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Full text of "A treatise containing a plan for the internal organization and government of marine hospitals, in the United States : together with observations on military and flying hospitals, and a scheme for amending and systematizing the medical department of the Navy"

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9 




TREATISE 

CONTAINING 

A PLAN 



CONTAINING *"*<V 



FOR THE 
INTERNAL ORGANIZATION AND GOVERNMENT 

OF 

MARINE HOSPITALS, 

IN THE 

UNITED STATES; 

TOGETHER WITH 

Observations on Military and Flying Hospitals, 

AND 

A SCHEME 

FOR AMENDING AND SYSTEMATIZING THE 
MEDICAL DEPARTMENT OF THE NAVY. 

BY 

WILLIAM P. C. BARTON, M. D. 

SURGEON IN THE NAVY OF THE UNITED STATES, STATIONED AT THE 
NAVY-YARD, PHILADELPHIA, AND FORMERLY PHYSICIAN TO THE 
ARMY IN THE 4tH MILITARY DISTRICT; PRESIDENT OF THE 
PHILADELPHIA LINNEAN SOCIETY, AND 

PROFESSOR OF BOTANY 

IN THE UNIVERSITY OF PENNSYLVANIA. 

m • LIBRARY. 

THE SECOND EDITION, ft ,. 

WITH EMENDATIONS AND ADDITIONS?"* —'"' 

wvwwwvwvwvw 

PHILADELPHIA : 

PRINTED FOR THE AUTHOR, 
AND SOLD ONLY BY HIM. 

1817. 



DISTRICT OF PENNSYLVANIA, to wit: 

Be it remembered, That on the twenty-seventh day of January, in the 
forty-first year of the independence of the United States of America, 
A. D. 1817, William P. C. Barton, of the said district, has deposited in 
this office the title of a book, the right whereof he claims as author, in the 
following words, to wit : 

" A Treatise containing a Plan for the internal organization and govern- 
ment of Marine Hospitals in the United States : together with Observations 
on Military and Flying Hospitals, and a Scheme for amending and syste- 
matizing the Medical Department of the Navy. By William P C. Barton, 
M. D. Surgeon in the Navy of the United States, stationed at the navy yard, 
Philadelphia, and formerly Physician to the army in the 4th military dis- 
trict; President of the Philadelphia Linnean Society; and Professor of 
Botany in the University of Pennsylvania. The second edition, with emen- 
dations and additions." 

In conformity to the act of the Congress of the United States, entitled, 
" An act for the encouragement of learning, by securing the copies of 
maps, charts, and books, to the owners and proprietors of such copies during 
the timtts therein mentioned." And also to the act entitled, " An act 
supplementary to an act, entitled, " An act for the encouragement of learn- 
ing, by securing the copies of maps, charts, and books, to'the authors and 
proprietors of such copies during the times therein mentioned," and ex- 
tending the benefits thereof to the arts of designing, engraving, and etch- 
ing historical and other prints." 

DAVID CALDWELL, 
Clerk of the District of Pennsylvania. 



TO 



DANIEL PARKER, ESQ. 

ADJUTANT AND INSPECTOR-GENERAL 

OF THE ARMY OF THE UNITED STATES. 



DEAR SIR, 

TO you more than to any other individual am 
I indebted, for the standing this work now maintains — a stand- 
ing which is not only flattering to me in the highest degree, but 
is a subject of legitimate pride. I should greatly dissemble 
did I withhold this confession. 

Influenced by the recommendations of medical men, prefixed 
to the work, and by a very laudable desire to patronize any 
efforts made to benefit the publick service of our country — you 
brought this book to the notice of the government. The liberal 
patronage extended to it by Mr. Crawford, late secretary of 
war, and yourself, while it is highly gratifying to me, demands 
my publick acknowledgement. Since the encouragement I 
have received has been effected through your instrumentality, 
I beg leave to inscribe to you this Second Edition, in evidence 
of the high sense I entertain of the service you have rendered 
me. 

As I have done this without your knowledge or consent, I 
crave the indulgence of your pardon for the liberty I have thus 
taken with your name. 

Permit me to avail myself of this opportunity to tender you 
the assurances of my esteem and regard, and believe me to be, 

Dear Sir, very truly your's, &c. 

WILLIAM P. C. BARTON. 

PHILADELPHIA, 
Jan. 1st, 1817. 



Sir, Adjutant and Inspector-General's Office, 15th October, 1816. 

THE Secretary of War has examined your Treatise, on the internal 
organization and government of Marine Hospitals, &c. and orders that it be 
distributed to the principal officers of the medical staff of the army. 

I have to request, that you will direct one hundred copies of the work to 
be sent to me , as soon as convenient . 

I am convinced that, in " this piping time of peace," our doctors will be 
able, with this treatise, to make great practical improvements in the de- 
partment where the military service suffered most, in the early part of the 
late war ; and in which an army of recruits, or militia cantonments, may 
again suffer, without practical knowledge of hospital arrangements. 

I seize this occasion to offer you the new assurances of my very great 
respect and regard. 

D. PARKER, 

William P- C. Barton, Esq. Adjutant and Inspector-General. 

Surgeon U. S. Navy, &c. &C. 



Sir, Navy Department, June 26th, 1815. 

YOU will be pleased to receive of Dr. William P. C.Barton, fifty 
copies of his treatise on Marine Hospitals, and pay him for the same, at the 
rate of two dollars per volume, chargeable to the general contingent ex- 
penses of the navy. 

I am, very respectfully, your obedient servant, 

George Harrison, Esq. B. W. CROWNINSHIELD. 

Navy Agent, Philadelphia. 



Sir, Navy Department, June 27th, 1815. 

YOU will be pleased to send forty copies of Doctor Barton's Trea- 
tise to this place, and deliver the residue to Doctor Heap, subject to fur- 
ther orders, for the use of the navy. 

I am, very respectfully, your obedient servant, 

George Harrison, Esq. B. W. CROWNINSHIELD 

Navy Agent, Philadelphia. 



PREFACE 

TO THE FIRST EDITION. 



JN EARLY three years ago, a law was passed by Congress, 
relative to the establishment of Marine Hospitals in the 
United States. When at Washington in July, 1811, the secre- 
tary 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 internal organization of the 
household, as might seem to me consistent with economy and 
health. Mr. Hamilton informed me, that he was required, by 
ah article of the marine hospital law, to prepare, by the next 
meeting of Congress, a report, on the police and domestick ar- 
rangements of such hospitals ; but that, conceiving the subject 
to be properly the province of medical men to treat of, 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 order and system 
as the limited time I had to devote to the subject, amidst the 
pressure of my professional duties on shipboard, permitted. 

The report containing them, which was chiefly written 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 
mental affliction, was certainly less perfectly digested, and more 
carelessly treated, than the importance of the subject demand- 
ed. But imperfect as it necessarily was under such unpropi- 
tious circumstances, I thought it my duty to transmit it to the 
secretary by the specified time. This was therefore done. — - 
Subsequent and more mature 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 Hos- 
pital Fund. With considerable additions, and I hope also with 



VI PREFACE. 

some emendations not entirely unimportant — the original plan 
sent to, the secretary is now presented in the form of a treatise, 
to the commissioners of the marine hospital fund, and the sur- 
geons in the navy. 

The second part of the work contains some miscellaneous ob- 
servations on the medical department of the navy. I have 
attempted to devise a more systematick plan for conducting it, 
— and have ventured to propose a scheme, for checking the 
abuses which grow out of its present loose administration. 

During the term of my sea-duty, I had many opportunities 
of seeing 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 
endeavoured to point out. If the propositions and suggestions 
exhibited in the few pages on these heads, that follow the treatise 
on marine hospitals, be thought worthy of adoption : and if, 
when executed, they shall be found calculated to achieve the 
object they have in view — I shall deem 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 medical de- 
partment 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 re- 
munerated. 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 en- 
deavours shall effect towards reforming and systematizing that 
department, without the efficient and able administration of 
which, the lives of thousands may be jeopardized or lost — 
whether this be by means that I have here proposed, or by in- 
viting 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 coepit habet." 



Prune-street, Philadelphia, 
February 1, 1814. 



PREFACE 

TO THE SECOND EDITION. 



1 HE fate of this book is somewhat remarkable. It was 
written by the request of a late secretary of the navy*, at a 
period when the youth of the author, (but then four-and-twenty) 
caused him to think of executing the task, with diffidence ; and 
when he finally determined on performing it — to look with 
fearful apprehension for the reception which awaited the result 
of his labours. The workf , however, was flatteringly recom- 
mended by the late Professor Barton, by Professors James, 
Coxe, Dorsey, and Chapman, and by Doctors Hartshorne and 
Hewson, the latter now professor of comparative anatomy. 

Notwithstanding these unqualified testimonials in its favour, 
supported by a very favourable review in this city, and an en- 
comiastick notice by a literary gentleman of Parish, — the work 
lingered for a short time on publick view, and was then forgot- 
ten. He, by whose request it was undertaken, had passed from 
office to the retired walks of private life, whence he could not, 
had he desired, have rendered it any substantial service ; and 
from his successor it never received, to the author's knowledge, 
even the compliment of a transient glance, much less that fos- 
tering protection and patronage to which the recommendations 
alluded to, and affixed to the work, indubitably entitled it. 

An ineffectual attempt§ was made in March, 1814, to bring 
it to the notice of the naval committee of Congress ; principally 
with a view to lay before its members a knowledge of the irre- 
gularities and abuses of the medical department of the navy ; 
for the reform and correction of which the author had proposed 
what he believed a feasible scheme. It resulted, however, in 
an indirect reference of the business to the secretary of the 
navy, whose attention to it, as Mr. Lowndes in his letter to the 

* Paul Hamilton, Esq. 

f The manuscript was transmitted to Mr. Hamilton, from Newport, R. 
Island, in November, 1811. J Mr. Warden. 

§ In this attempt, acknowledgment is due for the polite intercession of 
Charles J. Ingersoll, Esq. then a representative of this city. 



VU1 PREFACE. 

author very justly remarks, would naturally be attracted by the 
importance of the subject treated of. It has been already men- 
tioned, that Mr. Jones had not thought proper to bestow that 
attention on the work which, in the author's estimation, and the 
opinion of others, the importance of the subject demanded. Mr. 
Lowndes further intimated, that the naval committee could 
take no notice of, nor feel competent to decide on, subjects 
which involved professional knowledge. A copy of the work 
was sent to that gentleman. Had it reached him, which it ap- 
peared was not the case, he could have satisfied himself by a 
single glance at its contents, that subjects other than medical 
were pointed out as calling for reform ; such too as could only 
properly come under the cognizance of legislators, and the re- 
form of which could be accomplished by no other authority. 

It is plain, from this exposition, that the author had but lit- 
tle reason to be satisfied with the present, or sanguine respect- 
ing the future reception of his work. Yet, though not insen- 
sible to the palsied touch which seemed to have reached it, can- 
dour compels him to acknowledge — that he never despaired of 
its ultimate success. He trusts he will be exonerated from the 
imputation of vanity, in making this confession, when he de- 
clares- — that his hope was predicated on the recommendatory 
letters with which it had been honoured ; and he totally dis- 
claims the influence of that feeling of self-love which causes an 
author to consider his literary production as a part of himself, 
thus becoming wedded to its merits, and insensible, with true 
parental blindness, to its faults or imperfections. He has not 
been disappointed. Supported by such strength, the work has 
finally worked its own way into notice and favour. It has been 
patronized both by the navy and war departments, and pur- 
chased by their respective secretaries for the use of the naval 
and army surgeons: and although but three years have elapsed 
since its publication, a new edition is called for. What is the 
inference deducible from this statement? That the officers of 
government alluded to above, consider the work an useful xade- 
mecum for naval and army surgeons and mates. 

For this estimation of its merit, the author takes this oppor- 
tunity of rendering his thanks to those medical gentlemen, by 
whose passport it has at length gained admittance to the cham- 
bers of the great, after a chilling and tedious tarry at the portal, 
and many repulsive frowns from one of the servants in waiting. 

No. Ill, -5". Ninth-street, Philadelphia, 
Feb. 1, 1817. 



PART FIRST. 



A PLAN 



FOR THE 



INTERNAL ORGANIZATION AND GOVERNMENT 

OF 

MARINE HOSPITALS 

£ IN 

THE UNITED STATES. 



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 26th 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 



OBSERVATIONS ON 



tute a fund for navy hospitals. This fund was to be 
augmented. also, by all the lines 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 of 
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, seaman, 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 H03F1TALS. 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 
equity, 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, aud the whole plan 
proved abortive. 

The time however, has 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 in fact a^ 
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 institutions 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. 

country. And when we view the present want of ex- 
tensive institutions for the care of sick sailors, we can- 
not hut 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 Britannick 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 



O 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, I 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 wearisomencss 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 acceded 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- 



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 Avithout them, our na- 
vy cannot prosper, I sincerely liope 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 with convenience only about 
eight patients, twenty -J our 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. Mv 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 situation of 
the hospital with a view to the comfortable accommodation of the sick on 
that station ; and if you deem it necessary i 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 maybe, 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 JV. 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 minutim 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 maguitude 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 tiie 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/or 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- 
ediuto 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 

c 



JO 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 governour, 


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, . . 4 


10 per day. 


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 day. 


An apothecary and one assistant, 


93 10 


assistant, 


40. 


Three matrons, 


10 each. 


A school-master, 


150 


An organist, 


60 


A butler, .... 


25 


Inferiour Officers, 8£c. 




Crovernour's clerk, 


70 


Deputy treasurer, 


100 



lie 



OBSERVATIONS ON 



Salaries per 
L. 

50 
60 
50 
90 
30 
70 
50 
50 



Two treasurer's clerks, 

Secretary's deputy, 

His clerk, .... 

Assistant to the clerk of the works, 

Servant to surgeon, 

1st steward's clerk, 

2d and 3d ditto, 

4th ditto, .... 

Clerk to clerk of the checque, one of, 7^ 

50 
60 
15 
.30 
40 
15 
30 
15 
SO 
15 
15 
12 



aim, 

s. sterling- 
each. 



2d, 3d, 4th, ditto, . . 50 each 

Master brewer, 

Butler's mates, two, . . 15 each. 

Messenger, .... 

Cook of the east kitchen, 

Cook's mates, two, . . 15 each. 

Cook of the west kitchen, 

His mates, two, ... 15 each, 

Scullery man, 

His mates, two, ... 15 each. 

Porters, two, ... 15 each. 

Barber, •."'.'» 

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. U. every mate Is. 6d. and every private 
1*. per week, for pocket money. 



MARINE HOSPITAXS. IS 

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 71. 101. 
14/. and 18 I. 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 OBSERVATIONS ON 

Sterling 1 . L. per ami. 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, 111. 
per ami. : those who attend the sick are paid 161. 4s. : 
such as are employed to look after the helpless pen- 
sioners, 14/. 14s. : and such as are in the service of 
the boys, t6Z. 4s. 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 1. 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 ; 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 
takiug 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 buildiug ie 



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 and 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 Haskr, 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 of 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 : 



600 




500 


each. 




6 per day. 




5 per day. 


350 


per ann. 


350 




300 




300 





18 OBSERVATIONS ON 

L. *. 

A governour, who must be a post-cap- 
tain, with a yearly salary of 800 
Two physicians, who must belong to 

the navy, with a salary, one of 7'66 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 to 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. 



Salaries as at 
Haslar, 



MARINE HOSPITALS. 19 

This establishment is pretty nearly similar in its in- 
ternal eeonomy 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 array. 
The goveruour and lieutenant-governour. 



Military Officers 



General — governour, 

General — lieutenant-governour, 

Major, 

Adjutant, .... 

The treasurer is the paymaster-gene 

ral for the time being, to the land 

forces. 
His deputy, 

His clerk, .... 
Two chaplains, 

Secretary and register, ^ 

Two clerks, 5 

Magistrate to attest the invalids } 

aud out-pensioners, 5 

Physician, .... 
Surgeon, .... 

Two mates, -* 

Apothecary, 
Comptroller, 

Steward, j> 

Truss-maker, 
White wardrobe-keeper, 
Comptroller of the coal yard, 



Salaries per ami, 

£500 
400 
250 
100 



not known, 
do. 

100 each. 

Salaries not 

known. 



100 
100 



Salaries not 
known. 



MARINE HOSPITALS. 21 



Organist, 



Salaries not 
known. 



Clerk of the works, 

Master-lamplighter, 

Master-butler, 

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 121. 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 1, 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- 



S3 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 yi. 



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, Shecrness, 
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 administru- 
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 departments, 
aided by a sufficient number of medical and chirurgi- 
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 
often ders punished as the court should decide. Slight 
offences and irregularities of these officers, might be 

E 



;•>{} OBSERVATIONS DM 

brought under the cognizance of the officer highest in 
authority in the institution ; and the offending person 
subjected to natch punishment or penalty as he might 
deem 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 fort!) 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 Scotlaud to devote their time to the ser- 
vice of their country. 



MARINE HOSPITALS. 27 



SECTION IV. 



Of the proper situation and construction of J\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 he 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 use 
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. Kitchen gardens 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 
examined 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. 



30 OBSERVATIONS ON 

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 

them. 
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 is 
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 the kitchen ; 2dly, that the larders should 



MARINE HOSPITALS. SI 

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 parte 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 
with 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 render them other- 



32 OBSERVATIONS OX 

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, instead 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, 1 



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 auy 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 

r 



34 OBSERVATIONS O.N 

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 
tuuuel 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 residenoe 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. 30 

the size of the ward will admit it, it would he advisa- 
hle to leave it fifteen or eighteen feet in 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 Tor 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 



80 OBSERVATIONS ON 

wards, which appertain to the military hospitals of 
France. 

For the bed of a single person, the bedstead must 
be of the following dimensions. 

metre, centimetres. 

Inward lenghth, ... 1 94 
Breadth, 97 

Stanchions. 

Height of the head, - - 1 37 

Height of the foot, - - - 73 

Thickness at the head and foot, - 8 
Breadth of each face or pane, - 23 

Thickness of ditto, ditto, - - 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, . _ 175 

Thickness, . . 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 bedsteads 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, &fc. 

The hospital should be abundantly slocked with 
shirts, bowsers, 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 ; 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 any 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, &e. &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, " devil's bit" put 
on them, in addition to the name of the hospital. This 
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 tiieft 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 deeim. 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 c. in breadth. 

They should be made up with wool of a good qua- 
lily, 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- 
ted, 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 he less than 1 m. 67 c 
The length must he 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 
I'm. 94c. in inward 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. 



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 2£ 
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 
to]), 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 ; thoscv 

* 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 every chief 
physician and surgeon, a frock of brown linen. 

The dimensions of each apron must be 96 centime- 
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 Jlpparel. 

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 ON 

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 out- 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, aud 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 the 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 and 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 
those 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- 
crees. 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 
*»•? 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 



48 OBSERVATIONS ON 

tants of the room are not sensible of any coldness while 
this process is going on, for it will not even disturb tin- 
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 he so lit for respiration. 

If there he 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 OBSERVATIONS 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 former- 
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, in 
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 flue 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 iu other than maniacal apartments, with advantage. 
In hospitals not intended for the reception of lunaticks, 
the inconvenience of affording a ready passage for 



0£ OBSERVATIONS ON 

noise and vociferation from one story to another, Mould 
not be felt. Such lattice ventilations therefore, I would 
recommend for the lobbies or entries of the naval hos- 
pit;<ls. 

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- 
suited, 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 Rumford 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 German stoves constructed on the 



04 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 suc- 
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," lie 
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, " 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 Cliimney-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. &T 

fore 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 chinv 
neypiece, 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 



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 : 
arst, the consumption of fuel is lessened by three- 
fourths i 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 jlre-jjlace. 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 iu tiie room we can ; and is, besides, when pro- 
perly constructed in a marble chimneypiece, quite or- 
namental. It occupies no part of the room, and of, 
consequence does not contract the size of the apart- 

• S'.one-cutters, next door to St James' churcb. 



60 OBSERVATIONS ON 

ment in which it may he 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. 
ABCD. The marble front of the chiinneypiece. 

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 hiklmnopq. 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 with 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 






i lime Y-Flaee-§il owe , 
Fig.J. 



O O O o 



E 



O 



S 



o 



6 



o 



o 



o 



o 



% f 

o 



H* &i > 



o 



o 



*v 







o 




Sinokfi tnUrs 

division u<- 



QtU&^r i 



€ 



Fig. 3. 






uojo-- 



nil 






W PCB.i/.w& frl ttCl d 



MARINE HOSPITALS. 



61 



it four inches square, for the passage of the smoke in- 
to the first flue. 

y %. A vertical wall of brick, with an opening at 
the top, for the passage of the smoke into the second flue. 

aa bb. Another vertical wall of brick, with an open- 
ing at the bottom for the passage of the smoke into 
the third flue. 

cc dd. The damper. 

eeffgg hh. Four holes, 3 inches in diameter, made 
in the marble front of the chimneypiece, above the 
stove, according to the improvement of Dr. Caldwell. 

Fig. 3. 

A B. The line of the hearth. 

€ D. The main or partition-wall of the house. 

A C. The left coving of the chimney. 

B D. The right ditto. 

a b. The wall enclosing the air-chamber. 

c d. First vertical wall. 

ef. Second ditto. 

de. Third ditto. 

f g. Division wall. 

h i. The door into the furnace-chamber. 

The dotted lines represent the situation of the iron- 
pipes. 

The arrows show the course taken by the smoke 
over the different pipes that cross the flues of the stove, 
until it arrives in the chimney. 

The air-chamber may be carried round the sides of 
the stove, as well as at the back, by a double wall. 

The mouths of the air-tubes may be furnished with 
circular tin doors, cut to fit close, and turning on a pi 
vot, so that they may be closed when the stove is not in 
use, and thus prevent the cold air from rushing into 
the apartment from the cellar, or without 



OBSERVATIONS ON 



The cost of altering the fire-places and erecting 
these stoves, in this city, is about 50 dollars. Twen- 
ty dollars would doubtless be saved, if the chimnies 
were constructed for them. There are many of them 
now in use in this city ; and they are found to answer 
so well, and to be so superior to every other mode of 
heating rooms heretofore employed, that they are bo 
coming daily more and more in use. 

SECTION XI. 

Of the Diet. 

The diet of an hospital is an object of primary im- 
portance, as not only the health, and sometimes even 
the lives, of the patients depend on its being in a pro- 
per quantity, and of a wholesome kind, but likewise 
because provisions and liquors are articles of consider- 
able expense. If a proper system be not observed in 
the arrangements connected with this subject, in the 
establishment of an extensive hospital, the patients will 
suffer from their food being too slender or superabun- 
dant ; and the steward's returns will exhibit an ex- 
pense the very opposite of that degree of economy 
which ought to characterize his expenditures for pro- 
visions, in a well organized institution. Diet has been 
an object of much attention on this account, to the 
conductors of foreign hospitals, whose extent, indeed, 
rendered this subject a consideration of immense im- 
portance. Experience has proved to them, that an at- 
tempt to accommodate every individual patient with a 
diet suited to his peculiar case, was not only incompa- 
tible with the promptness and system necessary in the 
steward's department, and the arrangements of the. 
kitchen, but that in an hospital containing a great 
number of patients, it became next to impracticable 



MARINE HOSPITALS. 63 

Moreover, such a plan is fraught with numberless in- 
conveniences, as well as unnecessary expense ; and 
besides rendering the business of the steward and the 
cook needlessly complex, is, after all, of no material 
advantage to the patients. The practice of establish- 
ing diet bills, has been objected to by some writers on 
this subject, on the score of the supposed injury result- 
ing to the patient, by furnishing him with a diet that 
may not suit his particular condition ; but I really 
think, without any very good grounds. The physi- 
cian or surgeon always has it in his power to order in 
his prescription-bill, noticed in another place, such 
other articles besides the particular diet he may speci- 
fy, as he deems necessary for the health or cure of his 
patient. These articles come under the denomination 
of comforts, and do not at all interfere, when ordered, 
with the general diet of the house, to which they are 
only additions. 

In the French service, the ration for a sick seaman 
is established by a decree of the emperor ; and it is 
served out on board ship, in lieu of their common ra- 
tion, by the distributeurs de rations ; and in their na- 
val hospitals, as in the English establishments, by the 
steward. This is a judicious plan, I think, for the sea- 
service, since it is an economical one. The moment a 
sailor is taken on the surgeon's list, his common ration, 
which in our service is at present issued daily, however 
incapable the man may be to consume it, or any part of 
it, is stopped, and the sick-ration is issued in lieu of it. 
The same thing takes place, when a man is sent to an 
hospital from a vessel ; his ration on board the ship is 
stopped during his absence, and the sick-ration is serv- 
ed out for his support in the hospital, by the steward. 

The ration for a sick seaman in the French service, 
to which I have alluded, is as follows : 



-6$ OBSERVATIONS ON 



Kind of Provision. 




Quantity. 


White bread, 


. 


20 ounces. 


Egg, 

Mutton, 

Chicken, 

Mutton instead of chicken, 

Prunes, 


1 

8 ounces. 

1 part. 
4 ounces. 
4 do. 


Rice, 


- 


2 do. 


Butter or sugar, 


- 


ido. 



This is the ration allowed to all sick men on board 
ships, and in hospitals ; but the physician or surgeon of 
the hospital, or the surgeon of the ship, has the power 
to order the substitution of any article he wishes to 
prescribe, in the place of any one of the established 
articles ; they can likewise order any comfort in addi- 
tion to it, which they deem necessary. The French 
surgeons highly commend this plan; and they informed 
me it was productive of every end intended to be ac 
complished by its establishment. 

The plan of victualling pursued in the Pennsylvania 
hospital, when I resided in that institution, was an ex- 
ceedingly simple and good one. There were three differ- 
ent diets prepared in the house. — 1. The full or gene- 
rous diet. 2. The common diet of the house. 3. The 
low diet. Besides these, there was a soup made eve- 
ry day, in such quantity as necessary, according to the 
following receipt, called the vegetable soujj : 
Potatoes paired and cut into small 

pieces, - 3 parts, 

Ouions cut iu pieces, 1 part, 

Crusts of bread, - - 1 part, 

Boiled in water to one half, strained through a sieve 
<jr colander, and seasoned with salt. 

This plan gave but little trouble to the steward or 



MARINE HOSPITALS. 65 

the cook, and was sufficiently comfortable for the sick. 
The physician or surgeon ordered one of these diets 
for his patient, and when he deemed the soup of the 
common diet (should he order this) too gross for his 
condition, he substituted the vegetable soup. Under 
the first diet was comprised oysters, eggs, porter, wine, 
&c. &c. A plan similar to this is pursued in the diet 
arrangements of St. Thomas', St. Bartholomew's, 
Guy's, and St. George's hospitals, in London. 

Diet-bills are used in the royal naval hospitals at 
Haslar, Portsmouth, Deal, &c. in England ; and in the 
royal military hospital at Stonehouse, near the town of 
Plymouth-dock, I saw them pasted up in the apart- 
ment of every nurse. The medical officers of these 
hospitals informed me that they considered them, from 
experience, the most perfect system of victualling their 
publick establishments for sick seamen and soldiers. 
They are of opinion that they are productive of the 
greatest degree of economy possible, and that their 
larger hospitals could not be well conducted in the 
steward's department without them. 

The following Scheme of Diet I would recommend 
for adoption in the U. S. Marine Hospitals. It unites 
in an eminent manner, economy with convenience, dis- 
patch, method, and comfort to the sick. Economy in 
diet is a desideratum of great importance, and on this 
account, such a scheme as this ought not to be over- 
looked in the establishment of large marine hospitals 
in the United States. Promptness and system in the 
steward's department is also an object of great conse- 
quence ; and the comfort of the sick a primary consi- 
deration. These are sufficient reasons, and I appre- 
hend of no little weight, to induce the adoption of this 
establishment of diet. 

K 



66 OBSERVATIONS ON 

SCHEME OF DIET 

FOR THE U. S. MARINE HOSPITALS. 

Full Diet. 

A pint of tea in the morning for breakfast, and a 
like quantity in the evening; sixteen ounces of bread; 
sixteen ounces of beef or mutton ; one pint of broth ; 
sixteen ounces of greens, or good sound potatoes, and 
two quarts of small beer. 

Half Diet. 

Tea morning and evening as above; sixteen ounces 
of bread ; eight ounces of beef or mutton ; eight ounces 
of greens or good sound potatoes; one pint of broth; 
and three pints of small beer. 

Low Diet. 

Tea morning and evening as above; eight ounces of 
bread ; two ounces of butter, or in lieu of butter, one 
pint of milk ; half a pint of broth, or such an addi- 
tional quantity thereof as the physician or the surgeon 
shall judge proper. 

Casualty Diet for men received. 

The physicians and surgeons are to prescribe half- 
diet, or low-diet, for such patients, according to the 
state of their health when they are received ; and the 
proportions of each species of provisions to be issued 
by the steward, is the same as to the other patients on 
half and low-diet. 



MARINE HOSPITALS. 67 

Casualty Diet for men discharged. 

A pint of tea in the morning ; one pound of bread ; 
six ounces of cheese, and one quart of beer. 

One drachm and an half of good souchong tea, se- 
ven drachms of good muscovado sugar, and one-sixth 
part of a pint of genuine milk, to be allowed to every 
pint of tea. 

The broth should be made by boiling together the 
meat allowed in the half and full-diet, with the addi- 
tion of twelve drachms of good sound barley, twelve 
drachms of good onions, or one ounce of leeks, and 
three drachms of parsley, for every pound of meat. 

It will be found, on trial, that the meat intended for 
the patients on full and half- diet, will make a sufficient 
quantity of good broth, so as to yield a full phrt to them, 
and an half pint to those on low-diet. 

The steward will issue half an ounce of salt daily 
for each patient in the hospital, and one ounce of vine- 
gar to each patient on full and half- diet. 

By means of this diet bill, the steward's business 
is extremely simplified, and rendered easy of perform- 
ance even when the number of patients is very great. 

He attends witli his clerk and servants, at the larder 
or provision-room, which is an apartment appropriated 
for the reception of beef, fowls, bread, greens, &c. &c. 
in the morning after the physician and surgeon have 
gone their rounds. The ward-master delivers the pro- 
visions when apportioned out, to the nurses and atten- 
dants who repair to receive them, at stated hours. The 
steward, who is furnished with the prescription-bills 
of the day, makes his calculation of the aggregate quan- 
tity of each article requisite to be served out, and when 
furnished, he notes it down in his day-book. 



68 OBSERVATIONS ON 

As good bread is a standing article of these different 
diets, there should be a bakery attached to the hospi- 
tal, and a good baker employed to attend it. A siifli 
cient quantity of bread to furnish all the officers, pa- 
tients, labourers, &c. belonging to the hospital, should 
be baked every other morning. This will be an econo- 
mical arrangement, as the agent will be enabled by pur- 
chasing large quantities of flour at a time from the mill, 
or from store-houses, to procure it at a cheap rate. 

There is a brewery attached to some of the English 
naval hospitals of which I have spoken, and all the 
beer consumed in them is made by the brewer who 
conducts its operation. This too is attended with a 
saving of that profit, which the brewer has upon all the 
beer he brews, over and above the cost of the mate- 
rials, and the price of labour expended, in converting 
them into liquor. 

I do not contend for the necessity or expediency of 
imitating this plan, in our hospitals, unless, like the 
British hospitals, they be established upon a very large 
scale. But the bakery is absolutely iudispensable in 
an hospital of any extent, where economy and conveni- 
ence are considered as desiderata. 

Other drinks, such as rice-water, barley-water, trea- 
cle, or water combined with a small portion of mo- 
lasses, and other things of the like nature, may be sub- 
stituted in the place of beer, when this is deemed im- 
proper for particular patients. 

The regulations in the French military hospitals, 
with regard to diet, are the most minute possible. They 
may suggest many hints for the diet arrangements of 
our hospitals ; with this view I shall detail them fully. 
They are as follow : 

The portion of aliment for each patient per day, is, 
an half kilogramme of meat, (two thirds in beef, and 



MARINE HOSPITALS. 69 

one third in veal or mutton,) seven hectogrammes and 
an half of bread, which must be between the mixed 
and white, of pure wheat, and well baked. Half litre 
of wine, of a good quality, and as old as possible ; be- 
sides salt and vinegar. 

The daily aliment and drink for the sick, are pre- 
scribed by the physicians in the morning visits. 

When a patient is to have a full ration, no other kind 
of aliment is to be used than those specified ; and the 
prescription of the customary aliments is always to be 
by the full, three quarters, half, and a quarter ration, 
so that the bread for the soup may be taken in the ra- 
tion prescribed. 

Each loaf of bread procured for the hospital, must 
weigh, when cold, two full rations, to facilitate, with- 
out the trouble of weighing, the separation in three 
quarters, halves, quarters, and half-quarters, for the 
soup. It is to be weighed in the presence of the in- 
spector and sergeant of the platoon, previously to its 
being put away into the pantry ; and if it should be too 
much done, or burnt, or not of sufficient weight, it 
must be sent away, or returned to the provider. 

The subaltern officer on duty, is to assist at the dis- 
tribution of the rations. 

The meat must be fine, of the first quality, well 
Med, and neither the head, pluck, tongue, feet, nor 
blood, are permitted to be received. The whole quan- 
tity supplied must consist of two thirds of beef, and 
the other third of veal or mutton. 

The weight of meat for each patient, attendant, or 
servant, is to be at the rate of two hundred and fifty 
grammes. 

The distribution for the morning must take place at 
seven o'clock the preceding evening, and that for the 



70 OBSERVATIONS ON 

evening, between the hours of nine and ten in the 
morning of the same day. 

Besides the agent, one or more subalterns of the 
platoon are to attend the morning and evening's gene- 
ral weighing ; and the steward is to send them the list 
of the number of sick and attendants that are to draw 
rations. The inspector is also to assist at the general 
weighing. 

The contractor is to take back and replace the meat 
which has been rejected. 

As soon as the general weighing is finished, the 
meat is to be put into the larders, and the key intrust- 
ed to the sergeant of the guard, who at the customary 
hours must be present at the opening of the door. The 
meat is then taken out, and placed in the kettle, in his 
presence. 

A sentry is to be stationed in the kitchen, with or- 
ders not to let any meat be taken from it, before the 
distribution. 

As the hour of serving approaches, all the meat is 
taken out of the boiler, and cut into rations, in the pre- 
sence of the subaltern officer on duty. 

For each half kilogramme of meat that is put in the 
kettle, one litre and nine decilitres (two pints) of wa- 
ter should be added, and then boiled down to one litre, 
four decilitres (one and an half pints.) To this is to 
be added the requisite quantity of salt, and a sufficient 
proportion of vegetables, of such kind as the season 
affords. 

When the physician thinks proper to change this 
meat and broth, for some such broth of vegetables as 
he orders, this last is to be given in lieu of the other: 
but lie should give in a list of those that are to have 
the substituted broth to the steward, the day before, 
that their ration of meat may be stopped. 



MARINE HOSPITALS. 71 

The surgeon on duty, is obliged to see that the pa- 
tients on low- diet receive their broth at the hour 
established by the visiting physician. 

The wine used in the military hospitals for the ge- 
neral drink of the patients, must be either red or white, 
old, of good taste and flavour, and well clarified. New 
wines cannot be admitted, unless for the use of the 
overseers or servants. But if none can be procured 
except of the last vintage, it must not be put in use, till 
after the first of March. 

The wine employed as the daily drink, cannot be af- 
forded in any other quantity, than the proportion or- 
dered in the nourishing aliment. 

It is particularly prohibited to distribute more wine 
than specified in the ration. 

In countries which do not produce wine, nine deci- 
litres (one pint) of good cider must be substituted, for 
the patients ; and one litre, eighty centilitres of beer ; 
for the overseers. 

When the physicians think that the use of it would 
not be pernicious ; the beer may be given instead of 
wine, to those patients afflicted with the itch or vene- 
real disease, in countries where the cider is scarce. 
The benefit of the sick requires the greatest caution 
in the use of wine ; the physicians should therefore be 
very careful, to prevent any abuses on this point. 

The brandy used in the. hospitals, must be made 
from wine, and of nineteen degrees in strength. 

The vinegar must also be made of wine. The com- 
missary of war, is to make frequent surveys of the 
cellars, ware-houses, and magazines of the hospital, to 
acquaint himself with the qualities of the liquors they 
may contain. The physician general may attend him; 
and if any defective or spoiled wine be found, he is to 
have it immediately replaced. It is understood, that 



72 OBSERVATIONS ON 

he is to pursue the same plan, as respects the beer and 
cider. 

The uncommon aliments known in the hospitals by 
the name of light aliments, are : eggs in the shell, 
primes, milk, thickened-milk, rice-milk, and rice. 
They may be ordered in addition to the customary 
diets, but only one of them can be given at a time to 
patients under full, half, or under-ration. The panado 
and fat-rice are given them instead of soup, and it is 
to be understood, that their share of broth is to be used 
in it. Those under the vegetable diet, may be order- 
ed any sort of light aliments. 

In the panado, there must be an half hectogramme 
of bread ; in the thickened-milk, three decagrammes 
of flour. The quantity of rice in fat broth or milk, is 
an half hectogramme (one ounce and an half;) the 
quantity of milk, is one quarter of a litre ; the same 
quantity of milk is to be put into thickened-milk or 
rice-milk ; and lastly, six decagrammes of prunes 
weighed before the dressing. 

The physician may pursue the same plan in divid- 
ing these last mentioned aliments ; as is customary 
with respect to the ordinary aliments, that is, in three- 
quarters, half, and quarter rations. 

The rice must be of a good quality, well winnowed, 
and not small. 

Refined lamp-oil, sweet-oil, prunes, sugar, and ge- 
nerally all other kinds of provisions, must be of a good 
quality, sound and vendible. The provisions must be 
delivered in each hospital, at the expense of the con- 
tractor. They are all received by the commissary of 
war, in the presence of the inspector and physician- 
general, except the bread and wine. All such as are 
rejected, are placed to the account of the contractor. 



MARINE HOSPITALS. 73 

who is not indemnified for them, but is obliged to re- 
place them, with such as can be received. 

In countries where the liquors are bought, it is un- 
derstood that the contractor will deliver them with 
their casks and vessels, which must be returned to him 
as soon as emptied. 

The distribution of provisions is to take place at ten 
o'clock in the morning, and four in the afternoon ; but 
the commissary of war, with the concurrence of the 
physician-general, may change the time. 

The bread and broth are first distributed, while pre- 
parations are at the same time making for serving out 
the meat and other aliments, together with the wine, 
which are to be distributed immediately afterward. 
The serving must.be executed with carefulness, neat- 
ness and dispatch, and it is to take place every day 
for the succeeding day, so as to preserve order in the 
wards. 

The portions after having been calculated in the 
presence of the surgeon on duty, and the sergeant of 
the platoon, are carried by the servants and attendants 
to the respective wards they attend, and distributed 
to the patients. 

The commanding officer of the place, in which the 
hospital is established, is required to visit it every day. 
One or more officers of the garrison are to attend every 
morning and evening, at the distribution. They are 
to give their opinion on the broth, wines and other 
aliments, in presence of the steward and an attendant; 
and they are to inscribe and sign, on a register fur- 
nished by the commissary of war, their observations 
on the different provisions, &c. that they may be chang- 
ed if necessary. The subaltern officer is to see the 
distribution made to the patients in the different wards, 
and to keep good order. 



74 OBSERVATIONS ON 

The commissary of war is charged to attend as fre- 
quently as possible, the preparation of provisions, and 
the distribution itself; and to taste himself the broth 
and different aliments. The physicians are to pass 
their judgement on them daily, and if they find any de- 
fect, to make known the same to the commissary of 
war. The resident surgeon who attended the physi- 
cian in his morning visit, must go round the different 
wards, after the distribution, with the sick-list in his 
hand, to see whether every patient has received what 
was ordered for him ; taking care to diminish or stop 
the aliments for any one, who may have become worse 
since the morning's visit, and unable to consume the 
diet ordered, without injury. 

The inspector and commissary of war, are enjoined 
to be careful in having a daily register of the con- 
sumption of provision kept. This register must be 
exhibited to support, 1st, The invoices and receipts 
made by the commissary of war, in the presence of the 
inspector and steward, and as receipts for other ar- 
ticles besides bread and meat. &ndly, For the amount 
of the expenses of the sick at each visit, and order of 
the physician- general of the hospital, and the amount 
of the pay of the under-attendants of all grades. The 
register must also shew the names of all the patients 
and attendants, distinguishing those that were victu- 
alled from those that were not. 

The statement of the consumption of provisions, 
and the vouchers for the same, duly certified by the 
steward and inspector, are sent to the commissarys' of- 
fice the beginning of every month. The commissary 
then sends them to the contractor. 

The sick-list given to the steward, must mention 
the amount of aliments that are to be distributed. 

These sick-lists are transmitted to the inspector at 



MARINE HOSPITALS. 7& 

the end of every month, who is to examine them with 
the expenditure returns of provisions ; and in case any 
difference should be found between the consumption, 
and the number of sick, the difference is charged to 
the person who is accountable. 

All returns for consumption are to be rejected, that 
do not accord with the regulations, unless they be au- 
thorized by the commissary's orders, by the advice of 
the inspectors and physician-general. 

The provisions, liquors, and other articles of diet, 
remaining in the hospital at the annual survey, are to 
be estimated at the same price, as when purchased by 
the steward, or the con tractors. 

The overseers of the first and second class, are to 
have the same ration as the sick. These and all other 
persons whose rations are included in the general 
weighing, are not to be served, until the rations are 
issued to the sick ; and if there should not be provi- 
sion enough of the established proportion, eggs or 
other articles are to be substituted. 

The overseers are prohibited from taking any part 
of their rations out of the hospital. The particular 
cases that are to make an exception to this rule, are to 
be laid before the directing minister. The janitor of 
course is to stop any provisions going out. He is for- 
bid to permit any provisions or liquors to be taken into 
the hospital, except those ordered by the steward for 
the use of the hospital, or those for the particular use 
of the physicians or overseers. The door-keeper of 
military hospitals, is positively forbid to vend any 
kind of provisions or liquors, under the penalty of a 
removal from his office ; and the punishment must be 
more severe, if the trespass has given rise to any ex- 
cesses. Independently of their salary, the door-keepers 



7ft OBSERVATIONS ON 

are to be victualled from the hospital, at the same rate 
of ration as the sick. 

On no account are the physicians or attendants, to be 
permitted to take up any aliments or other articles of 
consumption, even though they return pay for the 
same. 

As I have in the preceding pages, when speaking 
of the French regulations, employed the new nomen- 
clature of their weights and measures, it may not be 
amiss, to give the value of these in our own weights 
and measures ; they are as follow : 

A metre, is about 3 feet 7 and l-3rd of a foot. 

A decimetre, is nearly 4 inches. 

A centimetre, is nearly 4-10ths of an inch. 

A millimetre is .03938 decimals of an inch. 

A kilolitre, is 264 gallons, and l-3rd of a cubick 
inch. 

A hectolitre, is 26 gallons, 4 l-3rd cubick inches. 

A decalitre, is 2 gallons and 6* t-3rd cubick inches. 

A litre, is 2 pints, and nearly l-8th of a pint. 

A kilogramme, is 2lbs. 2oz. 5drms. 

A hectogramme, is 3oz. 8 l-2drms. avoirdupois. 

A decagramme, is 6dwt. lOgrs. 44 hundredths. 

A gramme, is 15grs. 45 hundredths, Troy weight. 

SECTION XII. 

Of the Introduction of Patients into the Hospital. 

The patients who are brought to the hospital, should 
be first conveyed to the receiving-room, which ought 
to be a small unfurnished room, with a fire-place or 
stove, and containing only a couch and one or two 
chairs. They are here to be visited by the physician 



MARINE HOSPITALS. 77 

or the surgeon, (according as they are to come under 
medical or surgical treatment,) and examined respect- 
ing the nature of their complaints. They should then 
be assigned to their proper ward, previously to enter- 
ing which, they should be made to change the clothes 
they may have on, for a suit of clean, dry, hospital ap- 
parel. These clothes, as well as any others they may 
bring with them, ought to be deposited in the receiv- 
ing-clothes-room, until they be well washed ; they are 
afterward to be placed in another clothes-room, in 
racks alphabetically lettered. The patient's name, 
with the number of his ward and bed, should be affix- 
ed to these clothes, and deposited in that rack which 
has the initial letter of his name. 

Besides changing the apparel, the patient, before 
going into his ward, should undergo a process of com- 
plete ablution, if his condition will admit it. 

He should be put in the warm or cold-bath, as the 
physician or surgeon may think proper ; be well cleans- 
ed ; have his hair combed ; and when thus purified, and 
habited in his clean suit of hospital-apparel, should be 
conducted to his bed in the ward appointed for him. 

No patient ought, on any consideration, to be intro- 
duced into any ward, without having previously un- 
dergone this professional examination, and this very 
necessary purification. Should the patient or patieuts 
be brought into the hospital too late at night to submit 
conveniently to this ablution and change of dress, he 
should be placed for the remainder of that night in an 
anti-ward, destined for this purpose, by himself, where 
he should be well attended, and, as early as conveni- 
ent and proper on the following day, should be treated 
as above, and then sent into his proper ward. 

The nurses and orderly-men should atteud, to see 
that the new patients clean themselves properly, and to 



7S OBSERVATIONS ON 

afford their assistance to such as are unable to aid 
themselves. 

The mischief arising from a neglect of these precau- 
tions, will be very great, and fraught with the most 
ruinous consequences to the sick of the ward into which 
the patient should be introduced. All persons who 
have had any thing to do with a number of sick per- 
sons collected together in hospitals or ships, are suffi- 
ciently aware of the danger of introducing among them 
one unclean and infectious person. I once witnessed 
it during my residence in the Pennsylvania hospital, 
and have repeatedly had occasion to observe it on 
board ship, when new men were sent from shore. 

While I was attending physician and surgeon to the 
army in the city of Philadelphia, and that part of the 
4th military district in its vicinity, I had more than one 
opportunity of observing the pernicious consequences 
of introducing among disciplined men, who lived upon 
the regular ration, raw recruits, perhaps recently from 
jail ; infected with foul eruptions, and offensive from in- 
dulgence in the gross intemperance they generally give 
themselves up to, while the bounty-money lasts. It 
was particularly observable in the camp at Mantua, 
near Schuylkill, and in all the different rendezvous in 
the city and liberties. I never failed to have some pa- 
tients in a tent, where six or eight soldiers, who had 
been some time tented together, were joined by one, 
two, or more, filthy recruits. This circumstance can 
very readily be accounted for, independently of the 
supposition that these recruits carried about them the 
seeds of a contagious disease. The effect of the nox- 
ious effluvia from the body of a foul and contaminated 
man, labouring under the diseased state of system con- 
sequent to long continued intemperance, upon those 



MARINE HOSPITALS. 79 

who are in regular habits, particularly when we ad- 
vert to the circumstance of these loathsome creatures 
being obliged to sleep in the same tent with the healthy 
soldiers, — must be obvious to every one. During my 
visits to the sick of the army quartered at the U. S. La- 
zaretto, on the Delaware and Schuylkill, in April last, I 
was forcibly struck with the impropriety, and even 
danger, of introducing into the wards of an hospital 
containing any sick, either sick recruits, or sick sol- 
diers, without previously purifying their bodies by ab- 
lution, and keeping them in that state by clean appa- 
rel. The convalescents never failed to grow worse 
after such a measure. 

One more fact on this subject I was made acquaint 
ed with by the assistant-surgeon of the Romulus Eng- 
lish frigate, commanded by lord Balgonie, and which 
anchored under our stern* in Barnpool, (Plymouth, 
Eng.) having just arrived from the Peninsula, with 
French prisoners. The crew of the Romulus was per 
fectly healthy while at Lisbon, where she took on 
board eighty or an hundred French prisoners, and sail- 
ed for England with them. The prisoners were also 
healthy, and continued so. A short time after their 
embarkation, a genuine typhus carcerum, of the malig- 
nant kind, broke out amoug the crew of the Romulus ; 
the French prisoners continuing perfectly healthy ? 
though they were more confined below decks than the 
crew of the ship, and their diet and treatment being 
the same. This circumstance proves most satisfactori- 
ly, the propriety and healthfulness of the mode I have 
recommended of introducing patients into the wards of 
the hospital. 

* Essex frigate. 



80 OBSERVATIONS ON 

SECTION XIII. 

Of the Officers of the Hospital. 
The officers and persons requisite for the govern- 
ment and conduction of each naval hospital to be esta- 
blished in the United States, are the following : 

A governour. 

A physician. 

A surgeon. 

A dispenser. 

Two lieutenants. 

An assistant-physician. 

Two surgeon's-mates. 

An hospital-mate, or assistant-dispenser. 

An agent. 

A chaplain. 

A steward. 

A deputy-steward, or ward-master. 

A matron. 

Nurses and orderly-men. 

A baker. 

Laundresses. 

A cook. 

An assistant ditto. 

A scullion. 
A barber. 

Servants and labourers. 

A guard. 
The officers above-mentioned, are enumerated on 
the supposition that the hospital will be so extensive 
as to accommodate from three to four hundred patients, 
and one hundred pensioners. From this list it will not 
he difficult to select the requisite number for the admi- 
nistration of such institutions, as may be designed to 
receive and provide for 100, 150, 200, or 250 patients, 
and a proportionate number of pensioners. 



MARINE HOSPITALS. 81 

SECTION XIV. 

Of the Governonr. 

The governour of the hospital, in imitation of the 
English service, I would propose to be a post-captain 
in the navy, advanced in the service. He should re- 
side in a neat and commodious suit of apartments, fit- 
ted up for his habitation, or in a small and comfortable 
house attached to the hospital, and within its walls. 
His duties are various, and such as his title would im- 
port. He should have the entire general direction of 
the institution under his immediate charge and autho- 
rity. He should issue such orders for the internal ar- 
rangement of the establishment, as he may consider 
conducive to its better regulation and operation. He 
should attend to the reports of the physician and sur- 
geon, and should afford his ready co-operation in all 
matters proposed by them for the benefit of the institu- 
tion. He should attend at the council-room, at stated 
hours every morning, for the purpose of transacting 
the business of his office. He should inspect the re- 
turns of the physician, the surgeon, the dispenser, the 
agent, 'and the steward of the hospital ; and when in- 
spected, should file them, and deposite them in his of- 
fice. 

He should, every six or every twelve months, make 
out, or cause to be made out, such an abstract from 
these returns, as will exhibit the proceedings of the 
hospital for that time, and send it to the secretary of 
the navy's office. 

He should require all officers of the hospital to ob- 
tain his permission foy leave of absence, when they 



82 OBSERVATIONS ON 

desire to go without side the Avails. He should main- 
tain a nice inspection of the conduct of all the officers 
of the hospital, and over the economy of the household 
in general. His salary should be liberal. 

He should always wear the uniform of a post-cap- 
tain, when sitting upon business in his council-room, 
and when engaged upon any other duty of the hospital. 

SECTION XV. 

Of the Physician. 

No medical man should be elected physician of an 
hospital, who has not taken the degree of Doctor of 
Medicine ; and a preference should be given to such 
medical men as are in the U. S. naval service. He 
should reside in a building, or in apartments appropri- 
ated for him, within the walls of the hospital. He 
should have under his care, all the medical patients 
who are sent to the hospital, and should attend like- 
wise, such of the surgical patients, as the surgeon may 
desire him to visit and prescribe for. He should take 
his rounds in the hospital, at a regular hour every 
morning, attended by his assistant and the nurse of the 
ward he is visiting. He should enter his prescriptions 
in a printed bill, for that purpose, a form of which I 
will presently exhibit. He should likewise visit the 
sick in the evening, and oftener if necessary, of which 
he will be the proper judge. 

He should be invested with authority and power to 
make any arrangements in his department, which he 
may judge expedient, and for the benefit of the sick, 
and the hospital. Such arrangements, if they be of a 
trivial nature, he may direct the steward to make, and 
if any thing of more than common importance, he 
should report them as necessary to the governour, who 



MARINE HOSPITALS. 83 

ought to give proper orders on the subject. He should 
give such verbal directions to his assistants, as, besides 
his written prescriptions, he may deem necessary, for 
the good care of his patients. In a word, he is to per- 
form the duty of a physician, which either in a hospital 
or elsewhere, consists in a humane attention to the 
diseases, and necessities of the sick under his charge, 
to the best of his abilities. 

The following form of a printed prescription bill, I 
would propose for adoption in the U. S. Marine Hos- 
pitals. It answers not only for a prescription-bill, but 
as a voucher for the steward and hospital dispenser, 
for the correctness of their statements of expenditures. 

The use of this bill will promote method in the de- 
partment of the physician and surgeon ; facilitate the 
duty of the assistant-dispenser ; and is, besides, a brief 
record of the patients case, as well as a history of his 
treatment. The blank bills of this form should be 
carried round the hospital, by the physician and sur- 
geon in their visits to the sick, and should be filled up, 
as the patients' case may require, by specifying the 
quantity of any particular article prescribed, in the 
column assigned to it. They should be delivered to 
the assistants, who should carry them to the assistant 
dispenser for execution ; when filled up, they should 
be carefully filed for the purpose above-mentioned. 

The size of this bill, is contracted to bring it into a 
page. When a number of them is to be printed for 
the above purpose, the columns for necessaries, &c. 
should be six or eight inches longer, and those for the 
"disorder," and " medicines prescribed," extended in 
breadth, at least two inches each. When one is filled 
up, another is to be used, and so on, as often as re- 
quisite. 



84 



OBSERVATIONS ON 







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P o 



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V^-v*^ 






Pts. | Red 



Pts. | White 



Pts. j Porter. 



Lump 



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j Muscovado 
J Rice~ 
I Sag o. 
| Arrow-root. 
I Cinnamon. 



Cloves. 



Mace. 



Nutmeg 1 . 



Cocoa. 



Oranges. 



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Honey. 



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MARINE HOSPITALS. 



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 perforin 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 Mould 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 Disjjenser. 

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 IT. 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, 



SS 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 5 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 



MAftlNE 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, Match 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 

oi» 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 in 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 
certain 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. (Ft 

stands in need of it, and when their own duty does not 
engross their entire time. But this assistance should 
never be resorted to except in cases of emergency. 



SECTION XXI. 

Of the Assistant-dispenser, or Hospital-mate. 

The assistani-dispeneer, or hospital-mate, should 
be a young man who lias 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 (lie 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- 
sei vice. It would be well, I 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. 



93 OBSERVATIONS ON 

The assistants of the physician and surgeon should 
wear an undress uniform 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. Hiis 
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 H. 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 diilcrent departments ; and should submit such 
of 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. i 

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 aim. 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, ot- 
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- 
nisters 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 
es.ablished 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 system 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 prayers 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 offiees usually appertaining to his sta- 
tion. He should have taken orders in the church. 



>fARINE HOSPITALS. 9# 

SECTION XXIV. 

Of the Steicard. 

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 charge, all the 



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 haii-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 cheek 
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 OJS 

SECTION XXVII. 

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 a ('joining 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 then- 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 comforts 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-physiciau 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 side-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 I shall 
now speak. 



SECTION XXVIII. 

Of the Guard. 

The hospital should be furnished with a Serjeant's- 
_,uard from the marine corps, which 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 lukewarm 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 
baiber 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 patient 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, and 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 " 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 



106 OBSERVATIONS ON 

or regulations of the hospital, or refuse to follow the. 
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 by an immediate confinement 
fn 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 on 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 into 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. 

III. 

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 seni 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 
in 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. HI 



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. 

Mr. Latvohe's Iieport 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, forjned 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. Hekry Latrobe, 

Eng. Navy Hep. 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, 181S. 

i. The extent of an 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, 1 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 eacli 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 wide, 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 I 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 
iu large wards 80 feet long, and 30 feet wide; 24 pa- 
tients in each ward. The beds, therefore, will each 
of them stand in a space 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 frout the east and 
west. I have to this end shaded the south side of the 
house by an open arcade, 10 feet wide, an4 have pro- 



MARINE HOSPITALS. 140 

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 th€ 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 wails of the lower story are 1 foot 10 inches 
thick, and of the upper stories 1 foot 6 inches thick, 
the internal walls 14 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 apply, 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 freestone, - - - 10,260 

14-. The estimates therefore would stand thus : 

Faced with brick : hospital, - - 25,500 

Officers' house, &c. - 8,750 

8 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. Henky Latrobe, Eng. JV*. 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 
my 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» 
ascertaia 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 unlit 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 8 12 50 per thousand. But, without 
costing more, it would be better done under a foreman 
at B 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 8 8,000, 
by following the plan pursued at the capitol, and at 
all my publick works — that of days 7 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, Ens;. J\T. J). U. S. 



AN ACCOUNT OF THE PENNSYLVANIA HOSPITAL. 121 



SECTION XXXF. 

•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 ottered 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 cuil 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 in 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 — tiie 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- 

K 



i%2 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 vviiii^s 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 ventilated by openings into 
the chininies, 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 oft", 
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. 1~0 

The square ground plot on which the hospital stands, 
is 396 feet in width, and 468 feet 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 Alms-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 



12$ 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, - 4 

A library-room, on the first floors 
An apothecary's shop, ditto, I 

Manager's room, ditto, | 

Steward's room, ditto, - J 
The contributor's room, in the"i 
second story, - - 1 

Chambers for the resident physi- f 
cian 7 pupils, and steward, ditto, J 
Operation room, in the third story,"! 
Museum, ditto, 

Small apartments near the opera- £> 4* 
tion-room, for the patients ope- I 
rated on, ditto, 
Baking- rooms and larders in the 
cellar, - 3 

Bathing-rooms in the basement 
story of the west wing, - % 

Room for deputy-steward and 
his wife, in ditto, - - l 

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 



PENNSYLVANIA HOSPITAL. 1~0 

The square ground plot on which the hospital stands, 
is 396 feet in width, and 468 feet in length, containing 
about four acres. It is enclosed by a brick wall, with 
an iron palisade in its front. It is surrounded hy 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 
arc 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 per 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 planter of Paris of the 
gravid uterus — two wax models of the human body — 
pictures representing the blood-vessels, the foetus 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 hooks. 



PENNSYLVANIA HOSPITAL. 127 

The Library and museum are supported and en- 
larged by the fund accruing from Hie money paid by 
studen to attend the hospital, which is 10 dollars per 
annum each. This fund amounts to a yearly iucome 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 ease 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 infections 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 134,854 
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 ami. 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 8300 perann. 

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 

A labourer, - 144 

A watchman, 144 



PENNSYLVANIA HOSPITAL. 1&9 

A baker, S 144 per ann. 

A porter, 96 

Four nurses, each 8 1 33 per week, 276 64 

Five assistant do. each $ 1 25 per week, 325 

Cook, g 1 30 per week, ... 69 16 

Four chambermaids, each S 1 25 per 

week, 320 

Three laundresses, hired 5 or 6 days in 

each week, at 62| 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 employed 
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 taxes upon the vacant lots, just mentioned, are 
now (January, 1817) remitted, by a law of the State 
Legislature, passed during the session of 1815-16., 



( 180 ) 
SECTION XXIII 

OBSERVATIONS ON 
MILITARY AND FLYING HOSPITALS. 



ALL hospitals, connected with the publiek 
service, particularly during time of war, are calculated for 
the reception of the same class of men : Hospitals for 
sailors and hospitals for soldiers, are therefore one and 
the same thing. The same necessity for subordination 
exists in both. The same kind of wounds and diseases 
are found in both ; and the same dispositions are found 
to pervade the ranks of the line as are found to charac- 
terise the crews of ships. 

Whatever general regulations I have proposed for the 
government of Marine Hospitals, and all the minute in- 
ternal details of arrangement, will be found perfectly 
adequate to the organization of large permanent Military 
Hospitals. 

But, in time of war, it becomes necessary to establish 
hospitals of a minor description, in the vicinity of armies 
and militia cantonments ; and as the sick and wounded 
are always hindrances to the quick and efficient opera- 
tions of acting forces, it is expedient that they be re- 
moved from them. In this case, it becomes requisite to 
organize a kind of temporary sick quarters, which, from 



MILITARY AND FLYING HOSPITALS. 131 

the circumstance of their being appended to, and moving 
with the armies during a campaign, are denominated 
Flying Hospitals. 

With respect to the first of these two last named esta- 
blishments, it is only necessary to remark, that a health- 
ful exposure and convenient spot should be fixed on, 
for their erection ; and when made of boards, should be 
well covered with whitewash both in and outside. — 
Though much regularity or neatness is not attainable in 
such temporary establishments, yet every regard should 
be paid to cleanliness and convenience compatible with 
the disadvantages of local situation. I cannot help in 
this place, noticing a plan suggested by the late physi- 
cian and surgeon- general of the army of the United 
States. It is at least perfectly novel. He pro- 
posed that military hospitals should be built one story 
in height with round logs, having a fire-place or hearth, 
in the centre, without a chimney. The smoke was to 
be carried off through an inverted wooden funnel, affixed 
to an opening in the roof. The floors of these rooms 
to be of earth. It appears that this gentleman supposed 
that hospitals of this description would prevent the pro- 
pagation of diseases which have their origin in impure 
air, and which arise sometimes from the crowded wards 
of an hospital ! It seems the doctor supposed, that 
while wooden floors readily absorbed the matter or efflu- 
via of infection or contagion, those of earth would 
neutralize infectious principles ! I do not think any 
plan was ever conceived, so fraught with mischief as 
this ; and it certainly does not reflect either credit upon 
the inventor's ingenuity or discernment. Wooden floors 
kept clean and covered plentifully with sand, are perfect- 



132 OBSERVATIONS ON 

ly safe. I believe, notwithstanding the elevated rank of 
Dr. Tilton during the war, his plan was never adopted 
by a single surgeon. 

Flying Hospitals should be always ready to receive 
sick and wounded soldiers. They should accordingly 
be furnished with a requisite number of medical officers 
of reputation and ability, and a sufficient number of at- 
tendants. These attendants should be enlisted for the 
purpose — for when they are supplied by details from the 
line, they are utterly worthless. Large tents, capable of 
accommodating 20 patients, make good hospitals of this 
kind. Barns, or other convenient out-houses, also an- 
swer the purpose very well, where they can be got with- 
in a suitable distance. During the summer months, 
perhaps tents are preferable. After the dews fall in 
autumn, the other buildings are safest. 

Hospital encampments should be made on level and 
dry ground, and if gravelly so much the better. Drains 
should be made on either side, to carry off the rain. — 
The tents should occasionally be struck and pitched on 
new ground. It is recommended to let them stand but 
two weeks on the same spot. 

Privies should be dug at proper distances from the 
encampment, and if rivulets are in the vicinity, they 
may be made use of instead. 

Kitchens must be constructed of logs, stones, and 
mud — in the form of a large chimney place, covered 
with boughs and stems of trees. 

Flying hospitals should be furnished with plenty of bed 
sacks, with loop holes at the corners that can be stretch- 
ed on forks driven in the ground. These are portable, 
and answer better than bunks. All such encampments 



MILITARY AND FLYING HOSPITALS. 138 

should be furnished with a team and horses, and not 
rendered dependent on the quarter-master's department 
for one, when a removal of the army is ordered. 

The reader is refered to Larrey's work for much in- 
formation on these points. 



PART SECOND. 



A SCHEME 



AMENDING AND SYSTEMATIZING 



MEDICAL DEPARTMENT 



OF THE 



NAVY OF THE UNITED STATES. 



V 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. 

SECTION I. 
INTRODUCTION. 

THE following pages contain some miscel- 
laneous observations on the medical department of the 
navy. I have attempted to devise a more systematick 
plan for conducting it — and have ventured to propose 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 : Having entered the 
navy as a surgeon when very young, and having been 
ordered to one of the largest ships* belonging to it, with 
a complement of 430 men, stationed in a warm and va. 
riable climate — I soon found myself not a little embar- 
rassed by the perplexities which 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 vertical sun, as well as to the damp 
and heavy dews of night, and at all times to the insalu- 
brious exhalations of the surrounding marshy country — 
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, was about 

* The frigate United States. 



,136 OBSERVATIONS ON TUB 

40. In this situation, on board of a ship just refitted, 
commissioned, and equipped, I found myself without 
half the comforts and necessaries for the sick that the 
hospital 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 to- 
gether with the medicine chest had cost the government 
fifteen hundred dollars. There were neither beds for the 
sick, sheets, pillows, pillowcases, nor night- caps — nor 
was there a sufficiency of wine, brandy, chocolate, or 
sugar ; and that portion of these articles which the store- 
room contained, was neither pure nor fit 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 department of this ship ! 
Upon a representation of it however to her commander, 
Com. Decatur, he 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 im- 
mediately proceeded to sea, for a cruise of eight or ten 
months, upon my joining her, and before I had an op- 
portunity of examining into the condition of the medi- 
cine and store chests — which might have been the case, 
these having been reported as sufficiently furnished? 
What the consequence would have been must be obvi- 
ous ! 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 ? I answer — 
the want of an organised board of medical commissioners, 
whose peculiar province it should be, to order the pro- 



MEDICAL DEPARTMENT OF THE NAVY. 437 

per proportions and quantities of medicine, comforts, and 
necessaries, for the publick ships, and who should have 
no interest, directly or indirectly, individually or collec- 
tively — in the furnishing of articles thus ordered. 

As I was at that time a novice in the routine of ship 
duty, and having but recently left the Pennsylvania Hos- 
pital, an institution in which order, system, and punc- 
tuality, render the practice of medicine a pleasure, I was 
overwhelmed with the difficulties I had to encounter in 
the performance of professional duties, where every in- 
convenience and disadvantage that can be imagined was 
opposed to the exertions of the medical officer. My 
feelings revolted from the idea of continuing in such a 
distressing situation — and I became disgusted with the 
unavailing toil attendant upon ship-practice. I commu- 
nicated my sentiments on this subject unreservedly to 
my lamented friend, the late Captain William 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 conver- 

• 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 superior force. In him were united the valour of a hero, 
the virtues of a philanthropist, 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 heartfelt tribute to his memory. 

T 



138 OBSERVATIONS ON THE 

sations with him I often declared, that if such was al- 
ways the deplorable condition of sick men on ship- 
board, I wished not longer to be their medical attendant; 
since my feelings were pained every moment in the day 
by contemplating 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 su- 
perintending medical board, he tendered an offer of his 
assistance 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 concluding, that 
if proper steps were taken to furnish the ships with sick- 
necessaries of a proper kind, the practice of medicine 
and surgery in the navy, could be rendered more bene- 
ficial to the sick, and consequently 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 cor- 
rected, and its abuses abolished. 

In the following pages I have made an attempt to in- 
troduce a systematick plan for furnishing the ships and 
vessels of the United States, with such articles and stores 
as the hospital department requires. I have also made 
an effort to abolish the present irregular manner in which 
our medicine and store-chests are replenished, by the 
requisition of the surgeon — and to establish such regu- 
lations respecting his respcnsibility for the just appro- 
priation of the medicine and comforts, as I deem likely 
to result, if put into rigid execution, in the benefit of 



MEDICAL DEPARTMENT OF THE NAVY. 139 

the service. The good effects of this plan will not only 
be perceived 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. 
When it is necessary to replenish the medical and hos- 
pital store-rooms of our ships, at a short notice, ki some 
of our inconsiderable sea-port towns, where perhaps but 
a single druggist's shop is to be found — it is in the power 
of the apothecary to practice any exorbitancy or even 
extortion he pleases, and the surgeon has to choose be- 
tween the alternatives of signing the bilis containing un- 
just charges, or of putting 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 surgeons 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 reform. 

The principal objects that demand our attention, and 
that are susceptible of emendation, are: 1st. The intro- 
duction of the lemon acid, in abundant quantities, into 
free and liberal use in our ships. 2d. The present irre- 
gular mode of supplying the ships and vessels of war with 
medicine and hospital stores. 3d. The laxity 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 appro- 
priation of the articles intrusted to his charge, exclusive- 
ly for the benefit of the sick. 5th. The alteration of the 
present ration, or at least the liquid part of it*. 6th. 

* This subject, I conceive, comes properly undei* the cognizance of the 
.surgeon, since its defects or imperfections have so material an influence 



140 OBSERVATIONS ON THE 

The better ventilation and warming of our ships in the 
winter season. 7th. The practice of wet-scrubbing the 
decks in cold and damp weather ; and lastly, the im- 
propriety, and pernicious consequences to the service, 
of the present plan of recruiting : — 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 sur- 
geon's department, and some miscellaneous remarks on 
the internal government of ships, &x. It is my inten- 
tion to consider these points in the order I have men- 
tioned them. 

Many of the regulations which I have proposed, are 
closely connected with the business of the accountant 
of the navy department. Those particularly, requiring 
surgeons to verify their expenditure returns by oath, and 
those which are intended to diminish the exorbitancy of 
charges that are frequently made by druggists for sur- 
geons' necessaries, relate to his office. The mode by 
which I have proposed to accomplish this end, is by 
establishing a systematick plan of furnishing and re- 
plenishing the medical department, which will admit of 
regular prices, subject only to variation from the rise and 
fall in the market, of the articles in wholesale quantities. 

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 0/* .seniority 
in the advancement of officers of whatever grade. The 
infringement of this principle demands the united efforts 

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. 141 

of the officers of the navy, to discountenance and abolish 
it. It is not only unjust in itself, but destructive of the 
honourable pride and com fort of officers, and eminently 
subversive of that harmony, order, and subordination, 
which constitute the very existence of a well regulated 
navy. Merit and service should never be neglected or 
forgotten. When appointments are founded on injustice, 
or made under the influence of favour : they must, 
in the nature of things, be no less destructive of the in- 
dividual happiness of officers, than inimical to the con- 
tentment of the men. 

It has ever been remarked, that premature and unjust 
preferments, especially in the naval service, engender 
animosities, which sooner or later ripen into insubordi- 
nation. The transition from this unruly evidence of dis- 
contentment to mutiny, is very frequent and natural. — 
Can it be otherwise ? The promotion of junior, over 
the heads of senior officers ; or the advancement to si- 
tuations of honour and profit, of officers who have re- 
cently entered the service, in preference to those who 
have devoted their youth, their labour, and perhaps their 
health, to the faithful service of their country-*— can only 
be calculated to dispirit the exertions, not only of those 
who have been thus forgotten, but of those who may ex- 
pect to share a similar fate. Besides thus depressing 
the laudable ambition of officers, the practice is invidi- 
ous ; 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 re- 
ward or honour. 



142 OBSERVATIONS ON THE 

These observations, though true as respects the navy 
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 system. When this 
is done, then will service be honourable, be desirable. 

With a sincere hope that the exertions of the surgeons 
of the navy, to benefit the service ; and the conscientious 
and faithful performance of their duties : may meet with 
a kinder return than that which greeted mine — I submit 
the following pages particularly to their attention. If I 
have treated the subject to their satisfaction, I shall feel 
highly gratified. 

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, 
1 look for cavilling and censure at their hands. I, how- 
ever, am prepared to meet it. My independence in ex- 
pressing my sentiments on points of duty, in the navy, 
procured for me not a few enemies. But while I regret 
this consequence of a line of conduct that thrice the in- 
convenience could not have made me forego, I have the 
consoling assurance of having acquitted myself in the 
discharge of my duties 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 fet lings and my fortune have suffered by a 
determination made when I first entered the service, from 
the execution of which I never in a single instance 



MEDICAL DEPARTMENT OF THE NAVY. 143 

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 
private or publick interests of others, or differ from the 
customary proceedings of persons similarly situated with 
myself. 

The same independence which caused me to hold up 
my hands against the abuses of the medical department 
of the navy, emboldens me to expose them. 

I conceive that the country has a right to expect from 
every officer in its service, the result of his experience, 
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. I shall first offer some 
observations on the subject with a view to invite the at- 
tention of the officers of the navy generally, to the neces- 
sity of the changes I have proposed. 

I need hardly remind them, that any schemes sug- 
gested by an individual to the secretary of the navy, are 
not likely to be well received, unless they be seconded 
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 disappro- 
bation. To those officers, therefore, who stand at the 
head of the navy, and whose long and faithful service, 
justly entitles them to extensive influence in all its de- 
partments, I cannot think I shall apply in vain, for their 
co-operative influence in accomplishing 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 wil- 
ling to give all assistance in their power, in establishing 



144 OBSERVATIONS ON THE 

any regulations calculated to meliorate the condition of 
the seamen under their command. 

It is highly necessarj r 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, I repeat, from many I expect no 
thanks for what I have done. The schemes I have 
proposed interfere too manifestly with the private in- 
terests of some persons connected with the navy, to 
please them. Yet, anticipating their displeasure, it will 
neither surprise nor distress me. I have written this 
work with a proud consciousness of having faithfully 
performed my duty in every situation I have filled, 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 service, disposed to be correct, has 
to contend. As the irregular direction of the medical 
department, was a perpetual source of embarrassment to 
me, so the reform of it may smooth the path of duty for 
others. I scruple not to say, that these abuses embitter- 
ed every hour of my naval servitude. Whenever I re- 
sisted what I deemed oppression or interference with my 
duty, which I not unfrequently had occasion to do : my 
independence was rewarded, as may be supposed, by 
personal dislike and the displeasure of those whose in- 
fluence could materially affect my interests. Yet I was 
never deterred by the fear of this, from the uniform line 
of conduct I always pursued, viz. acting in obedience to 
my sense of duty, in opposition to established irregulari- 
ties and aberrations, regardless of the consequences to 
my own fate. 



MEDICAL 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 
esculent 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 such 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 : 

SIK, 

From the interest I feel in the welfare of the navy, 
the augmentation of which I anticipate as no improba- 



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 thfe 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 oi disease among sailors 
and soldiers, which at times has been more fatal than 
the sword itself. 

These narrations are replete with accounts of (he in- 
juries resulting from this cause to the' uational 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 terriiick 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. 14tf 

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 subjects, but to confine 
myself to a few observations on an article possessing 
important medicinal virtues, and capable of being 
made into one of the most wholesome a id agreeable 
diet-drinks that can be made on board of ship&, viz. — 
the clarified juice of lemons. 

The mode of procuring this article from the fruit is 
extremely simple. The juice is expressed from 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 post 
sesses considerable anti-scorbutick properties, as has 
been well ascertained. 

The late introduction of the liberal use of lemon- 
Jtiice 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, 1/80, 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 Drink water, 
in his account of this siege, thus mentions the circum- 
stance : — " 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, pevsevered 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 Daue was happily directed to our 
relief." This scurvy is said by Mr. Cairncross, an 
eminent surgeon, who was present at the siege, to have 
" 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 circumstance 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 five 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 
ti.ings. Sii* John Pringle, in his discourse before the 
Hoyal 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. 

Br. 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 were 
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 
^ome queries 1 proposed to him on the subject of the 
km on -juice : 



MEDICAL DEPARTMENT OF THE NAVY. 151 

Royal Hospital, Haslar, l§th April, 1811. 

BEAR 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. (yd. (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 tiie 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 OBSERVATIONS ON TII£ 

every part, with a strict attention to the persona! 
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 (tray. 
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, I 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. 



MEDICAL DEPARTMENT OP 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 
Heat. 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 I 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 sifpport 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. Od. sterling per gallon. 

x 



154 OBSERVATIONS ON THi: 

I think one of our small pnblick 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 in merchant ships, would be very considerable. 

I submit the feasibility of this plan to your better 
judgment and deeision. 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 an 
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 weight, 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. The 

* See Section III. 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. 1 was too ful- 
ly convinced of the absolute necessity for the introduc- 
tion of tin's acid into use in our ships, not to make eve- 
ry possible effort in my power to accomplish so impor- 
tant an object. Why these attempts on my part, to 
call the attention of the secretary to the subject, were 
unavailing ; or how it happened that my endeavours to 
elicit his inquiries respecting the expediency of the 
plan I had proposed, were fruitless : I know not. All 
I can say is, that both proved abortive, and my memo- 
rial was not noticed from 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 t 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- 
butive 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 influence in recommending it to the notice of the 
secretary. 



156 OBSERV ANIONS ON THE 

The letter, of which thp p.nc.lnsed is a copy, 1 trans- 
mitted to Mr. Hamilton in November last. 
1 am, sir, with great respect and esteem, 
V our obedient servant, 

William P. C. Barton. 
Capt. Porter, Essex. 

U. S. Frigate Essex, Newport Roads, Sist Dec. 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 st tion. 

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 onboard 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 houour to be, respectfully, 
Your obedient servant, 

D. Porter. 
Dr. Wm. P. C. Barton, Surgeon of 
the U. S. frigate Kssex. 

Newport, 11. 1. January % 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 infiueuce 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 yon, 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 THE 

U. S. Frigate President, Newport, Jan. 6, 1813, 

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 well 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. 161 

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, (Sumnani) 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 the 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 my 
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 



16S OBSERVATIONS ON THE 

Porters 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. Babtobl, 

Surgeon of the U. S. Frigate Essex. 

SECTION III. 

Of the ?node 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, 
&c. 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. 163 

fair man — or if he be rigidly honest, hut inexperienced 
in such matters, what a latitude is there for fraud, em- 
bizzlement, 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 snip 
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 for 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 subject would tend to make him 
diffident of withholding his ratification, even though 
he should feel so inclined. 

It is therefore expedient to guard against possible 
abuses, so far as practicable ; and 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 ruinous. 
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. 

When 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 

meat 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 the 
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, $£c." 

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 tine, 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 stale 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 outfit may be at. When these vessels only r 
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. 

lb. oz. lb. oz- 



Acid. Nitros dilut. 
Acid, vitriol, dilut, 
Adip. suillce, . . 
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 
Extract, colocynth 
Flor. chamgemel. 
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. . . 
Ol. lini, . . . 
Ol. menth. pip. 
Ol. olivar. . . 
Ol. ricini, . . 
01. terebinth. . 



oz. 
8 



12 
12 



1 
1 

6 

2 
1 
4 
8 
1 
32 

1 
4 
2 



12 

4 



resin, 
aloe, 



6. 
4 



12 



4 
3 
3 
96 
48 
6 
6 

8 

4 
2 



Opium purif. . . . 


1 


Pil. hydrarg. . . . 


. 1 


Ras quassia, . 


1 


Rhab. pulv. . • 


1 


Sal. vol. C. C, . . . 




Scm. lini, .... 


. 12 


Senna, 


4 


S per ma. ceti 


3 


Sp. sether nitros. . . 




Sp. lav end. comp. 


1 


Vin. rect 


4 


Tinct. digital. . . . 


1 


Tinct ferri. muriat. . 




Tinct. opii, 




Tinct. rhoei, . . . 


2 


Tinct. scillse, . . . . 




Ung. cerse, . . . 


24 


Ung. hydr. fort. . . 


16 


Ung nitrat, . . . 


1 


Ung. resin, flav. . . 


16 


Vin. antimon 




Zinc, vitriol, . 




Zinziber. pulv. . . 


2 



12 



12 



1 . 



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 

Phials 5 2 ounce > • • 66 

1 1Ual& I 1 ditto, . . 66 

pint, . . gross 4i 
Phial, ... 9 
Gallipots, in sorts, . . No. 66 
Pewter measures, . . 2 
Mortars and pestles (mar- 
ble) 

Ditto, ditto, (metal), . 
Ditto, ditto, ("Wedgewood), 
Scales and weights, . set 

Pot, . . No. 

Plaister, . 

Funnels, 

Sponge, oz. 10 

Fine tow, .... lbs. 1 6 



Corks 



Spatulas 



MEDICAL DEPARTMENT OF THE NAVY. 



169 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 
Ship of the First Rate. 

"Sheets, 
Pillows, 
Night-caps, 
Hair-beds, 



> 

CO 



£ 
o 
o 

o 

.Q 
o 



o 2 

y ■•? 

•J 

O 

h 









Oh 



Lemon-juice, 
Calico, . . 

Welch flannel, 
Lint, 
Tourniquets, 

| £ "J Right side, 
S.| S-Left side, 
eg £ J Double, 

Bed-pans, 
Urinals, 
Spitting. pots, 

g i . 7 Two quarts, 
'$ | § i- Three pints, 
w J S a,J One pint, 

Tea, 

Sago, 

Rice, 

Pearl-barley, 

Soap, 

Soft sugar, 

Portable-soup, 

Cases, 
Bottles, 

Chest for calico, &c. 
Chest for grocery, 
Boxes for portable-soup, 

Tea, 
Sago, 
gj j>Rice, 

II 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 


—m 


6 





3 


— 


2 





2 


— ~ 


8 


-W 


1 





1 


— 


2 





72 


lbs 


64 


— . 


128 


— . 


128 


— . 


25 


— 


412 


— . 


100 


— 


6 No. 


108 


— 


1 
1 

2 


— ■ 


— 


1 

1 
1 

1 
4 


— 


— 


— 


1 


_ 



170 



OBSERVATIONS ON Hit: 



Proportion of Medicines, Utensils, and Fumigating Articles, 
for a Ship of the Second Rate. 

lb 



oz. dr. 

7 

8 

8 

7 

3 4 
14 
14 

4 

1 6 
12 
14 

8 

14 



Acid. Nitros dilut. . 
Acid, vitriol, dilut. . 10 
Adip. suilloe, ... 10 
Ammonia praep. . . 
Antimon. tart. . . 
Antimon. pulv. . • 
Aq. amnion pur. 
Aq. litharg acet. . 5 
Argent nitrat. . . 
Calomel, .... 1 
Camphor, .... 

Cera flav 3 

Cerat. lap. calam. . 7 
Cerussa. acetat. . . 
Cinchon. puiv. . . 28 
Confect. aromat. . 7 

Confect. opiata, . . 15 
Crem. tart. ... 38 
Creta p p ... 112 
Cuprum vitriol, . 7 

Digital pur. pulv. . 3 

Emplast. cantharid. 10 8 

Emplast. cei-a c. .38 
Emplast. litharg. . 7 
Emplast. litharg. c. resin, 3 8 
Extract colocynth. c. aloe, 7 
Fior. chamaemel. ..54 

Flor. sulph 3 8 

sulph. viv. • . 7 
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. ... 2 
Magnes. vitriol. . . 84 
Natron vitriol. ... 42 
Nitr. purif. .... 5 4 

Oi. Iini, 5 4 

Ol. menth. pip. . . 2 

Ol olivar 7 

Ol. ricini, .... 3 8 
Ol. terebinth. . . . 1 12 



7 
10 
10 

7 

1 
10 
14 

7 



3 8 
2 10 
10 



Opium purif. 
Pii. hydrarg. 
Ras quassiae, 
Rhab. pulv. 
Sal. vol. C.C, . 
Sem. Iini, . . 
Senna, 

Sperma. ceti. 
Sp. aether nitros. 
Sp lavend. comp 
Sp. vin. rect. 
Tinct. digital. . 
Tinct lerri. muriat 
Tincl. opii, . 
Tinct. rhoei, 
Tinct. sciilae, 
Ung. cerae, 
Ung. hydr. fort. 
Ung nitrat, 
Ung. resin, flav. 
Vin. antimon. . 
Zinc vitriol, 
Zinziber. pulv. 



lb. oz.dr. 
1 5 
14 
5 



1 



10 

3 

2 



14 
5 
8 
8 

10 

10 

1 
8 

14 
7 

10 

12 
7 



21 
14 

14 



14 



10 4 
7 
12 



Fumigating articles, at the o/Uion 

of the surgeon. 
Vitriolic acid, ... 35 lbs. 
Nitre purif . . . . 35 

UTENSILS. 

Bolus knives, . . . No. 2 

Tiles, 2 

Bottles, \ pint, ... 60 
2 ounce, . . 60 
1 ditto, . . 60 
pint, . . gross 4 
.Phial, ... 8 
Gallipots, in sorts, . . No. 60 
Pewter measures, . . 2 
Mortar and pestle (mar- 
ble) 

Ditto, ditto, (metal), . 
Ditto, ditto, ("Vedgewood). 
set 
No. 



Phials 



Corks 



Scales and weights, 

Spatulas \*T- ' 
r I Plaister, 

Funnels, .... 

Sponge, .... 

Fine tow, . . . 



2 
oz. 10 
lbs. 14 



MEDICAL DEPARTMENT OF THE NAVY. 



171 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 
Ship of the Second Rate. 



> 






| 

c 



,fl 
O 



J3 

x ST 



to 
a - 



Sheets, 
Pillows, 
Night-caps, 
Hair-beds, 

Lemon-juice, 
Calico, . 
Welch flannel, 
Lint, 
Tourniquets, 

g S -I Right side, 
fj I Left side, 
J! £ j Double, . 

Bed-pans, 

Urinals, • 

Spitting-pots, 

I i "1 Two q uarts > 
'3 § S I Three pints, 
^« « c-J One pint, 

fTea, 

Sago, 

Rice, 

Pearl-barley, * 

Soap, 
I Soft sugar, 
L Portable-soup, . 

"g g ? Cases, 
£ 3 C Bottles, 

Chest for calico, &c. 
Chest for grocery, 
Boxes for portable-soup, 

<2 1 Tea, 

% I Sago, 

|J ^.Rice, . 

V j Pearl-barley, 

^ j Portable-soup, 

Cask for sugar, 



16 pairs. 
16 No. 
16 — 
16 — 

45 galls. 

180 yards. 

120 

9 lbs. 

12 No. 

12 — 

6 — 

3 — 

2 — 
2 — 

7 — 

I — 

1 — 

2 — 

63 lbs. 

56 — < 
112 — 
112 — . 

21 — 
348 — 
100 — 

5 No. 
90 — 

2 — 

1 — 

1 — 
1 — 

4 — 



17& OBSERVATIONS ON THE 

Proportion of Medicines, Utensils, and Fumigating Articles, 
for a Ship of the Third Bate. 

lb. ozdr 



6 
3 

12 
12 



Acid, nitros. dilut. . 

Acid, vitriol, dilut. 9 

Adip. suilloe, 9 

Ammonia praep. 

Antimon. tart. 

Antimon. pulv. 

Aq. amnion, pur. 

Aq. litharg. acet. 

Argent, nitrat. 

Calomel, . ; 8 

Camphor, . . 12 

Cera flav. 

Cerat. lap. calam. 

Cerussa acetat. 

Cinchon pulv. . 24 

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 
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. 
Liq. vol. C. C. 
Magnes. alb. 
Magnes. vitriol. 
Natron vitriol. 
Nitr. purif. 
Ol. lini, 

Ol. menth. pip. 
Ol. olivar. 
Ol. ricini, 
Ol. terebinth. 



1 4 



12 

6 
2 



aloe, 



3 
2 

2 

72 

36 

4 

4 

6 
3 
1 



6 
4 
9 
6 
1 
4 
12 
6 

4 

4 



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. cerse, 
Ung. hydr. fort. 
Ung. nitrat, 
Ung. resin, flav. 
Vin. antimon. 
Zinc, vitriol, 
Zinziber. pulv. 



oz. dr. 

2 
12 

2 
12 

4 4 



4 
9 
2 

12 
6 
9 
8 



18 
12 

12 



I 



12 

9 
6 
8 



Fumigating articles, at the ofition 

of the surgeon. 
Vitriolic acid, . 25 lbs. 

Nitre purif. . . 25 



UTENSILS. 

Bolus knives, 
Tiles, 
Bottles, 4 pint, 

Phials 
Corks 



5 2 ounce, 
il 



ditto, 

Si pint, . 

I Phial, . 
Gallipots, in sorts, 
Pewter measures, 
Mortar and pestle (marble) 
Ditto, ditto, (metal), 
Ditto, ditto, (Wedgewood), 
Scales and weights, 

S P atU,aS ^PlaWr, 
Funnels, 
Sponge, 
Fine tow, 



No. 2 

2 

54 

54 

54 

gross 3| 

7 

. No. 54 

2 



set 
No. 

2 

oz. 9 

lbs. 12 



MEDICAL DEPARTMENT OF THE NAVY. 



173 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 
Ship of the Third Rate. 





bhee 


-ts, 


12 pairs. 




Pillows, 


12 No. 




Night-caps, 


12 — 




Hair-beds, 


12 — 


a 

in 


Lemon-juice, 


45 galls. 


>> 


Calico, 


160 yards. 


-Q 


Welch flannel, 


100 


X 


Lint, 


61 lbs. 


3 


Tourniquets, 


10 No. 


13 


i||"J Right side, 


9 — 




a. i > Left side, 


6 — - 


Oh 

a 



K £ J Double, . 


3 — 


Bed-pans, 


2 — 


u 


Urinals, 


2 — 


.a 




Spitting-pots, . . . 


6 — 


H 


C 






2 i ") Two quarts, 


1 — . 




ill t Three pints, . 


1 _ 




Lu " °*J One pint, 


2 — 


"SJJ 1 


'Tea, 


54 lbs. 


2 § 1 


Sago, 


48 — 


£s . 


Rice, 


96 — 


§5^ 


Pearl-barley, 


96 — 




Soap, 


15 — 




Soft sugar, 


284 — 


H W ,Q 


_Portable-soup, . 


75 — 


"2 « 7 Cases, 


5 No. 




5 '3 C Bottles, . 


90 — 




Chest for calico, &c. 


1 — 




Chest for grocery, 


1 — 


en 


Boxes for portable-soup, 


1 — 


,»0 


£ ~) Tea, 


1 — 




4> 


Sago, 


1 — 




a .0 


>Rice, 


1 — 




•*-' 


Pearl-barley, 


1 — 




P - 


Portable-soup, 


3 ~ 




w Cask 


for sugar, 


1 — 



174 OBSERVATIONS ON THfc 

Proportion of Medicines, Utensils, and Fumigating Articles, 
for a Ship of the Fourth Rate. 





lb. 


oz. dr. 


lb. oz. dr. 


Acid, nitros dilut. 




3 


Opium purif. . 


Acid vitriol, dilut. 


4 


8 


Pil. hydrarg. . • 6 


Adip suilloe, 


4 


8 


Ras quassiae, • 


Ammonia praep. 




3 


Rhab. pulv. • • 6 


Antimon. tart. 




1 4 


Sal.vol.C.C. • 


Antimon. pulv. 




6 


Sem. lini, - • 4 8 


Aq. amnion, pur. 




6 


Senna, ... 18 


Aq. litharg. acct. 


2 


4 


Sperma ceti, . . 12 


Argent, nitrat. 




6 


Sp ^ther nitros, . 4 4 


Calomel, 




12 


Sp. lavend.comp. . 9 


Camphor, 




6 


Sp. vin- rect. . . 18 


Cera flav. 


1 


8 


Tinct digital. . 6 


Cerat lap. calam. 


3 




Tinct. ferri. muriat. 3 


Cerussa. acetat. 




6 


Tinct. opii, . 4 4 


Cinchon pulv. 


12 




Tinct. rhoei, • 12 


Confect. aromat. 




3 


Tinct. scillae, . . 3 


Confect. opiata, 




9 


Ung. cerse, . . 9 


Crem. tart. 


1 


8 


Ung. hydr. fort. . 6 


Creta p. p. 




12 


Ung. nitrat, . . 6 


Cuprum vitriol, 




3 


Ung. resin flav. . 6 


Digital, pur pulv. 




1 4 


Vin. antimon. . 4 4 


Emplast. cantharid. 


4 


8 


Zinc, vitriol, . 3 


Emplast. cera C. 


1 


8 


Zinziber. pulv. . 12 


Emplast. litharg. 


3 






Emplast. litharg. c.r 


esin, I 


8 


Fumigating articles, at the ofition 


Extract, colocynth.c 


.aloe, 


o 


of the surgeon. 


Flar. chamaemel, 


2 


4 


Vitriolic acid, . 20 lbs. 


Flor. sulph. 


1 


8 


Nitre purif. . . 20 


sulph. viv. 


3 






Gum. ammon. gutt. 




3 


UTENSILS. 


Gum. arab. 


1 


2 


Bolus knives, . • No. 2 


Gum. guaiac. 




4 4 


Tiles, ... 2 


Hydr. nitr. rub. 




3 


Bottles, 1 pint, . . 36 


Hydr. muriat. 
Jalap, pulv. 


1 


6 

2 


«*M!ST : 2 


Ipecac, pulv. 




6 


<»*»W: . sross3 6 


Ipecac, pulv. com. 




3 


Kali p. p. 


1 


8 


Gallipots, in sorts, . No. 36 


Liq. vol. C. C. 


1 


2 


Pewter measures, . 3 


Magnes alb. 


1 


2 


Mortar and pestle (marble), 1 


Magnes vitriol. 


36 




Ditto, ditto, (metal), . 1 


Natron vitriol. 


18 




Ditto, ditto, (Wedgewood), 1 


Nitr. purif. 


2 


4 


Scales and weights, . set 1 


Ol. lini, 

Ol- menth. pip. 


2 


4 
1 1 


Spatulas ^ ster> ; 


OL olivar, 


3 




Funnels, ... 2 


Ol. ricini, 


1 


8 


Sponge, . . oz. 6 


Ol. terebinth, 




12 


Fine tow, . . . lbs. 6 



MEDICAL DEPARTMENT OF THE NAVY. 



175 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 
Ship of the Fourth Mate. 

fSheets, . 
Pillows, 
Night-caps, 
Hair-beds, 



> 
U 

m 



*3 



a 



o 
H 



^3 2 

S G 

s * 

O <" ^ 



Lemon- juice, 
Calico, 

Welch flannel, 
Lint, 
Tourniquets, 

£ £ ") Right side, 
0. ! > Left side, 
£ £ J Double, . 

Bed-pans, 

Urinals, 

Spitting-pots, 

g i ^ ") Two quarts, 
'J s I y Three pints, 
J S c. J One pint, 



fTea, 
Sago, 
Rice, 
^<J Pearl-barley, 
Soap, 

Soft sugar, 
^Portable-soup, 



' o «j C Cases, 
I "3 ? Bottles, 

Chest for calico, 8cc. 
Chest for grocery, 
Boxes for portable-soup 

« 1 Tea, 
2 I Sago, 
'I § ^.Rice, 
V^ I Pearl-barley, 
£ J Portable-soup, 

LCask for sugar. 



6JD 1 



9 
9 


pairs. 
No. 


9 


— 


9 


— ' 


27 
80 
50 


galls, 
yards. 


5 


lbs. 


8 


No. 


9 


_ 


6 


— 


3 


— 


2 


___ 


2 


— 


3 

1 
1 

2 


-"-~ 


— 


27 


lbs. 


24 


— 


48 


— 


48 


— 


10 


— 


192 


— 


50 


— 


3 


No. 


54 


— 



2 — 
1 — 



176 



OBSERVATIONS ON THE 



Proportion of Medicines, Utensils, and Fumigating Articles, 
for a Ship of the Fifth Rate. 





lb. 


oz. dr. 


| 


lb. oz. dr. 


Acid, nitros dilut. 




2 4 


1 Opium purif. 


7 4 


Acid, vitriol, dilut. 


3 


12 


Pil hydrarg. 


5 


Adip. suilloe, 


3 


12 


i Rus quassiae, 


7 4 


Ammonia prsep. 




2 4 


1 Rhab. pulv. 


5 


Antimon. tart. 




1 2 


j Sal vol. C. C. 


1 7 


Antimon. pulv. 




5 


i Sem. lini, 


3 12 


Aq ammon. pur. 




5 


| Senna, 


1 4 


Aq. litharg. acet. 


1 


14 


j Sperma. ceti. 


15 


Argent, nitrat. 




5 


1 Sp. aether nitros. 


3 6 


Calomel, 




10 


Sp. lavend. comp. 


7 4 


Camphor, 




5 


| Sp. vin. rect. 


1 4 


Cera flav. 


1 


4 


i Tinct. digital. 


5 


Cerat. lap. calam. 


2 


8 


Tinct. ferri. muriat. 


2 4 


Cerussa. acetat. 




5 


Tinct. opii, 


3 6 


Cinchon. pulv. 


10 




Tinct. rhcei, . 


10 


Confect. aromat. 




2 4 


| Tinct. scillae, 


2 4 


Confect. opiata, 




7 4 


1 Ung. cerae, 


7 8 


Crem. tart. 


1 


4 


: Ung. hydr. fort. 


5 


Creta p. p. 




10 


Ung. nitrat. 


5 


Cuprum vitriol, 




2 4 


i Ung. resin, flav. 


5 


Digital pur. pulv. 




1 2 


Vin. antimon. 


3 6 


Emplast. cantharid. 


3 


12 


Zinc, vitriol, 


2 4 


Emplast. cera. C. 


1 


4 


Zinziber. pulv. 


10 


Emplast. litharg. 


2 


8 






Emplast. litharg. c. resin, 1 


4 


Fumigating articles, 


at the option 


Extract colocynth. c 


aloe, 


2 4 


of the surge 


on. 


Fiorrchamaemel, 


1 


14 


Vitriolic acid, 


15 lbs. 


Flor. sulph. 


1 


4 


Nitre purif. 


15 


sulph. viv. 


2 


8 






Gum ammon. gutt. 




2 4 


UTENSILS 




Gum. arab. 




15 


Bolus knives, 


. No. 2 


Gum. guaiac. 




3 6 


Tiles, 


2 


Hydr. nitr. rub. 




2 4 


Bottles, \ pint, . 


30 


Hydr. muriat. 
Jalap, pulv. 




5 
15 


Phials \ J ™' lce ' 
I 1 ditto, 


30 
30 


Ipecac pulv. . 
Ipecac, pulv. com. 




5 

2 4 


Corks SlP"*' 
uorks £ Phi a i, 


. gross 2| 
5 


Kali, pp. 


1 


4 


Gallipots, in sorts, 


. No. 30 


Liq. vol. C. C. 




15 


Pewter measures, 


2 


Magnes. alb. 




15 


Mortar and pestle (n 


larble), 1 


Magnes. vitriol, 


30 




Ditto, ditto, (metal), 




Natron vitriol, 


15 




Ditto, ditto, (Wedgf 


:wood), 1 


Nitr purif. 


1 


14 


Scales and weights, 


set 1 


Ol. lini, 


1 


14 


o ^ , ( Pot, 


. No. 1 


Ol menth. pip. 




n 


Spatulas | piai ' ster) 




Ol. olivar, 


2 


8 


Funnels, 


2 


Ol. ricini, 


1 


4 


Sponge, . 


oz. 5 


Ol. 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. 



3 

c 
c J 



a* 

g 
3 



o 



Sheets, 
Pillows, 
Night-caps, 
Hair-beds, 

Lemon-juice, 
Calico, 

Welch flannel, 
Lint, 
Tourniquets, 

ght side, 
side, 
Pjf, j .L/ouble, 

Bed-pans, 

Urinals, 

Spitting-pots, 

§ £ "1 Two quarts, 
'5 ^ c > Three pints, 
J 2 c.J One pint, 




T3 tfl 

jo J- 3? 






Tea, 

Sago, 

Rice, 

Pearl-barley, 

Soap, 

Soft sugar, 

Portable-soup, 

Cases, 
Bottles, 

Chest for calico, &c. 
Chest for grocery, 
Box for portable-soup, 

Tea, 
Sago, 
>Rice, 
Pearl-barley, 
Portable-soup, 

(^Cask for sugar, 



7 

7 


pairs. 

No. 


7 


— 


7 


— 


27 
70 
40 


galls, 
yards 


4 


lbs. 


6 


No. 


6 


— , 


3 


— 


3 


— 


2 


— : 


2 


— 


3 


-** 



1 

2 


— 


— 


*4 


lbs 


20 


__ 


40 


— 


40 


~_a 


7A 

2 


— 


160 


~m 


50 


— J 


3 


No. 


54 


— 



2 — 
1 — 



a a 



178 



OBSERVATIONS ON THE 



Proportion of Medicines, Utensils, and Fumigating Articles, 
for a Ship of the Sixth Rate. 



lb. oz.dr. 



Acid. Nitros dilut. 
Acid, vitriol, dilut. 
Adip. suillce, . . 
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 pp. . . 
Cuprum vitriol, 
Digital, pur. pulv. 
Emplast. cantharid, 
Emplast. cera c. 
Emplast. litharg. 
Emplast. litharg. c. resin, 
Extract, colocynth. c. aloe, 
Flor. chamaemel. . . 1 
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. . . 
Liq. vol. C. C . 
Magnes. alb. 
Magnes. vitriol. . .18 
Natron vitriol. ... 9 
Nitr. purif. .... 1 

Ol. lini, 1 

Ol. menth. pip. 
Ol. olivar. . . 
Ol. ricini, . . 
Ol. terebinth. . 



l 

4 
4 
t 

3 
3 
2 

6 

3 

12 

8 



1 

4 

12 

6 

1 

4 

12 

8 

12 

1 

2 

12 

8 

1 

9 

2 

1 

9 
3 
1 
12 
9 
9 



4i 



8 
12 

B 



Opium purif. 
Pil. hydrarg. 
Rus quussiae, 
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. 
4 4 
3 

4 4 
3 

1 1 
2 4 

12 
9 

2 2 
4 4 

12 
3 

1 4 

2 2 
6 

1 4 



Fumigating articles, at the ojition 

of the surgeon. 
Vitriolic acid, ... 10 lbs. 
Nitre purif. .... 10 

UTENSILS. 

Bolus knives, . . . No 2 

Tiles, 2 

Bottles, h pint, ... 18 

r.. . , C2 ounce, . . 18 

Phials i , .... ' 

1 1 ditto, . . 18 

c °*° US'. : : Bross l i 

Gallipots, in sorts, . . No. 1 8 
Pewter measures, . . 2 
Mortar and pestle (mar- 
ble), 

Ditto, ditto, (metal), . 
Ditto, ditto. ("Vedgewood), 
Scales and weights, . set 
Pot, . . No. 
Plaister, . 

Funnels, 2 

Sponge, oz. 4 

Fine tow lbs. S 



Spatulas 



MEDICAL DEPARTMENT OF THE NAVY. 



179 



Z< 



o I 






Proportions of Bedding, Lemon-juice, and Necessaries, for a 
Ship of the Sixth Rate. 

'Sheets, 
Pillows, 
Night-caps, 
Haii-beds, 

Lemon-juice, 
Calico, 

Welch flannel, 
Lint, 
Tourniquets, 

| g "J Right side, 
f. | > Left side, 
j5; £ J Double, 

Bed-pans, 

Urinals, 

Spitting-pots, 

? i ") T wo quarts, 
■| | I I Three pints, 
^J « a. J One pint, 

("Tea, . . . 

Sago, 

Rice, 
\ Pearl-barley, 

Soap, 

Soft sugar, 

Portable-soup, . 

<"\ g > Cases, 
|'S \ Bottles, 

Chest for calico, &c. 
Chest for grocery, 
Boxes for portable-soup, 



T3 w 

-I 

W £ 

"^ O 



o x « 

.2 ^2 

o S OT 



J <; 






Tea, 
Sago, 
^►Rice, 
Pearl-barley, 
Portable-soup, 



Cask for sugar, 



4 


pairs. 


4 


No. 


4 


— 


4 


— 


18 


galls. 


50 


yards 


30 


.. 


3 


lbs. 


4 


No. 


6 


.^^ 


3 


— 


3 


— 


2 


__ 


2 


— 


2 


— 



1 

2 


— 


— 


131 


lbs. 


12 


— u 


24 


— 


24 


— 


H 


— 


96 


— 


25 


— 


2 


No. 


36 


— 


1 

1 



— 


— 


1 


— 


1 
1 
1 


— 


1 
1 





180 



OBSERVATIONS ON THE 



Proportion of Medicines, Utensils, and Fumigating Articles, 
for a 



Acid, nitros. dilut. 
Acid, vitriol, dilut. 
Adip. suillce, 
Ammonia praep. 
Antimon. tart. 
Antimon. pulv. 
Aq. ammon pur. 
Aq litharg. acet. 
Ardent, 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, 
Extract, colocynth. c 
Flor. chamaemel. 
Flor. sulph. 

sulph. viv. 
Gum. ammon. gutt 
Gum. arab. 
Gum. guaiac. 
Hydr. nitr rub. 
Hydr. muriat. 
Jaiap pulv. 
Ipecac, pulv. . 
Ipecac, pulv com. 
Kuli p. p. 
Liq. vol. C. C. 
Magnes. alb. 
Magnes. vitriol. 
Natron vitriol. 
Nitr. purif. 
Ol. lini, 
Ol. menth. pip 
Ol olivar. 
Ol ricini, 
Ol. terebinth. 



lb. oz. dr. 
1 
1 8 

1 



8 
1 

2 

2 

12 

4 
2 



1 

3 
8 
4 
1 

1 8 



aloe, 



Sloop. 

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. rhcei, • 
Tinct scillse, 
Ung cerae, 
Ung. hydr. fort. 
Ung. nitrat, 
Ung. resin, flav. 
Vin. antimon. 
Zinc, vitriol, 
Zinziber. pulv. 



8 

1 

12 



12 

12 



lb. oz.dr. 
3 
2 
3 
2 



8 

6 

1 4 

3 

8 

2 

1 

1 4 

4 

1 



Fumigating articles, at the ofition 

of the surgeon. 
Vitriolic acid, . 10 lbs. 

Nitre purif. . . 10 

utensils. 

Bolus knives, . . No 2 

Tiles, ... 2 

Bottles, | pint, . . 12 

Phials S 2ounce > • I 2 

lhlalS \\ ditto, . 12 

Corks \\fff 9 ■ S''Oss 1 

C Phial, . . 2 

Gallipots, in sorts, . No. 12 
Pewter measures, . 2 

Mortar and pestle (marble), 1 
Ditto, ditto, (metal), . 1 

Ditto, ditto, (Wedgewood), 1 
Scales and weights, . set 1 

c~ .. i ^ P Qt » • • No. 1 
Spatulas J pi J 8ter> ( 1 

Funnels, ... 2 

Sponge, . . . oz. 3 

Fine tow, . . . lbs. 2 



MEDICAL DEPARTMENT OF THE NAVY. 



181 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 

Sloop. 





Shee 


ts, 


3 pairs. 




Pillows, 


3 No. 




Night-caps, 


3 — 


>> 


Hair-beds, 


3 — 


> 

3 


Lemon-juice, 


9 galls. 


X 


Calico, 


30 yards. 


X) 


Welch flannel, 


20 


^ 


Lint, 


2 lbs. 


"3 

c 


Tourniquets, 


4 No. 




| | 1 Right side, 


3 — 


o 


S, | > Left side, 


o 


<u 


dh J Double, 


3 — 








O 


Bed-pans, 


1 — 


<U 


Urinals, 


1 —, 


X! 

o 


Spitting-pots, 


1 — 


EH 








2 « ") Two quarts, 


— 




3as > Three pints, 


1 — 




_J « S.J One pint, 


1 — 


M 


"Tea, ... 


9 lbs. 


£ i ■ 


Sago, 
Rice, 


8 — 
16 — 


i.*H 


Pearl-barley, 


16 — . 


O s3 £* 


Soap, 


3 — 


J3 !- 0! 

a u 


Soft sugai*, 


64 — 




^Portable-soup, . 


25 — 


"o«3? Cases, 


I No. 




8*3 S Bottles, 


18 — 








Chest for calico, 8cc. 


1 — 




Chest for grocery, 


1 — 


t/5 


Boxes for portable-soup. 


— 


ba 








3 
'5 h 


Tea, 

Sago, 

>Rice, 


1 — 
I — - 
1 — 




c 


Pearl-barley, 


1 — 




H J 


Portable-soup, 


1 — 


1 


^Cask 


for sugar. 


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. . 


Acid vitriol, dilut. 


12 


Pil. hydrarg. . 


1 


Adip. suillce, 


12 


Ras quassise, • 


1 4 


Ammonia prsep. 


4 


Rhab. pulv. 


1 


Antimon tart. 


2 


Sal.vol.C.C. . 


, 3 


Antimon. pulv. 


1 


Sem. lini, 


12 


Aq- ammon. pur. 


1 


Senna, 


4 


Aq. litharg. acct. 


6 


Sperma ceti, ,. 


3 


Argent, nitrat. 


1 


Sp. jEther nitros, 


6 


Calomel, 


2 


Sp. lavend. comp. 


1 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 


Tinct. rhoei, . 


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 cahtharid. 


12 


Zinc, vitriol, 


4 


Emplast. cera C. 


4 


Zinziber. pulv. 


2 


Emplast. litharg. 


8 




Emplast. litharg. c. r 


ssin, 4 


Fumigating articles, at the option 


Extract colocynth.c 


.aloe, 4 


of the surgeon. 


Elor. chamsemel, 


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, 1 pint, . • 6 


Hydr. muriat. 
Jalap, pulv 


1 
3 


™* {*Z£ 1 


Ipecac, pulv. 


1 


^•itfit: . s " os i 


Ipecac, pulv. com. . 


4 


Kali p. p. 


4 


Gallipots, in sorts, • No. 6 


Liq. vol. C C. 


o 


Pewter measures, 


Magnes alb. 


3 


Mortar and pestle (mai-ble), 1 


Magnes vitriol. 


6 


Ditto, ditto, (metal), . 1 


Natron vitriol. 


3 


Ditto, ditto, ( Wedgewood), 1 


Nitr. purif. 


6 


Scales and weights, . set 1 


Ol. lini, 


6 


o . , ( Pot, • NO. 1 


Ol. menth pip. 


1| 


Spatulas J piai ' ster> . ! 


Ol. olivar, 


8 


Funnels, ... 2 


Ol. ricini, 


4 


Sponge, . . oz. 2 


Ol. terebinth, 


2 


Fine tow, . 


. lb. 1 



MEDICAL DEPARTMENT OF THE NAVY. 



183 



Proportions of Bedding, Lemon-juice, and Necessaries, for a 

Cutter, &c. 





'Sheets, . 


none. 




Pillows, 


do. 




Night-caps, 


do. 




Hair-beds, 


do. 




Lemon-juice, 


9 galls. 


>> 


Calico, .... 


20 yards. 




Welch flannel, 


10 




Lint, .... 


1 lb. 


c 


Tourniquets, 


3 No. 








*T3 


S i "J Right side, 


3 — 


■*-» 


o. 1 f ^ e ft s ide, 


3 — 


IS, 


d £ J Double, . 


3 — i 


o 
u 


Bed-pans, 


1 — 


o 


Urinals, 


1 — 


Spitting-pots,. 


1 — 


h 








2 i . ") Two quarts, 


— 




isc I Three pints, 


1 — 




J| « c-J One pint, 


1 — 


•S| fTea, 


41 lbs. 


ju c Sago, .... 


4 — 


"S. | I Rice, .... 


8 — 


§ x <uX Pearl-barley, 


8 — 


sii s ° a P' • 


n — 


•^ j * | Soft sugar, 


32 — 


H u jT L Por tablc-soup, . 


25 — 




"§ « C Cases, . 
1 .'3 J Bottles, 


1 No, 
18 — 




Chest for calico, 8cc. 


1 — 




Chest for grocery, 


1 — 




Boxes for portable-soup, 


— 


to 


01 ^ 


Tea, 


1 — 


U 1 
eg 

P-i 


V} 


Sago, 


1 — 




'2 fc, 

rt ,0 


>Rice, 


1 — 






Pearl-barley, 


1 T- 




H - 


Portable-soup, 


l — 



.Cask for sugar, 



1 ~ 



184 OBSERVATIONS ON THE 

N. B. All the preceding tables are calculated agreea- 
bly to the practice of the apothecaries 7 company, viz. 
8 drachms to the ounce, 16 ounces to the pound. 

g> 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 Britannick 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-niate 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. 



Bb 



186 



OBSERVATIONS OX THK 



Established proportion of Instruments, &c. to be provided 
by a Surgeon. 



Established proportion of 
Instruments, &c. 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 Forceps. 
Two dozen curved Nee 

dies. 
Two Tenaculums. 
Six Pettit's Screw 

Tourniquets. 
Pair of Bone- Nippers 

and Turnscrew. 
Three Trephines. 
Saw for the Plead. 
Lenticular and Rugine 
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. 
Puir of Bullet-Forceps. 
Scoop for extracting 

Balls. 



State of those in possession of the 
Surgeon of the Ship. 



In good or- 
der. 



Requiring 
repair. 



Unservicea- 
ble. 



Deficient of 
the 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. 



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 Rollers. 
Two 1 8 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 Hos/iital, at 
I do hereby certify, that in pursuance of the direction of the 
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 Jlosfiital. 



Requiring Unservicea^ 
repair. ble. 



Deficient of 
the estab- 
lished pro- 
portion. 



188 



OBSERVATIONS ON THE 



Established proportion of Instruments, &c. to be provided 
by a Surgeon 9 s-mate. 



Established proportion of 
Instruments, &c to be 
provided by a Surgeon's- 
mate. 



State of those in possession oi the Sur 
geon's-mate of the Ship. 



In good or- 
der. 



in 



Requiring 
repair. 



Unservicea 
ble. 



Amputating Knives, 

Ditto Saw- 

Metacarpal Saw with 
two Blades, 

Catlin, 

Curved Needles, 

Tenaculums, 

Tourniquets, 

Bone-Nippers, . 

Trephines, 

Head ■ aw, 

Lenticular, 

Raspatory, 

Forceps, 

Brush, 

Elevator, . 

Trocars, 

Silver Catheters, 

Elastic Gum Catheter, 1 

Scalpels, 

Key Tooth Instru- 
ment, 

Spare Claws of dif- 
ferent sizes, . 

Gum Lancet, 

Tooth-Forceps curv- 
ed, 

ditto straight, 

Punch, 

Seton Needle 
Scales, . 

Long Probe, 

Bullet-Forceps, . 

Probang, 

Set of Pocket Instru 
ments, 

Lancets, 

Pewter Syringes, 

U. S. Marine Hospital, at 

I do hereby certify, that in pursuance of the direction of the Board of Medic 

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 

pxamined the Instruments belonging to Surgeon's-mate of the 

and find their state to be as above expressed, 

Surgeon of Hospital, 



Deficient of 
the estab- 
lished pro- 
portion. 



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 jiroportions of mediciues 
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 spent in the service have familiarized me with 
jts usages j 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 ; and, 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 
arc 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 auy 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 at 
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 department 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. 
xV 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 to 
this rule should on no account be dispensed with. 



192 



OBSERVATIONS ON THE 



o 

I? 



O 



«3 


«~a 


•w 


& 


«s 


^ 


V 




u 












O 




*=5 


v 09 


S 


^ 


B 


~^ 


b) 


•53 


<u 




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53 



•5 

^ as 

§ 



« 






I 5 



£3 



£ 5f g £ 53 

siS3.iS 

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j3 

en t3 

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t/3 O 



8 2 
— o 

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CO V) 

Cu u . 

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3 CS g ett 

P" bb.ti 

*- c - tT ^ P< 

rt . -T o > rt 

x! ^ <a 2 «2 — 

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B 




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b 


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rt 


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£ p* 

B p. 

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S _: 
s "a 

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MEDTCAL DEPARTMENT OF THE NAVY. 193 







E 


• u 


















-1 




c 


■>- — "ii 




£> 














3 o 


V. 


(J 


C G "3 to 






£ 


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*-• c 









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u 


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£ 1 ~ 


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jcj 




Oh 




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cv 
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cham 
sulph 
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guaia 

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m 

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p p 
ol. C 
es vi 


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icetat 
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pur if. 
li. . 


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Extra 
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Gum. 






>*■ G 
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bo 


•r* W 



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194 



OBSERVATIONS ON THE 



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62 



© 






S 



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« 



^ 



■* 



.si° 1 

•53=- -.mi 



S .2 



3 .r 






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q- f - ~ :^« 

tJ O C - rt 

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R£ i* 5 d w » ci. ft.j.-< 





o 


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fc 


* Sepf - 




erae, 

ydr 

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esin 

1. 

ulv. 


«T 


u fl C ^ ,o C. 








ueni 

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iber 




52 cr 


c .5.2 


5 » 

o .73 


13 NN 


pqH 



MEDICAL DEPARTMENT OF THE NAVY. 195 



- ; . • . t5 2 ° £ -^ 5 "2 ~ fc « 

" & 8 3 *■§ {? 8 'dp S 1 s » '* 

^crt^-e^s -2 s . . «r . . . g ,. . o ^ . .a 

M 2 fe is ^T^- cfl>-~u&>£<2&~.,^o-P ) „ g,"^ .S P " § 
-2.S'2iSSo'0.2''3gc2»S f •£ S .a ^ *J A- § s 5 3 § 



196 



OBSERVATIONS ON THE 



V 

■5 "" 

IS 

PS 




£ 

t fa 
C 5 

s 

PS 




D 
fa 

■5 

a 

c. 
W 






"3 

o 






s 




5 




1 

1 


O £ fa fa 

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= S 8 3 

= .£ P 

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i 

s 

c 
a 


O .Q O .O O -O 95 m en 

*• ■ , - ^ ■ « -"3 ~ * o 

^ O O C/D £ &D • ~ • 

£' § "g > *? £ i | 

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VT> a '£ <q r 6 s «T "2 * "* ^ 1 . J !g -2 

vr vr n«an8m J -i •- m o c i- o •- o m 



o tT 



01 s- 

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,fl 



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XL & 



MEDICAL DEPARTMENT OF THE NAVY. 197 

2 u ^ g s § .9 .rj^Sg^g.gSg 

5 <g S " £ £ £ g v * 2? 8 "S "S -8 -a- ,2 

— ^3° -g go ~pC._-d*e r ^g-t w - 

1 -S »"S £ §S £ t 6 2-- 'I I Si ^ .£ |. .2 



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g 33 ft &• 3o5t;^2^ 



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g £ ^ £ -g s g -^^^^sSou^ 

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198 OBSERVATIONS ON THE 



SECTION VI. 

On the propriety of abolishing the Surgeons' 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 tiiis 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 
derm such a custom as that which hinds 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 1 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. W hoever 
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 OX THE 

cure. This happens till the disease assumes a serious, 
and uot unfrcquently a dangerous aspect. They will 
purchase for a trifle, on shore, drugs enough to ruin 
them, or do them at least essential injury, or apply to 
the lohlolly-hoy, 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 errour he 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 
jive-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. 

Iiet 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 OF 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 Surgeon's -mate in 
the Navy, on shiji-board. 

The duties of a surgeon, as detailed 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 siek. 

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. 



T) (I 



%02 



OBSERVATIONS ON THE 



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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 Jie 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 : 



304 



OBSERVATIONS ON THE 



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MEDICAL DEPARTMENT OF THE NAVY. 205 

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 States, Norfolk, Virg. Bee. 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. Bartox. 
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 Surgeon 7 s -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-mates, and hope they may 
not be deemed unworthy of insertion in the code of re- 
gulations for the navy. 



206 OBSERVATIONS ON THE 



Detail of the duties and offices of a Surgeon' s-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 suiFer 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 no account (unless unable to attend todut\ 



MEDICAL DEPARTMENT OF THE NAVY. 207 

himself) to commit the dressing of ulcers and wounds 
to the loblolly -boy, nor the men themselves, hut 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-hoy 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 sueh 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 ou the sick. 



208 OBSERVATIONS ON TH« 



SECTION VIII. 



Of the expediency of augmenting the pay of navy Sur- 



geons and Surgeon' s-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 G2 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 43 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 hesitation, 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 OP THE NAVY. S09 

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 navv, 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 part of his majesty's Order in Council of ihr 
2od January, 1805, for improving the situation of the Medical 
Officers of the Navy, as relates to such Officers serving on 
board Shijis. 

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 j 
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 14s. per day, his half-pay to remain at 
6s. per day. 

Surgeons of receiving-ships, slop-ships, convalescent-ships, 
prison-ships, 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. 



%i% onSKRVATIONS ON THE 

E 'ery 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 Avounded seamen ; but the sur- 
geons shall be required to provide, at their own expense, such 
suigical 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 half-pay 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 iodging-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 
sewed 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 Hank 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. 1 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 OBSERVATIONS ON THE 

be sufficiently respectable to give them a consequence 
among sea-officers, that they now have not. 

For my part, I eannot 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 I 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 our ration, at least the liquid portion of it. 



Rations allowed in the French service. 



Radon of a Workman. 



Nature of Provisions 
Fresh bread, 
Wine, 

Beer and cider, . 
Fresh meat, 
Green vegetables, 
Cod-fish, 

r Dinner, 
£ Supper, 
Rice, 
Dry vegetables, . 

■for cod-fish, 
Sweet oil 4 rice, . 

vegetables, 
■for cod-fish, 
Vinegar -{ r * ce > 



Cheese 



{ 
{' 



Former Weights and Measures. 
24 ounces. 
| of a pint. 
1^ pints. 
8 ounces. 
4 deniers. 
4 ounces. 

3 ditto. 
2 ditto. 
2 ditto. 

4 ditto. 

1 5 lb. per hundred weight. 
10 — ditto. 

5 — ditto. 

16 pints, ditto. 
5 ditto. 



vegetables, 2i 



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 



r 



Vinegar < 



Dinner, 

Supper, 
Rice, .... 
Vegetables, 

{for cod-fish, 
rice, . 
vegetables, 
cod fish, 
rice, 

vegetables, 
To sprinkle for 
the benefit of 
health, 
Mustard-seed, 
Salt, . 
Pepper, 
Fire-wood, 
Candles, 
Lamp-oil, 
Wicks, 

preserved sorrel, 
Sour-crout, 

fin Brest, St. Ma- 

« loes, L'Orient, 
Mutton^ . , 

j in the other sea- 

^ ports, 



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 piits per hundred weight. 
5 ditto. 

2 ditto. 



} 



7 pints per month for hundred men 



2 lb. 8 oz. ditto ditto. 

130 — ditto ditto. 

l 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. 

6 ditto. 

4 — — ditto. 



MEDICAL DEPARTMENT OF THE NAVY. 



217 



Mature of Provisions. 
Broth prepared in cakes, 
Chickens,. 
Eggs, 
Prunes, 

Butter, or preserve, 
Sugar, 
Grains, 
Hay, . 
Bran, 
Butter, 
instead of 
Sweet oil, 



! 



Former Weights and Measures. 
1^ ounces per man. 

A part. 

4 

15 lb per hundred men. 
10 — ditto. 

6 — ditto. 

9 — ditto. 

50 — per sheep. 
1 5 — per three thousand rations. 



for codfish, i. — 

rice, . i — 

vegetables, | — 



Rations of the sick at sea. 



White bread, 


. 


20 ounces. 


Egg> • 




1 


Mutton, 




8 ounces. 


Chicken, 




\ part. 


Mutton, instead of 


chicken, 


4 ounces. 


Prunes, 




4 ditto. 


Rice, 




2 ditto. 


Butter, or sugar, 


. 


i ditto. 



Rations of the Artillenj. 

Fresh or soft bread, . 26 ounces. 
(The rest like the ration for a workman.) 



Ration of Prisoners of War. 

Fresh or soft bread, 1 6 ounces. 

Fresh meat, 

Wine, 

Beer or cider, 

Fire -wood, 



16 ditto. 

? 

Look at the description, on this head, 



Ration of a Galley-slave, in prison. 

Fresh or soft bread, . 30 ounces, and water. 

Ff 



318 



OBSERVATIONS ON THE 



Ration of a Gallery -slave, at work. 

Nature of Provisions. 
Fresh or soft bread 
Biscuit, 



Cheese, 

Wine, 

Buer or cider, 

Vegetables, 

Sweet oil, 

Salt, 



Former W.-ights and Measures. 
30 ounces. 
23 ditto. 
1 ditto. 



| of a pint. 
1| ditto. 

4 ounces. 

1 lb. per hundred rations. 
20 — ditto ditto. 



Ration of Galley-slaves, without work. 

Fresh or soft bread, . 30 ounces. 
Bibcuit, 



Vegetables, 
Sweet oil, 
Salt, 



23 ditto. 

4 ditto. 

9 lb. per hundred men. 

2 1 — per thousand rations. 



Ration of Galley-slaves, invalids. 
Fresh or soft bread, . 24 ounces. 



Wine, . 
Fresh meat, . 
Green vegetables, 
Salt, 



1 pint 

8 ounces. 

6 deniers 
2 1 lb. per thousand rations. 



MEDICAL DEPARTMENT OF THE NAVY. 



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MEDICAL DEPARTMENT OF THE NAVY. 



221 



Sunday, 

Monday, . . . 
Tuesday, . . . 
Wednesday, . . 
Thursday, . . 
Friday, . . 
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DAYS OF THE 


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OBSERVATIONS ON THE 

It will be seen that anient spirits form no part ot* 
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 quautity 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, that it becomes every day more aud 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 must part are more attentive to their diet, arc 
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. £23 

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 Mi ere fore 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 ou board, 
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 mouths 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 lias been proposeit by 



MEDICAL DEPARTMENT OF THE NAVY. S2& 

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 there 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 of our navy 
are now victualled : 



Q 6 



$26 



OBSERVATIONS ON THE 



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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 



OBSERVATIONS ON THE 

bad weather the rushing of water into them might be 
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 while 
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 ray 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-deck, &c. 
frequently — and never washing the decks in wet or 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 2*, 1810. 

SIR, 

Since jour absence, the ship's company has be- 
come extremely unhealthy, and 1 am sorry to state to 
you, the prevalence of a genuine epidemick typhus le- 
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. I 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 in 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 inen, 
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 tine 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 
ditchers' 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, Sd 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 mc 
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 wou d 
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 a id 
trowsers. Although there is no regulation laid down 



MEDICAL DEPARTMENT OF THE NAVY. 

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 on 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- 
vul service, without a previous examination of them 
by a Surgeon or Surgeon's -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- 
ly 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, oris 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 ruj>- 
tures, sore legs, or confirmed eases 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 

gfee) ; 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 joiuts, one 
leg or one arm being shorter than another, the club- 
foot, &c. &c. not only interfere with the aetual 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 
gome 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 melancho- 
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." 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 two-thirds were 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- 
fui 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, or chock forward : that is to say, 



S38 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 IT. 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. 239 

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 their 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. 

0. 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 uot closely watched. 
This regulation is adopted in our best regulated ships j 
but in others it is not strictly followed. 



240 OBSERVATIONS ON TflE 

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, renler the water not only cathartick, but 1 
have known it to induce the most severe and obstinate 
choliek, and dysenteries. It spoils more readily than 
soring- water, which of course would make it impro- 
per to till 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 any of his plans for meliorat- 
ing the condition of the men, and promoting the conva- 
lescence and cure of the sick. 



INDEX. 

Dedication . Page. 

" " S 

Recommendatory letters 

Preface to the first edition 

Preface to the second edition - m 



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, 

CheHea 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, 



8 
9 
16 
17 
18 
19 
21 
22 
ib. 
ib. 
ib. 
23 
ib. 



Royal navy-yards, 

SECTION III. 

General remarks on the establishment and administration 
of naval hospitals in the United States, . . . 23 

SECTION IV. 

Of the proper situation and construction of navy hospitals, 27 
Of the offices and rooms appertaining to an hospital, . 29 

SECTION V. 

Of the structure of wards, 31 

Of water-closets and tub-rooms, 



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, &c 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 ot 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, 8cc. 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, . . 76 

SECTION XIII. 

Of the officers of the hospital, 80 



IXDEX. XXI 

Page. 
SECTION XIV. 

Of the governour, 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, 

SECTION XXII. 
Of the duty of the agent, ... 92 

SECTION XXIII. 
Of the chaplain, .94 

SECTION XXIV. 
Of the steward, 

SECTION XXV. 

Of the deputy-steward, steward's clerk, and ward-master, 97 

SECTION XXVI. 

Of the matron, • 



XXII INDEX. 

Page 
SECTION XXVII. 

Of the nurses and orderly-men, 100 

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, 10? 

SECTION XXXI. 

Mr. Latrobe's report on marine hospitals, . . . 1 1 1 

SECTION XXXII. 

An account of the Pennsylvania hospital, . . . 121 

SECTION XXXIII. 
Observations on Military and Flying Hospitals 130 

PART SECOND. 

A scheme for amending and systematizing the medical de- 
partment of the navy, ... . . 135 

SECTION I. 

Introduction, . 

SECTION II. 

Of the introduction of lemon-acid into the navy, • 1*5 

Letter fiom Dr. Gray, of Haslar hospital, England, on the 
subject of the lemon- juice, Sec. • • • • l^ 1 



INDEX. XX1U 

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 

— oi tne proportions of medicineb, £^c. for a ship of the 



fourth rate, 171 

of the proportions of bedding, lemon-juice, Sec. for 



ditto, 17* 

of the proportions of medicines, Sec. 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, 1 78 

. of the proportions of bedding, lemon-juice, Sec. for 



ditto, 179 

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 



XXiv INDEX. 

Page 
SECTION IV. 

Of the mode of furnishing surgical instruments to the navy, 184 
Of the number and kind of instruments necessary for a sur- 

186 
geon, .....•••• 

Qf the number and kind of instruments, for a surgeon's- 

18S- 
mate, ....-••• 

SECTION V. 

Of the mode of making expenditure returns of medicines, 

&c 

Blank tables for these returns, 

SECTION VI. 

On the propriety of abolishing the surgeons' five-dollar per- 

19S 
quisite from the navy, 

SECTION VII. 

Of the duties of a surgeon and a surgeon's-mate in the na- 

201 
vy, on ship-board, ... • 

Form of a blank printed sick-report, . 

Form of a semi-annual sick-return, . • • 204 

Detail of the duties and offices ot a surgeon's-mate m the 

206 
navy, 

SECTION VIII. 

Of the expediency of augmenting the pay of navy surgeons 

208 
and surgeon's-mates, ...••• 

Regulations for pay, Sec. of the medical officers in the Bri- 



210 
tish navy, 

SECTION IX. 

Of the propriety of establishing the rank of navy surgeons, 215 

SECTION X. 

Of the expediency of altering the present ration, . 215 

Rations of the French service for a workman, 

. when on a cruize, 

. of the sick at sea, . ..217 

. of the artillery, • ... 



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 XL 

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 



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 line 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" rewlwas. 

219, in the note to the ration-bill, (of some few copies,) second line, insert 
one-half before the word " pint." 









I 



* 



hi