We have listed a number of diseases which threatened the soldier on Caribbean service but we might also have included various anaemias, lung complaints and rheumatic disorders. The doctors accompanying the various expeditions between 1793 and 1815 had a daunting task. It was the responsibility of the Medical Board in London to provide an adequate number of medical officers for West Indian service. The members of the Board were subject to much criticism in the course of the wars but it was not easy to recruit sufficient army doctors for such an unpopular destination. There were good intentions on the part of the Government and Abercromby’s first expedition to the region arguably had better medical arrangements than any previous force leaving British soil. The Portsmouth part of the army was accompanied by a staff of four physicians, six staff surgeons, four apothecaries, 30 hospital mates and nine purveyors whilst with the Saint Domingue contingent there were seven physicians, twelve staff surgeons, two apothecaries and 70 hospital mates. These medical staff – that part of the department later to be described by Wellington as the ‘medical gentlemen’ – were in addition to the regimental surgeons and assistant surgeons, the number of which had been augmented. Hospital equipment – cots, bedding, marquees and innumerable other items – was supplied on a massive scale and medicines such as Peruvian bark, opium and ipecacuanha were packed into barrels, bales and drums. As we have seen, the expedition’s officers departed with the advice of a specially convened medical committee ringing in their ears.
These preparations were well-meaning but not all believed that the quality of medical provision matched the quantity. Colin Chisholm, an inspector general of the ordnance medical department in the West Indies, was scathing.
The medical staff of Sir Ralph Abercromby’s army was principally composed of young men who had little or no practice, and who were totally unacquainted with the climate, and its diseases…
There were, he says, a smaller number of regimental surgeons who had served before in the region and who had some experience of local conditions but they were unable to agree with the more senior medical staff regarding the nature of the prevailing fevers.
Whatever the competence of the army’s doctors, and this was very variable, they were just as vulnerable to infections as their soldier patients. It has been estimated that a quarter of serving British medical officers died during the Revolutionary and Napoleonic Wars, mostly from disease. Of the 11 physicians who accompanied Abercromby to the West Indies, six died in the short campaign and only one, Nathaniel Bancroft, was still serving in 1800. We have no precise figures for the medical department’s casualties for the totality of the Caribbean campaigns but the desperate state of affairs is revealed in contemporary medical reports. Inspector General of Hospitals Thomas Young struggled to obtain enough hospital mates (the most junior of the medical staff) to attend the hospitals on St Lucia in 1795, ‘…from the dreadful sickness and mortality that prevails there…it is with difficulty I can get any to go there – the C.O’s are constantly asking for assistance: within the last twenty-four hours hospital mates Hall, Currie, Culpepper and McCauley are reported to be dead’. The surviving medical men were crushed by the burden of work. An apothecary in Saint Domingue in 1796 complained that the sick ‘were in want of medical help’ and that, in addition to his normal duties pertaining to the delivery of medicines, he was in medical charge of a hospital and the 56th and 67th Regiments.
We have fleeting glimpses of these doctors in soldiers’ memoirs. Most of the references are complimentary. Thomas Phipps Howard applauds his regimental surgeon.
We were here infinitely Obliged to the Humanity of Dr. [Alexander] Baillie, our Surgeon, who tho’ ill himself & suffering every Deprivation with the rest of the Army, exerted himself in the relief of the Unfortunate Men by bleeding and other Remedies…
In similar vein, Lieutenant Henry Sherwood, struck down with yellow fever on Martinique in 1800, expressed his gratitude to his regimental surgeon who removed him to his own quarters and treated him with great kindness. ‘He gave up his own bed for me for I had no bed of my own having always used a hammock.’ Andrew Bryson had a more mixed experience; his regimental surgeon, Robert Salmon, was competent but the assistant surgeon, Samuel Cathcart, was a drunkard who ‘could not keep from tumbling over the beds’ when he entered the hospital.
Even the most sober medical officers had little real understanding of the diseases which affected their patients. The wars pre-dated by a full century the emergence of the science of microbiology with its insights into micro-organisms and the role of vectors such as mosquitoes. Most doctors believed that the majority of diseases were caused by ‘miasma’ or ‘miasmata’, invisible poisons in the air exuded from rotting animal and vegetable material, the soil and standing water. This theory was popular in the West Indies and was propagated by influential medical men including Robert Jackson.
…the physicians of every age do not entertain a doubt that fevers of the intermittent and remitting kind owe their origin to exhalations from swampy and moist grounds. Daily experience still proves it: and there are few men whose observations are so circumscribed, as not to know, that it is in the neighbourhood of swamps, and near the banks of fresh water rivers, that those disorders chiefly prevail.
Jackson’s colleague, Colin Chisholm, held similar views, attributing the genesis of fevers to ‘various combinations of gaseous productions of animal and vegetable substances in a putrescent state’. These intelligent men thought that the cause of the bewildering array of fevers that afflicted the army was to be found in ‘the spoil of dunghills and the putrid thaw’. The soldiers were not inhaling pure air but ‘a nauseous mass of all obscene, corrupt offensive things…’ There were discordant voices. Indeed much of the medical debate was bad-tempered although there was no repeat of the duel fought in Jamaica in 1750 where the physicians John Williams and Parker Bennet slew each other following a dispute regarding the nature of yellow fever. Some army doctors proposed the ‘contagion theory’ where disease was somehow passed from person to person. Among the ‘contagionists’ was Thomas Dickson Reide, Surgeon to the 1st Foot Regiment who warned of the dangers of rejecting the new theory in his treatise on the diseases of the army published in 1793.
An opinion has lately gone forth into the world, that fevers are not contagious in warm climates; an opinion which, if believed, will be of the most dangerous consequences, not only to individuals but to Nature at large; for if a fever or dysentery break out among troops in barracks or on board His Majesty’s ships, the idea of them not being contagious will throw inexperienced practitioners off their guard and a dreadful mortality will ensue.
The more astute army medical officers strained to better understand the fevers of the region and Chisholm performed experiments on Martinique in 1809. ‘The air which was emitted from the bottom of the pool by stirring with a stick, deflagrated upon the approach of a torch, and appeared to be hydrogene in combination with carbonic gas.’ He also performed post-mortems. Jackson admitted that he had no understanding of the nature of the ‘effluvia’ which were supposed to cause disease and Hector McLean conceded that fevers were the result of ‘unknown powers’. It was tempting to fill this hiatus with fanciful theories, Jackson surprisingly invoking the full moon as a factor in some types of fever.6
This ignorance did not prevent the doctors of the West Indian army making cogent suggestions for the prevention of disease. Jackson and others advocated numerous reforms which, if they had been fully instituted, would undoubtedly have reduced the mortality among the troops. Some of these initiatives have been previously discussed and they will be only briefly recapitulated here. Jackson stressed the importance of relatively simple changes to the soldiers’ lifestyle and accoutrements. They should eat in messes and their diets should be closely monitored by their officers, who were to impose penalties for ‘transgressions’. Daily exercise, Jackson believed, was essential but it was ‘an object very little attended to in the British Army’. He proposed changes to the kit fo
r West Indian service whilst admitting that it was a difficult task to persuade the men to set aside a uniform which ‘adds so much to the brilliancy of appearance’.
The timing of arrival in the Caribbean, the nature of the transfer from home, and the location of camps were all subjects which featured prominently in contemporary medical texts. Benjamin Moseley emphasises that an army must arrive in the region and commence active operations in the coolest months of December to March. Hector McLean, whose writings focus on Saint Domingue, advocates a period of ‘seasoning’ in the warm but healthy climate of Gibraltar before departing for the Tropics. Like Jackson, he stresses the importance of discipline, exercise and assiduous personal hygiene. All agree that the worst ravages of disease could be avoided if it were possible to station troops in the hills and mountains. Physician William Fergusson admits that this outpouring of well-intentioned advice was invariably not heeded.
In the West Indies, I found medical opinion equally at a discount. The convenience of the Engineer, the whim of the Quarter-Master-General, or General commanding, and the profit of the contractor, seemed alone ever to be consulted. There was not a station in the command where the health of the troops seemed ever to have been thought of, or a health opinion called for.7
The sick troops benefitted little from the treatments they received. The misunderstanding of the nature of disease led to a reliance on ‘antiphlogistic’ regimens in which patients were purged, made to vomit, bled, doused with cold water and subjected to other indignities only likely to render them more miserable and shorten their lives. The following account of the management of fever cases in the West Indies in 1801 was written by a hospital mate.
The men on admission were conducted to a wash house containing warm and cold baths. They were instantly bled to the quantity from 16 to 20 ounces. They were, on revival from fainting, which generally occurred, plunged into a warm bath in numbers of four to six together and confined in by blankets fastened over the machine till about suffocated. From here they were dashed into cold baths and confined until appearing lifeless. Immediately after, a strong emetic was administered, they were carried to bed, and a dose of 8 grains of calomel and 6 grains of James’s powder given as a purge, which occasioned a train of distressing symptoms for the relief of which they were bled again and blistered from head to foot. They were bled a fourth and fifth time in the space of thirty hours, and usually lost 60 to 70 ounces of blood.
Most of the drugs were useless or harmful. A notable exception was Peruvian bark, the cinchona from which quinine was later to be extracted. Quinine remains an important drug in the treatment of malaria. Its efficacy in the West Indian campaigns very likely depended on its quality and the amount administered. George Pinckard relates an episode where he purchased the drug from a local doctor; ‘His bark, he assured us, was ‘of the best’, for he had plenty of the ‘Cort Peruv. optimum…’8
The hospitals were broadly of two types, regimental and general. The smaller regimental facilities were not much employed in the early years of the conflict. Robert Jackson was a great supporter of the regimental hospital system and when he arrived in Saint Domingue in 1796 he made efforts to extend its use. He was convinced that sick men would be better treated by their own regimental surgeons and that there would be less opportunity for malingering. The Medical Board was lukewarm in its support but Jackson made a success of the enterprise, changing the supply system so that the sick were fed with fresh food and there was an annual saving of £80,000. He had unequivocal support from at least some of the army’s officers, Henry Clinton writing to his brother describing the doctor in glowing terms. There are relatively few allusions to regimental hospitals in soldiers’ accounts; Andrew Bryson was variably admitted to general and regimental hospitals during his illness.
Despite Jackson’s initiative, the major provision for sick men remained the large static ‘garrison’ or ‘general’ hospitals. These were opened throughout the wars on the islands held by the British. In 1796, there were eleven general hospitals with a total of 83 medical staff officers. The largest was on Martinique where there were 16 medical officers and the other sizeable institutions were on Barbados, St Lucia, Grenada and St Vincent. Scattered over 600 miles, these hospitals were administered by four assistant inspectors who were also expected to help out on the wards as physicians or surgeons.
We have only occasional glimpses of the routine of the general hospitals in the diaries and journals of the wars. Andrew Bryson informs us that when he was admitted to the hospital on Martinique he was put into a room of 24 beds, all of which were full. He survived his stay but not all were so fortunate; ‘About 10 O Clock 2 men in the next beds died, which shocked me Very much, as one of them was in a Brain fever and was obliged to be tyed’. Bryson was informed by the surgeon that ‘one man is as Good as another the moment they enter the Gates of the Hospital’ but this was not true. Officers received preferential or at least separate treatment. When Captain Thomas Henry Browne was wounded on Martinique in 1809 he was first admitted to the general hospital converted from the house of a sugar plantation. He occupied a small room with four fellow officers, the men lying on Indian corn and dried plantation leaves and covered by blankets. When an officer of the 4th West India Regiment was admitted with a wound there was no space for another bed and Browne shared his.
The general hospitals were under constant strain and it was difficult for the medical staff to maintain high standards. Some buildings were of wholly unsuitable construction and inappropriately sited. The following extract relates to the naval hospital on Antigua in 1809 but it could equally apply to one the army’s general hospitals. The institution was apparently well placed in an elevated position but the sanitation arrangements were primitive.
The necessary [toilet] is situated to the westward of the hospital, and not above fourteen paces distant from it. Here, everything execrementitious has been, and is presently deposited, and allowed to rot immediately under the walls of the hospital…When the wind blows from the westward, or during the existence of calms, the hospital is completely charged with stench and pestilential exhalation. Here is an evident and fertile source of injury to those sent to this hospital for the cure of disease…
In Port au Prince, the packed wards of the general hospital were hot and stinking and the motionless patients afflicted by a ‘low, muttering, grim, melancholy’. To add to this nightmarish scene, men delirious with yellow fever were liable to leap out of the windows. The eighty patients on each ward were the responsibility of a single doctor.
Soldiers feared the hospitals even more than disease itself. Bryson believed the hospital on Martinique to be ‘loathsome’ and most of his comrades would have agreed with him. In Demerara in 1796, George Pinckard tried to persuade a sick grenadier to attend the general hospital.
He instantly expressed great alarm, and said, ‘I am not ill: if you take me to the hospital, I shall catch the fever and die.’ – On my stating the impropriety of his remaining among the well men, and not using the proper means of recovery, he replied ‘I am not sick, and only want an appetite to be quite well’, and when I urged him further to go into the hospital, he answered with quickness, ‘Indeed I am not bad, and if I was, I would rather stab myself at once, than go where so many are dying every day of yellow fever’.
Some attempts were made to compensate for the lack of suitable hospital buildings. Pinckard describes temporary hospital accommodation being brought ashore at Carlisle Bay in 1797. The wooden frames were reassembled by the Corps of Artificers and local workmen. Other strategies to cope with the overspill of sick soldiers included the employment of hospital ships, tents and convalescent facilities. Clinton approvingly notes that Jackson moved more than 200 debilitated men to a convalescent hospital in Jamaica. Often these measures have the air of desperation. Thomas Phipps Howard says that the mortality in Saint Domingue was at such a level that ‘any Stable or Barn that would contain a quantity of Beds was obliged to be converted in [to] a Sick Ho
use’. At the height of the epidemics of yellow fever and malaria, the general hospitals were overwhelmed and many sick were housed in the regimental hospitals or outside the hospital system. A return for the Windward and Leeward Islands for the period April to October 1796 reveals that there were a total of 14,902 soldiers ‘sick in hospital’ and 10,058 ‘sick in quarters’. In the unhealthiest months the figures for the two are almost equal.9
The sick soldier in hospital needed not only a competent army doctor but also good quality nursing care. Unfortunately, these duties usually ended up in the hands of a few ‘hospital orderlies’ or ‘assistants’, non-combatants from the regiments. There were probably some good orderlies but, judging from soldiers’ accounts, most appear to have been dredged from the army’s disaffected elements. They treated their patients with disdain and fought over their belongings when they died. The sick were often left to cope as best they could. Harry Ross-Lewin was admitted to a general hospital in Saint Domingue in 1796.
The number of the hospital assistants was now reduced to the ratio of one to a hundred patients; when at least ten times as many were necessary; the consequences of this alteration to the sick were deplorable – the poor fellows, being unable to fan away the flies themselves, and having no proper attendance, died with their mouths full of them, and frequently, as their heads were shaved, they were covered with such swarms that the skin was completely hid.
Death Before Glory Page 31
