON common principles, nearly the same effects will be found to be produced on the air as when the stove is made of iron, as I have very frequently had occasion to observe." Where the expense of them can be met, the large Russian or soap-stone stoves, might perhaps be more useful than those of iron. There is one advantage that stoves possess over open fire-places, and that is, that they prevent the sudden chilliness of the room, when the fire is suffered to go out in them, that sue- ceeds the dying of a fire in the chimney-place. The temperature of the room is very gradually and imper- ceptibly diminished in the one case, while its reduc tion is sensibly and disagreeably sudden in the other. This inconvenience on the other hand, of the open fire- places, may be easily obviated, by keeping up a con- stant fire during the day and night. But here the con- sumption of fuel is a consideration of no little impor- tance. Mr. Robert Reid, an eminent architect of Edin- burgh, has proposed the warming of hospitals in the following manner: " A certain degree of heat," he says, " should be communicated throughout the build- ing, by means of flues running along the floors of the galleries. It has occurred to me," he continues,i( that this can be most effectually done, by constructing a flue to traverse the floors of the galleries, having a small tin pipe laid along the inside of it, and the pipe attach- ed to the boiler in the under part of the building. The hot steam in this pipe would soon warm the air in the flue, which would be easily admitted into the galleries, by means of registers, placed in different situations. This mode of warming the building, and having at the same time ventilators for fresh air in the ceilings, would keep up an almost constant change of air, and would MARINE HOSPITALS. 55 not be liable to the objections of heated air com- ing from flues through which the smoke passes. The smoke in this way, would be carried off, in a separate upright flue, immediately from the fire-place, under the boiler, and cleared out, without any interfe- rence with the flue in which the steam-pipe would be placed. A very small quantity only of fuel would be requisite, as the pipe, when once filled with steam, would retain its heat for a considerable length of time after the fire below the boiler had been extinguished." This is unquestionably a very ingenious plan, and consistent with the strictest economy. It is certainly worth a trial in some portion of one of the navy hos- pitals that may be erected. On this subject, however, it is necessary to say but little. It is more particularly the province of the ar- chitect who furnishes the plans for the buildings, to devise such arrangements, as shall in his estimation seem best calculated to economize expense and pro- mote comfort. It is not to be forgotten also, that the situation of an hospital, as respects its exposure to the sun; and its site, whether in the northern or southern states—must considerably influence and modify the va- rious methods that have been, or may be employed, for heating their apartments to an agreeable and unvary- ing temperature. Upon the whole, however, I cannot but think, that the method of warming hospitals by- stoves, is to be preferred. Of all their various struc- tures, I think that one which is eminently entitled to our preference, is the Pettibone-stove, improved by Moore and Herkness, now getting into general use in this city. Whether we take into view the inconsidera- ble consumption of fuel, the bland and vernal-like heat it produces, its safety, or its beauty, it is equally deserving our attention. The principle upon which 56 OBSERVATIONS ON this Chimney-place-stove is constructed, is this : the cold air from the cellar, or the outside of the wall, is introduced into an air-chamber, at the back part of the chimney, and passes into the room, through a number of sheet-iron pipes or tubes, so constructed, that they become hot enough, by the action of the fire below, to heat this cold air previously to its escaping from them. The precise manner of constructing this stove is as follows : When it is to be formed in a common fire-place, the chimney-piece is first to be taken down, and the elevation of the arch or front enlarged, so as to make its key, in perpendicular height from the hearth, about four feet six inches. The back and covings of the chimney-place are now broken away ; the first to the main or partition wall, and the latter as extensively on the left side as possible, and just far enough on the right side, to leave room for a narrow flue of about nine inches, to communicate with the main flue of the chimney, through which the smoke passes from the fire. This is on a supposition that the chimney flue is on the right side ; the arrangement must be re- versed, when the flue is on the left. A perforation is now made through the basement arch, into the cellar, of about 4 inches square, and at a distance of three.or four inches from the main wall. This aperture is left open. A wall of brick is now to be raised from the back part of the hearth, up to the throat of the chimney, at such distance from the main wall, as to leave the opening into the cellar between it and the main wall, and to form an air-cham- ber of about nine inches in depth, of the height of the brick wall, and the breadth between the enlarged co- vings. The throat of the chimney is next to be arch- ed over, leaving only the narrow flue on the right, be- MARINE HOSPITALS. 57 iore spoken of. The front is now filled up by fitting perpendicularly in, a soap-stone-slab, of about three inches in thickness, and as wide and deep as the open- ing may require. In this slab are six or eight perfora- tions, about three inches in diameter, and corresponding openings through the brick wall into the air-chamber behind. The communication between this chamber and the room is now completed, by means of six sheet- iron pipes, which pass from the brick wall to the soap- stone front, opposite to, or rather over, the correspond- ing openings of each. About twenty inches from the hearth another soap-stone slab is laid horizontally, close from the right side, and with an opening of about six inches on the left, for the passage out of the smoke from the furnace chamber formed below. Four or five subdivisions are made with brick, in the chamber enclosed between the upper arch, the lower soap-stone slab, and the covings of the fire-place. These walls are formed transversely, and the intention of them is to break the free and quick passage of the heat and smoke of the fire up the chimney. It now traverses up one opening and down another, until it passes over four or five, heating the iron pipes (and of consequence the cold air passing through them) in its passage over them, until it reaches the small flue on the right side of the chimney, which communicates with the main flue. At a few inches distance from the main flue, the small canal is furnished with a damper, which, by means of a handle perforating the wall above the chim- neypieee, can be made to close up the passage altoge- ther, or leave it open at pleasure. The use of this damper is to confine the heat contained in the different chambers of the stove, after the wood has been reduc- ed to a coal, when of course no smoke arises from it which requires a passage up the chimney. Then by i 58 OBSERVATIONS ON closing the door of the furnace-chamber, which is small, and at the lower part of the front slab, on the hearth, the heat is confined effectually for many hours, and the air continues to pass out of the pipes into the chamber, very hot. When it is judged expedient to bring the air from the outside of the wall, instead of the cellar, it is only requisite to perforate the wall externally, so that a cur- rent of cold air may gain free access to the air-cham- ber. An improvement has been made in this contrivance by Dr. Caldwell, by which all the heat produced in the stove, is effectually saved; and in-so-far as it as- sists in the grand object of economy in fuel, it is deserv- ing attention. It is evident, that from the heat strik- ing against the upper part of the stove, it must become very hot; the Dr. suggested, that three or more addi- tional perforations should be made through the marble or stone chimneypiece, above this arch. The air of the chamber, which passes into these apertures, will of course come'out considerably heated. This improve- ment is now incorporated with the original structure. This gentleman has also proposed the partial cover- ing of the aperture into the cellar, with an iron plate, so laid, that it may form the hearth or bottom of the furnace-chamber. By this contrivance, the air, in its first passage from the cellar to the air-chamber, strikes against the plate, which of consequence is heated by the fire of the furnace, and thus it becomes warm, even before it passes into the iron pipes. I have no doubt that this contrivance will be found to answer a very good purpose. The principal advantages of this stove are four: first, the consumption of fuel is lessened by three- fourths : secondly, as the soap-stone parts with its heat MARINE HOSPITALS. 59 slowly, the air of the room becomes gradually heated to an equable and unvarying temperature, and this too in all parts of it, those remote from the stove, as well as those in the immediate vicinity of it: thirdly, it ef- fectually prevents accidents from fire: and, fourthly, it is not necessary to replenish the fuel but twice dur- ing the day. These considerations sufficiently entitle this stove to the attention of those who are employed to erect hospitals of any description. Where the chimney - places are constructed purposely for them, the expense and trouble will be considerably lessened. As it is not very easy to get a clear idea of the in- ternal structure of this stove, I have annexed a plate of its ground-plan and elevation. It must be observ- ed, that the measurements here given, vary, necessari- ly, with the different dimensions of the chimnies in which they are to be constructed. As I have said that this stove was the Pettibone-stove, improved by Moore and Herkness,* it may not be improper to mention in what this improvement consists. The rarefying-air- stove, constructed by Mr. Pettibone, upon Dr. Frank- lin's principle, was modified in a variety of different structures ; but they were all separate from the fire- place. Moore and Herkness improved the plans of Mr. Pettibone, by constructing his stove within the area of the fire-place. This is an improvement of no little importance. It prevents the necessity of remov- ing the stoves in the summer season, to enjoy all the space in the room we can ; and is, besides, when pro- perly constructed in a marble chimney piece, quite or- namental. It occupies no part of the room, and of consequence does not contract the size of the apart- • Stone-cutters, next door to St James' church. 60* OBSERVATIONS ON Bient in which it may be erected. As this stove is Without a name, I have called it the American Chim- ney-place-stove. EXPLANATION OF THE PLATE. (A view of the stove and chimney-piece, when completed.) Fig. 1. A B C D. The marble front of the chimneypiece. Fig. 2. C E and D F. The upright marble pillars. abed. The open space of the fire-place filled up by the soap-stone slab. efg hiklm n o p q. Twelve circular holes, three inches in diameter, in the soap-stone-front, and which communicate with the air-chamber in the back of the Chimney, by the iron pipes. G. An iron or soap-stone door, 12 inches square, opening the furnace-chamber. r. A small circular door in the larger one. s t. The arch or slab covering the throat of the chimney, and forming the top of the stove, having a small opening on the right, communicating writh the flue of the chimney. u v. A wall of brick, raised perpendicular to the hearth, at right-angles with the front slab, and to with- in four inches of the top of the stove. At the bottom of this wall an opening is made into the furnace-cham- ber, to convey the soot into it. This is stopped up with a brick and mortar, and only removed when the chimney is to be swept. w xx. A soap-stone-slab carried to the back wall, and extending parallel with the line of the hearth, to within four inches of the left coving of the chimney; or it may be carried entirely across, if a hole be left in CMjamiey-Flaic e-Stove. W- y o 6 ^ *v o fef o JHV^' G 0 0 o o Srrwltt inters an}. ,/.-, tttVuim. viiS marhed if du. doUccl^r /in- if? A Fig.3. 4ir Chamber 9 inches w A a c , i / . > 4 t1 4 +fat ih-nt hX----------:--------- w H (I y; f cg32d 3 Fo » o B CT9 -S o a a. o en ft 3 r+ 1 en cr 2 o o* >X3 P*R" CO E» 3 n ta n 3 •O o 1 o O CD r* *e Pts. j Red i 5 Pts. | White Pts. j Porter. g | Lump CO g J* Muscovado o CO* f g 1 R^e. • 2 CD O CO en en -o.. 3 I S J Sago. g f Arrow-root. g | Cinnamon. Cloves. ft> O 5* Mace. CO p. £> Nutmeg. Cocoa. 3 9 Oranges. I •— 1 cr Honey. o N MARINE HOSPITALS. 85 SECTION XVI. Of the Surgeon. The surgeon of the hospital, should be a man skill- ed in the science and practice of surgery. A prefer- ence should likewise be given in a choice of this offi- cer, to one of the oldest surgeons of the navy, who may be distinguished for ability and energy. He should likewise reside within the bounds of the hos- pital, either in a separate building, or in apartments appropriated for his use. He should have under his charge, all the surgical patients of the hospital, and should perform all operations necessary to be done there. For this purpose there should be a commodious operation room, so contrived that the light may be abundantly and properly thrown on the operating ta- ble. He should visit his patients once a day, or of- tener as he may think necessary and proper, attended by his assistants, and the nurse of the ward he visits. His jurisdiction over his own department should be uncontrouled, and the steward, upon his requisition, should make such arrangements in it, as he shall spe- cify for the benefit of his patients. Any arrangements of magnitude however, the surgeon should report as necessary, to the governour, who should immediately order their execution. Both the physician and the surgeon should keep a book, in which should be recorded the names of their respective patients, the dates of their admission into the hospital, and the outlines of their treatment. The termination of their disease, should likewise be men- tioned, in cure, discharge or death, as may hap- pen. They should exact from the surgeon of any 86 OBSERVATIONS ON vessel, or in his absence, from the acting-surgeon or surgeons'-mate, sending a sick man or men to the hos- pital, a history of the disease, with which he or they may be afflicted, and an account of the treatment that has been pursued with them. These they should file or have recorded, in such a manner, that access may- be readily had to them. I think it would be a good plan, for the physician and surgeon, to make out abstracts from their books every three months, comprising the names of patients admitted during the quarter preceding, the dates of their entry, the names of their diseases, the vessels or places from whence they came, and the times of their discharge, cure, or death. These quarterly returns should be sent into the council-room on the first day of every quarter, for the inspection of the governour, who should transmit them to the secretary of the navy's office, there to continue as publick documents of the state of the hospital. SECTION XVII. Of the Dispenser. The Dispenser of the hospital should be a practical apothecary. He should have under his sole direction, the laboratory and apothecary-shop, or dispensary. He should prepare all medicines, tinctures, syrrups, cerates, ointments, &c. usually manufactured by the apothecary, and deposite them in the dispensary, for the use of the hospital and U. S. vessels. He should superintend the economy of the dispensary establish- ment, and be responsible for all the medicines, arti- cles, shop-furniture, and utensils appertaining to it. MARINE HOSPITALS. 87 He should inspect all medicines and medicinal articles purchased for the hospital, previous to their being re- ceived into his store-rooms, and should report their good or bad condition, and whether the charges for them are reasonable or exorbitant, to the agent. He should make out quarterly-returns of the expenditures of the dispensary, for the authenticity of which, the prescription-bills of the physician and surgeon, and the receipts of the agent for articles drawn for his de- partment, will be sufficient vouchers. SECTION XVIII. Of the Lieutenants. There ought to be two lieutenants attached to the hospital, who should be chosen from among the oldest on the naval list. The general outlines of their duty may be comprised in a few words. They should be assistants to the governour of the hospital, in the exe- cution of the various functions appertaining to his im- portant office. They should reside in apartments, fit- ted for their accommodation, in the hospital. They should transact all out-door business of a general na- ture, and should afford a willing and prompt acquies- cence in all orders and injunctions of the governour. They should keep such records of the household as the governour may deem necessary and proper. They should act as supervisors of the minuter regulations of the establishment, and should exert all their authority and care, to preserve the harmonious progression, and accurate operation, of all the different departments in the hospital; taking care, however, to make no impro- per interference with the professional departments, 88 OBSERVATIONS ON with the economy of which they cannot be supposed to have the requisite acquaintance. When on particular duty, they should be distinguished by the undress uni- form of a lieutenant in the navy. They should divide their duty by agreement between themselves. SECTION XIX. Of the Physician's Assistant. The assistant to the physician, who ought to have the commission of a surgeon's-mate, should be a young man possessed of considerable medical information^ and should have been some time in actual sea-service, either in the capacity of surgeon's-mate, or acting-sur- geon. His general duty, as his title imports, should be to assist the physician in the dischage of the func- tions attached to his office. He should attend the phy- sician in all his visits to the sick, and should prescribe for his patients in his absence, or upon any sudden emergency. He should visit these patients frequently, and at all hours, to see that they are not in want of any thing, and that the nurses do their duty. He should see that the nurses receive from the assistant-dispenser the medicines, and from the steward the comforts, pre- scribed and specified in the prescription-bills. He should perform all the operations of bleeding and cup- ping necessary for the patients under the care of the physician; and should, in the intervals of his visits, make any trivial alterations in the patients' treatment, that he may deem proper; but all changes of any im- portance should come from the physician himself. He should report all sudden changes in the patients' con- dition for the worse, immediately to the physician. He MARINE HOSPITALS. 89 should keep an exact record of his own prescriptions, which he should exhibit to the physician, informing him at the same time, his reasons for any alterations he may have made. He should on no account whatever, fail to administer any medicine or medicines prescrib- ed by the physician in his morning or evening visits, without stating to him the changes that may have oc- curred in the interval of his visits, and the time speci- fied for the administration of the medicine, which may have made it proper to omit the prescription. He should attend upon the sick with humanity, tender- ness, and fidelity ; and should, in all dangerous cases, watch during the night with them. He should report all irregularities that fall under his observation, to the proper persons invested with authority to correct them. He should, in time of very great press of busi- ness, afford any reasonable assistance in his power, to the assistants of the surgeon, in the discharge of their duties. But he should by no means be called upon for such assistance, except in cases of actual necessity, where these assistants have more business to attend to, in the opinion of the surgeon, than they are able pro- perly to execute ; and even then, not if his own avoca- tions occupy his entire attention. SECTION XX. Of the Surgeon's Assistants. The surgeon's assistants of the hospital, should be surgeons'-mates in the navy of advanced standing and considerable experience, who have been some time in the sea-service in the capacity of surgeon's-mates, N 90 OBSERVATIONS ON or acting-surgeons. They should assist the surgeon in the discharge of all his duties, and in performing ope- rations particularly. They should bleed, cup, dress the wounds and ulcers, of all the surgical patients in the hospital. They should visit these patients with the surgeon in his daily rounds, should attend to his verbal directions concerning them, and should give such information to him respecting the state of their disorder in the interval of his visits, as they may deem it serviceable for him to learn. They should have under their care all the instruments belonging to the surgeons' department of the hospital, and should be required to keep them hi perfect cleanliness and or- der. They should be responsible for the safe-keeping of them. They should see that the patients of the sur- geon are supplied with all the comforts and necessaries ordered for them, and that the medicines prescribed in the day-bills are prepared for the nurses, and adminis- tered faithfully by them, to the sick. They should keep journals of all cases in the surgical department, and should be held responsible for the faithful execu- tion of all the orders of the surgeon. They should be kind and conscientiously humane in their attentions on the sick, and particularly assiduous in their care of pa- tients who have recently undergone operations, and should watch with them at night when the surgeon shall deem it necessary. For the sake of preserving harmony between them, this duty should be performed in alternation. For the purpose of dividing the general duty of the hospital, the surgeon should apportion a Gertain number of wards to each of them, for the care and superintendance of which they should be account- able. They ought to extend all necessary aid to the phy- sician's assistant, when the physician shall think he MARINE HOSPITALS. 01 stands in need of it, and when their own duty #oes not engross their entire time. But this assistance should inever be resorted to except in cases of emergency. SECTION XXI. Of the Assistant-dispenser, or Hospital-mate. The assistant-dispenser, or hospital-mate, should be a young man who has resided at least two years with an apothecary, and who is tolerably skilled in pharmacy. His general duty should be to assist the dispenser in his pharmaceutical operations. He should prepare the prescriptions of the physician, the surgeon, and their respective assistants, according to the morn- ing bills delivered to him by the assistants. When the different medicines prescribed are prepared, he should carefully affix the name of each patient, and the num- ber of his ward, to the medicine intended for him, and should then deliver the whole to the nurses of the re- spective wards. In the English service, the hospital-mates are can- didates, after a year or two years' service, according to their qualifications, for the situation of assistant-sur- geons in the navy. This is a judicious arrangement; since their residence as hospital-mates, gives them an insight into pharmaceutical knowledge, very requisite for the assistant-surgeons, besides enabling them to see a great deal of naval surgical practice, which peculiar- ly fits them for embarking in their career in the sea- service. It would be well, 1 think, to imitate this ar- rangement in our naval hospitals ;—we should then have persons commissioned as surgeons'-mates, who would be every way qualified to discharge the duties of their station with ability. §& 0BSERVATI0>.S ON The assistants of I he physician and surgeon should wear an undress uuii'orm at all times; and they, as well as the dispenser and his assistant, should reside in the hospital. The physicians and surgeons of the royal naval hos- pitals in England, wear an uniform differing from that of officers of their grade afloat, only in the button. This difference consists in the impression, in addition to the common stamp, of initials designating their stations. The physician has on his buttons the initials H. P. hospital-physician; the surgeon II. S. hospital-sur- geon. They, as well as their assistants, are obliged to appear on duty, constantly in an undress uniform. It would be proper, I think, to adopt this regulation in our service. The present eagle-button should be stamped with the letters H. P. for the physician, and H. S. for the surgeon. These minutiae may appear trifling, but they all contribute to the general system and regularity. SECTION XXII. Of the duty of the Agent. The agent should be a man of respectability and trust, as his is an office of great responsibility and temptation. He should likewise be possessed of abili- ties for business, and alertness in the conduction of it. He should have under his charge all the publick pro- perty deposited in the hospital, which he should see kept in a state of preservation. He should be contrac- tor general, and purveyor of the hospital. He should receive all proposed contracts for furnishing the hos- pital with the articles, stores, and liquors, requisite in its different departments ; and should submit such pf them as he might deem proper for acceptance, to the MARINE HOSPITALS. 93 inspection of the governour of the hospital, with whose approbation and concurrence he should file them for reception. He should superintend the purchase of all provi- sions, and see that they be of a good quality when furnished—likewise of all the articles of the medical department of the navy, not contracted for by the agents of the board of medical commissioners*—also of all the clothing, bedding, hospital-utensils, fuel, &c. consumed or employed in the hospital. He should have the general superintendance of all the medical store-rooms and cellars in the hospital, and should at- tend in person, to the furnishing from them, such ship or ships as may want out-fitting or replenishing, with the necessary and established proportions of medi- cines, comforts. &c. He should see that his clerk, or sub-agent, preserves the nicest arrangement in his store-rooms and cellars, and that he keeps the instruments, medicines, and li- quors contained in them, in a safe condition, and in re- gular order, so that a ship can be fitted out on the shortest notice. That a respectable man, and one of abi- lity, may be procured for the office of agent, a liberal salary ought to be afforded by the government, and al- so convenient rooms for his residence in the hospital; or, if that be impracticable, in the vicinity of it. The agents in the royal hospitals of Haslar and Plymouth, receive a salary of 350/. sterling per ann. and are fur- nished with commodious houses, or suits of apart- ments, in the area of the hospitals. The agent should be furnished with printed bills, specifying the proportions of medicines, utensils, and hospital comforts, for the vessels of different rates, as • The establishment of such a board I have proposed in another part of this work 94 OBSERVATIONS ON established by the board of medical commissioners, or by the secretary of the navy. He should always keep in readiness, for delivery on board such ships as may want them, chests of a convenient size, containing ca- iiisrers of proper compass for the allowed comforts, which may be filled at a short notice. He should paste on the inside of every such chest, a printed bill of the established allowances of all the different articles fur- nished for the medical department, for which the sur- geon of the vessel should receipt to him, upon their safe delivery on board. The advantages in point of promptness, accuracy, and economy, arising from such a method of furnishing the medical department of ships of war, over that loose and irregular syrstem now in use in our navy, would be incalculably great. SECTION XXIII. Of the Chaplain. The chaplain should belong to the navy. He should reside in the hospital. He should read pipyers twice a week to the patients who are unable to leave their wards. He should preach a sermon every Sunday morning in the chapel belonging to the hospital, and perform divine service both morning and afternoon. He should attend the funerals of all the patients who are buried from the hospital. He should attend such as desire his consolation in their last hours; and should exhibit, by his pious and upright conduct, a good ex- ample to all persons in the hospital. In fine, he should do all manner of offices usually appertaining to his sta- tion. He should have taken orders in the church. MARINE HOSPITALS. 95 SECTION XXIV. Of the Steivard. It is not more necessary that the agent should be a man of integrity, than that the steward should be a man of the sternest honesty and sobriety. His charac^ ter should, on these points, stand the strictest scrutiny. He should moreover be a man of method and activity. He should have under his charge, all provisions used in the hospital, and all the liquors and comforts for the sick. The provisions he should see cooked in a proper manner, and formed into the different diets established by the Diet Bill; (see article Diet of the Hospital,) and the liquors and comforts he should furnish to the ward-master or nurses, as may be found convenient, upon their delivering to him the prescrip- tion-bill of the day. These bills he should file in re- gular order, and produce them as vouchers for the correctness of his expenditure returns. His returns should be made out on the first day of every month, and should exhibit the total amount of the expenditure of provisions, liquors and necessaries for the sick, during the preceding month; they should be sent to the governour of the hospital for his inspection. They should previous to this, however, be signed by the physician and the surgeon of the hospital, whose signatures (which should not be afforded till the stew ard has submitted to their inspection the files of their prescription-bills for the time his statement specifies an expenditure) ought to be considered by the gover nour as a proper ratification of the steward's accounts The steward should have under his charire. all the 96 OBSERVATIONS O.N clothing, beds, bedding, house-linen, &c. in actual use in the hospital. He should procure from the agent any quantity of these articles which may be thought requi- site for the use of the sick and convalescent, by the physician and surgeon. But when furnished, it should be his peculiar province to inspect them once a week, or oftener, to see that they be well taken care of, and that they be not sold nor exchanged, either in the hos- pital or out of it. He should require the co-operation of the matron, ward-master, nurses, and orderly-men, in the discharge of this duty. He should visit every ward of the hospital regularly in the morning and evening, and see that every thing goes on properly, and that the sick have received the comforts pre- scribed for them. He should be vigilant to detect all abuses or irregularities that exist, either among the nurses and other persons under his authority, or the patients themselves, and should report all such as are of an important nature to one of the lieutenants of the hospital. He should maintain a general superintend- ance over the minute regulations respecting the internal economy of the household, and should be invested with authority to punish any improprieties or negligencies in the servants, &c. of the hospital. He should there- fore be responsible for their correct demeanour. He should hire all the womeu employed in washing, iron- ing, &c.—all the cooks, under-cooks, scullery men, labourers, &c. employed in the hospital and its appur- tenances,—and should exact from them all a rigid and punctual performance of their respective duties. In fine, the steward should have an entire controul over the household operations, for the proper conduction of which he should be held the responsible person. He should faithfully execute all orders and injunctions gi- MARINE HOSPITALS, 97 ven him by the governour, the physician, the surgeon, the lieutenants, and the agent. The duties appertaining to the station of a steward, as just detailed, will fully show the necessity of his being a man' possessed of qualities such as specified in the beginning of this article. Indeed his task is more arduous, from the variety of minute duties that are rendered the objects of his attention, than that of any other officer belonging to the establishment. He should therefore be liberally remunerated for his trouble. He should keep a record of all persons employed in the hospital, and their wages; of all patients, with the dates of their entry, their disease, and discharge, cure or death ; together with such other occurrences as may be thought worthy of perpetuation. In this task his clerk, or deputy-steward, should assist him. SECTION XXV. Of the Deputy-Steward,Steward's Clerk, and Ward- Master. One person may very well perform all the duties an- nexed to these stations. His general duty should be to assist the steward in his business, and his particular province to take care of the wards of the hospital. His duty, in fact, is that of the steward, on a minute scale. He should superintend in person the wards of the hos- pital, and maintain the proper regulation, order, and cleanliness, necessary to be observed in them. He should see that the nurses are attentive and faithful in the performance of their duty, and that all orders given by the physician or surgeon respecting the cleansing of the wards, beds, bedding, &c. the ventilation and o 98 OBSERVATIONS ON warming the wards, &c. be punctually performed. He should inspect the mess-table when prepared with breakfast, dinner, and supper, for the convalescent and such sick as are able to eat at it, previous to the bell being rung for their assemblage; and should see that every thing is in a decent, comfortable, and proper con- dition. He should report all irregularities of any im- portance that may fall under his notice, to the steward, and should correct all such as are of a trivial nature himself. He should take care that no games of any de- scription are played by the patients, nurses, or other persons employed in the hospital; and that no liquor, nor food of any kind, be brought into the wards by the nurses, patients, or the friends of either who may visit them, other than those prescribed and allowed by the physician and surgeon. He should see that the wards be kept properly heated, and that the beds, bedding, clothing of the patients, &c. be preserved as clean as possible. He should order such mattresses, bed-pil- lows, fracture-pillows, and the like, as are wetted, and too much matted from use, sent to the hair-room,* to be opened and dried. He should visit the wards at a regular hour before going to bed, and see that all un- necessary lights are extinguished, and that the fires are safe. * The hair-room is an apartment so called in the English naval hospitals, and indeed in some of the London hospitals, in which all the old beds are opened, and the hair picked and dried. It is then made up into new mat- tresses, &c. This practice, I was informed by the surgeons of these institu- tions, was a saving of half the number of beds formerly expended in the hos- pitals. Many mattresses apparently damaged and useless, are made anew in this way. Besides the economy of this plan, it is productive of great advan- tages in point of health, cleanliness, and comfort, to the patients. Old men or women, maimed or lame in their legs, and other useless persons or pa- tients, are employed in this business. I have seen rooms in Haslar and Ply- mouth hospitals, of considerable size, filled to the ceiling with old matted hair—the whole of this is picked by the hands, and made anew, MARINE HOSPITALS. 99 He should, as well as the steward, be a man of so- briety and decorum, as he has it in his power to check or encourage a vast number of abuses and neglects—to connive at or suppress any licentious behaviour in those under his eye, according as he is himself a man of cor- rect and upright conduct, or corrupt character. SECTION XXVI. Of the Matron. The matron should be a discreet and reputable wo- man, capable of attending to business. She should be neat, cleanly, and tidy in her dress, and urbane and tender in her deportment. She should have a general controul over the nurses and orderly-men, assistant- nurses, ward-attendants, and all women and men em- ployed in the laundry, the larder, the kitchen, &c. She should have under her charge, the clothes and linen- rooms, and should see that every article deposited in them be cleanly washed and well dried, and in their proper places. She should visit the wards frequently, and see that the nurses attend to their duty there, and that they make up the beds in proper time. She should visit the wash and ironing-house frequently, and see that the clothes, linens, &c. are well washed, ironed, and dried, before they are placed in the racks and shelves destined for their reception. She should like- wise superintend the dairy, the milk-house, and the kitchen, and see that the cooks perform their duty. 100 OBSERVATIONS ON SECTION XXVIL Of the Nurses and Orderly-men. The nurses, whose number should be proportionate to the extent of the hospital, and number of patients, should be women of humane dispositions and tender manners ; active and healthy. They should be neat and cleanly in their persons; and without vices of any description. They should reside in small convenient apartments adjoining the wards they belong to. They are to attend with fidelity and care upon all the sick committed to their charge; should promptly obey their calls, and, if possible, anticipate their reasonable wants. They should administer all medicines and di- ets prescribed for the sick, in the manner and at the times specified in their directions. They should re- pair, at an appointed hour, to the dispensary and the provision-room, to receive from the assistant-dispenser and the steward, the medicines and eomforts prescrib- ed. They should be watchful of the sick at all hours, and should, when required, sit up with, them at night. They should attend the physician and the surgeon in their visits to the wards, to give information respecting the patients, and to receive orders and directions. They should make up the beds, and keep the wards clean, and should report to the assistant-physician and surgeons'-mates, whenever it is necessary to have them washed; and should not wet them, when they think proper, for the sake of the sick, to omit it at that time. They should report all sudden changes in the disorders of the sick, and all deaths, immediately to the assistant-physician or surgeons'-mates. They should obey punctually all orders from their superi- MARINE HOSPITALS. 101 ors; and should exact a ready acquiescence in their commands, from the attendants under them. The orderly-men are nothing more than male-nurses, and their duty is to assist the former. A certain num- ber of them is requisite and useful. They can perform many offices in attending upon sick-men, that women could not decently attend to. The other persons mentioned as necessary for the conduction of an hospital, are, the baker, the laun- dresses, the cooks, the scullion, the barber, servants, and labourers. The offices to be performed by these, are so well understood, that it is unnecessary for me to say any thing on the subject. There ought likewise to be attached to every naval hospital, for the purpose of better governing the same, a guard, of which 1 shall now speak. SECTION XXVIII. Of the Guard. The hospital should be furnished with a serjeant's- guard from the marine corps, whicli should be relieved regularly once or twice a day, as convenience may di- rect. The men composing the guard should prevent the entering of all improper persons, and the exit of any of the patients, nurses, or other inferiour officers employed about the hospital, without they exhibit a printed ticket for leave of absence, signed by the go- vernour, one of the lieutenants, or the physician or surgeon of the hospital. They should obey all orders and injunctions given to them by the sergeant of the 102 OBSERVATIONS ON guard, who is to receive his proper instructions, or his day-orders, from one of the lieutenants of the hospital. One of the guard is to be employed as janitor or porter, and he should be relieved every four hours. SECTION XXIX. Rules and Regulations for the government of the pa- tients and pensioners, and the preservation of order and quietness in the Hospital. I. Every patient in the hospital shall be obliged to wash his face and hands, and comb his hair before breakfast. Those patients who are unable to perform this ablution themselves, must be assisted in doing it, or have it done for them, by their neighbour patients or nurses of the ward. Such patients must be washed with luke-warm water. To facilitate this business, each ward should be fur- nished with two or three tin washing-basins ; and long rolling towels should be hung up on the doors, or in other convenient places. II. If any convalescents or pensioners neglect or refuse to perform this process, the nurses must deny them their breakfast until it be done. III. All patients or pensioners that are able to rise from their beds, and continue up during the day, are to dress themselves .before breakfast, and keep them- selves neat and clean. If any refuse, who are capable MARINE HOSPITALS. 103 of doing so, the nurses must report them to the ward- master. IV- Every patient must consent to be shaved when the barber takes his rounds through the wards, if possible. Should any good reason appear for declining to sub- mit to this operation, at the usual hour, the barber shall in such case return at a time when it may be con- venient to the patient. V. Every patient shall keep his clothes, and what little matters he may be permitted to bring into the hospital to amuse himself and beguile his time, in the drawer of the table at the head of his bed, or in a small box, or on a shelf, or in whatever convenience for this purpose the wards of the hospital may be furnished with. He is enjoined to preserve, in so far as he is able, every thing about his own bed in order and cleanliness. VI. There is to be no gaming nor smoking in the wards or other apartments of the hospital. Those who smoke tobacco, are only permitted to do it in the court-yards, or other walking-places. VII. No patient is permitted to spit on the floors of the wards, enteries, or other apartments of the hospi- tal ; nor throw any filth or dirty matter, either on the floors or out any of the windows of the hospital. That the patients may have no excuse for infringing this rule, each ward should be supplied with a sufficient number of spitting-pots, containing sand, which the nurses are to have emptied every morning. 104 OBSERVATIONS ON VIII. There is to be no profane swearing, vociferation, nor loud talking, in the wards of the hospital; nor any noise made by any person, calculated to disturb the quietness of the patients. IX. If any patient be guilty of drunkenness, or is tur- bulent and refractory, or is convicted of any riotous behaviour, or other scandalous conduct, the nurses shall report such person to the ward-master for punish- ment. X. No patent in the hospital shall quarrel with any other patient, nor any other person whomsoever, nor use provoking or reproachful words, gestures, or menaces, to any one. Any patient guilty of such im- propriety, shall immediately be reported to the ward- master for punishment. XI. If any patient be found guilty of stealing from any person in the hospital, or of purloining any articles of clothing or other matters from another patient, he must be punished. XII. No patient shall leave the hospital on any pre- tence whatever, without a liberty-ticket, specifying the number of hours he is permitted to be absent, signed by the physician or surgeon, and countersigned by the governour, or one of the lieutenants. XIII. Any patient who has left the hospital on lib- erty, and returns intoxicated, or over-stays his time. MARINE HOSPITALS. 105 by more than one hour, shall be deprived of his beer allowance for three days, aud forfeit any title to obtain a second leave of absence, while he continues on the the hospital-books. XIV. Any pensioner who is guilty of the abovemen- tioned improprieties, shall also forfeit his beer allow- ance, and lose his right to a leave of absence for one month. XV. If any patient, who leaves the hospital upon li- berty, shall be absent more than four and twenty hours, he shall be considered as a deserter, and appre- hended and treated according to the laws and usages of the navy. XVI. If any pensioner who leaves the hospital upon liberty, over-stays his time by forty-eight hours, he shall also be considered as a deserter; his name shall be marked ib run," on the hospital-books, and he shall forfeit his pension for six months. XVII. No patient shall be granted a longer leave of absence than twelve hours ; and no pensioner liberty exceeding forty-eight hours. XVIII. All patients in the hospital, shall be obedient to the proper and legal orders of the nurses, assistant- nurses, ward master, steward, matron, and indeed all persons in authority. XIX. If any officer-patient shall disobey any of the rules p 106 OBSERVATIONS ON or regulations of the hospital, or refuse to follow < i* advice and prescriptions of the physician or surgeon, they shall, for the first offence, remonstrate with him upon the impropriety of such behaviour. If he repeats his offence, he must be reported to the governour of the hospital, and be reprimanded by him in the presence of the physician and surgeon. Should he persist in his misconduct, he shall be immediately discharged from the hospital, if his condition will permit it; and forfeit a right to any allowance for sick-quarters, or medical aid. XX. If any other than an officer-patient be guilty of such infraction of the established regulations, he shall, for the first or second offence, be punished according to the will of the governour. His contumaciousness in of- fence shall be punished byr an immediate confinement in a solitary room, during his continuance in the hos-^ pital. XXI. It shall be the duty of patients in a sick ward, to reciprocate and interchange with their fellow-pa- tients, and sufferers in disease, such little offices of kindness, humanity and attention, as they may be able to afford, for the comfort and convenience of the whole. XXII. All crimes, misdemeanors, and offences, not speci- fied in this code of laws and regulations, for the go- vernment of officer patients, patients, and pensioners, are to be punished and corrected according to the usages of the navy oh ship-board, and other service. XXIII. That ignorance of the rules may not be plead MARINE HOSPITALS. 107 in excuse for violating them, a printed copy of them should be neatly framed, and hung up in some conspi- cuous part of each ward; and since many of the pa- tients may be unable to read, they should moreover be read aloud by the ward-master every Sunday morning after a muster of the patients, in each ward of the hospital. SECTION XXX. Miscellaneous Rules and Regulations respecting the internal police of the Hospital. I. No sick person belonging to the navy, shall be re- ceived iuto the hospital without an order signed by the surgeon, and counter-signed by the commander, of the ship, navy-yard, marine barracks, or post, to which he belongs ; and it shall be the duty of the surgeon to send with such sick person, a brief history of his case and treatment. II. No pensioner shall be admitted into the hospital, without an order from the secretary of the navy. HI. When a sick seaman, ordinary seaman, marine, or boy, is sent to an hospital from a vessel, or any post to which a purser is attached: the purser must send with such sick person, a statement of his account. This shall be transmitted to the purser of the ship, navy-yard, or station, to which the patient may be sent when dis- charged from the hospital. 108 OBSERVATIONS ON IV. Any case of sudden accident may be admitted with- out the usual forms. V. Any persons attached to foreign national vessels, may be admitted into the hospital, if the consul or agent of the power to which such vessel may belong, will agree to pay a requisite and just sum per week ; and to defray the funeral charges, should the patient die. VI. No officer or person connected with the administra- tion of the hospital, shall have any interest, either di- rectly or indirectly, in the furnishing of hospital sup- plies. VII. Any officer convicted of embezzlement of hospital property of any kind or description, shall be cashier- ed, and obliged to refund the amount of the articles so appropriated. VIII. The ward-master is to see all lights put out at eight o'clock in winter, and nine in summer, except those that are absolutely necessary for the convenience of the sick. IX. When a patient dies, it shall be the duty of the ward-master to take an inventory of his effects as soon as convenient, and deposite them in a place of safe- keeping, till called for by the persons entitled to them. X. When an officer dies, the steward shall take an in- ventory of his effects and papers, and seal the latter MARINE HOSPITALS. 109 up. He shall deposite them in a safe place, till they are claimed by those entitled to receive them. XI. The dead shall be immediately removed from the wards after their demise, into the dead-house; and if an officer, into an apartment appropriated for that'pur- pose in the hospital. XII. It shall be the duty of the ward-master to attend all funerals, and see that they be conducted with becoming decency and propriety. XIII. All clothing, and other property belonging to the pa- tients, officer-patients, or pensioners, who have been deceased nine months, shall, if they be not claimed after sufficient advertising after that period, be sold for the benefit of the hospital. XIV. If any officer refuse to observe the rules and regula- tions of the hospital, or refuse to obey the just and pro- per commands of the physician, the surgeon, or others iu authority, he shall be discharged from the hospital. XV. Every person in the hospital, except the medical officers, the governour and lieutenants, the steward, the agent and other officers, shall receive a daily allowance of provisions equal in value to a navy ration, that is, twenty cents per day. XVI. The floors of the wards shall be carefully washed twice every week, and swabbed dry. It is positively 110 OBSERVATIONS ON prohibited, however, that this process should at any time be begun, without first obtaining the consent of the physician or surgeon, or their assistants. When the floors are to be washed, those patients confined to their beds are to be carried on them into an adjoining ward, and not brought back until the floor be thoroughly dried. The walls must be white-washed thrice a year, or oftener if necessary. XVII. No relation or acquaintance shall be permitted to visit any of the patients in the wards, without a written order from the assistant-physician or surgeon's-mate. XVIII. No strangers shall be admitted into the wards; and the nurses are strictly enjoined not to permit any un- necessary visits. XIX. When a patient is discharged from the hospital, a receipt shall be taken for him from the person into whose charge he is delivered. XX. It shall be the duty of every officer in the hospital, to enforce the observance of these rules; and to co- operate so far as in his power lies, with his colleagues, to maintain subordination, harmony, and quietness in the institution* MARINE HOSPITALS. Ill SECTION XXXI. With a view to render the subject of these pages more complete, I subjoin the following report made by Benjamin Henry Latrobe, esq. engineer of the U. S. navy department, to the late secretary of the navy. It exhibits a calculation of the probable expense of erect- ing a marine hospital, calculated to contain for the pre- sent 100 patients, and a proper proportion of pension- ers. The well known talents of this gentlemen, render any apology for inserting his report at length, unne- cessary. Air. Latrobe's Report on Marine Hospitals. The Honorable Paul Hamilton, Secretary of the Navy of the United States. Washington, July 3d, 1812. SIR, Agreeably to your direction, I respectfully submit to you the annexed report and design of a marine hos- pital, formed agreeably to your instructions—" that it should present such an arrangement, as, for the present would accommodate 100 patients, in a building, plain and substantial, and capable of being so enlarged, as at some future day to form an establishment adequate to the increased wants and means of the country." I am with high respect, Your obedient humble servant, B. Henry Latrobe, Ens- Navy Dep. U. S 112 OBSERVATIONS on Report of B. Henry Latrobe, on his design for a Marine Hospital, respectfully submitted to the Se- cretary of the Navy, U. S. the Secretary of the Treasury and the Secretray of War, Commissioners appointed by law, of the Marine Hospital Fund. July 3d, 1813. \. The extent of au hospital establishment depends principally, and originally on the quantity of space which it may be deemed sufficient to allow to each pa- tient, or convalescent, with a view to health and con- venience. 2. The extent of such an establishment will also be affected by the mode of lodging the patients; whether many or few are lodged in each ward together. 3. Without discussing theoretically any part of the merits of the question, whether large roomy wards in which patients are lodged together, or whether smaller wards containing few patients in each, are in a medi- cal view preferable, I will only state that I have adopt- ed the latter system from my own conviction that it is the best in a medical point of view, but principally be- cause more patients may be safely accommodated in less space in this arrangement, than in the former. 4. In the erection of every publick building, to eco- nomize space is to economize expense. With the li- mited fund of the hospital therefore, the first consider- ation in forming the design was to cover as little ground as possible ; because the materials and workmanship being the same, the only comparison between two dif- ferent plans in view of their expense would be, as to their areas. 5. The design presented to the commissioners, as far as it goes, consists of two parts; the hospital for MARINE HOSPITALS. 113 the sick, and the house of the steward, or of whatever officer may preside over the institution. 6. In examining this plan, it will be necessary in the first place to enquire into the adequacy or redun- dance of the space allowed to each patient. It will be found on inspection that each story is divided into 8 spaces, six larger and 2 smaller ones. The two latter contain, the one the stair-case, the other I have called the tub-room, the use and necessity of which I shall hereafter explain. The wards allotted to the patients are six; they are 24 feet from north to south, and 20 feet wide. The bedstead of a patient ought not to be less than 6 feet long, although they are sometimes only five feet nine inches; and 3 feet wide. Each bed requires to admit a chair, or the passage of a nurse or physician, 18 inches at the least, by its side; which makes a square of six feet necessary for each bed. In these wards, therefore, there may be placed on each side 4 beds, and between their feet there will be a passage of 8 feet from north to south. This is the minimum, therefore, of accommodation which is safe. But if the bedsteads are made only 2 feet nine inches w ide, and the passage between the beds only 2 feet, then 10 patients may be crowded into such ward. Every medical man how- ever would condemn such arrangement, however well the wards might be ventilated. 7. Before 1 go further, I beg to refer to the plan of a marine hospital by one of the surgeons in the navy U. States. In this plan the patients are to be lodged in large wards 80 feet long, and 30 feet wide,- 84 pa- tients in each ward. The beds, therefore, will each of them stand in a spaee of six feet square; and the passage between their feet will be 18 feet wide: 24 beds will occupy 2400 superficial feet. If, therefore, 114 OBSERVATIONS ON in the plan submitted to you by me, three wards con- taining 24 patients occupy only 1524 superficial feet, (including walls) it cannot, I believe, be supposed pos- sible further to contract the space allotted to the pa- tients, and of course to diminish the extent of the hos- pital, or lessen its expense. One of the greatest ad- vantages attending the lodging of the patients in small numbers in separate wards is this : that those whose cases are of a nature to annoy such others as require repose, may be kept distinct from the latter; and in ge- neral, that the patients most requiring it, can be kept quiet. In hospitals in which many patients are lodged in one large ward, this distinction not only becomes impossible, but the ward itself becomes a thoroughfare for the whole business of the attendance of medical men, of nurses, and of servants. To avoid the latter great inconvenience, I have placed a general passage of communication along all the wards, 8 feet in width. This passage takes the place of all the large stalls and spaces necessary for communication on the other sys- tem, and prevents the necessity of passing through any ward without having business with the patients that are in it. It also is sufficiently wide to contain the ta- bles, drawers, and other conveniences required by the nurses and surgeons, and for the preparations neces- sary to the administration of chirurgical or medical relief. 8. The next point of consideration, respects the ven- tilation of the wards. I have endeavoured to avoid the imperfect ventilation of wards arranged on each side of a long middle passage, and the inconvenience of the sun shining into single wards extending across the whole building, especially of such as front the east and west. I have to this end shaded the south side of the house by an open arcade, 10 feet wide, and have pro- MARINE HOSPITALS. 110 vided the north passage with a range of large windows. The wards themselves have two doors leading to the south arcade, the other to the north passage, and have 4 windows, one at each side of each range of beds. By opening all the windows and doors, the most perfect communication with the external air can be effected, which may be diminished at pleasure on either side. 9. The south arcade also serves for a walk, or a seat in the open air to such as can leave their beds; and to all convalescents. 10. One of the greatest difficulties in planning hos- pitals is to provide for the removal of the faeces; and other disagreeable matter. I have endeavoured to do this, by means of two smaller rooms, one in each floor, which I have called tub-rooms. Those who can go to these rooms, may find the accommodation of conve- nient vessels ; those who are obliged to remain in their wards, must have vessels, to be emptied into a larger one in the tub-room. This latter is then, every morn- ing very early, and late in the evening, or perhaps only once in the night, let down by a rope and pulley into a cart, and removed to the proper place in the yard, without annoyance to the house or neighbourhood. In the medical schools built by me in Philadelphia, a pit is connected with the dissecting-rooms, which most perfectly answers the purpose of keeping the house free from disagreeable smells, and of getting rid very conveniently of all noxious matter. The fear lest the springs of the hill (near Washington,) should be cor- rupted by such a pit, will probably forbid its use in the hospital. 11. The offices belonging essentially to a hospital are: 1. A kitchen. 2. A bake-house. 3. A provision cellar, and dry store-room. 116 OBSERVATIONS ON 4. A depository of the clothing belonging to patients. 5. A depository of hospital clothing and bedding. 6. A laboratory and dispensatory. 7- Warm and cold baths. 8. A receiving-room, in which the patient is examined, clothed, and prepared for the ward to which he is to belong. 9. Lodging rooms for the nurses and steward of the house. 10. Operation and dissecting rooms. For the six first of these offices, there is a simple and permanent provision made in the basement story of the plan submitted to you. But for the three latter there can be no room spared, without either enlarging the building, or for the present converting the uses of the offices as follows : 1. The kitchen may also be the wash-house. 2. The wash-house may furnish the bath-room. 3. Both species of clothing may be contained in one room, and the second become a lodging-room for female servants and nurses.— Male servants may lodge in the passages of the communication. 4. The first ward must be converted into a receiving- room, and the twelfth into an operating room. But it is evident that two wards being thus lost, only 80 patients can be received into the house, unless more than eight be lodged in each ward. 12. I have explained generally, the principles on which the arrangement and extent of my plan have been determined. The next view that must be taken of it in point of expense, is the kind and quantity of material of which it is to be built. Bricks are certainly the least expensive of the solid materials of this city. MARINE HOSPITALS. 117 If the foundations of the house are laid in quarry- stone, and the external walls carried up in the same materials as far as the surface : if the internal walls are built of bricks, or the external of quarry-stone, faced with free-stone as high as the water-table : and if the two upper stories (above the basement) be built entirely of brick, with free-stone fascias and window- selles; and the basement story of the two tub-rooms be entirely vaulted in bricks, then the hospital will cost, according to the best estimate that can be made, S 25,426. And if the whole of the north wall, forming in the whole design part of the north front, be faced with plain free-stone, without any decoration, so as to as- sume the appearance exhibited in the drawing; then the hospital will cost S 28,000. This estimate is made on a supposition that the ex- ternal walls of the lower story are 1 foot 10 inches thick, and of the upper stories 1 foot 6 inches thick, the internal walls li bricks thick ; and when it is con- sidered that the external walls are 152 feet long, and 40 feet in height, without any connexion with the in- ternal walls, it will not be thought practicable or safe to diminish the strength I have given to them. 13. The plan, or part of the plan, to which the above observations applyr, includes only the building appropriated to lodging the patients. At the west corner of this building is proposed to be the house or dwelling of the steward. It contains two rooms and four chambers for a family, with the necessary kitchen, offices, and a library, or consulting- room, for the medical officers. The largest of the chambers m >y be made to communicate with the up- per passage of the hospital, and furnish a museum or dispensatory until the plan shall be enlarged. 118 OBSERVATIONS ON This building will cost, if built of brick, as proposed for the hospital in the first estimate, JS 8,750 If faced with free stone, - - - 10,260 14. The estimates therefore would stand thus : Faced with brick: hospital, - - 25,500 Officers' house, &c. - 8,750 S 34,250 Do. with free-stone : hospital, - 28,000 Officers' house, - 10,250 £ 38,250 Should the plan submitted contain an arrangement ap- proved by you in its general principles, but appear li- able to correction and alteration in part; the same principles may be applied to an infinite variety of ar- rangement : and I will only remark, that in any such arrangement, the following points must be observed. 1. That the building must front north and south, i. e. that its greatest length must be from east to west. 2. That the north wall of the sick wards, should not be exposed to the weather—it being a correct observa- tion, that in wards of which the north walls are thus exposed, the greatest number of deaths occur on the north side; but that in hospitals in which there are wards on each side of a middle passage, the north side of the south wards exhibits no difference of deaths from the south side. This naturally arises from the chilliness of the atmosphere of a wall exposed to the N. W. and N. E. winds and rains. 15. The estimates submitted above, are exclusive of the fencing, planting, and laying out of the ground, and of single buildings, sheds, gates, or other accessa- MARINE HOSPITALS. 119 ries. To estimate these, the site of the buildings must be known. Holding myself in readiness to explain or give any information which may be required, I am, very respectfully, Your obedient humble servant, B. Henry Latrobe, Eng. N. D. The Honorable the Secretary of the Navy of the United States. Washington, July 3,1812. (Private.) SIR, It was my duty, agreeably to your suggestion on Thursday last, to examine into the practicability of executing the work of the hospital, by the workmen or the means now collected in the navy-yard. I was always of opinion, that the best and cheapest method of executing publick works, is under well-paid foremen, by the day; and the very worst, by contract. Journeymen will do their duty for the publick as well as for individuals ; and when the time of the men, and the profit of the master, mean the same thing, as in all works executed by contract they do, work will be ra- pidly done, or done by a few hands, and those at the lowest wages ; provided it is only turned out in such a manner as barely to authorize the payment of the ac- count. I have therefore always recommended the former method, and hitherto successfully'. In what manner myr works are executed, you can judge ; and they cost all of them at least 25 per cent, less than the measure or value price. It is only necessary to compare the cost of the N. and of the S. wing of the capitol, to ascertain this fact. 120 OBSERVATIONS ON MARINE HOSPITALS. I would warmly recommend, therefore, that all the wood-work, glazing, and painting, be done by the workmen of the yard. All the timber, much of which may be that which is unsound, but unfit for naval use, may be saved at the rate of the actual expense of the saw-mill; all the framing and joiner's work executed in the joiner's shop ; all the ironmongery procured by the store-keeper; and the glass cut and put in by the glazier; and the painting executed 200 per cent. cheaper than can be done out of doors. The brick-work may indeed be executed by con- tract ; and there are many men who would perform it very faithfully at $ 12 50 per thousand. But, without costing more, it would be better done under a foreman at S 2 50 per day. The stone-work must necessarily be done by measurement. The publick, however, should buy the stone of the quarry-men. It would cost 7 dols. per ton. I have called this a private letter, chiefly to distin- guish it from my report, which is of a publick nature; and also because there are many very excellent mecha- nicks, and respectable men, who would be disappointed, should the course which is suggested be adopted, and with whom I do wish to take upon myself the respon- sibility of their recommendation. The estimate I have submitted for the whole build- ing approaches 40,000 dols. I am fully convinced from experience, that the publick would save JS 8,000, by following the plan pursued at the capitol, and at all my publick works—that of days' work, under fore- men, and in this instance under those of the yard. I will add, that having had occasion to measure the bank of Pennsylvania, I found it to have cost less by g 32,000 than the measure and value price. I am, very respectfully, your's, B. Henry Latrobe, Eng. N. D. U. S. AN ACCOUNT OF THE PENNSYLVANIA HOSPITAL. 121 SECTION XXXII. An Account of the Pennsylvania Hospital, and its in > ternal police. It is obvious, that in proposing regulations and ar- rangements for the internal administration of hospitals, whether naval, military, or civil; or in suggesting plans for the structure of wards and other domestick con- trivances, but little can be offered that is new. In both cases, the best we can do, is to take a view of some of the similar institutions in highest repute, and cull from their various and well devised plans, such as are most useful and consistent with the principles of economy and neatness. With this view, I deem it far from irrelevant to the object of this work, to present some account of an in- stitution, with the internal police of which 1 have long been familiarized ; and which I believe, from a com- parative view with the first hospitals of England, to be one of the best conducted institutions of the kind, per- haps iu any country. The hospitals of London are, it is true, conducted on a much more extensive plan: St. Thomas', Guy's, and St. Bartholomew's, being per- haps twice as large as the one of which I am speak- ing—the Pennsylvania hospital. But I think I can with truth assert: that the regularity', neatness, and re- gard to comfort, which characterize this noble institu- tion, eminently entitles it to a preference to any of these, at least so far as it goes. The architectural plan of the building : its beautiful and healthy situa- tion, surrounded as it is by a constant current of fresh air, unimpeded by any buildings, or other hindrances: render this institution one of the most salubrious re- st i'22 AN ACCOUNT OF THE sorts for the sick or afflicted, that could possibly be contrived in the midst of a large and populous city. The hospital presents a south front; the wings which intersect the long buildings that join them to the main edifice, at right angles: present the one an east, and the other a west front. The centre building, or main edi- fice, is sixty-four feet in front, elevated above all the adjoining buildings, (being three stories high,) and pro- jecting beyond them both front and back. On the sum- mit of the roof is a sky-light, forming the apex of the operating theatre, which receives its light entirely from this. Two large stair cases, leading to the seve- ral wards and apartments up-stairs, are constructed in this building, running from the main hall. Adjoining this centre edifice on the east, is a build- ing 80 feet front, and 27 feet deep, two stories high from the surface of the ground, and three, including the range of windows in the area below. This build- ing is divided in its upper stories, into two wards, ex- tending nearly to its entire length and breadth; and the lower or basement story, is subdivided into a row of cells on the south side, and a lobby on the north. The two long wards are veutilated by openings into the chimnies, of which there are four in each ward, near the ceiling. At the east end of these wards, two small apartments are partitioned off, about 10 feet square, the one intended for a pantry, and the other for a lodging-room for the assistant-nurses of the ward. At the other, or west termination of the upper ward, two small rooms of the same size are partitioned off, for patients who may require a separate room. The lower ward extends in length to the centre building. Intersecting this long building at right angles, and adjoining it, facing the east, is a wing two stories high, running north and south, extending in length 110 feet. PENNSYLVANIA HOSPITAL. 123 In the middle of this wing, opposite to and communi- cating with the long ward, is an hall 28 feet square, in- cluding the stair-case, projecting beyond the line of the wing sufficiently to cover the cornice, and raised one sto- ry above it, with a cupola. In the north and south ends of this wing, are two sick wards, and between them and the hall, on each side of it, are two lodging rooms for the nurses. The arrangement in the second story is the same. Adjoining the centre edifice, on the west, is a long building, 34 feet deep, divided into 42 cells for luna- ticks, with a window in each. These cells front north and south, and are separated in the middle by a long lobby about twelve feet wide, which is lighted from the cells, by the small windows over each door. The west wing, which intersects this long building at right angles, is in all respects subdivided like the east. The structure upstairs is the same as that of the first sto- ry, being divided into wards and a double row of cells. In the basement-story, there is likewise a dou- ble row of cells, all round the wing and long building, the windows of which open into the area. All the cells are warmed by flues in their partition walls, communicating with the chimney, and opening into wall-stoves, the doors of which are in the lob- bies__one stove warms tw7o rooms. The whole extent of the buildings, from east to west, is 278 feet. In con- sequence of the length of the wings crossing the long wards and rows of cells, the east and west fronts pre- sent a finished and agreeable appearance. Detached from the main building, and at a conveni- ent distance from it near the east wall, is a two story building: divided into a kitchen, pantry, lodging-room for a nurse, and four small wards for venereal pa- tients. 124 AN ACCOUNT OF THE Near the west wall are two buildings, two stories high, the one containing washing, ironing, and drying rooms ; the other stables, &c. The different apartments in this hospital are as fol- low : Centre Building. Kitchen, scullery, steward's din- ing-room, maids' lodging-room, in the basement story, - * A library-room, on the first floor,-! An apothecary's shop, ditto, I . Manager's room, ditto, j Steward's room, ditto, - J The contributor's room, in the second story, Chambers for the resident physi- cian, pupils, and steward, ditto, Operation-room, in the third story," Museum, ditto, Small apartments near the opera- £> 4 tion-room, for the patients ope- rated on, ditto, Baking-rooms and larders in the cellar, - 3 Bathing-rooms in the basement story of the west wing, - 2 Room for deputy-steward and his wife, in ditto, 1 Cells for lunaticks in the west wing, 70 Ditto, in the east, - - 16 For sick and wounded in the whole building, 23 wards. ' In all, wards and rooms, 130 I'ENNSYLVANIA HOSPITAL. 125 The square ground plot on which the hospital stands, is 396 feet in width, and 468feet in length, containing about four acres. It is enclosed by a brick wall, with an iron palisade in its front. It is surrounded by fine rows of lofty sycamore trees, and the grounds are well laid out in a beautiful garden behind, and grass plots and hedges in front. There is a vacant square to the east, and half a square on the west, making together above six acres. These squares lay across Eighth-street on the east, and Ninth-street on the west, parallel to the lines of the hospital-enclosure. Besides these, there are three vacant squares on the south side of Pine- street, opposite the hospital, which belong to this in- stitution ; so that every benefit that arises from airiness of situation, is insured to this hospital. The other half square on the west, belongs to the Aims-House, and it is intended to be kept open; so that the Pennsylvania hospital may be said to stand in the middle of several great squares, which, without including the open streets, contain more than thirteen acres. This institution was founded by the contributors in the year 1752, for the relief of lunaticks, and the sick- poor of Pennsylvania. These contributors are such persons as have paid into the hospital fund the sum of 10 pounds, or upwards. " They have perpetual succes- sion, with the power to elect twelve managers, a trea- surer, and all other officers of the institution, and to make rules and regulations for the government of the household. They may receive and take the lands, hereditaments, and tenements, not exceeding the year- ly value of one thousand pounds, of the gift, aliena- tion, bequest, or devise, of any person or persons whomsoever, and of any goods and chattels whatso- ever : Provided, that no general meeting of the con- tributors, or persons acting under them, shall employ 126 AN ACCOUNT OF THE any money or other estate, expressly given to the capi- tal stock of the hospital, in any other way than by ap- plying its annual interest or rent toward the entertain- ment and care of the sick and distempered poor, that shall from time to time be brought and placed therein, for the cure of their diseases, from any part of the state, without partiality or preference." The contributors have vested the managers with the authority to establish the mode of admitting and dis- charging patients, and the terms upon which they are to continue in the hospital; also to elect the medical and other officers of the institution. They admit as many other poor patients (after the established number of paupers supported by the capi- tal stock are admitted) as they can agree to take upon reasonable rates. The fund arising from the profits of the board and nursing of such patients, is appropriated to the same uses as the interest money of the publick stock. The overseers of the poor of Pennsylvania, and its religious societies, pay three dollars [.' r week for each patient. Those of other states pay four dol- lars: private patients, residents of Pennsylvania, from three and an half to six dollars ; those of other states from four and an half to eight dollars. The anatomical museum contains a collection of dried preparations—castings in plaister of Paris of the gravid uterus—two wax models of the human body— pictures representing the blood-vessels, the fetus in utero, &c. &c. in crayons, the gift of Dr. John Fother- gill, of London ; together with many valuable prepa- rations in spirits. Every stranger or visitor pays one dollar for admission into this museum. Students who have taken a ticket to attend the practice of the house, are however admitted without any extra charge. The medical library consists of about 3000 volumes of well chosen books. PENNSYLVANIA HOSPITAL. 127 The library and museum are supported and en- larged by the fund accruing from the money paid by students to attend the hospital, which is 10 dollars per annum each. This fund amounts to a yearly income of above two thousand dollars, the number of students who take tickets being usually between two and three hundred. The managers, the physicians, the surgeons and the contributors, serve the institution gratuitously. Per- sons however who are able to do it, are at liberty to remunerate the attending physicians and surgeons, as they would in private houses. Every private patient has the liberty of choosing any one of the physicians of the hospital to attend him. whom he prefers. The amputation of a limb cannot be performed without a consultation and agreement of the three sur- geons of the house; and in no case without the con- sent of the patient. No medical man can be elected a physician or sur- geon of the hospital, who is under twenty-seven years of age. The sitting managers meet on Wednesday and Saturday mornings of every week, to admit and dis- charge patients. Between these periods the patient desiring admit- tance, must apply to the attending physician or sur- geon, and obtain his certificate that he is a proper sub- ject for admission. This is carried to one of the sit- ting managers, who takes the usual security, and orders his admission. Overseers from the country, who bring a patient for admission, are obliged to have a certificate signed by two magistrates, signifying that they are in office, and that the pauper belongs to their district. 128 AN ACCOUNT OF THE Persons with infectious diseases are not admitted. Incurables are not admitted, except lunaticks. All cases of sudden accident are admitted without form or charge, if brought within 24 hours after they have happened. The capital stock of this hospital amounts to 124,854 dollars. The real estate consists of vacant lots sur- rounding the hospital area, &c. &c. These vacant lots are most unjustly and illiberally made subject to a city as well as a county tax, which amount to about 1200 dollars per ann. They ought, according to every principle of humanity, liberality, justice and charity, to be exempted from these most ill-judged contributions. This sum would go far to- wards supporting an additional number of paupers. The officers of the institution are as follow : 12 Managers, who serve gratis. 3 Physicians, who also give their attendance gratis. 3 Surgeons, ditto. A physician to the lying-in department, ditto. A physician to the out-patients $300 per ann. A resident physician, who serves gratis. A dresser, and an apothecary, (pupils of the house, who serve 5 years) ditto. A steward, and a matron, - 600 Deputy-steward, or superintendant of the west-building, and deputy matron of the same, - - 350 A gardener, - - 216 An assistant do. - - 144 Four cell-keepers, - 144 each. .A carter, - - .. 144 V labourer, - - 144 \ watchman, - - 144 PENNSYLVANIA HOSPITAL. 129 A baker, - - - Jg 144 per ann. A porter, 96 Four nurses, each SI 33 per week, 276 64 Five assistant do. each 81 25 per week, 325 Cook, St 30 per week, - 69 16 Four chambermaids, each 8 1 25 per week, - - - 320 Three laundresses, hired 5 or 6 days in each week, at 62i cents per day, 487 50 A sufficient number of women are hired every spring, to whitewash and tho- roughly clean every part of the. house. Their wages and materials employ- ed amount to* - - 167 50 The resident physician, the dresser, the apothecary, the steward, and all other officers who reside in the house, are furnished with a table. The rules and regulations respecting the duties and offices of the resident physician and pupils of the house, are six in number, viz. u 1st. That the constant personal attendance of the resident physician and surgeon is indispensable, and enjoined by every motive of duty, honour, and confi- dence. " 2d. That the resident physician shall direct the services of the pupils, who are also enjoined to observe the most scrupulous regard to unremitted personal at- tendance on their duties ; and when not engaged in services in other parts of the house, the apothecary's shop is to be considered the room where they may al- ways be found. " 3d. That vials or bottles of uncommon form or co- lour be furnished to the nurses, in which to keep lauda- * It appears from this statement, that it requires the interest of 75,000 dollars to pay the salaries of the officers. s 130 AN ACCOUNT OF THE num, and that written or printed labels be pasted upon the vials and boxes containing the medicines of the patients. " 4th. That wine, and spirits of all kinds, in the day time should be administered when prescribed, by one of the pupils only, when the patient is not in a condi- tion from disease, or bad habits, to be trusted with it; in the night this duty may be performed by the nurses, who are to report how they have administered the spi- rits to the resident physician. " 5th. The pupils of the house shall at all times be under the direction and controul of the resident physi- cian, who shall be responsible to the board for their due attention to their duties; nor shall they at any time be absent but by his permission. "6th. The resident physician sinll keep a journal or diary relating to his department, noting therein his own times of absence, of permission of absence granted to the pupils, and of their observance to return in due time—of any extraordinary medical or surgical case under his notice, with remarks thereon—of every ir- regularity in his department, either as respects pa- tients, or nurses—of any useful improvement that he thinks might be introduced either in the wards, or the apothecary's shop—or in the economical supply or ad- ministration of the medicines or liquors—of surgeon's instruments or shop furniture—of any improvement in the wards differing from what is in use, as respects cleanliness, ventilation, bedding, &c.—and generally such other observations as he may deem useful; which journal or diary shall be laid on the table of the board at every stated meeting."* • These rules were first drawn up in the month of July, 1809, by Zac- cheus Collins, Esq. and the late Wm. Poyntell, Esq. who were a committee appointed for that purpose by the board of managers. They were adopted by the board at the next meeting, and still continue in force. PENNSYLVANIA HOSPITAL. 131 SECTION XXXIII. Hints and Propositions suggested to the Managers of that Institution, for the better ventilation of the Wards, and improving some of the internal ar- rangements. Ably conducted as is this institution, systematick as is its internal police, and salutary as are its general regulations, there is, nevertheless, room for amend- ment and reform. It may not be amiss to suggest a few improvements, which I think would render this hospital more complete. I would propose, 1st. That all the wards in the east and west wings (I mean the buildings which front east and west) should be ventilated by means of air-ducts in some one corner of each ward, communicating externally. These wards have no contrivance for ventilation. 2d. That the long wards of the building that joins the centre to the east wing, should be furnished with four or six ventilators in the window-sashes, to ren- der the ventilation of those wards more perfect. 3d. That an air-duct should be introduced into the entry of each story of the west building, that contains the cells for lunaticks, which air-ducts should be ten or twelve feet in length, so as to pass through the cor- ner cells of each story, and communicate with the ex- ternal air; these air-ducts should be introduced al- ternately in the north and south walls, from the lower story. 4th. That a communication should be made between the lower entry and that of the ground-floor, by grat- ings similar to those in the entries of the second and third stories. This could easily be done, by removing 132 AN ACCOUNT OF THK the boards covering the openings that appear to have been originally left. Though I have before remarked that this part of the hospital is uncommonly well ven- tilated, yet these alterations and additions would, I think, render the ventiLiikr niitt, perfect. 5th. I would recommend that vvurm, cold, and va- pour baths be cor si? acted in some convenient part of the east building on the first floor, to be appropriated exclusively to the use of the patients of that part of the hospital, and such private patients (not maniacs) as in- habit the large rooms in the west building. 6th. That two small buildings be erected about twelve or fourteen feet square, and two stories high., at the distance of about fifteen feet from the north end of the east and west wings, and communicating with each story of these wings, by means of a covered corridor. These buildings should contain -the tub-rooms spoken of and described in page 32 of this work. Or should this plan be found inconvenient, such buildings might be erected on any part of the north side of the hospi- tal, that an architect should deem most proper. 7th. That a building containing convenient dissect- ing rooms, be erected in some part of the area of the hospital, remote as possible from the main buildiugs— for the purpose of examining and dissecting dead bo- dies. No hospital is complete without such a building. 8th. That the American chimney-place-stove be erected in the managers' room, the library-room, and as many of the wards as convenient. The first cost of these stoves would be considerable, but their erection would result in an annual saving of three- fourths of the quantity of fuel usually consumed in open fire-places. 9th. That a concise and well written account of the hospital be printed in small pamphlets, of four or five PENNSYLVANIA HOSPITAL. 133 pages, and be sold by the gate-keeper for three-pence each, to such strangers as visit the hospital, who may be disposed to purchase them. Scarcely any person visits an institution of this kind, who would not wil- lingly give three-pence for an account of it—and the annual amount of the sale of such pamphlets at the gate, would, 1 am persuaded, be considerable. The perquisite for shewing the great hall of Greenwich hospital to strangers, is one shilling, three pence of which goes to the person who exhibits it. The re- maining nine-pences make an annual revenue which supports, clothes, and educates, twenty boys, the sons of distressed seamen. I would propose that the fund arising from the sale of such description of the hos- pital, be appropriated toward the support of an addi- tional number of paupers in the institution. 10th. That at some future day, when the finances of the hospital will admit of it, and their vacant lots shall be exempted from the present unjust taxes to which they are subjected, a lunatick asylum be erect- ed on such one of the vacant lots as may be deemed best situated for the purpose ; and that all that portion of the present building now divided into cells, be con- verted into wards for the sick. In fact the legislature of this state should grant an adequate sum of money for this purpose, and enable the contributors to the institution to commence such an asylum immediately. 11th. That the resident physician be invested with more authority and controul over the general economy of the household than he now has. His consequence in that institution, considering the important station he fills, is much too inconsiderable. 12th. That as the attending physicians and sur- geons of the hospital serve gratuitously, the hard duty they are now obliged to perform, in visiting all patients 134 AN ACCOUNT OF THE PENNSYLVANIA HOSPITAL. previously to their being admitted into the house, who are not able to call on them, be, under certain cir- cumstances, dispensed with—and that in such casea the resident physician's certificate for admission shall be deemed sufficient and satisfactory. 13th. That the bedsteads be all raised at least six or eight inches, and that only twenty-four be arranged in each long ward; and six in each of the wards of the east and west wings. With a hope that these hints, which are thrown out entirely with a view to benefit an institution, to the in- terests of which I feel attached, will be received by its managers with the same good will as they are of- fered, I submit them to their consideration. When the motive is taken into view, in suggesting what I believe would be improvements, they will, I am persuaded, receive them well. ----------------—— " Vitavi denique culpam, Non laudem merui." END OF PART FIRST PART SECOND. A SCHEME FOB. AMENDING AND SYSTEMATIZING THE MEDICAL DEPARTMENT OF THE NAVY OF THE UNITED STATES. WITH A FEW OBSERVATIONS ON THE EXPEDIENCY OF ALTERING THE PRESENT RATION; AND PROMOTING THE BETTER VENTILATION AND WARMING OF SHIPS. ALSO, SOME STRICTURES ON THE PRACTICE OF FRE- QUENTLY WET-SCRUBBING THE DECKS IN THE WINTER SEASON; AND THE IMPROPRIETY OF SHIPPING MEN FOR THE UNITED STATES' VESSELS, WITHOUT A STRICT AND CONSCIENTIOUS EXAMINA- TION BY A SURGEON OR SURGEON'S MATE, OF THEIR EFFICIENCY AS ABLE-BODIED MEN. PART SECOND. A SCHEME FOR AMENDING AND SYSTEMATIZING THE MEDICAL DEPARTMENT OF THE NAVY. SECTION I. Introduction. IN the following pages I have made an attempt to introduce into our naval medical department, a syste- matick plan for furnishing the ships and vessels of the United States, with such articles and stores as the hos- pital department requires. I have also made an effort to abolish the present loose and irregular manner in which our medicine and store-chests are replenished, by the indent of the surgeon—and to establish such regulations respecting his responsibility for the just appropriation of the medicine and comforts, as I deem likely to result, if put into rigid execution, in the be- nefit of the service. This benefit will not only be per- ceived in the actual cost of the requisite articles, but will be evidenced in the diminished amount of the bills that come under the inspection of the accountant. For when it is necessary to replenish the medical and hos- pital store-rooms of our ships, at a short notice, in T 138 OBSERVATIONS ON THE some of our inconsiderable sea-port towns, where per- haps but a single druggist's shop is to be found—it is in the power of the apothecary to practice any exor- bitancy or even extortion that he pleases, and the sur- geon has to choose between the alternatives of signing the bills containing such unjust charges, or of putting n to sea, perhaps for a cruise, or long voyage, without the articles he stands in absolute need of. This has happened to me, and, I doubt not, to many other sur geons in the service. In an attempt to amend and systematize the medical department of the navy, it may be proper to state briefly, the chief points that require correction or re- form. The principal objects that demand our attention, and that are susceptible of emendation are : 1st. The introduction of the lemon-acid, in abundant quantities, into free and liberal use in our ships. 2d. The present irregular mode of supplying the ships and vessels of war with medicine and hospital stores. 3d. The lax- ity in the necessary checks to abuses that grow from ^ it. 4th. The faultiness of the regulations respecting the responsibility of the surgeon for the safe-keeping and proper appropriation of the articles intrusted to his Charge, exclusively for the benefit of the sick. 5th. The alteration of the present ration, or at least the li- quid part of it.* 6th. The better ventilation and warm- ing of our ships in the winter season. 7th. The prac- tice of wet-scrubbing the decks in cold and damp Weather; and lastly, the impropriety, and pernicious consequences to the service, of the present plan of're- • This subject I conceive comes properly under the cognizance of the surgeon, since its defects or imperfections have so material an influence upon the health of the crews of ships. In a prophylactick point of view, then, at least, it may be said to appertain to the medical department, MEDICAL DEPARTMENT OF THE NAVY. 139 cruiting;—in which men are shipped without a strict examination by a professional man. I shall also add some few observations on the structure of that part of,a vessel connected with the surgeon's department, and some miscellaneous remarks on the internal go- vernment of ships, &c. It is my intention to consider these points in the order I have mentioned them; but I shall first offer some observations on the subject with a view to invite the attention of the officers of the navjr generally, to the necessity of the change I have pro- posed. I need hardly remind them, that any schemes pro- posed by an individual to the secretary of the navy, are not likely to be well received, unless they be se- conded by officers high in rank and reputation. Such schemes are generally denominated innovations, and are looked upon with a very jealous eye, if not with total disapprobation. To those oflBcers, therefore, who stand at the head of the navy, and whose long and faithful service, justly entitles them to extensive in- fluence in all its departments, I cannot think I shall apply in vain, for their powerful influence in accom- plishing my design. With some of these officers I have frequently conversed respecting the deplorable want of system that marks the medical department of the navy. It affords me the greatest satisfaction to say : that I ever found them willing to give all assist- ance in their power, in establishing any regulations calculated to meliorate the condition of the seamen under their command. I am induced to believe, from the attention with which commodore Rodgers and captain Porter treated my attempt to get the lemon-acid introduced into the navy, that those officers at least, will not now withhold their influence in promoting the adoption of the plans 140 OBSERVATIONS ON THE I have suggested for improving the medical depart- ment. The regard they have always shown for the health of their men, in making any arrangements in their ships for the accommodation of the sick : con- vinces me that my confidence in their willingness to give any assistance in their power, to surgeons desir- ous of benefitting the service, is not ill-placed. I can- not here refrain from mentioning the noble and hu- mane consideration evinced by commodore Decatur and captain Porter, while I served in their ships, in every instance that could call it forth—for the health and comfort of their respective crews. It affords me a lively pleasure to speak in this publick manner, of the prompt co-operation they always afforded me in any of my efforts to relieve the miseries, and promote the comfort, of the men under my medical attendance. Besides this, they spared no pains in ensuring, as far as their assistance could extend, the health, and, of course, the happiness, of the men in general. To their liberality to sick officers, whose condition made it requisite for them to be removed on shore, in authorizing the payment of every little comfort I could suggest for their relief, however expensive—and to the still more generous indulgence extended to myself and my mates, by permitting us to continue as mueh as possible on shore, when such cases occurred, defray- ing our necessary expenses while there : I may justly attribute the satisfaction I feel, of having never lost an officer under my care while in the service. And it is but just to observe, that I have had some on the sick- list, who, but for this noble generosity, must inevitably have died'on board, where, owing to the weather and other unavoidable circumstances, neither comfort, qui- etness, nor accommodation, could be had. Persuaded then as I am, that the health and the hap MEDICAL DEPARTMENT OF THE NAVY. 141 piness of the officers and men under their command, are ever the first objects of their attention—for the achieving of which no pains nor expense will ever be wanting on their parts : I feel confident, that in calling their notice to the regulations and plans 1 have pro- posed in the following pages, I commit them to officers most willing to second my design. Many of the regulations which I have,proposed in this part of the present work, are closely connected with the business of the accountant of the navy depart- ment. Those particularly, requiring surgeons to veri- fy their expenditure returns by oath, and those which are intended to diminish the exorbitancy of charges that are frequently made by druggists for surgeons' necessaries, relate to his office. The mode by which I have proposed to accomplish this end, is by estab- lishing a systematick plan of furnishing and replenish- ing the medical department, which will admit of regu- lar prices, subject only to variation from the rise and fall in the market, of the articles in wholesale quanti- ties. I may therefore very properly call the attention of the present able accountant, Thomas Turner, Esq. to the subject, and solicit his influence in promoting the adoption of my scheme. The very friendly and obliging conduct I have ever received at his hands, in the transaction of official business with him, and a be- lief that'he is persuaded of the necessity for some such reform as I have proposed, embolden me to expect he will not be neglectful of the subject. It is highly necessary that these officers, as well as others in the navy of any influence, should give what assistance they may be able to afford, to those who show any willingness to correct abuses. For my own part, from many, I expect no thanks for what I have done. The schemes I have proposed in- 14U OBSERVATIONS ON THE terfere too manifestly with the private interests of some persons connected with the navy, to please them. Yet, anticipating their displeasure, it will neither surprise nor distress me. I have left the navy with a conscious- ness of having faithfully performed my duty in every si- tuation I was placed, to the extent of my abilities—but I have done more : I have made an exposition of the multifarious abuses with which every surgeon in the ser- vice, disposed to be correct, has to contend. As I found that the irregular direction of the medical department, was a perpetual source of embarrassment tome, so the reform of it may smooth the path of duty for those who follow there. I scruple not to say, that these abuses embittered every hour of my naval servitude ; and gladly indeed did I hail that day which emanci- pated me from trammels so grievous and so weighty! Whenever 1 resisted what I deemed oppression or in- terference with my duty, which I not unfrequently had occasion to do: my independence was rewarded, as may be supposed, by personal dislike and the displea- sure of those whose influence could materially affect my interests. Yet I was never deterred by the fear of this, from the uniform line of conduct I always pursu- ed, viz. acting in obedience to my sense of duty, in op- position to established irregularities and aberrations, regardless of the consequences. The result has been, that I have been put on the half-pay list, with the mor- tification of seeing officers junior to me by many years, enjoying the benefits of lucrative and important sta- tions. I cannot in this place silently pass over, without no- ticing the consequences of it—the violation of that prin- ciple which is the life of naval and military service—I mean that which enforces the observance of seniori- ty in the advancement of officers of whatever grade MEDICAL DEPARTMENT OF THE NAVY. 143 The infringement of this- principle demands the unit- ed efforts of the officers of the navy, to discountenance and abolish it. It is not only unjust in itself, but de- structive of the honourable pride and comfort of offi- cers, and eminently subversive of that harmony, or- der, and subordination, which constitute the very exist- ence of a v/ell regulated navy. Merit and service should never be neglected or forgotten. When ap- pointments are founded on injustice, and expanded un- der the influence of favour: they must, in the nature of things, be no less destructive of the individual hap- piness of officers, than inimical to the contentment of the men. It has ever been remarked, that premature and un- just preferments, especially in the inaval service, en- gender animosities, which sooner or later ripen into in- subordination. The transition from this unruly evi- dence of discontentment to mutiny, is very natural and frequent. Can it be otherwise ? The promotion of junior, over the heads of senior officers; or the ad- vancement to situations of honour and profit, of offi- cers who have recently entered the service, in prefer- ence to those who have devoted their youth, their la- bour, and perhaps their health, to the faithful service of their country-—can only be calculated to dispirit the exertions, not only of those who nave been thus for- gotten, but of those who may expect to share a simi- lar fate. Besides thus depressing the laudable ambi- tion of officers, the practice is invidious; since, to those unacquainted with the abuses of the service, and the latitude that is given to create improper distinctions, it always implies that the officer advanced is eminently entitled to his preferment, while he who is neglected, though senior in rank, is undeserving of reward or ho- nour 144 OBSERVATIONS ON THE Let then this practice of merging the claims of s<- nior officers in the engulphing pretensious of juniors, whether these last have become the objects of favour from the circumstance of political affinity, from ca- price, or from whatever other motive....be rooted out of the service. Let every fibre of its ramifications be de- stroyed, or the rank tree will still send forth its perni- cious shoots. When this is done, then will service be honourable, be desirable. These observations, though true as respects the na- vy generally, are more particularly applicable to the officers of that department which is most defectively organized. I well know, that many of the surgeons of the service feel the truth of what I have advanced. Let them make some effort to subvert this ruinous sys- tem. The purity of my motives for proclaiming the necessity of expunging gross and palpable abuses, cannot now be questioned, since my private interests are no longer dependant on the maintainance, or ex- pulsion of any practice from the navy. Nor is the ag- grandizement of self-interest, in any way connected with denunciations of irregularities of any kind. With a sincere hope that the exertions of the sur- geons of the navy, to benefit the service; and the con- scientious and faithful performance of their duties : may meet with a kinder return than that which greet- ed mine....I submit the following pages particularly to their attention. If I have treated the subject to their satisfaction, I shall feel highly gratified. MEDTCAL DEPARTMENT OF THE NAVY. 145 SECTION II. Of the introduction of the Lemon-Acid into the Navy. Among the important additions that may be made to the medical department, is the introduction of the cla- rified juice of lemons, in liberal quantities. The prevalence of scurvy among sailors is ever dis- astrous and terrifick in its consequences. As it is a disease peculiarly incidental to, if not inseparable from the sea-faring life, it becomes the duty of every surgeon of a ship, and every commander, to promote the use of such prophylacticks as experience has en- titled to a preference. Though this disease does un- doubtedly sometimes make its appearance in ships, garrisons, &c. where the men have not been confined to a diet of salted meat alone, but have been abun- dantly supplied with fresh beef, greens, and other esculeut vegetables and roots: yet there cannot be a doubt that it generally arises from a long subsistence upon salt-junk, assisted in its pernicious effects upon the system by unavoidable exposure to cold and damp- ness. The most effectual remedies for this disease are acids. Of these, the juice of lemons or limes is to be preferred. Every ship should therefore be furnished with sueh quantities of this article as may be sufficient to meet the probable wants of the crew. In the following letter, which was addressed to the late secretary of the navy, two years ago, the benefit of this acid is fully considered. I would here re- mark, that as the object of it still remains to be accom- plished, I hope the present effort will be more suc- cessful than the first: SIR, From the interest I feel in the welfare of the navy, the augmentation of which I anticipate as no improba- u 146 OBSERVATIONS ON THE ble occurrence before the lapse of many years, I have been induced to address you, on one of those points contributive to the health of seamen, which elicit the attention of the surgeon. The British naval annals, and the history of their military campaigns, as well as the accounts of the ope- rations of the armies of France, Russia, Spain, Portu- gal, &c. and the relations of their naval expeditions— afford innumerable instances of the dreadful waste of life, produced by the ravages of disease among sailors and soldiers, which at times has been more fatal than the sword itself. These narrations are replete with accounts of the in- juries resulting from this cause to the national con- tests in which the naval and land forces have been en- gaged. Need I do more than cite two memorable in- stances to attest the truth of this position ?—the fail- ure of the famous English expedition, many years ago, under the command and conduction of admiral Knowles, against Carthagena, on the Spanish Maine; and the more recent, but to the English nation not less disastrous expedition under the command of lord Chatham to the Scheld.—The mortality in the first attempt, from a variety of diseases, but principally the scurvy; and in the second, from the terrifick ravages of the fever of Walcheren, which would have frustrat- ed the designs of the best concerted expeditions—im- press us with a lively sense of the necessity of such re- gulations for the health of seamen and soldiers in our naval and land forces, as will be most likely to pre- serve them from the devastation of those diseases inci- dental to their peculiar mode of life and occupation. With respect to the navy, which is my object at pre- sent, the regulations that are most to be depended on, for preserving and promoting the health of sea- MEDICAL DEPARTMENT OF THE NAVY. 147 men, are such as have in view a diet of healthful qua- lity, the personal cleanliness of the crews, and the pu- rity and free ventilation of the ships they inhabit. It is not my intention at this time to enter into the consideration of these different subjec+s, but to confine myself to a few observations on an article possessing important medicinal virtues, and capaV*. t»i neing made into one of the most wholesome a.v .igi*e»- e diet-drinks that can be made on board of ships) viz.— the clarified juice of lemons. The mode of procuring this article from the fruit is extremely simple. The juice is expressed iiom the lemons, clarified, and a certain portion of rectified spi- rits of wine added to it, to keep it from fermentation and spoiling. Its virtue depends upon the citrick acid, which the juice contains in great abundance; and this acid pos- sesses considerable anti-scorbutick properties, as has been well ascertained. The late introduction of the liberal use of lemon- juice into the British navy, has been proved by expe- rience to be a regulation of great salutariness and im- portance. It is afforded in abundant quantities to all the vessels in his Britannick majesty's service, for the use of the hospital department. The great benefit resulting from the free use of this article, is spoken of by the English surgeons in terms of the highest commendation. I have been informed by some of them, that during the summer season, it is frequently served out from the purser's department, with consent of the men, in ships stationed in warm climates, in lieu of some other article of the establish- ed ration, which can be advantageously dispensed with. They mix it with water, and sweeten it with molasses, and thus make an agreeable, cooling, and 148 OBSERVATIONS ON THE wholesome drink. Sometimes they add a small por- tion of spirit to it, and convert it into a palatable punch, much less injurious than the rum or whiskey and wa- ter, known by the name of grog. The effect of this acid in preventing and curing scurvy, is well ascertained. During the siege of Gi- braltar, in February, 1780, the British garrison, which was reduced to great straits, were obliged to live a considerable time on salted provision, without the use of fresh vegetables. In consequence of this, the scur- vy made its appearance among the troops of the garri- son, and raged in so alarming a manner, as to threaten the most fatal consequences. At this time, the captain of a Danish dogger from Malaga, laden with lemons and oranges, afforded a cure for the disease. The car- go was purchased by the governour for the use of the garrison ; and the free use of these fruits, which were liberally distributed among the troops, soon put a check to this terrifick malady. Captain Drinkwater, in his account of this siege, thus mentions the circum- stance :—i( At this time the scurvy had made dreadful ravages in our hospitals, and more were daily confin- ed ; many, however, unwilling to yield to its first at- tacks, persevered in their duty, to the more advanced stages. It was therefore not uncommon at this period, to see men, who, some months before, were hale, and capable of enduring any fatigue, supporting themselves to their post upon crutches, and even with that assist- ance scarcely able to move along. The most fatal con- sequences, in short, were to be apprehended to the garrison, when this Dane was happily directed to our relief." This scurvy is said by Mr. Cairncross, an eminent surgeon, who was present at the siege, to have 6i differed in no respect from the disease usually con- tracted by sailors in long sea-voyages ; and of which MEDICAL DEPARTMENT OF THE NAVY. 149 the immediate cause seemed to be the subsisting for a length of time upon salted provisions only, without a sufficient quantity of vegetables or other ascescent foods. The circumstauce related in the voyage of that celebrated circumnavigator, lord Anson, of conso- lidated fractures disuniting, and the callosity of the bone being perfectly dissolved, occurred frequently in our hospitals ; and old sores and wounds opened anew from the nature of the disorder. Various anti-scorbu- ticks were used without success, such as acid of vi- triol, sour-crout, extract of malt, essence of spruce, &c. ; but the only specificks were fresh lemons and oranges, given liberally; or, when they could not be procured, the preserved juice in such quantities, from one to four ounces per day, as the patient could bear. Whilst the lemons were found, from one to three were administered each day, as circumstances directed. The juice given to those in the most malignant state, was sometimes diluted with sugar, wine, or spirits ; but the convalescents took it without dilution. Wo- men and children were equally affected, nor were the officers exempted from this dreadful disorder. It be- came almost general at the commencement of the win- ter season, owing to the cold and moisture ; and in the middle of the spring, when vegetables were scarce. The juice was preserved by adding to sixty gallons of the expressed liquor about live or ten gallons of bran- dy, which kept it in so wholesome a state, that seve- ral casks were opened in good condition at the close of the siege. The old juice, however, was not so speedily efficacious as the fruit, though by persevering longer in its use, it seldom failed." When lord Anson sailed round the world, his men were severely afflicted with the scurvy. At the island of Tinian he found an abundance of oranges, and 150 OBSERVATIONS ON THE from an indulgence in the free use of them, the scurvy- patients all recovered. In consequence of the report made by the commodore on his return to England, of the good effect of this fruit on his men, it was deemed worthy the attention of government to inquire into its anti-scorbutick virtue. Accordingly captain Cook, in his last voyage, was supplied with large quantities of lemon and orange juices, inspissated to a rob ;—he, however, was not very loud in his praises of the efficacy of the acid. He objected to its dearness, and thought its good effect depended much on its conjunction with other things. Sir John Pringle, in his discourse before the Royal Society, was of a different opinion from capt. Cook on this subject. He thought these fruits exceed- ingly efficacious in the sea-scurvy. He prefers the juices depurated, to the extract of them, because this last cannot be prepared without dissipating many of the finer parts. Dr. John Gray, one of the physicians of the royal naval hospital at Haslar, informed me. that, during the four years he was physician of the English fleet in the Mediterranean, there fell under his observation scarcely a single case of scurvy, though the ships wore much at sea, and their crews confined for a long time to the use of salted provisions. This circumstance he attributed in a great measure to the liberal use of le- mon-juice, issued to the men from the surgeons, and occasionally from the purser's department. In the following letter, which, as it contains some useful hints on other important points of the economy of ships, I insert at length—you will find an answer to some queries 1 proposed to him on the subject of the lemon-juice : MEDICAL DEPARTMENT OF THE NAVY. 151 Royal Hospital, Haslar, 19th April, 1811. DEAR SIR, I have the honour to acknowledge the receipt of your letter of the 17th inst. and permit me to assure you, it will afford me much pleasure to give you any information in my power to the inquiries you have done me the honour to make, relating to the medical department of the British navy. As you have acquainted me that the Essex will pro- bably sail in two or three days, I am sorry I cannot procure you in time the ration, as issued to the navy. The sick-bay, in ships of the line, is placed forward on the main-deck, under the forecastle, and separated by a bulk-head generally made of canvas, with wood- en frames, so as to be easily taken down and removed, as occasion may require. I am of opinion, the constant wetting and washing decks, more especially during the winter season, is very prejudicial to the health of seamen, producing catarrhal and pulmonick complaints. When it is ne- cessary to wash them, the state of the weather should be attended to ; when cold and moisture prevails, it is preferable to dry rub them with sand.—I cannot ex- actly say what may be the cost of lemon juice on its arrival in this country, freightage inclusive ; but I do not think it much exceeds 2 s. 6 d. (sterling) per gal- lon ; there is a pint of rectified spirits of wine to every nine pints of the juice, to keep it from fermentation. There cannot be a doubt that the citrick acid is a pow- erful means in preventing scurvy, when the ship^s company has been any length of time on salt provi- sions ; but much depends upon the goodness of provi- sions, which has of late years been particularly attend- ed to in the navy ; taking also into consideration the internal economy of the ship, free ventilation of air in 152 OBSERVATIONSS ON TILE every part, with a strict attention to the personal cleanliness of the men. I shall be very happy to hear from you, when an opportunity and leisure permit. Believe me to be, Dear sir, Your most obedient humble servant, John Gray. To Dr. Barton, U. S. ship Essex, Cowes, Isle of Wight. During the latter end of the year 1809, and the sum- mer of 1810, 1 had an opportunity of trying the effica- cy of the simple expressed juice of limes, which was liberally allowed on my indent, by commodore Deca- tur, in eight or nine cases of sea-scurvy, which occur- red on board of the frigate United States. Two of these cases were very bad ones. I had the satisfac- tion to find that 1 easily checked the disorder by an early and liberal administration of lime-juice, undilut- ed, three or four times a day, and in the form of le- monade, for drink, at all times. These good effects were witnessed by Dr. Gerard Dayers, now acting- surgeon of the U. S. brig Viper, and Mr. William Clarke,* at present surgeon's-mate on board of the United States, both at that time my mates in that ship. The juice prepared, as mentioned in Dr. Gray's let- ter to me, just quoted, is the same kind as that of which 1 had the pleasure to furnish you a specimen by lieutenant Ballard, last July. It was one of four dozen bottles 1 brought from England. This quanti- ty was generously furnished by captain Smith, upon my requisition, although it had never been customary * The first of these gentlemen is now surgeon of the Adam's frigate, and the latter, surgeon of one of our sloops of war. N MEDICAL DEPARTMENT OF THE NAVY. 153 to allow the article to our medical department. The experience I had with this acid during our passage home of two months, confirmed the high opinion 1 had conceived of its usefulness in large quantities, from the information I had received of the British surgeons, as well as the limited experience I myself had with it in commodore Decatur's ship. I found it peculiarly efficacious in relieving the stomach from that distressing and convulsive reching from sea-sick- ness, by mixing it with a portion of the salt of tartar, and administering the draught in the quantity of half a tumbler full, while in a state of effervescence. Two of the most distressing cases of sea-sickness that I ever witnessed, were on board the Essex in our home passage—the lady of the late American minister, and lieut. Grayson, of the marine corps, who was bearer of dispatches. Though neither of these persons seem- ed to be aware of the danger they were in, from the violent convulsive reching that always came on dur- ing any turbulence of the sea, yet T was not unfre- quently very justly apprehensive of serious conse- quences supervening upon this uninterrupted sickness. They were both much relieved by occasionally quaf- fing the effervescing lime-juice ; and I am persuaded that the temporary relief thus obtained, which was ge- nerally followed by a short respite from the convul- sive reching, enabled them to support life during the continuance of rough weather. From all these circumstances, I am strongly im- pressed with a desire to propose the introduction of preserved lemon or lime-juice, into general and libe- ral use in our ships and vessels of war. It is prepared in the island of Sicily, and other parts of the Mediterranean. It is purchased on the spot for Is. 6d. sterling per gallon. x 154 OBSERVATIONS ON THE I think one of our small publick vessels might be sent thither for the purpose of purchasing on account of government, a large quantity of the juice. Thus would the freightage be saved, which, were it import- ed iu merchant ships, would be very considerable. I submit the feasibility of this plan to your better judgment and decision. In whatever way, however, this article be imported into this country, care should be taken to procure it good, as its long preservation depends materially upon its pristine purity. If, sir, you should think'it expedient and proper to allow the hospital department of our ships to be fur- nished with this article, I would propose that it be yielded to them in the proportions mentioned in the tables I have drawn up in the following pages.* With a hope that this scheme, which, with a view to the benefit of the service, I have offered for your consideration, will meet your approbation, I have the honour to be, Sir, with very great respect, Your obedient servant, William P. C. Barton. Lancaster, Nov. 1811. To the Hon. Paul Hamilton, Esq. Secretary of the Navy, Washington. The preceding letter was an effort to accomplish aa object which I could not but believe was one eminent- ly entitled to the notice of the secretary of the navy. With a view to give my proposal more w eight, I ap- plied to commodore Rodgers and captain Porter, for their assistance in the business. The answers of these officers were highly favourable to the design of the plan suggested in the letter to Mr. Hamilton. Th* * See Section IU. following. MEDICAL DEPARTMENT OF THE NAVY. 155 motive that induced me to write it, was grounded en- tirely on a desire to benefit the service. I was too ful- ly convinced of the absolute necessity for the introduc- tion of this acid into use in our ships, not to make eve- ry possible effort in my power to accomplish so impor- tant an object. Why th se attempts on my part, to call the attention ot the secretary to the subject, were unavailing; or how it happened that my endeavours to elicit his inquiries respecting the expediency of ilie plan I had proposed, were fruitless : I know not. Ul I can say is, that both proved abortive, and my memo- rial was not noticed IV-.un the department. Though the first proposition was not acceded to, it may not be inexpedient to make a new effort to achieve so desirable an object. In order that this second at- tempt may have more weight than the former one, I will insert two letters from officers of high standing, in favour of adopting such a plan. For the sake of connexion, I shall insert the whole of the correspon- dence, which was as follows : Newport, R. I. December 28, 1811. SIR, To a commander who takes so much interest in, and so much pains to establish the comfort of his men, as do you, I feel assured I shall not apply in vain for co-operative influence in accomplishing the adop- tion by the secretary of the navy, of any plan contri- bute ve to the health of the crews of our ships, and, in- so-far, the well-being of the navy. I therefore send for your perusal, a letter address- ed to Mr. Hamilton, on an important subject as con- cerns the health of seamen. I could wish to have your opinion on the subject of it, and, if you think proper, your iuftuence in recommending it to the notice of the secretary. 156 OBSERVATIONS ON THE The letter, of which the enclosed is a copy, 1 trans- mitted to Mr. Hamilton in November last. 1 am, sir, with great respect and esteem, Your obedient servant, William P. C. Barton. Capt. Porter, Essex. U. S. Frigate Essex, Newport Roads, 31st Dee. 1811. SIR, I have received your letter of this date, accompa- nied by the copy of a communication made by you to the honourable secretary of the navy, on the introduc- tion of lemon-juice into general and liberal use in the hospital department of ships and vessels of the U. S. navy. I feel myself highly flattered by the manner in which you have requested my opinion on the subject, and, so far as my influence may extend, over vessels destined on distant voyages, shall certainly use means to have them liberally supplied with the article recommended by you: I shall also recommend to my brother offi- •cers the introduction of it on board their vessels ; and shall take the first favourable opportunity of mention- ing the subject to the secretary of the navy. My opinion as to the efficacy of lime-juice in pre- venting and removing scorbutick complaints, has been long since firmly established, founded on some of the facts mentioned in your letter, and on experience. In the Mediterranean, where the opportunities of provid- ing fresh provisions for the crews were not so frequent as on the home station, my vessel, by the advice of doctor Heap, was constantly supplied with lemon- juice, which we provided at Messina in large quanti- ties, nearly as cheap as vinegar, and issued to the crew in the lieu thereof, by which means my men were medical department of the navy. 157 never affected by the scurvy, when several cases of it appeared about the same time on board other vessels on the same station. Salt of lemon I have also found to have its beneficial effects, more convenient because more portable, but much too expensive for general use. On long voy- ages through different climates, where the transitions from heat to cold and from dry to wet are very great and frequent, the ravages of the scurvy are more dreadful, and lemon-juice is found to be indispensa- bly necessary as a preventive to that disease ; for af- ter long use of salt provisions, fresh provisions and ve- getables have not the desired effect, as they frequently bring on dysenteries more destructive to life than the scurvy ; indeed, there have been instances of persons on long voyages, who have suffered greatly by scorbu- tick affections, that have abstained entirely from the use of salt provisions. It requires the utmost care to preserve a northern constitution on the coast of Africa, near the line, from the scurvy; and I have understood that the British ships of war stationed there, are well supplied with lime or lemon-juice, and that to each of the crew a spoon-full is issued, to be taken every morning fast- ing, and has been found to have the effect wished; this practice is also pursued by some of the most provident India captains, and to that circumstance is frequently owing the preservation of the health of their crews. Sudden and frequent changes of climate, great ex- posures to inclement weather, violent fatigue, the bad air created on board ships from uncleanliness, and bad provisions and water, are among the principal causes of the scurvy at sea; some of those causes also pro- duce the same disease in armies; and it is beyond a doubt, that the most powerful remedy for the com- 158 OBSERVATIONS ON THE plaint, is acid of lemons or limes ; with which all those having charge of the medical department should always be supplied, and the quantity should be in pro- portion to the liability of men being exposed to such causes. In the present state of our navy, while in our natu- ral climate, where we are not greatly exposed, when due attention is paid to the comfort of our men, and the cleanliness of our ships, cases of the scurvy rarely occur; but the time may come when we may be order- ed on a different service ; and should it be the case, I am convinced that a strict attention to your plan would guard the seaman from the greatest evil to which he is liable. I have the honour to be, respectfully, Your obedient servant, D. Porter. Dr. Wm. P. C. Barton, Surgeon of the U. S. frigate Essex. Newport, R. 1. January 4, 1812. SIR, From the desire I feel to get introduced into our navy, the free use of clarified lemon-juice, as allowed to the ships and vessels in his Britannick Majesty's navy, I addressed a letter in November last, to the secretary of the navy on this subject. I deem this an article so invaluable, nay so indis- pensable, to the hospital department of ships of war, in large quantities on foreign service, and in smaller proportions on the home station—that I would wish to have my proposition for its introduction into our navy, seconded by that influence which the coinciding opinions of commanders of high standing always does, and ever ought to afford, in the establishment of any MEDICAL DEPARTMENT OF THE NAVY. 159 plan or plans, for the better conditioning the crews of our ships. I therefore exhibited to the very sensible and well^ informed commander of the frigate to which I am at?' tached, a copy of my letter to the secretary on the subject of the lemon juice, and requested his opinion on the salutariness and efficiency of introducing the liberal use of it as proposed to the secretary, on board the ships and vessels of war belonging to the United States. His letter to me on this subject, is highly in favour of its introduction, when our navy shall be so much extended, that our ships may be frequently ordered on foreign service. It speaks however for itself. I have taken the liberty to send it, together with a copy of my letter to the secretary, for your perusal. It will afford me great pleasure if you, too, are fa- vourably inclined towards the introduction of this ar- ticle into our navy. Your influence in recommending to the attention of the secretary, the consideration of this subject, I should be glad to see exerted, provided you think the subject merits it. May I beg the favour of you, to give me when you return the enclosed letters, your opinion on this subject. I have the honour to be, sir, With very great respect, Your obedient servant, William P. C. Barton, Commodore John Rodgers, President Frigate, Newport Roads, 160 OBSERVATIONS ON THJt U. S. Frigate President, Newport, Jan. 6,181S- SIR, ^#- Your letter of the 4th inst. with the papers it ac- companied, relative to the benefits which you suggest would result to the crews of our ships of war, by a more general and frequent use of the clarified lemon- juice, I duly received. Your observations relative to the effects of this va- luable acid, as a preventive against scurvy; as also of its efficacy in removing from the system that horrid disease, to which seamen (especially after long voy- ages, when their diet has consisted principally of salt- ed provisions) are particularly liable, I have perused with much pleasure: as w7ell because they serve as a proof that you wish to benefit the service by your ex- perience; as of my conviction of the correctness of what you represent. In the course of my own obser- vation, I have in many instances witnessed the salutary effects of acids, and particularly those of limes and le- mons, not only in removing scorbutick affections from, but in fortifying the system against the disease; and I have not the least doubt, but the most beneficial ef- fects would result by the introduction of lime or lemon juice on board of our ships of war, in the manner you mention; particularly when they are employed on fo- reign service. In the years 1800 and 1801, I cruised near thirteen months on the coast of Guiana, in the U. S. sloop of war Maryland; and although the climate is considered one of the most unwholesome, my ships' company ne- vertheless, from having very little communication with the shore, was for a considerable time particularly heal- thy. The men being obliged however to live almost entirely on salt provisions, the scurvy (after eight or MEDICAL DEPARTMENT OF THE NAVY. l6l nine months) made its appearance, and in a short time made such ravages on the constitutions of a large por- tion of them, as necessarily obliged me to return into port, (Surrinam) where, to my astonishment, in fifteen days after my arrival, by the profuse use of limes and sour oranges, which were not only taken internally, but applied externally, by cutting them and rubbing the body, legs, thighs, and arms, with them several times a day, the complaint was completely eradicated from the system of every person who had had it; al- though several of them had been affected to such a de- gree as to lose, some a number of, and others the whole of their teeth. After this, from the profuse and con- stant use of the same description of fruit, the same men, as well as the rest of the ships' company, continued healthy and particularly free from scorbutick affec- tions. In my own estimation, this case being of itself a sufficiently conclusive proof of the importance of lemon-juice, I shall content myself at present by add- ing, that I hope your endeavours to get it introduced into She service to the extent you mention, may meet with that attention which they so justly merit; and I would have you to be assured that, so far as is in toy power to render you any assistance in effecting so de- sirable an object, I will do so with infinite pleasure. Verjuice, or cider made from crab-apples, is, I have understood, endowed with anti-scorbutick qualities, not very far inferiour to lime or lemon-juice. This li- quor can at all times be procured in our own country, and I beg leave to suggest to your better experience, whether, on home service, it would not answer in the place of lemon-juice. I have noticed, with particular pleasure, Captain Y 162 OBSERVATIONS ON THE Porter's remarks to you on the virtues of lime and lemon-juices; they are certainly very pertinent and well worthy of respectful notice. I am, sir, With great respect, Your obedient servant, John Rodgers. Dr. Wm. P. C. Barton, Surgeon of the U. S. Frigate Essex. SECTION III. Of the mode of furnishing the medicine and store chests. The next subject of consideration, according to ray plan, is, the present irregular and unsystematick mode of supplying the ships and vessels of war, with medi- cines and hospital stores. According to the existing custom, when a surgeon joins a ship, he examines into the state of the medicine chest, and the condition of the hospital store-room. He then draws up, if he thinks proper, a requisition for all medicines, stores, articles, utensils, instruments, &:■. that, in his opinion, are necessary to complete the medical department. This is signed by the comman- der of the ship, who, in all probability, knows not whe- ther the articles he is authorizing the purchase of, be necessary or not—he is unacquainted with the names of medicines, or the requisite quantities of them. If the surgeon happen to be experienced in the service, and a conscientious man, his requisition will exhibit a faithful schedule of the deficient necessaries, and in such case the government is neither defrauded, nor imposed upon by unnecessary cost. But, should the surgeon, on the other hand, not be that upright and MEDICAL DEPARTMENT OF THE NAVY. 168 fair man—or if he he rigidly honest, but inexperienced in such matters, what a latitude is there for fraud, em- bezzlement, and imposition !—or how innocently may the surgeon be betrayed into the errour of overfurnish- ing. and thus oppressing the government with unne- cessary expense: or into the opposite extreme, of reple- nishing too parsimoniously, and thus contriving injury to the service—so far as it be connected with the ship to which he may belong! In fact, there cannot be a system more opposite to economy, more incompatible with the good of the ser- vice, or more pernicious in the temptation it holds forth, for unnecessary waste, and even fraud: than this plan of allowing the medical and hospital store-chests of our ships, to be fitted out and replenished upon the indent of the surgeon of the ship. It is true, an appa- rent check would seem to exist in the necessity there is lor the approval of this indent; but this is a mere nominal controul. It has no virtual operation or effect on the licence of the surgeon to commit irregularities, and vanishes entirely upon a nearer inspection.—For how can the commander of a vessel be reasonably sup- posed acquainted with the precise proportions of me- dicines, stores, &c. requisite for the use of his ship? His ignorance on this s .hject would tend to make him diffident of withholding ids ratification, even though he should feel so inclined. It is therefore, expedient to guard against possible abuses, so far as practicable; aud to forbear by the establishment of loose systems, to invite irregularities. The practice of fitting out the medical department of ships, in accordance to the indent drawn up by the surgeons of them, existed many years ago in the Bri- tish navy But it was discovered, that the abuses and temptations to embezzlement, to which it necessarily 164 OBSERVATIONS ON THE gave origin, were of a nature extravagantly rukious. Accordingly the plan of established proportions was adopted, and the evil thus remedied. The practice of permitting apothecaries to make re- quisitions, in the absence of the surgeon of the ship, and to furnish the articles specified by themselves, or to survey the ships when the medical department wants replenishing, is equally improper. It cannot, I apprehend, be productive of any thing else, than a me- dicine-chest overloaded with a superabundance of use- ful, and often-times a cumbersome load of useless ar- ticles—a store-room, furnished with a superfluity of bad, and a paucity of good and wholesome comforts— and a slender proportion of such articles or medicines, as either from their rarity or expense, hold forth no prospect to the apothecary of reaping an exorbitant profit from overfurnishing them. Wlien I was ordered to the frigate United States in the beginning of the year 1809, I found the medical department of that ship overstocked with an useless mass of old, inert, and bulky medicines, roots, &c.— and of those that were useful and good, there was such a superabundance, as to be troublesome to take care of, and in fact more than enough for a cruise of three years. 1 believe I was not singular in my complaints on this subject. Several of the surgeons of the other vessels, particularly the larger ones, furnished with medicines, &c. at Washington, by the indent of the contractor, were sensible of the same abuses. It is always impolitick to choke up the store-room, which is at best very small, with such an useless quan- tity of medicines. They either become damaged, or cause the surgeon or his mates to be wasteful. The impropriety of uniting the office of director and purveyor, either in hospitals, or in the medical depart- MEDICAL DEPARTMENT OF THE NAVY. 165 nieut of ships, from the invitation it extends to the most nefarious practices, has long been known in the British army and their naval and military hospitals. It is noticed by almost all English writers on this sub- ject, who lay peculiar stress upon the impolicy of such a system. Monro, in his work on the army, speaks with strong emphasis, of the pernicious and destructive consequences of this practice—and of the known de- triment that frequently accrued from it, to the poor dis- tressed soldiers. The province of a purveyor, or contractor, ought to be entirely distinct from that of the director. And tiie druggist who furnishes the medicines, and the grocer who supplies the store chests of our ships, ought to have nothing to do with the specification of the quan- tities of medicines and necessaries required to complete them. With a view to correct these abuses, I would in the first place propose: that there be established a sufficient number of commissioners to govern the medical de- partment of the navy, and that they be styled a " board of medical commissioners, for conducting the hospital department of the U. S. naval service, and providing for sick, hurt, and disabled seamen." I would recommend that for the present, this board shall be composed of six or eight of the senior sur- geons of the navy, of known abilities. It should be their peculiar province to furnish the navy department with such schemes, or systems of arrangement, as in their opinion would be adopted with most interest to the service. They should create established propor- tions of medicines, dietetick articles, instruments and utensils, necessary for the different vessels, &c. &c. Such an association appertains to the British navy, under the title of " Commissioners for conducting his 166 OBSERVATIONS ON THE majesty's transport service, for taking care of sick and hurt seamen, 5fc." I would propose that the board of medical com- missioners, should also be" a board of examiners of candidates for the appointments of surgeons, and surgeons'-mates in the navy—and that persons should never be commissioned in these capacities in the United States naval service, until they had satisfac- torily passed this board.* In fine, the board of medical commissioners should maintain a general su- perintendance over the medical department of our ships, and should from time to time, suggest to, or ad- vise the secretary of the navy, of any alterations, amendments, or arrangements, that in their opinions might be deemed for the benefit of the medical naval service. The physicians and surgeons of the hospital or hospitals at Washington, as the seat of government, might ex officio, constitute a standing part of the board. It should be their duty to examine the returns of ex- penditure and practice, made by the surgeons to the navy department, after a cruise. They should survey the state of the instruments, as well as the remains of medicines, stores, utensils, &c. returned by the sur- geons of ships, and which are to be re-deposited in the store-rooms of the hospital agent. The physi- cians and surgeons of the hospital at Washington, Philadelphia, Norfolk, New-York, Newport, and Boston, should be styled, agents of the board of medi- cal commissioners—and should receipt to the sur- geons for every thing returned by them into the hospi- tal agents' store-rooms on these different stations; and should file a specification of their condition when re- turned. * Graduates in medicine should be exempted from this examination, un- less there is reason to believe they have received their degrees by favour. MEDICAL DEPARTMENT OF THE NAVY. 167 Until such a board of commissioners be organized, I would propose, for the furnishing of our ships with medicines, comforts, and necessaries, the following tables of proportions. They contain the exact proportions in which medi- cines, utensils, fumigating articles, comforts, bedding, lemon-juice, and other necessaries ought to be furnish- ed to our ships of war, so as to supply them amply with every thing requisite; maintaining at the same time as strict an observance of economy, as is consist- ent with the necessities of the sick, and of consequence the interest of the service. Although we have not at this period any ships of the first or second rate actually afloat, yet with a view to render the subject complete, and because I look for- ward with pleasing anticipations, a few years, when a proud fleet of ships of the line shall stretch itself along our shores, 1 have added tables of proportions for such vessels. They will be useful, I hope, when our seventy- fours are built and commissioned. I am persuaded this plan would be a saving of one-third, or perhaps one-half, of the present cost of our medicine and store chests. The articles in the proportions here stated, should be properly put up in chests, boxes, &c. and be ready for delivery, on the shortest notice, to any ships that may want them, by the agent of the medical com- missioners, in such port or station as the vessels re- quiring out-fit may be at. When these vessels only want replenishing, it ought to be the duty of the medical agent of the port, to survey the state of the medicine and store chests, and furnish such articles as are deficient. The economy and promptness of such a plan must be obvious to every one. 168 OBSERVATIONS ON THE Proportion of Medicines, Utensils, and Fumigating Articles, for a Ship of the First Rate. Acid. Nitros dilut. Acid, vitriol, dilut. Adip. suilloe, . . Ammonia praep. . Antimon. tart. Antimon. pulv Aq. amnion, pur. Aq litharg. acet Argent, nftrat. Calomel, . . . Camphor, . . . Cera flav. . . . Cerat. lap calam. Cerussa. acetat. . Cinchon. pulv. Con feet, aromat. Confect. opiata, . Crem. tart. . . Creta p p . . Cuprum vitriol, Digital, pur. pulv. Emplast. cantharid Emplast. cera c. Emplast. litharg. Emplast. litharg. c. resin, Extract colocynth. c. aloe, Flor. chamaemel. Flor. sulph. . Flor. sulph. viv. Gum ammon. gutt Gum. arab. . . Gum. guaiac. . . Hydr. nitr. rub. Hydr. muriat. . . Jalap, pulv. . . Ipecac, pulv. . . Ipecac, pulv. com. Kali p. p. ... Liq. vol. C. C . . Magnes. alb. . . Magnes. vitriol. . Natron vitriol. . . Nitr. purif. . . . OI. lini, .... OI. menth. pip. OI olivar. . . . OI. ricini, . . . OI. terebinth. . . lb. oz. 3 12 12 1 1 6 2 1 4 8 1 32 1 4 12 4 8 4 6 4 8 96 48 6 6 12 Opium purif. . Pil. hydrarg. Ras quassiae, . Rhab. pulv. Sal. vol. C. C, . Sem. lini, . . Senna, Sperma. ceti. . Sp. aether nitros. Sp lav end. comp Vin. rect. . . Tinct. digital. . Tinct. ferri. muriat Tinct. opii, . . Tinct. rhoei, Tinct. scillae, . Ung. cerse, Ung. hydr. fort. Ung nitrat, Ung. resin, flav. Vin. antimon. . Zinc, vitriol, Zinziber. pulv. lb. oz- 1 1 1 1 12 4 3 1 4 1 8 12 8 12 24 16 1 16 12 8 Fumigating articles, at the ofition of the surgeon, Vitriolic acid, ... 40 lbs. Nitre purif. .... 40 UTENSILS. Bolus knives, . . . No. 2 Tiles,...... 2 Bottles, h pint, ... 66 „,. . C2 ounce, . . 66 Phials -J , ... ' cc I 1 ditto, . . 66 Corks 5* Pint> ' ' §ross4i Gallipots, in sorts, . . No. 66 Pewter measures, . . Mortars and pestles (mar- ble), ..... Ditto, ditto, (metal), . Dkto, ditto, (Wedgewood), Scales and weights, Spatulas 3p°Vc Funnels, Sponge, Fine tow, I Plaister, set No. oz. lbs, 2 10 16 MEDICAL DEPARTMENT OF THE NAVY. 169 Proportions of Bedding, Lemon juice, and Necessaries, for a Ship of the First Rate. J3 . ["Sheets, Pillows, Night-caps, Hair-beds, Lemon-juice, Calico, Welch flannel, Lint, Tourniquets, t i "| Right side, §.§ i-Left side, -g £ J Double, . Bed-pans, Urinals, Spitting-pots, g . "J Two quarts, • t o g L Three pints, ^3 2 p. J One pint, Tea, Sago, e-| . Rice, o * u*<^ Pearl-barley, £"3 £ | Soap, . -0 5 S | Soft sugar, £ S JP ^Portable-soup, o H Cases, Bottles, ! Chest for calico, &c. Chest for grocery, Boxes for portable-soup, « ""j Tea, | I Sago, |J [>Rice, j " j Pearl-barley, | p J Portable-soup, '^Cask for sugar, 20 pairs. 20 No. 20 — 20 —. 54 galls. 200 yards. 140 ---- 10 lbs. 15 No. 12 — 6 -— 3 — 2 — 2 — 8 -r 1 — 2 — 72 lbs 64 — 128 — 128 — 25 — 412 —- 100-— 6 No. 108 — 1 — 1 — 2 — 1 — 1 — 1 — 4 — l — Z 170 OBSERVATIONS ON THE Proportion of Medicines, Utensils, and Fumigating Arlicles for a Ship of the Second Rate. lb 3 7 28 Acid. Nitros dilut. Acid, vitriol, dilut. Adip. suilloe, • • Ammonia praep. -. Antimon. tart. Antimon. pulv Aq. ammon. pur. Aq. litharg acet. Argent nitrat. Calomel, . . . Camphor, . . . Cera flav. . . . Cerat. lap calam. Cerussa. acetat. Cinchon pulv. Confect. aromat. Confect. opiata, . Crem. tart. . . Creta p p . • Cuprum vitriol, Digital, pur. pulv. Emplast. cantharid Emplast. cera c. Emplast. litharg. Emplast. litharg. c. resin, 3 Extract, colocynth. c. aloe, Flor. chamaemel. Flor. sulph. . . sulph. viv. Gum ammon. gutt Gum. arab. Gum. guaiac. . Hydr. nitr. rub. Hydr muriat. . Jalap pulv. Ipecac, pulv. Ipecac pulv. com Kali p. p .... 3 Liq- vol. C. C . . . 2 Magnes alb. ... 2 IVlagnes. vitriol. . .84 Natron vitriol. . . . 42 Nitr. purif. .... 5 OI. lini,.....5 OI. menth. pip. OI. olivar. .... 7 OI. ricini, .... 3 OI. terebinth. ... 1 oz. dr. 7 8 8 7 3 4 14 14 4 1 6 12 14 8 14 7 5 1 3 8 1 12 7 3 10 8 3 8 8 7 5 4 3 8 7 7 2 10 10 7 1 2 10 14 7 8 10 10 4 4 2 8 12 Opium purif. Pii. hydrarg. Ras quassiae, Rhab. pulv. S«d. vol C C, . Sem. lini, . . Senna, . • Sperma. ceti. . Sp. aether nitros. Sp lav end. comp Sp vin. rect. Tinct. digital. . Tinct ferri. muriat Tinct. opii, . . Tinct. rhoei, Tinct. sciilcE, Ung. cerae, Ung. hydr fort. Ung nitrat, Ung. resin, flav. Vin. antimon. . Zinc, vitriol, Zinziber. pulv. lb. 1 10 3 2 oz. dr. 5 14 5 14 5 2 8 8 10 10 4 1 5 8 14 7 10 4 12 7 21 14 14 14 10 7 12 Phials Fumigating articles, at the ofition of the surgeon. Vitriolic acid, Nitre purif . UTENSILS Bolus knives, Tiles, .... Bottles, $ pint, . ( 2 ounce, I 1 ditto, Corks $>?' I Phial, . Gallipots, in sorts, Pewter measures, Mortar and pestle ble), .:..-. Ditto, ditto, (metal), . Ditto, ditto. CVedgewood), set No. . 35 lbs. . 35 . No 2 2 60 60 60 . gross 4 8 . No 60 2 (mar- Scaies and weights, c . i <\ Pot, Spatulas Jpi£iister} Funnels, . . Sponge, . . . . Fine tow, . . . oz. lbs. 2 10 14 MEDICAL DEPARTMENT OF THE NAVY. 171 Proportions of Bedding, Lemon-juice, and Necessaries, for a Ship of the Second Rate. Sheets, Pillows, Night-caps, I Hair-beds, > 3 X G * J -a i Lemon-juice, Calico, Welch flannel, Lint, Tou; niquets, B o V a i "j Right side, g_ 2 I. Left side, 3 £ j Double, . x o T3 !fl B B o x . b3 .3 Bed-pans, Urinals, Spitting-pots, i 1/3 X 3 C T3 ' B o u CO x o H Lemon-juice, Calico, Welch flannel, Lint, Tourniquets, u «' "J Right side, S.5 I Left side, £ £ J Double, Bed-pans, Urinals, Spitting-pots, -3 f £•5 CD C o x u'3 u > >. }Two quarts, Three pints, One pint, » fTea, Sago, I Rice, { Pearl-barley, Soap, Soft sugar, Portable-soup, . Cases, Bottles, Chest for calico, 8cc. Chest for grocery, Boxes for portable-soup, « "J Tea, | I Sago, g.S J>Rice, V"*" j Pearl-barley, £ J Portable-soup, Cask for sugar, 174 OBSERVATIONS ON THE Proportion of Medicines, U ensils, and Fumigating Articles, for a Ship of the Fourth Rate. lb. oz dr Acid, nitros dilut. 3 Acid vitriol, dilut. 4 8 Atiip. suilloe., . 4 8 Ammonia praep. . 3 Antimon tart. . 1 Antimon. pulv. . 6 Aq ammon. pur. . 6 Aq litharg acet. . 2 4 Argent nitrat. Calomel, . 12 Camphor, . . 6 Cera flav . . 18 Cerat lap. calam. . 3 Cerussa acetat. Cinchon pulv. . 12 Confect. aromat. . 3 Confect. opiata, . 9 Crem. tart. Creta p. p. . . 12 Cuprum vitriol, . 3 Digital, pur pulv. . 1 Emplast cantharid. 4 8 Emplast. cera C. 18 Emplast litharg. . 3 Emplast. litharg. c, resin, 1 8 Extract colocynth.c Fior. chamsemel, Fior sulph. suiph. viv. Gum. ammon. gutt Gum. arab. Gum. guaiac. H>dr nitr. rub Hydr. muriat. Jalap pulv Ipecac pulv Ipecac pulv. com. Kali p. p. Liq. vol. C C. Magnes ulb. Magnes vitriol. Natron vitriol. Nitr. purif. OI lini, OI menth. pip. OI oiivar, OI ricini, OI. terebinth, aloe, 2 4 1 8 3 3 1 2 4 3 1 2 6 3 1 8 1 1 36 18 2 2 3 1 4 4 1 8 12 Opium purif. . PL hydrarg. . Ri.s quassiae, - Rnab. pulv S«J.vol. CC Sem. lini, Senna, Sperma ceti, . Sp jEther nitros, Sp lavend.comp. Sp. vin rect. . Tinct digital. Tinct ferri. muriat. Tinct. opii, finct ihoei, Tinct acillae, . Ung cerae, Ung. hydr. fort. Ung. nitrat, Ung. resin flav. Vin. antimon. Zinc, vitriol, Zihziber. pulv. oz. dr. 9 6 9 6 2 2 2 4 9 8 6 3 4 12 3 4 3 12 Fumigating articles, at the ofition of the surgeon. Vitriolic acid, Nitre purif. 20 lbs. 20 UTENSILS. Bolus knives, Tiles, Bottles, I pint, „, . , C 2 ounce, Phials No. 2 2 36 36 36 gross 3 6 36 3 1 ditto, Corks 5*Pint' ' uoncs ^phial, _ Gallipots, in sorts, . No. Pewter measures, Mortar and pestle (marble), Ditto, ditto, (metal), . Ditto, ditto, (Wedgewood), Scales and weights, Spatulas ^;ster> Funnels, Sponge, . Fine tow, set No. 2 oz. 6 lbs. 6 MEDICAL DEPARTMENT OF THE NAVY. 175 Proportions of Bedding, Lemon-juice, and Necessaries, for a Ship of the Fourth Rate. x 'Sheets, . Pillows. Night-caps, Hair-beds, Lemon-juice, Culico. V'elch flannel, Liat, Tourniquets, ^~) ±i } Rig' £ I £= >^h ° ~ Z l 5 \ O Right side, side, bie, tfevi-j^ns, Urinals, Spitting-pots, Pi 1 1 Wl 'I \\ fT,U Two quarts, ee pints, ne pint, CO 2 X! «-* V C5 ^ 0 6 ^< o 2 u < V '3 > CU >* 3 X CO 0 fTea, Sago, Rice, Pearl-barley, Soap, Soft sugar, Portable-soup, .•.- § « C Cases, £.'=, £ Bottles, Chest for calico, 8cc. Chest for grocery, Boxes for portable-soup; rt < K/> 1 Tea, I I Sago, gj; ^>Rice, j Pearl-barley, C J Portable-soup, ^Cask for sugar, 9 pairs. 9 No. 9 — 9 — 27 galls. 80 yards. 50 --- 5 lbs. 8 No. 9 — 6 — 3 — 2 — 2 — 3 — 1 — 1 — 2 —. 27 lbs. 24 — 48 — 48 — 10 — 192 — 50 — 3 No. 54 — 1 — 1 — 1 — 1 — 1 — 1 — 1 « 2 — 1 — 176 OBSERVATIONS ON" THE Proportion of Medicines, Utensils, and Fumigating Arlicles, for a Ship of the Fifth Rate. lb oz. dr. lb. oz. dr. Acid, nitros dilut. 2 4 Opium purif. 7 4 Acid, vitriol, dilut. 3 12 Pil hydrarg. 5 Adip. suilloe, 3 12 Ras quassiae, 7 4 Ammonia praep. 2 4 Rliab puiv. 5 Antimon. tart. 1 2 Sal vol. C. C. 1 7 Antimon pulv. 5 Sem. lini, 3 12 Aq. ammon. pur 5 Senna, 1 4 Aq litharg. acet. 1 14 Sperma. ceti. 15 Argent nitrat. 5 Sp. aether nitros. 3 6 Calomel, 10 Sp. lavend comp. 7 4 Camphor, 5 Sp. vin. rect. 1 4 Cera flav. 1 4 Tinct. digital. 5 Ccrat. lap. calam. . 2 8 Tinct. ferri. muriat. 2 4 Cerussa, .:cetat. 5 Tinct. opii, 3 6 Cinchon pulv 10 Tinct. rhoei, . 10 Confect. aromat. 2 4 Tinct. scillae, 2 4 Confect. opiuta, 7 4 Ung. cerae, 7 8 Crem tart. 1 4 Ung hydr. fort. 5 Creta p.p. 10 Ung. nitrat. 5 Cuprum vitriol, 2 4 Ung. resin flav. 5 Digital pur. pulv. 1 2 Vin- antimon. 3 6 Empiast cantharid. 3 12 Zinc vitriol, 2 4 Emp.ast. cera. C 1 4 Zinziber. pulv. 10 Emplast. litharg 2 8 Emplast. litharg c r esin, 1 4 Fumigating articles. at the ofition Extract co»ocynth. c. aloe, 2 4 if the surgeon. Fior. chamaemel, 1 14 Vitriolic acid, 15 lbs. Flor. sulph. 1 4 Nitre purif. 15 sulph viv. 2 8 jGum ammon. gutt. 2 4 UTENSIL! Gum. arab. 15 Bolus knives, . No. 2 Gum. guaiac. 3 6 Tiles, 2 Hydr. nitr. rub. 2 4 Bottles, ^ pint, . 30 Hydr. muriat. 5 ™H?dZ? 30 JaLp pulv. 15 30 Ipecac, pulv. . 5 c°* \}C; . gross 2| Ipecac, pulv. com. 2 4 5 Kali, p p. 1 4 Gallipots, in sorts, . No. 30 Liq. vol C. C. 15 Pewter measures, 2 Magnes. alb. 15 Mortar and pestle ( marble), 1 Magnes. vitriol, 30 Ditto, ditto, (metal) 1 Natron vitriol, 15 Ditto, ditto, (Wedg ewood), 1 Nitr purif. 1 14 Scales and weights, set 1 OI lini, Oi menth. pip. 1 14 Spatulas \l°^ter . No. 1 > • 1 OI. olivar, 2 8 Funnels, 2 OI ricini, 1 4 Sponge, . oz. 5 01. terebinth, 10 Fine tow, . . lbs. 5 MEDICAL DEPARTMENT OF THE NAVY. 177 Proportions of Bedding, Lemon juice, and Necessaries, for a Ship of the Fifth Rate. Sheets, Pillows, Night-caps, Hair-beds, x X o X SV Lemon-juice, Calico, Welch flannel, Lint, Tourniquets, S s "J Right side, H. 1 f Left side, £ f, J Double, Bed-pans, Urinals, Spitting-pots, § . ~) Two quarts, "| I c [-Three pints, _J S HJ One pint, fTea, I Sago, Rice, Peai-l-barley, Soap, Soft sugar, Portable-soup, Cases, Bottles, Chest for calico, &c. Chest for grocery, Box for portable-soup, 2 "] Tea, | I Sago, , ij !>Rice, I" j Pearl-barley, H J Portable-soup, l_Cask for sugar, a a 178 OBSERVATIONS ON THE Proportion of Medicines, Utensils, and Fumigating Arlkit*, for a Ship of the Sixth Rate. lb. oz. dr. lb. oz.dr. Acid. Nitros dilut. . 1 4 Opium purif. . . . 4 4 Acid vitriol, dilut. . 2 4 Pil. hydrarg. . . 3 Adip. suilloe, . . . 2 4 Ras quassiae, 4 4 Ammonia praep. . . 1 4 Rhab. pulv. . . . 3 Antimon. tart. 6 Sal. vol C C, . I 1 Antimon. pulv. . . 3 Sem. lini, . . . . 2 4 Aq. ammon pur. 3 Senna, . . 12 Aq. litharg. acet. 1 2 Sperma. ceti. 9 Argent, nitrat. . . 3 Sp. aether nitros. . . 2 2 Calomel, .... 6 Sp. lavend. comp. 4 4 Camphor, .... 3 Sp. vin. rect. . . . 12 Cera flav..... 12 Tinct. digital. . . . 3 Cerat. lap. calam. 1 8 Tinct ferri. muriat. 1 4 Cerussa. acetat. . . 3 Tinct. opii, . . 2 2 Cinchon. pulv. . . 6 Tinct. rhoei, 6 Confect. aromat. 1 4 Tinct. scillae, . . . 1 4 Confect. opiata, . . 4 4 Ung. cerae, . . . 4 8 Crem. tart. . . • 12 Ung. hydr. fort. 3 Creta p. p. ... 6 Ung nitrat, . . . 3 Cuprum vitriol, 1 4 Ung. resin, flav. . . 3 Digital, pur. pulv. . 6 Vin. antimon. . . . 2 3 Emplast. cantharid. 2 4 Zinc, vitriol, . . . 1 4 Emplast. cera c. 12 Zinziber. pulv. . . 6 Emplast. litharg. 1 8 Emplast. litharg. c. resin, 12 Fwnigating articles, at the ofition Extract, colocynth. c. aloe, 1 4 of the surgeor . Flor. chamaemel. . . 1 2 Vitriolic acid, . . . 10 lbs. 12 . 10 sulph. viv. . 1 8 UTENSILS. Gum. ammon. gutt. 1 4 Bolus knives, . . . No. 2 Gum. arab. . . . 9 2 Gum. guaiac. . . 2 2 Bottles, ipint, . . 18 Hydr. nitr. rub. Hydr. muriat. . . . 1 4 3 phiais $?r;ce> ■ £ 1 ditto, 18 18 Jalap, pulv. . . Ipecac, pulv. . . 9 3 Corks 5 ^ Pint' ' uoiks £ Phial, m . gross 1^ 3 Ipecac, pulv. com. 1 4 Gallipots, in sorts, . . No. 18 12 Pewter measures, . 2 Liq. vol. C. C. . . 9 Mortar and pestle (n lar- Magnes. alb. . . 9 ble), .... 1 Magnes. vitriol. . 18 Ditto, ditto, (metal), 1 Natron vitriol. . . . 9 Ditto, ditto, (Wetlge-w r6od), 1 1 2 .Scales and weights, .'-'. set 1 OI. menth. pip. 1 2 ^2 Spatulas ^ter; . No. 1 1 l 8 2 01. ricini, . . . 12 oz. 4 01. terebinth. . . 6 Fine tow, . . . , lb&. 3 MEDICAL DEPARTMENT OF THE NAVY. 179 Proportions of Bedding, Lemon-juice, and Necessaries, for a Ship of the Sixth Rate. Sheets, Pillows, Night-caps, Hair-beds, CO > s- 3 tn X o Lemon-juice, Calico, Welch flannel, Lint, Tourniquets, £ f "} Right side, J 2 I Left side, 5 £ J Double, Bed-pans, Urinals, Spitting-pots, P i 1 Two quarts, | g S J- Three pints, J One pint, 2 rt 5 O 3 *s o O * co co .a fTea, Sago, Rice, ; Pearl-barley, Soap, Soft sugarj . Portable*soup, Cases, Bottles, a a Ph Chest for calico, &c. Chest for grocery, Boxes for portable-soup, (Tea, Sago, Rice, Pearl-barley, Portable-soup, Cask for sugar, 1 —. 180 OBSERVATIONS ON THE Proportion of Medicines, Utensils, and Fumigating Articles, for a Sloop. Acid, nitros. dilut. Acid, vitriol, dilut. Adip. suilloe, Ammonia praep. Antimon. tart. Antimon. pulv. Aq. ammon pur. Aq. litharg. acet. Ardent, nitrat. Calomel, Camphor, Cera flav. Cerat lap. calam. . 1 Cerussa. acetat. Cinchon pulv. . 4 Confect. aromat. Confect. opiata, Crem. tart. Cretap p. Cuprum vitriol, Digital pur. pulv. . Emplast. cantharid. 1 Emplast. cera C. Emplast. litharg. . 1 Emplast. litharg. c. resin, Extract, colocynth. c. aloe, Flor. chamaemel. Flor. sulph. sulph. viv. . 1 Gum. ammon. gutt. Gum. arab. Gum. guaiac. Hydr. nitr. rub. Hydr. muriat. Jalap pulv. Ipecac, pulv. . Ipecac, pulv. com. . Kali p. p. Liq. vol. C. C. Magnes. alb. Magnes. vitriol. . 12 Natron vitriol. . 6 Nitr. purif. OI. lini, OI. menth. pip. OI olivar. . . l OI ricini, OI. terebinth. oz.dr 1 8 8 1 4 2 2 12 4 2 8 1 3 8 4 1 8 8 8 1 12 8 1 6 1 1 6 2 1 12 12 Opium purif. . Pil hydrarg. . Ras quassiae, Rhab pulv. Sal vol. C. C. Sem. lini, Senna, Sperma. ceti. Sp aether nitros Sp lavend. comp. Sp. vin. rect. Tinct. digital. Tinct. ferri. muriat Tinct. opii. Tinct. rhoei, . Tinct. scillae, Ung. cerae, Ung. hydr. fort. Ung. nitrat, Ung. resin, flav. Vin. antimon. Zinc, vitriol, Zinziber. pulv. lb. oz.dr. 3 1 8 8 6 1 3 8 2 1 1 4 1 3 2 Fumigating articles, at the ofition of the surgeon. Vitriolic acid, . 10 lbs. Nitre purif. . . 10 UTENSILS. Bolus knives, Tiles, Bottles, -f pint, 2 ounce, I ditto, Phials 5 i P^t, CP . No. 2 2 12 12 12 gross 1 2 . No. 12 2 Corks C Phial, Gallipots, in sorts, Pewter measures, Mortar and pestle (marble), 1 Ditto, ditto, (metal), . l Ditto, ditto, (Wedgewood), 1 set 1 No. 1 1 2 oz. 3 lbs. 2 Scales and weights, Spatulas $£?*.' • r £ Plaister, Funnels, Sponge, Fine tow, MEDICAL DEPARTMENT OF THE NAVY. 181 Proportions of Bedding, Lemon-juice, and Necessaries, for a Sloop. x CO Oh g o cj -3 .O I, co n <" r1 Rice, Pearl-barley, Portable-soupj * J ^Cask for sugar. 3 pairs. 3 No. 3 — 3 —■ 1 — 182 OBSERVATIONS ON THE Proportion of Medicines, Utensils, and Fumigating Articles, for a Cutter, &c. lb. oz. dr. lb. oz.dr. Acid, nitros dilut. 4 Opium purif. . 1 4 Acid vitriol, dilut. 12 Pii. hydrarg. . 1 Adip. suilloe, 12 Ras quassiae, • 1 4 Ammonia praep. 4 Rhab. pulv. 1 Antimon. tart. 2 Sal. vol. C.C. • , o Antimon. pulv. 1 Sem. lini, 12 Aq. ammon. pur. 1 Senna, 4 Aq. litharg. acet. 6 Sperma ceti, . 3 Argent, nitrat. 1 Sp. ./Ether nitros, 6 Calomel, 2 Sp. lavend. comp. I 4 Camphor, 1 Sp. vin- rect. . 4 Cera flav. 4 Tinct. digital. 1 Cerat. lap. calam. 8 Tinct. ferri. muriat. 4 Cerussa acetat. 1 Tinct. opii, 6 Cinchon pulv. 2 1 inct. rhcei, . 2 Confect. aromat. 4 Tinct. scillae, . 4 Confect. opiata, 1 4 Ung. cerae, 1 8 Crem. tart. 4 Ung. hydr. fort. 1 Creta p. p. 2 Ung. nitrat, 1 Cuprum vitriol, 4 Ung. resin flav- 1 Digital, pur pulv. 2 Vin. antimon. 6 Emplast cantharid. 12 Zinc, vitriol, 4 Emplast. ceraC. 4 Zinziber. pulv. 2 Emplast. litharg. 8 Emplast. litharg. c. r esin, 4 Fumigating articles, at the ofition Extract, colocynth. c .aloe, 4 of the surg °on. Flor. chamaemel, 6 Vitriolic acid, 5 lbs. Flor. sulph. 4 Nitre purif. 5 sulph. viv. 8 Gum. ammon. gutt. 4 UTENSILS Gum. arab. 3 Bolus knives, . No. 2 Gum. guaiac. 6 Tiles, 2 Hydr. nitr. rub. 4 Bottles, I pint, 6 Hydr. muriat. Jalap, pulv. 1 3 «** K? 6 6 Ipecac, pulv. 1 <»*■ \iS;: gross 1 Ipecac, pulv. com. . 4 1 Kali p. p. 4 Gallipots, in sorts, . No. 6 Liq. vol. C. C. 3 Pewter measures, o Magnes alb. 3 Mortar and pestle (marble), 1 Magnes vitriol. 6 Ditto, ditto, (metal), Natron vitriol. 3 Ditto, ditto, (Wedgewood), Nitr. purif. / 6 Scales and weights, set 1 OI. lini, OI. menth pip. 6 1| S^S gaiter, . No. 1 OI. oiivar, 8 Funnels, 2 OI ricini, 4 Sponge, . oz. 2 01. terebinth, 2 Fine tow, . . lb. 1 MEDICAL DEPARTMENT OF THE NAVY, 183 Proportions of Bedding, Lemon-juice, and Necessaries, for a Cutter, &c. Sheets, . Pillows, Night-caps, Hair-beds, > u 3 10 >> X i< co X o H U X u C § * Left side, £J £ J Double, Bed-pans, Urinals, Spitting-pots, g i . ") Two quarts, 3sS I Three pints, _o ™ ^ J One pint, fTea, ISago, Rice, Pearl-barley, Soap, Soft sugar, Portable-soup, r § g C Cases, w.'l, £ Bottles 60 . o ei Chest for calico, Sec. Chest for grocery, Boxes for portable-soup, £ 1 Tea, | j Sago, c fe J>Rice, Pearl-barley, Portable-soup, Cask for sugar, 1 „. 184 OBSEItV ATIONS ON Til h N. B. All the preceding tables are calculated agreea- bly to the practice of the apothecaries' company, viz. 8 drachms to the ounce, 16 ounces to the pound. &1 When the portable-soup is required to be complet- ed, it should not be issued in quantities less than one canister. SECTION IV. Of the mode of furnishing Surgical Instruments to the Navy. It will be observed, that in the preceding tables there is not any mention made of surgical instruments. The reason of that omission is this. They are at pre- sent furnished at the expense of government to our ships and vessels ; but I would propose that this regulation be abolished, and the one observed in the English navy adopted in its stead. The surgeons and assistant-sur- geons of his Britanniek majesty's navy, are obliged to provide themselves, at their own expense, a set of instruments, of the number and quality direct- ed by the commissioners for sick and disabled seamen. This arrangement was made in order to prevent the losses sustained by the service, from the neglect of sur- geons of the publick instruments intrusted to their care. As I have more than once seen instances of this culpa- ble neglect in our own service, I cannot help believing that it is absolutely necessary, now the navy is augment- ed, to adopt the same regulation. In such case, I would recommend the established proportion of instruments for a surgeon and surgeon's-mate, as used in the British ser- vice, which I will presently subjoin. The list should be printed in the following form, with a blank certificate at MEDICAL department of the navy. 185 the bottom. When a surgeon or a surgeon's-mate is or- dered to a ship, he should be obliged to exhibit his instru- ments to the surgeon of one of the U. S. marine hospitals, or to some one of the agents of the board of medical com- missioners, and should be required to repair any defi- ciencies that may be found, either in the number of in- struments, or their condition. The surgeon who examines them should then enter in the appropriate columns, specifications of the state of the instruments, and fill up the blank certificate at the end. It must not be forgotten, that though the expense of an out-fit of a surgeon or surgeon's-mate, would, ac- cording to this regulation, be very considerable; yet the property once purchased, would always be valuable. In case of capture by an enemy's vessel, these instru- ments (when this regulation of the service is known to the captors) would come under the denomination of the private or personal property of the medical officers, and of course would be respected as such. Under the ex- isting regulation, the instruments being a part of the out- fit of a ship, as much so as her pistols or sabres, they ne- cessarily and justly become the property of the captors. This regulation would at first bear hard upon sur- geons ; but the good of the service makes it necessary. Many surgeons would take as much care of publick in- struments as their own; but there will always be found some disposed to be neglectful. u h 186 OBSERVATIONS ON THE Established proportion of Instruments, &c. to be provided by a Surgeon. Established proportion of Instruments, Sec. to be provided by a Surgeon. Three Amputating Knives. One Ditto Saw with spare Blade. One Metacarpal ditto with ditto. Two Catlins. Pair of Artery Foreeps Two dozen curved Nee- dles. Two Tenaculums. Six Pettit's Screw Tourniquets. Pair of Bone-Nippers and Turn screw. Three Trephines. Saw for the Head. Lenticular andRugine.l Pair of Forceps. Elevator. Brush. Two Trocars. Two Silver Catheters Two Gum Elastic ditto Six Scalpels. Small Razor. Key Tooth Instrument. Gum Lancet. Two pairs of Tooth- Forceps. Punch. Two Seton Needles. Pair of strong Probe Scissars. Curved Bistory with a Button. Long Probe. Pair of Bullet-Forceps. Scoop for extracting Balls. State of those in possession of die Surgeon of the Ship. In good or- der. Requiring repair. Unservicea- ble. Deficient of tlu estab- lished pro- portion. MEDICAL DEPARTMENT OF THE NAVY. 187 Established proportion of Instruments, &c. to be provided by a Surgeon. {Continued.) Established proportion of Instruments, &c. to be provided by a Surgeon. State of those in possession of the Surgeon of the Ship. In good or- der. Requiring repair. Unservicea- ble. D ficient of the estab- lished pro- portion. Two Probangs. Half a Pound of Liga- ture Thread. One Paper of Needles. Case with Lift-out. Apparatus for restoring suspended animation. Set of Pocket Instru- ments. Six Lancets, in a Case. Two dozen Bougies, in a Case. Two Pint Pewter Clys- ter Syringes. Six small Pewter Sy- ringes. Two sets or bundles of common Splints. Set of japanned* Iron ditto for Legs. Twelve Flannel or Li nen Roller s. Two 18 tailed bandages. Twenty yards of Web for Tourniquets. Sixty yards of Tape, different Breadths A Cupping Apparatus consisting of one Scarificator and six Glasses. U. S. Marine Hosfiital, at I do hereby certify, .that in pursuance of the direction of th<- Board of Medical Commissioners for conducting the Hospital De- partment of the U. S. naval service, and for providing for sick, hurt, and disabled seamen : I have this day examined the instruments belonging to surgeon of the and find their state to be as above expressed. Surgeon of Hosfiital. 188 OBSERVATIONS ON THE Established proportion of Instruments, &c. to be provided by a Surgeon's-mate. Established proportion of Instruments, &c to be State of those in possession of the Sur geon's-mate of the Ship. " Deficient of the estab-lished pro-" portion. provided by a Surgeon's-mate. In good or- Requiring 1 Unservicea der. repair. ble. No Amputating Knives, 2 Ditto Saw, . 1 Metacarpal Saw with two Blades, . 1 Catlin, . . 1 Curved Needles, 12 Tenaculums, . 2 Tourniquets, . 2 Pone-Nippers, . 1 Trephines, . 2 Head saw, . 1 lenticular, . 1 1 Raspatory, . 1 | Forceps, . . 1 ; Brush, . . 1 Elevator, . . 1 Trocars, . . 2 •Silver Catheters, 2 ; Elastic Gum Catheter, 1 i Scalpels, . . 6 i Key Tooth Instru- i ment, . • 1 | Spare Claws of dif- ! ferent sizes, . 3 Gum Lancet, . 1 Tooth-Forceps curv- ed, . . 1 „.-----ditto straight, 1 j 1 Punch, . . 1 | Seton Needle in Scales, . . 1 Long Probe, . 1 Bullet-Forceps, . 1 Probang, . . 1 Set of Pocket Instru- ments, . . 1 Lane ts, . . 12 Pewter Syringes, 6 U. S. Marine Hospital, at I do hereby certify, that in pursuance of the direction of the Board of Medi- cal Commissioners for conducting the Hospital Department of the U. S. naval service, and for providing for sick, hurt, and disabled seamen : I have this day examined the Instruments belonging to Surgeon's-mate of the and find their state to be as above expressed. Surgeon of Hospital. MEDICAL DEPARTMENT OF THE NAVY. 189 SECTION V. Of the Mode of making Expenditure Returns of Me- dicines, 8£c. The next subject for consideration, is the laxity of the necessary checks to abuses that grow from the irre- gular and unsystematick mode now in use, of furnish- ing the medical department of our publick vessels. In the rules and regulations for the government of the navy, under the head of the duties of the surgeon, are the following articles : " Stores for the medical department are to be fur- nished upon his requisition, and he will be held re- sponsible for the expenditure thereof." " He will keep a regular account of his receipt and expenditure of such stores, and transmit an account thereof to the accountant of the navy, at the end of every cruize." These are the only restrictions that are laid upon the surgeon, for the just expenditure of hospital stores. The impropriety of furnishing them according to the first of these regulations, I have endeavoured to prove, and I hope the systematick plan of accomplishing the same purpose, by established proportions of medicines . and comforts, and by the direction of a board of medi- cal commissioners, will not be deemed unworthy of no- tice. It now remains for me to suggest some better regulations, for ensuring the faithful appropriation of the articles furnished for the sick. In the first place, this regulation just quoted, faulty as it is, respecting the rigid check it should impose, is not executed. Five years%ent in the service have familiarized me with its usa-es; and I can confidently assert, that this rule is 190 OBSERVATIONS ON THE not obeyed. In fact, it is not required of surgeons at the department, to make such expenditure returns, and from long disuse, the regulation seems to have been forgotten ; aud, if ever noticed, is only when the sur- geon chances to cast his eye over the code of regula- tions respecting his duties. There are few, if any, sur- geons afloat, who think it incumbent on them to trans- mit to the navy department, any account of the expen- diture of stores ;' and as to medicines, the rules of the navy do not require any account to be given of the ex- penditure of them—as if their value is so inconsidera- ble, that the embezzlement, or wasteful use of them, deserved not any consideration. I cannot, however, but look on this subject as a matter of great moment— convinced as I am, that until more vigorous means are enforced, of obligating the surgeon to make a con- scientious appropriation of the medicines, stores, &c. under his charge, the publick treasury will be sub- jected to very unnecessary and unjust demands, and the sick must inevitably suffer. Not but what I am ful- ly persuaded that most of the surgeons of the navy do now, even without any obligation scarcely to be correct, appropriate their necessaries and medicines to their proper uses—yet this is no argument against the ex- pediency of adopting more strict regulations than al present exist. Those who are upright and faithful without checks, can have no objection to be bound by rigid rules—those who are otherwise, may be forced to correctness. To correct these abuses, then, I would propose, First, That the surgeon be held responsible for eve- ry article, &c. &c. for which he receipts to any one of the agents of the board of commissioners—and that the responsibility be virtually enforced and maintain. MEDICAL DEPARTMENT OF THE NAVY. 191 ed by proper rules, the observance of which shall on no account be dispensed with. Secondly, That he be not suffered to condemn, of his own accord, any medicines or stores, in however small quantities. That when any articles belonging to his depaitment are deemed by him unfit for use, he shall report such defects to his captain, if at sea, or to the agents of the medical commissioners, when in port. A survey should then be directed to be held by a suffi- cient number of surgeons, on the damaged or useless articles ; and their report alone shall authorize the de- struction of such articles. I would propose that printed blanks, of the form following, be furnished by the board of commission- ers, to the surgeon of every vessel, who should fill up and execute the accompanying oath, when he returns them to the agents of the board of commissioners. .The surgeon should be required to return these ex- penditure accounts to the agents of the board of com- missioners of the port at which the vessel he belongs to may arrive, after a cruize. And he should not be permitted to proceed to sea again, without having ful- filled this regulation. In consequence of these blanks being printed and furnished to the surgeons of ships, &c. an inducement will be held forth to them for keeping correct accounts; and when returned into the office of an agent of the medical commissioners, they can be regularly filed and preserved as office papers. A strict conformance ti» this rule should on no account be dispensed with, Account of the Receipt and Expenditure of Medicines and other Articles, on board the U. S. Ship Guns, Captain, between day and this Surgeon, Remaining on charge from last account, or re- Received since. I Remains per the Survey. Names of Medicines, &c. At [At At Total. Expenditure. Returned into store. ceived from pre- 181 decessor. 181 181 181 MEDICINES AND lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. UTENSILS. ." . * ■ Acid, vitriol, dilut. ■' / '... Adip. suilloe, p. p. '' v ■-'■'-■ Aloes socotorine, ■f Antimon. tart. pulv. Aq. litharg. acet. • Argent, nitrat. Calomel, Camphor, Cera flav. Cerat. lap. calam. Cerus acetat. Cinchon. pulv. Confect. aromat. Crem. tart. p. . Creta, p. p. Cuprum vitriol, ; ! Digital, pur. pulv. Emplast. cantharid. cera. C. litharg. com. cum hydr. Extract, colocynth. c. Flor. chamaemel, sulph. Gum. ammon. gutt. arab. guaiac. . Hydrarg. nitr. rub. muriat. n Jalap, pulv. o Ipecac pulv. com. Kali, p p Liq. vol. C C. Magnes vitriol, alb. Mel. acetat. Natron vitriol, Nitr. purif. OI. lini, . menth. pip. olivar. ricini, terebinth. . OS Account of the Receipt and Expenditure of Medicines, &c. (Continued.) Remaining on charge from last account, or re-ceived from pre-decessor. Received since. Total. Expenditure. Returned into store. Remains per the Survey. 181 Names of Medicines, Sec. At 181 At 181 At 181 Opium, . Ras quassiae, . Resin flav. Rhabarb pulv. Sal vol. C.C. Semen lini, Senna, Sperm, ceti. Spirit lavend.'comp. Tinct. scillae, . ferri muriat. Unguent cerae, hydr. fort, nitratum, resin flav. Zinc, vitriol. Zinziber. pulv. ib. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb. oz. dr. lb-, oz. dr. lb. oz. dr. lb. oz. dr. Bolus knives, No. Tiles, Bottles (half pint), Gallipots, in sorts, Pewter measures, Mortars and pes- tles (marble), Ditto (metal), . Needles, com. ch. Scales and weights, sets, Spatulas, . No. Funnels, . Sponge, . . oz. Chests & boxes, No. Sheets, . pairs, Pillows, . No. Night-caps, Beds, Linen, . yards, Calico, Welch flannel, Lint, . . lb. Soap, Bed pans, . No. Urinals, . Spitting-pots, . Tourniquets, . Trusses, . Lemon-juice, galls. Account of the Receipt and Expenditure of Medicines, &c. (Continued.) Remaining on charge tioni last nccouiit or re-ceived from pre (kcessur. Received since. Total. Expenditure. Returned into store. Remains per the Survey. 181 Names of Med it ines, &c. At 181 At 181 At 181 Ditto (cases), No Ditto (bottles), gt Vitriol, acid, lb §1§ ^Boxesfordo No. g « /Nitre pulv. lb. f* '" 'Boxes for do. No Tea, . . ib. Sago, Rice, Pet.rl barley, . Soft sugar, Portable-soup, Brandy, . galls. Porter, . bottles, Gin, . gulls. Port wine, iVIadcira or white Mine. All articles mentioned in this list not specified in the tables of 'ro/ioruj/h';, such as wine, porter, oc<_. I suppose to have been issued by the Purser, on order of the Surgeon; for these articles ought to be in charge of the Purser, and not the Surgeon. Aotr. The Surgeon is to pay every possible attention to the preservation of the different packages ; those of concentrated vitriolic acid, >,nd the lemon juice, as well as the different cases, bottles, jars, &c are articles of consi- derable expense, and must be duly accounted for, previous to certificates being granted ; they are to be delivered to tlie Agents of the Board of Medical Commissioners, in the same manner as the other remains, whose receipts g for the same must be transmitted with this account. C The quantity of wine, over and above the ship's allowance, received and issued during the period of this account, a is to be duly noted in the account. *"* When the remaining medicines and articles are delivered to a successor, he is to sign a receipt for them as under. O Received, the day of 181 of Doctor my predecessor, in the £ U. S. ship the remaining articles mentioned in the above said account. *j Surgeon. S w This Deponent, Surgeon of the U. S. ship the voluntarily maketh oath, a* that the above account of the receipt and expenditure of the different articles of medicines, stores, &c. is just and ^ true ; and this deponent further maketh oath, that the amount of the bills drawn by him for Su> geon's necessaries, ** was faithfully expended for the said service ; and that the different articles purchased, as well as the supplies received jjj from the Agents of the Board of Medical Commissioners, were faithfully supplied to the people entitled to the be- » nefit thereof, and not expended for any other use whatever ; and he fu. ther maketh oath, that he hath not, either di- ^ rectly or indirectly, received any emolument or profit from any person concerned in supplying the said medicines, ^ store , and necessaries; this deponent also further maketh oath, that the different articles of diet supplied to the sick by the Pu.ser, in lieu of their salt provisions, were all good in their kind, and administered to the patients in the lull p oportions contained in the demands given to the Purser, to the best of his knowledge and belief. Sworn this day of 181 198 OBSERVATIONS ON THE SECTION VI. On the propriety of abolishing the Surgeons9 Jive-dol- lar perquisite from the navy. In entering on the consideration of this subject, I am not insensible of the unpopularity of such a proposition as I shall begin it with, viz. to expunge this perquisite from the navy altogether. I am aware that the surgeons generally, think their pay sufficiently inadequate to their arduous service, already, without further dimi- nishing their emoluments by abolishing this perquisite. But I feel persuaded that the most considerate of them will allow with me, that an augmentation of pay by such means, is neither agreeable to the feelings, nor perhaps strictly consonant with justice. By the five-dollar perquisite, I mean that fee or re- muneration which it is customary for surgeons of our ships and hospitals to receive for the cure of the vene- real patients, from the pursers attached to such ships or stations, who charge the amount against the respec- tive persons who have unfortunately contracted the disease. It is true, there is no established article of the navy laws, to authorize the payment of such sum. But immemorial custom has given this regula- tion the importance and effect of a law. It is still said, that it is optional with the foremastman to sign the order for the deduction of this sum of five dollars from his pay, to be given to the surgeon ; but an inti- mate acquaintance with the opinions of the seamen in our navy on this subject, enables me to declare, that most of them believe it a compulsory rule—at least they think it so far so, as to entertain the idea, that if MEDICAL DEPARTMENT OF THE NAVY. 199 they refuse to pay this sum to the surgeon, they forfeit his good opinion, and ensure his displeasure. This a generous hearted tar would ever be desirous of avoid- ing, and, of course, however unjust he might really deem such a custom as that which binds him to the performance of an act, that he perhaps would not vo- luntarily execute, he nevertheless believes it incum- bent on him to follow the general usage. It is true, that but few of the sailors do refuse the payment of this perquisite to the surgeon, yet I know that some will do it. It has been urged in favour of this regulation, that it deters the sailor from an indulgence in those excesses, which give origin to the disease. Whoever believes this can know nothing of the character and disposition of this class of men. Sailors are thought- less, improvident, and venturous. No experience of the fatal consequences of pleasures attended with pre- sent revelry and mirth, will ever operate sufficiently on their minds to cause any moderation in the indul- gence of the like excesses. They think only of the present, and are never regardful of consequences that are even a few hours distant. How then can it be rea- sonably supposed, that these men, reckless as they are by disposition and by habit, will ever be deterred from the commission of pleasurable excesses, from a fear of incurring a penalty so inconsiderable ? This argu- ment, therefore, can have no possible tendency to esta- blish the inexpediency of abolishing the unjust con- tribution of which I am speaking. One fact I am ac- quainted with, however, which goes far to prove the propiety of expunging this regulation from the naval service. It is to surgeons of the service well known, that seamen sometimes, but more frequently landmen and marines, do frequently conceal their complaints for fear of being obliged to pay the doctor for their 200 OBSERVATIONS ON TIIE cure. This happens till the disease assumes a serious, and not unfrequently a dangerous aspect. They will purchase for a tritie, on shore, drugs enough to ruin them, or do them at least essential injury, or apply to the loblolly-boy, or some man on board who pretends to know how to cure the disease, rather than make known their complaint to the surgeon. Can any thing be more destructive to the health of the men, and of course to the good of the service, than a regulation that induces such conduct and such consequences ? How then shall this ei rour be corrected ? A cus- tom similar to this existed formerly in the British na- vy—fifteen shillings sterling were allowed to the sur- geon for the cure of this disorder, which sum, like our five-dollar perquisite, was deducted from the pay of the men. A conviction of the fatal consequences to the service, such as 1 have above specified, by the conti- nuance of this rule, induced the rulers of the medical department to alter it. Accordingly eight pounds ster- ling per annum for every hundred men of the comple- ment, were allowed to the surgeon by government, as a substitute for the abolished perquisite. The conse- quence was, that all the ill effects of the first regulation were prevented. Let us then imitate their example, and allow the sur- geons of the navy a sufficient compensation for their trouble. It is right and just that they should be re- munerated for the cure of this disorder ; but I do con- tend that it is neither just nor wise to cause this remu- neration to come from the foremastman. I pretend not to specify any sum, which shall be a just compensation to the surgeon for the abolishment of the present per- quisite, but leave that to those whose more immediate province it is. All I think it necessary to do, is to make a fair exposition of the bad consequences of a re- MEDICAL DEPARTMENT OP THE NAVY. SOI gulation that should be done away, and to suggest the means by which its object might be accomplished in a manner more agreeable to the surgeon, more con- sonant with the good of the service, and more just and wise. SECTION VII. Of the duties of a Surgeon and Surgeon9s-mate in the Navy, on ship-board. The duties of a surgeon, as derailed in the navy re- gulations, would be, if the regulations I have suggest- ed in the foregoing pages are ever adopted, not suffi- ciently definite. I would propose that they be amend- ed as follows : It shall be the duty of the surgeon, 1. To inspect and take care of the necessaries sent on board for the use of the sick men ; if not good, he must acquaint the captain; and he must see that they are duly served out for the relief of the sick. 2. To visit the men under his care twice a day, or oftener, if circumstances require it; he must see that his mates do their duty, so that none want due attend- ance and relief. 3. In cases that are difficult, he is to advise with the surgeons of the squadron. 4. To inform the captain daily of the state of his pa- tients, by entering their names on a printed blank sick- report of the form following. nd SOS OBSERVATIONS ON THE The printed blank sick-reports were first introduc- ed by me into the navy. I used them on board the frigate United States in the early part of the year 1809, and they have since got into use in some of the ships. MEDICAL DEPARTMENT OF THE NAVY. 203 These blanks should be furnished in sufficient quan- tities to the ships, by the agents of the board of medi- cal commissioners, and when filled up by the surgeon for the captain, should be regularly filed. 5. When the sick are ordered to a hospital, he is to send with them to the surgeon, an account of the time and manner of their being taken ill, and how they have been treated. 6. But none are to be sent to sick-quarters, unless their distempers, or the number of the sick on board, are such, that they cannot be taken due care of; and this the surgeon is to certify under his hand, before re- moval. 7. To be ready with his mates and assistants in an engagement, having all things at hand necessary for stopping of blood and dressing wounds. 8. To keep a day-book of his practice, containing the names of his patients, their hurts, distempers, when taken ill, when recovered, removal, death, prescrip- tions, and method of treatment, while under cure. 9. From this book he is to form two journals, one containing his physical, and the other his chirur- gical practice. 10. He shall keep an exact expenditure account of medicines, stores, &c. by filling up the blank sheets given him by the agents of the board of commissioners who furnished the ship, and shall execute the oath accompanying them. He shall then return them into the charge of the agent of the port at which the vessel he is attached to may arrive. 11. To make out a semi-annual return to the captain of the ship, and one to the board of medical commis- sioners, in the following form : Semi-annual return of patients admitted on the sick-list, with what diseases, when discharged for duty, sent to the Hospital, or cured on board, the U. S. ship of guns, Commander, Surgeon; from the day of to tiie day of following, inclusive. No. Names of Pa-tients. Rank or sta-tion on board ship. When admitted. Diseases. Discharged for duty. Died on board. Sent to hos-pital. Died in hos-pital. i •\ ! MEDICAL DEPARTMENT OF THE NAVY. S05 Such a return it was always my practice to make out every six months, while I was in the ship-service, as will be seen by the following letter : Frigate United Slates, Norfolk, Virg. Dec. 26,1809. SIR, You will receive with this, a semi-annual return of patients admitted on the sick list, discharged cured for duty, died, or sent to the hospital, on board the United States. Though it has, I believe, never been customary to make out such a return, I have done it, because I sup- posed it would prove satisfactory to the commander of a vessel, to see at one view every six or every three months, the state of his crew as respects health. Should you deem it so, I will continue the practice, either half-yearly or quarterly. I am, sir, respectfully, Your obedient servant, William P. C. Barton. Stephen Decatur, Esq. This plan seemed to meet the approbation of those officers who were made acquainted with it; and as I do really think it would be a good regulation, I re- commend the adoption of it. Of the Duties of a Surgeon9s-mate. As there are no duties specified or detailed for a surgeon's-mate in the navy regulations, and as I know that many of these officers, upon first entering the ser- vice, are often at a loss to know what are the func- tions of their office, I will propose the following detail of duties for the surgeon's-inates, and hope they may not be deemed unworthy of insertion in the code of re- gulations for the navy. * 306 observations on the Detail of the duties and offices of a Surgeon9s-mate of the Navy. 1. The surgeon's-mate is to visit the sick-bay every morning before eight o'clock, to see if the sick are in want of any thing before breakfast, and also every night, previously to his turning-in, to see that they are provided with all necessaries prescribed for them. He is to bleed, to dress all ulcers and wounds daily, or oftener, if required by the surgeon. He is to give all medicines ordered for patients seriously ill, with his own hands, and see that all other patients have their medicines properly administered, at the spe- cified hours. He is to put up all the prescriptions of the surgeon, and to keep the furniture of the cock-pit clean, and the surgical instruments in perfect order. 2. He is to prescribe for the sick in the absence of the surgeon, and to report all unfavourable changes in the diseases of the patients, immediately to him. He is to be responsible to the surgeon for the expenditure of all hospital-stores and comforts committed to his charge. He should keep a daily account of the ex- penditure of these, and render a monthly return of the aggregate consumption of each individual article to the surgeon. 3. He is to give out to the loblolly-boy, all such li- quors and comforts as are prescribed for the sick, and never suffer him to go into the store-room for the pur- pose of getting them. He is not, on any pretence, to loan to any person or persons, a single article of hos- pital-stores, nor any liquors ; and he is strictly enjoin- ed to be economical in the necessary expenditure of these costly articles. 4. He is on woaccow?^ (unless unable to attend to duty MEDICAL DEPARTMENT OF THE NAVY. 207 himself) to commit the dressing of ulcers and wounds to the loblolly-boy, nor the men themselves, but is re- quired to dress all sores, however inconsiderable, him- self. 5. He is to see that the ship's coppers are kept per- fectly clean ; for this purpose he should inspect them daily, at such times as they are cleansed by the cook. Should the cook neglect to keep them wholesome and pure, he is to report such neglect in person to the of- ficer of the deck. 6. He is to see that the loblolly-boy dresses blisters properly and with tenderness ; that he discharges his duty faithfully ; and that he humanely attends to the wants and necessities of the sick. He is to take parti- cular care that he does not expend the provisions and liquors put into his charge, for improper purposes, and that he does not give them to other than such sick per- sons as they were ordered for. He is to see that he has the sick men shaved at least twice a week, and washed daily—and that he keeps them otherwise clean and comfortable. 7. He is to see that the loblolly-boy rings the bell fore and aft the berth and gun decks, to collect the sick men to the after part of the half-deck, at such times as the surgeon shall denote. When the sick are all col- lected, he is to have the dressing-board brought up to the half deck, and then report in person to the sur- geon, that the sick men are ready for his attendance. 8. He is required to report in person neglects of duty or attendance on the part of the loblolly-boy, to the of- ficer of the deck, that he may be punished. 9. He is to attend rigidly to these instructions, and, above all, should bestow his attentions with kindness and humanity on the sick. 208 OBSERVATIONS O.N THE SECTION VIII. Of the expediency of augmenting the pay of navy Sur- geons and Surgeon9s-mates. The pay of a surgeon in the navy of the United States, is 50 dollars per month, and two rations per day, which are never drawn in kind, but in their value in money, that is, 40 cents per day, making the entire amount of pay and emoluments 62 dollars per month. The pay of a surgeon's-mate is 30 dollars per month, and two rations per day, which are generally • drawn in their value in money; so that the pay and emoluments of officers of this grade are 42 dollars per month. Is the pay then of surgeons and surgeons'-mates sufficiently liberal ? Is it adequate to the value of their services ? When it is taken into consideration, that this pay is not, as in the British navy, augmented by every year's service, and when it is also remem- bered how inconsiderable a portion of prize-money these officers are entitled to, I cannot help believing that every reasonable man acquainted with the nature of the service, will without Iiesitation, answer these questions in the negative. I can declare, without fear of contradiction, that the officers of the navy generally deem the pay of surgeons and surgeons'-mates, particu- larly the first, much too inconsiderable.—Why is it not at least equal to the pay of surgeons and surgeons'- mates of the army ? Why this invidious distinction ? Are not officers who encounter the disasters, and sub- mit to the privations of a sea-life, equally entitled to liberal remuneration with those who undergo no such MEDICAL DEPARTMENT OF THE NAVY. 209 toil and exile from all that can render life comfortable or happy ? Are the duties of an army surgeon more arduous ? Let those who have been in the habit of practising on ship-board, and who at the same time are acquainted with the land-service, answer this ques- tion. Let the pay of the naval medical officers be aug- mented to that of officers of their grade in the army, and let, as I have before suggested, some compensation be added by government for the cure of venereal pa- tients. An inducement will then be offered to surgeons to continue in the service. This inducement I know is now wanting. The medical officers of the navy, one and all, believe their pay an insufficient remuneration for their labour—this is not from selfish motives. Those who have left the service, and have no idea of again entering it, and whose interests are therefore nei- ther incorporated with, nor dependant on any usages in the navy, are loudest in asserting the necessity for reform here. I do hope, therefore, that the discussion of this subject before Congress will not be far distant, and that when such an event takes place, a demand will be made for the opinions of the flag officers and captains in the service, as to the expediency of in- creasing the pay. If it be left to their decision to af- fix the sum that may be considered as a fair and just equivalent to the services of the medical officers, the surgeons need not tremble for the issue. Should this subject ever be brought under the cog- nizance of the naval committee, I would wish the members composing it to be informed of the regula- tions respecting the pay of the medical officers of the British navy. I shall therefore subjoin a minute de- tail of them, in the hope that they will give some hints for the reform I have proposed. They are as follow: e e 210 OBSERVATIONS ON THE "Particulars of such fiart of his majesty's Order in Council of the 23d January, 1805, for imfiroving the situation of the Medical Officers of the Navy, as relates to such Officers serving on board Shifis. It is ordered, that the number of assistants heretofore called « Surgeon's-mates," to be allowed to the surgeons of his majes- ty's ships, shall in future be regulated as follows: First rate,.........3 Assistants Second rate,.........3 ditto Third rate,.........2 ditto Fourth rate, ........ 2 ditto Hospital ships,........3 ditto And all other ships entitled according to the existing regulation to bear mates, ,.........1 ditto That no person shall, in future, be appointed to serve as an assistant to the surgeon of any of his majesty's ships, who shall not have been found qualified on examination to serve as sur- geon, or first assistant: that the pay of assistants so qualified shall be 6s. 6d. a day, besides the ship's provisions; with half- pay when reduced, at the rate of 2s. per day, provided they shall then have served two years subsequent to the date of this regulation, and 3s. per day, if they shall have served three years from that date. That such assistants shall be required to fur- nish themselves with such surgical instruments as the commis- sioners for sick and wounded seamen shall direct; and that they shall be rated on the ship's books, where the complement ad- mits of more than one, according to their seniority on the list to be kept by the sick and wounded board. Whereas there are many surgeon's-mates now serving on board his majesty's ships, who have not obtained, and who may not for some time have an opportunity of obtaining the qualifica- tion before required, it is directed that such as serve as first or second mates or assistants, shall be allowed 5s. per day, and those rated third mates, or assistants, 4s. per day. These three classes or assistants shall not be required to pro- MEDICAL DEPARTMENT OF THE NAVY. 211 vide instruments, nor shall they be allowed half-pay; but they shall nevertheless, on proving themselves duly qualified, be plac- ed on the same list with the other assistants, from the date of the first appointment they may receive after such qualification, and commence the time to be reckoned from half-pay from such ap- pointment. All surgeons of the navy who shall not have served in the whole six years, of which not more than three years time as hos- pital-mate or assistant-surgeon shall be allowed, shall receive, when employed, a full pay of 10s. per day ; and when not em- ployed, a half-pay of 5s. per day. Surgeons of ships in active service, after having served six years, of which not more than three years time as hospital-mate or assistant-surgeon shall be allowed, shall be paid 1 Is. per day ; their half-pay to be 6s. per day. After having served ten years, allowing not more than three years as hospital-mate or assistant-surgeon, the surgeon's full pay shall be augmented to Us. per day, his half-pay to remain at 6s. per day. Surgeons of receiving-ships, slop-ships, convalescent-ships, prisoivships, and all other ships, except hospital-ships, employ- ed only in harbour duty, shall be allowed full pay, 10s. per day, with half-pay according to the time of their service. Surgeons appointed to hospital-ships shall receive a full pay of 15s. per day, unless in cases where, by the length of their ser- vice, they may have become entitled to a superior rate of pay- ment; their half-pay to be regulated, as in the case of surgeons of other ships, by the length of their service. Every surgeon in the navy, excepting surgeons serving on board receiving-ships, slop-ships, convalescent-ships, or any other ships than hospital-ships, employed only on harbour duty, shall, after twenty years service on full pay, including not more than three years time as hospital-mate or assistant-surgeon, be allowed 18s. per day: and after such length of service, all sur- geons, in whatever ships they may have served, shall have a claim to retire on a half-pay of 6s. per day; but if the cause of their retirement shall be ill health contracted in the service, and it shall be so certified by the commissioners of sick and wound- ed seamen, the rate of half-pay on such retirement, after twenty years actual service, shall be 10s. per day. 21& OBSERVATIONS ON THE Every surgeon in the navy, after thirty years service, on full pay, including not more than three years as hospital-mate or as- sistant-surgeon, shall have an unqualified right to retire on half- pay, at the rate of 15s. per day. That medicines and utensils shall be provided for the service of his majesty's ships and vessels, at the expense of government, in such proportions as shall from time to time be arranged by the commissioners for sick and wounded seamen ; but the sur- geons shall be required to provide, at their own expense, such surgical instruments as shall be judged necessary by the said commissioners. No person shall be appointed physician to a fleet or an hospi- tal, who shall not have served as surgeon at least five years; the daily pay of a physician, on his first appointment, to be one gui- nea, his halPpay half-a-guinea. When he shall have served three years as physician to a fleet or an hospital, his full pay shall be one guinea and an half per day, his half-pay 15s. per day. The full pay of a physician, who shall have served in that ca- pacity more than ten years, shall be two guineas per day, his half-pay one guinea per day. That physicians, when a residence is not provided for them, shall be allowed one guinea per week lodging-money. To the widows of physicians and surgeons, such a pension shall be allowed as the lords commissioners of the admiralty shall think it right to grant. None of the officers before mentioned, who shall retire from their respective employments without the approbation of the commissioners for sick and wounded seamen, or who shall re- fuse to serve when called on, if judged capable of service, shall be allowed to receive half-pay, nor shall their names remain on the naval list. Their widows will not in consequence be entitled to any pension. No officer, of whatever description, shall be entitled to any of the advantages arising from this regulation, who shall not have served during the present war, or until he shall have satisfied the commissioners for sick and wounded seamen of his inability to serve, but such persons shall be permitted to remain on the same establishment on which they may now respectively happen to be. MEDICAL DEPARTMENT OF THE NAVY. 213 SECTION IX. Of the propriety of establishing the Rank of navy Surgeons. It will be a matter of surprise to those who are ig- norant of the fact, to learn : that at this late period of our naval establishment, the rank of a grade of officers confessedly among the most important of those who compose the navy, is not yet determined. The inconveniences and disadvantages of this omis- sion, are well known to the medical and other officers of the service. I have sorely experienced them ; and would venture to assert, that every surgeon in the navy has at some period or other of his service, also felt the effects of his indefinite standing as respects other officers of the navy. In the British sea-service, surgeons rank with lieu- tenants of the navy and captains of the army, and they are subordinate only to the sea-lieutenants of the ship to which they are attached. In the French service, a similar arrangement is established. Why then should the surgeons of the navy of the United States, infe- riour to none in the world so far as it goes, be suffered to experience the mortification arising from a want of so necessary a rule ? If it is ever expected that men of talents and education, who have spent much of their time in acquiring such a knowledge of a difficult, a la- borious, and, to most persons, a painful profession, as will enable them to serve their country with advantage, will enter and continue in the naval service : the rank of surgeons must be established. And this rank should » 214 OBSERVATION. S ON THE be sufficiently respectable to give them a consequence among sea-officers, that they now have not. For my part, I cannot but believe it essentially ne- cessary for the welfare of the navy, that this establish- ment of rank be immediately made. The errour is old enough, and sufficiently productive of bad consequen- ces, to demand a quick and efficient reform. When this is the case, we shall not have surgeons who have just continued long enough in the service to be well ac- quainted with the nature of sea-duty, and to be of course the better prepared to benefit it by their experi- ence, becoming disgusted with their unimportant situa- tion, and leaving a service productive neither of emo- lument nor increasing respectability. I do hope there- fore that this subject will claim the attention which it so eminently merits. Persuaded as I am that when naval surgeons are placed upon a more respectable footing than that they now hold, the expediency of the regulation will be manifest to all, 1 must strenuously urge the establishment of rank, as 1 have done the ne- cessity for an augmentation of pay. MEDICAL DEPARTMENT OF THE NAVY. 215 SECTION X. Of the expediency of altering the present Ration. Previously to entering on a consideration of this subject, I will exhibit some of the French rations— the English naval ration—the ration proposed by Mr. Turnbull, a navy-surgeon—and the existing ration of our sea-service. A comparative view of the compo- nent parts of these different bills, will enable me to explain more clearly the reasons that I think exist for altering oar ration, at least the liquid portion of it. Rations allowed in the French service. Ration of a Workman. Nature of Provisions. Former Weights and Measures. Fresh bread, . . 24 ounces. Wine, . . . | of a pint. Beer and cider, . . 1£ pints. Fresh meat, . . 8 ounces. Green vegetables, . 4 deniers-. Cod-fish, ... 4 ounces. r Dinner, . 3 ditto. Cheese ) _ _ ,. £ Supper, . 2 ditto. Rice, ... 2 ditto. Dry vegetables, . .. 4 ditto. {for cod-fish, 15 lb. per hundred weight. rice, . 10 — ditto. vegetables, 5 — * ditto. {for cod-fish, 16 pints, ditto. rice, . 5 ---- ditto. vegetables, 2£---- ditto. 216 OBSERVATIONS ON THE Nature of Provisions. Salt, . Fire-wood, . Candles, Former Weights and Measures. 130 lb. per 3000 rations. look at the description following. 9 lb. per month for every hundred men. Rations when on a Cruize. Flour or biscuit, Fresh bread, Wine, Brandy, Beer or cider, Salt pork, . Salt beef, . Cod-fish, Cheese < _ C Supper, Rice, .... Vegetables, for cod-fish, Sweet oil Vinegar <> 18 ounces. 24 ditto. | of a pint. | ditto. 11 pints. 6 ounces. 8 ditto. 4 ditto. 3 ditto. 2 ditto. 2 ditto. 4 ditto. 15 lb. per hundred weight. 10 — ditto. 5 — ditto. 16 pints per hundred weight. 5 ---- ditto. 2 ---- ditto. rice, vegetables, cod-fish, rice, . vegetables, To sprinkle for ~\ the benefit of 17 pints per month for hundred men. health, J 2 lb. 8 oz. ditto ditto. "130 — ditto ditto. ■| ounce per hundred rations. Look at the description following. 9 lb. per month for hundred men. 9 — ditto ditto. 1 ounce for one month's cruize, i ounce per man. 1 ounce ditto. Mustard-seed, Salt, . Pepper, Fire-wood, Candles, Lamp-oil, Wicks, Preserved sorrel, Sour-crout, fin Brest, St. Ma loes, L'Orient, "| in the other sea- l_ ports, Mutton^ ditto. ditto. MEDICAL DEPARTMENT OF THE NAVY. 217 Nature of Provisions. Broth prepared in cakes, Chickens,. Prunes, Butter, or preserve, Sugar, Grains, Hay, . Bran, Butter, instead of Sweet oil, { for codfish, rice, . vegetables, Former Weights and Measures. 1^ ounces per man. i part. 4 15 lb. per hundred men. 10 — ditto. 6 — ditto. 9 — ditto. 50 — per sheep. 15 — per three thousand rations. Rations of the sick at sea. White bread, . . 20 ounces. Egg.....I Mutton, ... 8 ounces. Chicken, ... \ part. Mutton, instead of chicken, 4 ounces. Prunes, . . . 4 ditto. Rice, .... 2 ditto. Butter, or sugar, . . \ ditto. Rations of the Artillery. Fresh or soft bread, . 26 ounces. (The rest like the ration for a workman.) Ration of Prisoners of War. Fresh or soft bread, . 16 ounces. Fresh meat, Wine, Beer or cider, Fire-wood, 16 ditto. 1 pint. Look at the description, on this head. Ration of a Galley-slave, in firison. Fresh or soft bread, . 30 ounces, and water. if 218 OBSERVATIONS ON THE Ration of a Galley-slave, at work. Nature of Provisions. Former Weights and Measures, Fresh or soft bread, 30 ounces. Biscuit, 23 ditto. Cheese, 1 ditto. Wine, | of a pint. Beer or cider, 1| ditto. Vegetables, 4 ounces. Sweet oil, 1 lb. per hundred rations Salt, 20 — ditto ditto. Ration of Galley-slaves, without work. Fresh or soft bread, . 30 ounces. Biscuit, . . . 23 ditto. Vegetables, . . 4 ditto. Sweet oil, ... 9 lb. per hundred men. Salt, . • • » 21 — per thousand rations. Ration of Galley-slaves, invalids. Fresh or soft bread, . 24 ounces. Wine, . Fresh meat, . Green vegetables, Salt, i pint. 8 ounces. 6 deniers. 21 lb. per thousand rations. a > < W 33 H O H & W S PS •< fl- w p << o I—I Q Daify allowance for one Man in the British naval sei'vicc. Days. Bread. Bee Beef. Pork. Peas. Oatmeal. Sugar. Butter. Cheese. Sunday, . . . Monday, . . . lb. gallons. lb. lb. 1 halfpint. halfpint 1 oz. 2 oz. 2 oz. 4 Tuesday, . . 2 •• •> •• •• Wednesday, •• •• 1 2 2 4 Thursday, . . Friday, . . . ., 1 1 2 2 4 Saturday, . . 2 •• •■ •• •• •• Weekly proportion to each man, . 7 7 4 2 4 3 6 6 12 N. B Flour and suet are issued in lieu of half the beef—in foreign stations, when the beer is all served, -} pint of spirits, or a pint of wine, is issued in lieu—and when the butter and cheese arc out, the men are in general served with cocoa. Scheme of Diet for the more effectual Preservation of the Health of Seamen, by Mr. Turnbull. DINNER. Days. Beef. Pork. Rice. Portable-soup. Flour. Suet. Plumbs. Peas. Butter. Cheese Sour-crout. lb. lb. oz. oz. lb. lb. lb. Pint. oz. oz. lb. Sunday, . . • " 1 4 •• " •• " 2 '• •• Monday, . . . - •• .. 4 •• » •• 1 2 2 4 •• Tuesday, . . . 2 •■ •• ■• •• •• i 2" Wednesday, . . ■• •• ■• l 2 \ 7. l 2 •• 2 4 Thursday, . . •• 1 4 •• - •• " » 2 •• Friday, • • . - 4 " " •• 1 2 2 4 •• Saturday, . . • 2 •• •• - " •• 2 • l 2 A Table of the component parts of the ration allowed in the navy of the United States, on the days (3* VJ I lie ivcti% ' POUNDS OF OUNCES OF HALF PINTS OF < 'u 'a, o Ph fa 3 C/3 n O » Oi tf > CO O H fc W Sunday, . • . H t 3 1 4 14 •• •• •• •• Monday, . . . .. 1 •• •• 14 •• 1 •• •• Pi -< Tuesday, . . . 1 •• •• 14 2 •• •• •• " w a o Wednesday, . . •• 1 •• - 14 •• •• 1 •• -•• Thursday, . . n •• 1 1 4 14 •• •• •• - Q pa Friday, . . . .. •• 14 4 2 •• 1 1 •• S Saturday, . . . .. 1 - 14 •• •• 1 •• •• 1 3i J 1 1 98 6 2 2 2 1 1 7 N. B. Whenever any article is issued in lieu of another, the quantity of the substitute should never ex- ceed in value the price of the article for which it is a substitute. %%% OBSERVATIONS ON THE It will be seen that ardent spirits form no part of the preceding foreign rations—but that light wine, beer, and cider, are judiciously allowed for the liquid portion of the aliment. The use of sweet oil, prunes, and eggs, cannot be too highly commended, where they are sufficiently cheap to come within the govern- ment price of each ration. When our ships are sta- tioned in the Mediterranean, the sweet oil should be introduced into the ration. I think this article would at all times be preferable to the rancid and impure but- ter of the American navy-ration. As I have proposed the use of malt-liquor in this ration, I think that when it falls short, a sufficient quantity of wine should be al- lowed in lieu of it. Cod-fish forms part of the French rations. Why should it not be occasionally used for variety, in our ships ? These things are highly de- serving our attention on many considerations. The diet of seamen is at best but little calculated to give due nourishment to the system. The salted pro- visions, of which it is chiefly composed, contain but an inconsiderable proportion of nutritious matter; and the constant use of them so weakens the tone of the stomach, tiia'. it becomes every day more and more unable to perform with the necessary perfection, the office of digestion. Hence it is that the diet has al- ways been considered as the chief cause of the dis- eases of seamen; and hence it is too, that officers, who for the most part are more attentive to their diet, are seldom afflicted with scurvy. Since it is absolutely necessary that salted meats should form so large a part of the solid ration of a seaman, it is proper that such correctives to their pernicious effects on the constitu- tion, should be combined with their use, as will modify or counteract them. In the present ration of our navy, MEDICAL DEPARTMENT OF THE NAVY. 223 whiskey or rum, in the proportion of half a pint per day, forms the liquid portion. One or other of these liquors is mixed with three parts of water, and consti- tutes what is called by the sailors three-water-grog ; and the grog thus mixed, is served out at twelve o'clock in the morning, and at four in the afternoon. It is not necessary in a work of this kind, where it is my intention to avoid as much as possible all tech- nical phraseology, because I design it for the perusal of other besides medical men, to enter into a minute detail of the effects of spirituous liquors on the human system. It is sufficient for me to say, that the drink of the sailor called grog, is highly pernicious to his con- stitution, destructive of his morals, and productive of insubordination and wickedness. It is a notorious fact, that most of the crimes committed on ship-board, are perpetrated either while the offender is intoxicated, or grow in some way or other out of such disgraceful condition. Besides this, the constant use of this heat- ing and inflammatory liquor, depresses the system, al- ready sufficiently enervated by the use of salted pro- visions ; and it affords no counteracting effect to the consequences of a confinement to a diet of these meats. For this reason I would propose, that whiskey or rum be expunged altogether from the ration, and beer substituted in its stead. The anti-scorbutick effects of this liquor are well ascertained, and its nutritive quality equally well known. The advantages it has over spirituous liquor as a drink for seamen, are : 1. It is anti-scorbutick ; it will therefore tend to counteract, or at least lessen, the injurious effects of salt provisions on the system. 2. It is highly nutritious and wholesome; it does not therefore vitiate the stomach, or destroy digestion. 3. It prevents the use of bad water, the pernicious 224 OBSERVATIONS ON THE effects of which not even the whiskey can counter^ act. 4. It requires very large quantities to induce intoxi- cation. 5. It gives exhilaration to the spirits, not by its im- mediate effect, but by giving tone and vigour to the system. 6. The constant use of it does not beget an immode- rate thirst for it, and of consequence does not so fre- quently induce intemperance. 7- The habitual use of it is not destructive to the morals. For these reasons, I think malt-liquor should be substituted in the ration, for whiskey. I will venture to predict, that if this is done, we shall soon hear, as happened in the British navy, the highest commenda- tion of the change. The bread or biscuit that forms the chief vegetable portion of the ration, is a fruitful source of disease. It not unfrequently, especially when kept long, and loose in the bread-room, or in casks not water-tight, becomes sour, dry, mouldy, or wormy. In this state it produces the most distressing cholicks, dyspepsia, and other af- fections of the stomach. I cannot see why flour should not be taken to sea, and fresh bread baked on boards as has always been the case in the French navy. In- deed, it has also been done in the English navy, and always with eminent advantage. It is very practicable to bake bread even daily on board ship. I have eaten hot bread every morning for two months at sea. It is true, it was baked in small quantities ; but when bak- ed for the men, it would not be necessary to have more than one batch baked a week. Flour can be rammed tight, so as to occupy as little space as biscuit; and a very good substitute for yeast has been proposed by MEDICAL DEPARTMENT OF THE NAVY. 225 Mr. Turnbull. His directions for preparing it for sea are as follow : " Let a quantity of barm or yeast be spread thin on boards, and exposed to a moderate de- gree of heat, so that the humidity may be evaporated, and that it may be left in a dry granulated state. It must then be put into phials well corked and sealed. Let tliere be next a strong solution of wort, into which throw a small proportion of the above powder ; and in the nineteenth degree of Fahrenheit, a brisk fermenta- tion will soon be excited, perfectly qualified for every purpose for which barm is employed.'* I would propose then to amend the solid ration, by substituting, when the weather will permit it, at sea, fresh bread for biscuit; and cannot help believing, that the service would be benefitted, if, while in port, the crews of ships were always furnished with soft bread from shore. When it is necessary to use bis- cuit, it should always have a cast in the oven. 1 would propose the following ration-bill, in place of the one by which the seamen and others oi our navy are now victualled : eg Scheme of Diet for promoting and preserving the Health and Morals of the Seamen in the U. S. naval service, by Wm. P. C. Barton. Oi DAYS OF THE WEEK. POUNDS OI OUNCES OI HALF PINTS OF GALLS. S-. o P-. 1 u O U =1 C/3 *3 O tn S 2 6 u U s *-> -^ 'o V 73 •A .5 'tn tn a o C 6 tn 1 u tA tn "o 1. ( 1 I Wednesday, . ■ •■ 1 - 16 .. 1 " •• l ■• Thursday, • . 4 1 2 1 4 14 •• ■• 2 •■ •• - Friday, . . • •■ 16 4 1 •• - l 1 Saturday, . . . Weekly allowance, 1 - 14 •• 1 I 3i o 1 I 2 56 48 6 1 1 6 1 2 t 2 1 2 7 MEDICAL DEPARTMENT OF THE NAVY. 227 SECTION XL On the Ventilation and Warming of Ships. I notice these subjects, because I well know that they are not sufficiently attended to in our navy. I am acquainted with no part of the internal economy of our publick vessels so defective, as the ventilation and warming the decks, &c. I have often known a ship's crew half smothered by the closeness of the berth- deck, and sweltering with heat, when a few wind-sails, which might have been rigged up in ten minutes, would have rendered their situation comfortable and healthy. What, under such circumstances, must be the situation of a sick man, labouring under a vio- lent inflammatory fever, in which fresh and pure air are so necessary to a cure ? And what must be the feelings of the medical officer, who sees his pa- tients burning with a fever, necessarily kept in an at- mosphere sufficient of itself to beget such a disease? The ventilation of a ship consists in keeping the hold dry, by introducing pure and fresh air into it, and occasionally fires—in freeing the well from foul air and moisture, by the same means ; and in admitting a constant current of fresh air through all the decks and apartments of the ship. This is very practicable by means of wind-sails, with which every ship is abun- dantly supplied, though they are in some not frequent- ly enough used. I think communications might be made from one deck to another by means of tin or cop- per tubes, for the purpose of ventilation. They might be furnished with plugs air and water-tight, so that in 228 OBSERVATIONS ON THE bad weather the rushing of water into them might b< prevented. The decks should always be dried after being wet- ted by bad weather, or in cleaning—by means of fires. They should never be suffered to dry of themselves ; for this process is slow, and the moisture exhaled w bile it is going on, induces disease. Every ship should be furnished with a sufficient number of small close- stoves, with pipes or flues communicating with the hatchways, in the winter season. The berth-deck par- ticularly should be thus warmed. If this practice was followed, it would, I am persuaded, be the saving of the lives of hundreds. Fumigations have been strongly recommended for the purpose of purifying the air of ships. The opi- nions of surgeons on the subject of their efficacy in pro- ducing this effect, are very diverse and opposite. This is no place to enter into the merits of either question, though I have no hesitation in saying, for my own part, that I have no faith in them. For this reason, I never employed them while on ship-board. Yet as there are many surgeons who advocate this fumigating process, and perhaps too with good reason, 1 have add- ed the fumigating articles in my tables of proportions, but have mentioned that they are to be taken or not, at the option of the surgeon. The plan most to be depended on for preserving ships pure and healthy, is keeping the decks dry by fires— shutting the windward ports in bad weather—introduc- ing a constant current of fresh air throughout every part of the ship, especially during the night, by means of wind-sails, &c.—whitewashing the berth-deek, &c. frequently—and never washing the decks in wetor cold weather. MEDICAL DEPARTMENT OF THE NAVY. 229 SECTION XII. On the impropriety of frequently Wet-scrubbing the Decks in the Winter season. I am acquainted with no practice more pernicious to the comfort of the men, or more fraught with dis- ease and destruction of life, than that of perpetually drenching the main, gun, and berth-decks, with water. The mistaken idea of cleanliness that leads to this practice, cannot be too severely reprobated. It is not at all necessary for me, after all that has been written on this subject by English naval writers, to enter ex- tensively into a consideration of the numerous inconve- niences and dangers consequent upon this ill-judged practice. It is not the object of this work to dive in- to medical disquisitions—but to call the attention of the officers of the navy to such points, relative to the internal economy of their ships, as call for reform. I speak now particularly of the wetting the decks in the winter season. I have seen the most destructive sick- ness induced by this practice indiscreetly followed during all kinds of weather, rainy, moist, wet, and cold; and I have no hesitation in saying, that in one instance I saw a contagious fever produced by it. Yet I was never able to convince any one of the sea-offi cers with whom I conversed on this subject, of the in- jury resulting from this custom. The following letter will show what ground I have for the assertion just made, that wet-scrubbing the decks has produced, within my own knowledge, ty- phus contagion on ship-board 230 OBSERVATIONS ON THE Frigate United States, Annapolis Roads, April 2i, 1810. SIR, Since your absence, the ship's company has be- come extremely unhealthy, and I am sorry to state to you, the prevalence of a genuine epidemick typhus fe- ver. Of this fever, we have lost three men—one, a marine, who was taken ill the day before our arrival in these roads, died in four days—-another, a land man, on the fifth day ; and yesterday, two hours after his admission on the sick-list, one of the painters. There are at present fourteen men ill with this fever,* six of whom were taken this morning. The other pa- tients are afflicted with inflammatory catarrhs and rheumatisms, and we have four convalescents from pleurisies. But since the appearance of this fever, they have all partaken in some degree of its typhus symptoms. With respect to the cause of this epidemick, I am entirely at a loss to give you any correct opinion, at this time. I think, however, a change of the diet of the crew, for fresh provisions and greens, would have some effect in checking its progress. 1 think, too, that were the berth and gun-decks, particularly the former, less often wet-scrubbed, the cases of typhus, so nume- rous now, would be less frequent. . I am. sir, respectfully, Your obedient servant, William P. C. Barton. Com. Decatur. Trotter says, that iu the winter of 1793-4-, a contagi- ous fever broke out in the Russel, and is of opinion, that the frequent washing of the decks (three times a week) principally caused it. Such is my conviction of the bad • The number was afterwards increased to forty. MEDICAL DEPARTMENT OF THE NAVY. 231 effects of this practice, that I do not hesitate to assert: that it would be far better for the health of the men, if the berth-deck was never wetted from Novem- ber till April.—How then will this deck be kept clean, it will be asked ? I answer, by dry-rubbing with stones and sand, according to the usage in the best re- gulated ships in the British navy, and in some few of our own. The gun-deck might be washed once a week, always choosing a fine dry day for the purpose, and the main-deck twice. In the intervening time let them be dry-rubbed. When it is necessary to or- der the men to this business, the officer of the deck should see that every man takes off his shoes and stockings, and rolls up his trowsers. Those who have good strong boots may be exempted from this regula- tion. Perhaps it would be adviseable for the purser to lay in among his slops, a sufficient number of boots of this description, or such as are known by the name of ditchers9 boots. If this plan was adopted, the necessi- ty for washing the decks in bare feet would be done away, and this would be not a little desirable. For though it certainly is better that the men should do this, than keep on wet shoes and stockings all day, yet even this exposure to cold and moisture is perni- cious. It is a practice only to be advocated, as the least of two evils. In the British navy, where the internal regulations of the ship are always made with a view to the health and comfort of the men, I know that during the winter season, the decks of ships are now seldom or never wetted, but are kept clean by dry rubbing and sweep- ing. This I learned from actual observation, (having spent part of a winter in the midst of the English fleet at Plymouth, and the remainder in the vicinity of the fleet at Spithead.) as well as from the information of 232 OBSERVATIONS ON THE the surgeons and officers with whom I became ac- quainted. I will conclude these few observations on the impropriety of continuing this practice, by insert- ing a letter from one of the physicians of the English navy, in answer to some inquiries I made of him on this subject, and respecting dress, and the means used to guard boats' crews, who went on duty before break- fast, against the effects of inanition. Royal Hospital, Haslar, 3d May, 1811. MY DEAR SIR, I have the honour to acknowledge the receipt of, your polite letter of the 24th ult. and should have im- mediately answered it, but it was only to-day that I have been able to procure the seamen's ration, as esta- blished in the navy, which 1 herewith enclose. 1 cannot express how highly sensible I feel the sen- timents of esteem you have done me the honour to make. Permit me to assure you, that it will afford me much satisfaction, when you again visit this country, to have the pleasure of seeing you, and being more in timately acquainted. With respect to the first query, I believe it is the uni- versal practice throughout the navy, previous to wash- ing decks, for the seamen to be bare-footed—it would otherwise be very prejudicial to the health of men, producing catarrhal complaints. Seamen are in gene- ral an improvident class of men, and if attention was not strictly paid by the officers to make them shift their clothes when wet, they would not do it of their own accord. 2d. During the winter season, in cold climates, the ships' companies are always served with flannel shirts or banyans, and flannel drawers, blue jackets aid trowsers. Although there is no regulation laid down MEDICAL DEPARTMENT OF THE NAVY. 233 by government relative to dress, yet it is common in all ships, where the health of seamen is at all consi- dered of any importance, to make them dress according to the climate they are in. 3d. I believe it was formerly much the practice in the East and West-Indies, to give boats' crews (when going c:i duty early in the morning, to wood or water) a dose of bark with wine ; but I think a better prophy- lactick would be to have a warm breakfast of cocoa, which is usually supplied in these climates in lieu of butter and cheese: With every wish for your health and prosperity, Believe me to be, with great esteem, My dear sir, Your's most sincerely, John Gray. Dr. Barton, Surgeon of the U. S. fri- gate Essex, Cowes, Isle of Wight. SECTION XIII. Of the impropriety of shipping men for the U. S. na- val service, without a previous examination of them by a Surgeon or Surgeon9s-mate. It is well known that an advance of two months pay is made by the recruiting-officer to every seaman and landman he may ship for the service. This advance is authorized by government. Now it not unfrequent- ty happens, when these men have not been examined by a medical man, that after this advance has been expended, which commonly happens in a few days, and after the government has paid, or is charged with, a considerable sum for transporting such men to the port Hh 234 OBSERVATIONS ON THE at which the vessel they are destined for may be sta- tioned, they are discharged on the report, of the sur- geon of the ship, after inspection, as unfit for service. This unfitness for the most part is on account of rup- tures, sore legs, or confirmed cases of lues venerea. What is the consequence of such a measure ? Either government or the recruiting-officer must lose the amount of the advance and travelling, and other inci- dental expenses. It is not just that the recruiting-offi- cer should be thus oppressed, since government did not order to his rendezvous a medical officer, to inspect the men. And if the government must bear these ex- penses, what ruinous devastations will not be made upon the treasury, by a repetition of such cases ! It has happened to me to be under the necessity of re- porting unfit for ship-service, at least 20 men, who had never performed one day's duty on ship-board, or else- where, in one year ! The recruiting-officer was cer- tainly not to blame for this—since no medical officer had been attached to his rendezvous. Yet this does not set the matter in a better point of view. The er- rour exists, and it is necessary to correct it. It should be a standing rule, never to be dispensed with, that to every recruiting station should be attach- ed a surgeon or surgeon's-mate, whose duty it should be to inspect all men offering for service. He should have it in his power to reject all those he may deem unfit for service. That this duty may be the better performed, the medical officer should be one who has been to sea some time, since he can best tell what kind of men are fit for the service. He should reject all those who have, 1. Ruptures; 2. sore legs, or the marks of sores on them; 3. all who have the venereal disease badly, (and, if requir- ed for immediate service, all who have it in any de- MEDICAL DEPARTMENT OF THE NAVY. 235 gree); 4. all who have any defect in their limbs; 5. all who appear of weak and melancholy tempera- ment. The necessity for this strictness is felt by every me- dical man who has been to sea. In the first place, if ruptured persons are admitted on board, the cost to government in trusses, is very heavy; besides which they frequently make this complaint an excuse to skulk, and it is very difficult to ascertain whether real or feigned pain causes the request for exemption from duty. It would be inhuman to proceed in such cases, on an uncertainty. In the second place, it may be remarked, that a sore leg is an everlasting plague to the surgeon, a vexation to the sea-officer, and a never failing plea for inability to perform duty, on the part of the man himself. Thirdly, the venereal cases, when bad, generally deprive the ship of the services of the men, for two or three months; and the delicacy of the constitution, and its liability to disease, by exposure to cold and damp- ness, after a cure from this complaint: render the effi- ciency of such men still more precarious. Fourthly, defective limbs, such as stiff joints, one leo- or one arm being shorter than another, the club- foot, &c. &c. not only interfere with the actual per- formance of duty, but are unsightly objects on ship- board. Every thing that offends the feelings in this way, should, if possible, be avoided. And, lastly, weak and melancholick men are the first subjects, and generally are the victims of typhus contagion. The sea-life engenders low spirits itself, without choosing or taking men constitutionally pre- disposed to dejection and despondency. This caution is particularly applicable to landmen. I have seen some die, who a short time before, in perfect health, 236 OBSERVATIONS ON THE assured me that they could not live long, so much did they desire to get on shore. These were all mclancho- lick men. I have said, none should be passed who have the marks of sores. This may appear an unnecessary caution. I know it, however, to be otherwise. Old ulcers, and of the worst kind, too, frequently skin- over, or are slightly cicatrized, so as to prevent the man from coming under the head exemption for sore-legs. Yet in these cases the slightest scratch or bruise (which can never be avoided by the most careful, on ship-board) will bring on most extensive ulceration. While I was attending physician to the army in Phi- ladelphia, I frequently refused to pass men with such marks. The officers, some of them, offended with my fastidiousness, took the responsibility of enlisting these men, who had, they said, " perfectly sound legs.99 In the course of their riots and broils while spending their bounty-money, it always happened that the skin be- came abraded—ulceration came on, the men did not pass general muster, and were of course discharged. I cannot too strenuously urge the necessity of exa- mining strictly, for the existence of ruptures. This complaint is more common than is generally imagined. In the first year of the present war, I examined two thousand recruits in the city, and from the neighbour- hood of Philadelphia. Twelve hundred only of this number did I pass as able-bodied men; and of the re- jected number, 800, more than tioo-thirds tvere refus- ed on account of ruptures. These facts therefore will, I hope, establish the absolute necessity for the good of the service, of amending the recruiting plan as I have proposed. MEDICAL DEPARTMENT OF THE NAVY. 237 SECTION XIV. Miscellaneous Observations on the internal Arrange- ments of Ships, and some necessary Regulations in their Government. Under this head, 1 shall throw together a few curso- ry and unconnected remarks on the structure of some part of the publick ships, connected with the surgeon's department, the health of the men, and the comfort of the sick. 1. The sick-bay in double-decked vessels, is usual- ly placed amidships, and is separated from the other part of the berth-deck only by means of a tarpaulin, or canvass curtain, and sometimes not even by these. From the situation of the bay, then, it is necessarily exposed to the damp air of the cable-tier, as well as the cold air of the mid-hatch above it, which is generally open, at its after end; and to the unpleasant smell of the fore-hold, where the beef, pork, &c. are kept; as well as the cold air that blows down the fore-hatch, at its forward end. The screens or curtains of which I have spoken, are but ineffective barriers to these unhealth- ful currents. Added to this, the berth-deck, accord- ing to the existing usage of the navy, is frequently, if not daily, wetted. Can any place, then, be conceived of, better calculated to injure the patients and distress the surgeon, than such a sick-bay ? This subject, then, demands the attention of all those connected with the direction of the internal structure of ships. I see no reason why the sick-bay should not be con- structed farther aft, pr chock forward: that is to say, 238 OBSERVATIONS ON THE between the steerage and root of the main-mast, or forward of the fore-mast. It should, too, be encom- passed or partitioned off by moveable bulk-heads, lin- ed with baize, and should be ventilated by tubes from the gun or main-decks. It should be furnished with small and well-slung cots, in such number as it will conveniently contain. In the summer season, perhaps, it would be more conducive to health and comfort, to have the sick-bay amid-ships, where it now usually is placed ; but I have seen too much of the inconveni- ence and danger of placing sick men in this place in the winter season, not to think it highly necessary that some change should be made. 2. The paint-room should be so constructed, that the noxious vapour arising from the white lead, green paint, &c. which are generally kept on board, cannot reach the place allotted for the men to sleep in. This caution is particularly meant for the commanders of single-deck- ed and small vessels. I was once called to visit the crew of the late U. S. brig Nautilus, at Norfolk, the greater part of which was taken down with the most violent colica pictonum I ever saw—the surgeon him- self narrowly escaped with his life. Upon inquiring in- to the cause of this disease, I had no hesitation in pro- nouncing its origin to have been derived from the paint, which was put in tanks en masse, at the forward part of the berth-deck. The vessel being attached to com- modore Decatur's squadron, upon my report, he di- rected an alteration to be made in the paint-room. 3. When ships are laid up in ordinary, care should be taken in the choice of a place for this purpose. It should not be one exposed to damp and marshy exha- lations ; for by long exposure to these, however se- curely the ship may be covered, the timbers imbibe so much moisture, that for a considerable time after be- MEDICAL DEPARTMENT OF THE NAVY. 23& ing fitted out and commissioned for service, they ex- hale a dewy vapour. This caused in some of the French and English ships, the most dreadful havock among the men. It is therefore an object not unwor- thy of attention. 4. The lower-deck ports should all be furnished with bunting-sashes. The air-ports should be open- ed as often in the summer season as the weather and nature of the service in which the ship may be engag- ed, will justify or admit. Wind-sails should be rigged up in every hatchway, with branches communicating with the holds, cable-tier, &c. in a warm season, when- ever the weather will permit. This is attended to in some of our ships, but, I have reason to think, not ri- gidly enough in others. 5. Boats' crews sent on duty on shore, to wood or water, or for other purposes, early in the morning: should always receive theit breakfast previously to their going. When it is necessary to send them on morning duty in marshy situations, they should be al- lowed a warm breakfast. It is well known to naval surgeons, that boats' crews are always more liable to disease than the rest of the crew. Every regulation, therefore, that has a tendency to guard against this cir- cumstance, should be considered with attention. 6. A sergeant or corporal of marines should always superintend the exchange of ship's provisions by the men, for articles brought along-side in bom boats, for this traffick. Without this superintendance, a practice that might be highly conducive to the health of the crew, may be productive of very pernicious conse- quences. For sailors will exchange any of their ne- cessaries for spirituous liquors, if not closely watehed. This regulation is adopted in our best regulated ships; but in others it is not strictly followed. 240 OBSERVATIONS ON THE 7. When the ships are anchored in our rivers, the men should be prevented, as far as practicable, from drinking water from along-side. And the ship's water should never be supplied from these sources. The putrid vegetable matters, &c. which these rivers contain, render the water not only cathartick, but 1 have known it to induce the most severe and obstinate cholick, and dysenteries. It spoils more readily than spring-water, which of course would make it impro- per to fill for ship's use from it. 8. That dancing and musick among the men be promoted and encouraged as frequently at sea, as the duty of the ship will permit. These amusements be- guile the time, and make the sailor more contented with his situation. 9. The most willing co-operation of the comman- ders and other officers of ships, should always be af- forded to the surgeon, in ?iny of his plans for meliorat- ing the condition of the men, and promoting the conva- lescence and cure of the sick. MEDICAL DEPARTMENT OF THE NAVY. 241 Conclusion. In the foregoing pages I have been necessarily led into the exposition of many and palpable abuses in the medical department of the navy. There are not a few persons with whose interests such an exposition will very much interfere. From them, therefore, I expect no thanks. On the contrary, I look for cavilling and censure at their hands. I however am prepared to meet it. My independence in expressing my senti- ments on points of duty, while in the navy, procured for me not a few enemies. But while I regret this con- sequence of a line of conduct that thrice the inconveni- ence could not have made me forego, I have the con- soling assurance of having acquitted myself in the way of my duty, to the entire satisfaction of those of the officers with whom I have served, whose regard and good opinion were of any moment, in my estimation. Both my feelings and my fortune have suffered by a determination I made when I first entered the service, from the execution of which I never in a single in- stance swerved—to pursue that line of conduct that I deemed consistent with the faithful performance of my duty and my trust, however such conduct might clash with the prirate or publick interests of others, or dif- fer from the customary proceedings of persons similar- ly situated with myself. The same independence which caused me to hold up my hands against the abuses of the medical depart- ment of the navy, while I held any responsibility, or took any active part in it, now emboldens me to ex- press them. I i » 242 OBSERVATIONS, &C. I conceive that the country has a right to expect from every officer in its service, the result of his expe- rience, if that can in any way lead to the interests of the nation. I therefore tender with very unaffected diffidence, my mite towards its general weal. APPENDIX. LIST OF SURGEONS IN THE NAVY OF THE UNITED STATES, In the Year 1814. Edward Cutbush. Peter St. Medard. George Davis. Samuel R. Marshall. Larkin Griffin. Lewis Heerman. Joseph G. T. Hunt Jonathan Cowdery. Samuel D. Heap. Robert L. Thorn. Samuel R. Trevett. William P. C. Barton. Joseph W. New. Joseph J. Schoolfield. George Logan. Amos A. Evans. Robert Kearney. Robert Morrell. John A. Brereton. James Page. John D. Mc Reynolds. Thomas Harris. William Turk. Hyde Ray. William Baldwin. Walter Buchanan. Samuel Ayie. E. L. Lawton. Charles Cotton. Gerard Dayers. William Caton. Robert R. Barton. Benjamin Kissam. Charles Campbell. John A. Kearney. Richard C. Edgar. Bailey Washington. William M. Clarke. Thomas Chidester. James Inderwick. George T. Cannon. 244 APPENDIX. LIST OF SURGEONS'-MATES IN THE NAVY OF THE UNITED STATES, In the Year 1814. John Harrison. Stith Lewvis. Samuel Horseley. Gustavus R. Brown. Theodore C. Vanwyck. William B. Hatfield. Daniel Hatfield. Robert C. Randolph. William Barnwell. Joseph G. Roberts. Walter W. New. Henry Hunt. Charles B. Hamilton. Richmond Johnson. William Belt. Samuel Vernon. John D. Armstrong. H. M. Clarke. Usher Parsons. P. C. Whittelsey. Peter Christie. John Young, junior. Samuel Jackson. , Richard Gregory. E. D. Morrison. Horatio W. Waring. ^John M. Lynn. John H. Gordon. Samuel M. Kissam. Leonard Osborne. William Swift. John Dix. Thomas Williamson.' Thomas B. Salter. Seaborn I. Saffold. Tho?nas Sprague. George Bohrer. Benjamin Austin, jun. John Cadell. Lewis Mitchell. Silas D. Wickes. Isaac Baldwin, jun. Wilmot F. Rodgers, Jabez W. Hustead. II1E EMJ. ★ ★ ARMY * * MEDICAL LIBRARY Cleveland Branch 1214 ^1