An Account of the Diseases which were most frequent in the British military hospitals in Germany

Chapter IX: Letter I: received from the Gentleman whose Care I left him (3)

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Cleanness and Neatness in the Camp is another Article that ought to be particularly regarded. _Portius_, _Ramazini_, and most other Authors who treat of Camp Diseases, attribute those of the putrid Kind in a great Measure to the Stench and putrid Effluvia arising from the Excrements of Men and Beasts, and from the dead Bodies of Men, Horses, and other Animals, lying unburied in the Neighbourhood of Camps, and have in a particular Manner mentioned the Necessity of burying such putrid Substances. Dr. _Pringle_ has very justly recommended the Digging of Deep Pits for Privies in Camp, and covering the Excrements with Earth daily[142] till the Pits are near full, and then to fill them up with Earth, and dig new ones; and to punish every Person who shall ease himself any where in Camp but in the Privies: And he remarks, that when the Camp begins to turn unhealthy, that often the only Means that will preserve the Health of the Men, is to change the Ground, and to leave behind all the Filth and Nastiness which gave Rise to those putrid Disorders.

[142] The divine Lawgiver _Moses_ has enjoined Cleanliness in
the Camp to the _Jews_ in a particular Manner, when he says,

"Thou shalt have a Place also without the Camp, whither thou
shalt go forth abroad; and thou shalt have a Paddle upon thy
Weapon, and it shall be when thou wilt ease thyself abroad
thou shalt dig therewith, and shalt turn back and cover that
which cometh from thee. For the Lord thy God walketh in the
Midst of thy Camp; therefore shall thy Camp be holy, that he
see no unclean Thing in thee, and turn away from thee."
_Deuteronomy_, chap. xxiii. verses 12, 13, 14.

In fixed Camps, the striking the Tents at Mid-Day in fair Weather, and turning and airing the Straw, and changing it often, as recommended by Dr. _Pringle_, will contribute much to preserve the Health of the Men; and making the Men wash themselves daily, and change their Linen often, and keep themselves otherwise clean, ought never to be omitted by the Officers.

All military Authors have recommended to Commanders always to have Straw for their Men when they come to their Ground, if possible; and to have the Army well supplied with Provisions; giving proper Encouragement to the Country People, and to Suttlers and Merchants of all Sorts, to bring in every Kind of Provisions and other Necessaries to Camp; and preventing, as much as possible, the Soldiers from moroding. And the Commanders of every Corps ought to take Care that their Men form themselves into Messes, and that Stoppages be made for buying them Provisions.

In _Germany_ every Regiment of the _British_ Troops contracted with a Butcher, who was obliged to carry along with them, at all Times, a certain Number of live Sheep and Oxen to kill when wanted, and to sell the Meat at a fixed Price. Every Soldier was obliged to take a certain Quantity, which was paid for by Stoppages made in his Pay; and this Meat was boiled in the Camp Kettles, with such Roots and Greens as could be got; by which Means the Men, whenever they could use their Kettles, had always a good warm Soop, as well as Meat, to refresh them after their Fatigues, which, along with their Ammunition Bread, made a good wholesome Food.

In Countries where Fruit is plentiful, a certain Quantity of what is fully ripe, distributed to the Men in warm Weather, and in hot Climates, will contribute to preserve their Health, though the Abuse of it will prove prejudicial; but unripe and acrid Fruits are always hurtful[143].

[143] The _British_ Soldiers in _Germany_ used sometimes to
hurt their Health by eating great Quantities of raw unripe
Apples, Plumbs, and other unripe Fruits; but the foreign
Troops had a much better Method of using such Fruits: They
commonly boiled or stewed them, and eat them with Bread, or
with their Meat, which in a great Measure corrected their bad
Qualities.

The Orders in the _French_ Camp, prohibiting the Men from
eating unripe Fruit, were strictly complied with every-where
in _Germany_ during the late War.

Water is another Article which Commanders endeavour to have their Camp well supplied with, and therefore they generally encamp near Rivers or Rivulets. Where the Stream is small, Care ought to be taken that its Course be not interrupted, and that no Filth or Nastiness, or any Thing that will spoil or corrupt the Water, be thrown into it.

When there are no Rivers or Rivulets near a Camp, and the Men are supplied from Wells, if the Water is not pure, very often the digging of deep Pits, and covering the Bottom and Sides with large Stones, and over these a Lay of Sand, Gravel, or Chalk, will make the Water pure in a few Hours.

In fixed Camps, where the Water is bad, _Portius_[144] proposes straining it thro' Sand, and has given Figures of Machines to be used for that Purpose; but the Method proposed by Dr. _Lind_ is still more simple, which is, to get a broad Cask with one End struck out; then put a longer Cask, with both Ends struck out, in the Middle of it; fill the short Cask one-third with Sand, and the inner longer Cask above one-half; fill the Rest of the inner Cask with the Water, which will filter through the Sand, and rise above the Sand in the outer Cask, where it may be allowed to run off into Vessels placed to receive it, by Means of a Cock, put into the Side of the outer Cask, fifteen or twenty Inches above the Level of the Sand.

[144] See the Treatise published by Dr. _Luc. Anton. Portius_
in 1686, _de Militis in castris sanitate tuenda_, _part._ ii.
_cap._ vi. In this Book we have many useful Things mentioned
relative to the Health of Soldiers.

Where there are no such Conveniences for purifying the Water, what is used for Drink ought to be mixed with a small Proportion of Spirits, or Wine, or with Vinegar, or Cream of Tartar, when neither of the other two can be got; and if the Water be previously boiled, it will be so much the better.

In Expeditions into warm Countries, where fresh Water is difficult to be had, a few Stills, with a proper Apparatus, ought to be carried out; and after a Landing is made, the Stills ought to be set to work for distilling fresh Water from Sea Water in the Manner mentioned by Dr. _Lind_[145]; and although a sufficient Quantity cannot be distilled for serving the whole Army, yet enough may be got in this Way for the Use of the Sick.

[145] Dr. _Lind_ relates a Number of Experiments of his
having distilled Sea Water in different Manners, as
recommended by others; and concludes, that the best Way of
getting fresh Water from Salt, is to distil the Sea Water by
itself, without any Mixture; and he proposes having a Still
Head to the Coppers or Iron Pots in which the Meat is dressed
aboard a Ship. _Ibid. note to p. 84_, &c.

When Men are very warm, after long Marches, and other hard Duties, in Summer; Officers should endeavour to prevent their swallowing immediately great Quantities of cold Water, and persuade them to wait a little till they cool; and at such Times, if Spirits can be got easily, to order a small Quantity to be mixed with the Water in each Man's Canteen.

Though the Abuse of vinous and spirituous Liquors is very destructive to the Constitution, yet these same Liquors, given in Moderation to Soldiers on Service, during the Times of great Fatigues, are some of the best Preservatives of Health. Spirits, for common Use, ought to be mixed with Water; and in the hot Climates made into Punch; though in very cold and wet Weather, and in damp Nights, a Glass of pure Spirits, given to the Men going on Duty, is of great Service; for it is always observed, that Men are much less apt to catch Diseases from being wet when they are upon a March, or at hard Work, than when they stand Centinels, or are upon Out-Posts where they move but little, or when they lie down in their wet Cloaths; and that they are less liable to be affected by the Weather after a hearty Meal, or drinking a Glass of Spirits, or some generous Liquor, than when their Stomachs are empty.

An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has been found to encrease their Efficacy as Preservatives both against the Effects of Cold and malignant Distempers. Dr. _Lind_ has recommended an Infusion of Garlick in Spirits as one of the best Stomachics and Diaphoretics he knows in cold wet Weather. And many have recommended a Tincture of the Bark[146]: Towards the End of the Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_ military Hospital in the late War, then a Mate to a marching Regiment, was ordered to go down the _Rhine_ with a Party of Sick, who had the Seeds of the Hospital Fever among them, and were to go in Bilanders, from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put aboard as Part of the Stores for the Sick, he was afraid lest the Men should make too free with the Spirits; to prevent which he threw in a Quantity of Bark into each Cask, and gave the Men regularly, Morning and Evening, a Glass of this bitter Tincture. At the same Time, the Men were kept extremely clean. By these Means most of the Sick mended upon the Passage, without the Malignant Fever appearing again amongst them; whereas, Dr. _Pringle_, who takes Notice of the other Parties who came from the same Hospitals in _Germany_, tells us, that the Malignant Fever broke out in a violent Degree, and Half the Number died by the Way, and federal others soon after their Arrival[147].

[146] During the Campaign in _Hungary_, in the Year 1717,
Count _Boneval_ preserved both himself and Family from
Disorders, by taking himself, and making all his Domesticks
take, two or three Times a Day, a small Quantity of Brandy,
in which Bark had been infused, at a Time when all the Rest
of the Army were infected with malignant Disorders. A
Regiment in _Italy_ continued healthy by the Use of the Bark,
when the Rest of the _Austrian_ Army, who did not pursue the
same Method, were greatly annoyed with Sickness. See
_Kramer._ quoted by Dr. _Lind_.

[147] _Observat._ part. i. chap. iii.

Commanding Officers ought always to endeavour to proportion the Time the Men are to be upon Duty to the Weather and the Nature of the Climate. The Time of standing Centinel in very hard Frost, and in cold wet Weather, or in the Heat of the Day in Summer, when the Weather is very warm, and in hot Climates, ought to be shorter than when the Weather is dry and more temperate.

The Marches of Troops ought, if possible, during the Time of very hot Weather, to be made either very early in the Morning, in the Evening, or at Night; and Officers, during the Course of an active Campaign, ought to spare their Men as much as possible.

And when they are in Quarters, and have nothing to do, they should narrowly inspect into their Manner of living; and have them out daily, when the Weather will permit, and exercise them, or march them two or three _English_ Miles a-Day, in order to prevent their falling sick for want of Exercise; for Soldiers left to themselves are very subject to Diseases when they come into Quarters after an active Campaign, by leading too indolent a Life, if Officers do not take Care to prevent it. However, at such Times, the Exercise ought to be moderate, and the Men should not be brought out in wet Weather.

OF MILITARY HOSPITALS.

Whenever Men are seized with Distempers, they ought immediately to be separated from those in Health, and either sent to the Regimental[148] or General Hospital.

[148] Some of the regimental Surgeons in _Germany_, when they
took the Field, had always some spare Tents carried along
with their Medicine Chests; and when any of their Men fell
sick in Camp, and they could get no House for a regimental
Hospital in Villages, they ordered these Tents to be pitched,
and had the Ground within well covered with Straw and
Blankets, and then put the Sick into them, and there took
Care of them till they found an Opportunity of sending them
to the Flying Hospital.

There is no Part of the Service that requires more to be regarded than the Choice of proper Places for Hospitals, and the right Management of them, on which the Health and Strength of an Army often depends; for in wet unwholesome Seasons, if infectious Disorders get into the Hospitals, which possibly might have been prevented by proper Care, they often weaken an Army in a very short Time far more than the Sword of the Enemy.

We have no Account of the particular Manner in which the Antients took Care of their Sick and Wounded in Times of War; for although we read in _Homer_[149] of Surgeons or Physicians attending the _Grecian_ Camp, and in _Xenophon_[150] of _Cyrus_'s having appointed Physicians to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that the wounded _Romans_ were received into the Houses of the Nobility, and had Physicians to attend them, and were furnished with Fomentations and other proper Remedies; and from _Justin_[153], that the _Lacedemonians_ followed the same Method: yet these Authors make no Mention of the particular Oeconomy or Manner in which these Hospitals were conducted.

[149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of
_Æsculapius_, as two excellent Physicians or Surgeons in the
_Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery
were antiently exercised by the same Persons.

[150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.

[151] _Tacitus_, after giving an Account of 50,000 People
being killed by the Fall of an Amphitheatre at _Fidena_,
during the Time of a Shew of Gladiators, has these Words:
"Ceterum post recentem cladem, patuere procerum domus,
fomenta & medici passim præbiti; suit urbs per illos dies,
quanquam mæsta facie veterum institutis similis, qui magna
post prælia saucios largitione & cura sustentabant." _Vid.
lib._ iv. _Annal._ § 63.

[152] In _Livy_ we find the following Passage: "Neque immemor
ejus quod initio consulatus imbiberat, conciliandi animos
plebis, saucios milites curandos dividit patribus. Fabiis
plurimi dati, nec alibi majore cura habiti." _Vid. lib._ ii.
cap. xlvii.

[153] _Justin_ mentions the same Thing of the _Spartans_
after their Defeat at _Sellasia_--"Patentibus omnes domibus
saucios excipiebant, vulnera curabant, lapsos reficiebant."
_Vid. lib._ xxviii. cap. iv.

The Hospitals commonly wanted for an Army acting on the Continent, are,

1. One in the Rear, to follow their Motions, so as to be always ready to receive the Sick from Camp, which is called the Moveable or Flying Hospital. 2. One or more, at some Distance, in Towns, to receive such of the Sick as can be moved from the Flying Hospital, when they are obliged to go from one Place to another; or when a greater Number of Sick is sent to them than they can easily take Care of[154].

[154] When Parties of Sick or Wounded are to be sent from
Camp, or from one Hospital to another, Care ought to be taken
that they are placed properly in the Waggons; that they have
proper physical People, Nurses, &c. to attend them; as well
as Provisions, and other Necessaries, so as to be in no
Danger of wanting any Thing while they are on their Journey.

Each of the Hospitals ought to be provided with Physicians, Surgeons Mates, Purveyors, or Commissaries, and others, to attend and take Care of the Sick.

Besides the physical People who attend the Hospital, one or two Physicians ought to go along with the Army to attend the Commander in Chief, and the General and Staff Officers, in Case of Sickness; and an Apothecary, provided with a small Chest of Medicines, ought to attend at Head Quarters to make up the Prescriptions of the Physicians.

A Number of Hospital Surgeons also, with Mates, ought to attend the Army, to be ready in Case of an Action. These ought to be attached to the Suite of the Commanders of the different Corps or Brigades, and to be quartered or encamped with them. And each Surgeon should be provided with a Waggon or some Horses loaded with a proper chirurgical Apparatus, as Instruments, Bandages, Lint, and other Things necessary for taking Care of the Wounded.

A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and Utensils for a small Hospital, and two, three, or four hundred Sets of Bedding, should be carried about with the Army, in Case of an Action, for the Use of the Wounded, till they have Time to receive Assistance from the Flying Hospital. Some of the Bedding ought to be carried on Horseback, so as to be at Hand when any of the Surgeons are sent with Detachments that are going upon an Attack.

To prevent crowding the General Hospitals in Winter Quarters, every Regiment ought to take Care of their own Sick, and to have proper Hospitals fitted up for them.

Dr. _Pringle_ has laid down some very good Directions with regard to the Choice of Places fit for Hospitals, and the Method of preventing infectious Disorders in them; and we find many excellent Hints of this Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of Preserving the Health of Seamen, and some likewise in Dr. _Brocklesby_'s late Treatise on military Disorders.

In the Time of Service the Commander in Chief generally orders the Hospitals to be established in Towns or Villages that least interfere with the military Operations, to which the Sick and Wounded can most easily be conveyed; and which he can best protect from the Insults of the Enemy[155].

[155] The _Roman_ Generals seem to have sent their Sick and
Wounded into Towns, in the same Manner as is done by those of
the present Time. For we read in _Cæsar's Commentaries_ of
this Method having been practised on more Occasions than one.
In the sixty-second Chapter of the third Book, _de Bello
Civili_, we have the following Passage: "Itaque nulla
interposita mora, sauciorum modo & ægrorum habita ratione,
impedimenta omnia silentio prima nocte ex castris _Apolloniæ_
præmisit, ac conquiescere ante iter confectum vetuit. His una
legio missa præsidio est."--And immediately after, in chap.
lxv. "Itaque præmissis nunciis ad Cn. Domitium Cæsar
scripsit, & quid fieri vellet ostendit: præsidioque
_Apolloniæ_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
quique erant ex vulneribus ægri depositis; per Epirum atque
Arcarniam iter facere cæpit."

And in the twentieth chapter, _de Bello Africano_, we read:
"_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
in plaustris deligatos _Adrumentum_ deportari."

It would be a right Measure, in the Beginning of every War,
to settle by a Cartel that military Hospitals on both Sides
should be considered as Sanctuaries for the Sick, and
mutually protected; as was agreed upon between the late Earl
of _Stairs_, who commanded the _British_ Troops, and the Duke
_de Noailles_, who commanded the _French_ in the Campaign in
_Germany_ in the year 1743. See _Dr. Pringle's Preface_.

In Towns, the Places fittest for Hospitals are public Buildings, which have large dry airy Apartments, situated on a high Ground, where there is a free Draught of Air, and a Command of Water.

In Winter, those Houses, which have open Fire Places in the Rooms, are always preferable to such as have close Stoves, or no Fire Place at all; for an open Fire Place serves to keep up a free Circulation of Air in a Room, as well as to keep it warm. And for the same Reason, where nothing but Stoves can be got to warm the Wards, the Wynd Stoves, which open into the Room or Ward, are vastly preferable to the close ones.

Where there are no public Buildings, private Houses answering nearest to the above Description are most proper for Hospitals. In general, Houses with small Rooms make but bad Hospitals; and very Damp and close Places ought by all Means to be avoided.

In Summer, when the Moveable or Flying Hospital is ordered into Villages, large Barns, and the largest airy Houses, are the best.

Churches, situated on a dry high Ground, make good Summer Hospitals; and in Winter, when Necessity obliged us sometimes to use them in _Germany_ for this Purpose, they were found to answer very well, when we had Bedsteads or Cradles for the Men to lie upon, and the Wynd Stoves to keep them of a moderate Heat.

In making Choice of Houses for Hospitals, particular Regard ought to be had to the Privies or Necessaries; because, where their Smell is offensive, there is always Danger of infectious Disorders. If, therefore, there be no proper Conveniencies of this Kind about an Hospital, such ought to be contrived so as to prevent any Danger from their putrid Effluvia. If there be a River near the Hospital, the Necessaries may be made above it at a Place where there is a rapid Stream below. In Villages deep Pits may be dug in the Ground behind the Hospital, and Seats made over them, as in Camp; and a thick Lay of Earth be thrown above the Foeces every Morning, till the Pits are near full, and then they must be filled up, and others dug to supply their Place.

When once the Places are fixed upon for Hospitals, every Ward ought to be made perfectly sweet and clean; first, by scraping and washing with Soap and Water, and afterwards with warm Vinegar; and then they ought to be fumigated with the Smoke of wetted Gunpowder and of Aromatics, and afterwards well dried and aired by lighting Fires, and opening the Windows, before any Sick are admitted.

After this the Beds ought to be laid; in doing of which great Care should be taken not to crowd the Wards too much, as nothing corrupts the Air so much, or so soon brings on infectious Disorders. Dr. _Pringle_ says, the Beds ought to be laid so thin, that a Person unacquainted with the Danger of bad Air, might imagine there was Room for double or triple the Number. In high lofty Apartments, and in Churches, and other large Places, the Beds may be laid much closer together than in Rooms with low Cielings. In Churches, or such Places, thirty-six square Feet, or a Square of six Feet by six, may be allowed for each Man; but in common Wards we must allow from forty-two square Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight by eight, according to the Height of the Cieling, the Airyness of the Place, and the Nature of the Diseases of the Patients.

The Bedding most fit for Hospitals, is Palliasses and Bolsters filled with Straw, Sheets, and Blankets, as they can easily be washed. Feather Beds and Matrasses are apt to retain Infection, and cannot be easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be set up for laying the Bedding on: But in the Moveable or Flying Hospital the Bedding must be, for the most part, laid on the Floor.

When once the Beds are laid, and the Sick arrive, some of the Gentlemen belonging to the physical Department ought to attend, to distribute the Sick properly through the Hospitals.

All the Surgery Patients, such as have Wounds, Ulcers, Sores, the Venereal Disease, &c. should be separated from the Rest, and put either into particular Wards by themselves, or into an Hospital fitted up for that Purpose under the Direction of the Surgeons.

Those labouring under infectious Fevers and Fluxes, should each of them be placed in good airy Wards by themselves, where the Beds are laid much thinner than in the other Wards of the Hospital. If the Flux Wards have a Privy near them, where the Men can ease themselves, without being offensive either to their own Ward, or any other Part of the Hospital, they are so much the fitter for such Patients. In the Hospital I attended at _Bremen_, the Flux Ward had a Necessary that opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug in the Field about twenty Yards from the Barn where the Flux Men lay, which kept these Wards always sweet.

Patients that have got the Itch, or any other infectious Distemper, ought likewise to be put into separate Wards by themselves; and at all Times a Place should be set apart for those who may be taken ill of the Measles or Small-Pox. A House separated from the other Hospitals, with a distinct Set of Nurses and other Attendants, bids fairest to prevent the Infection from spreading.

When once the Sick are properly ranged, the next Care must be to prevent infectious and malignant Disorders from being generated, and from spreading amongst the Sick; which is principally to be effected by keeping the Sick and the Hospital extremely clean and well-aired, and the Wards as sweet, and free from putrid and offensive Smells, as possible.

Every sick Man, as soon as he arrives at an Hospital, should be washed with warm Water, or if there is a warm Bath, or bathing Tub, to be put into it; and afterwards be supplied with a clean Shirt[156] well-aired before he be put to Bed; and his own dirty Linen should be immediately carried to the Wash-House: And every Morning each Nurse ought to carry a Bucket full of warm Water, and a Piece of Soap and a Towel, round to each of her Patients, and make them wash their Hands and Face, and their Feet, when dirty.

[156] Every military Hospital ought to have a Number of
Shirts belonging to it, for the Use of the Sick who arrive
without having clean Linen with them. As soon as their own
Shirts are washed and dried, or that new ones are provided by
their Regiments, the Hospital Shirts ought to be taken from
them.

Every Morning all the Wards ought to be scraped and swept, and afterwards sprinkled with warm Vinegar; and when dirty, they ought to be washed after the Fires are lighted.

Every Thing in the Wards, and about the Sick, should be kept as clean as possible; the Chamber-Pots and Close-Stools ought to be carried away as soon as used, and immediately emptied and washed before they be brought back.

The Windows of the Wards ought to be kept open to admit fresh Air Morning and Evening, for a longer or shorter Time, according as the Weather will permit.

If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises to remove some Part of them, and to open the Garret Story to the Tiles[157]; and if the Opening of the Windows is not sufficient to air the Wards, Ventilators of different Kinds, such as those mentioned by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the Weather is hot.

[157] In Wards which are too close, it has been found that
one or two square Holes (of about six or eight, or ten Inches
diameter), cut in the Cieling, and a Tube made of Wood fitted
to it, and carried up into the Chimney of the Ward above, so
as to enter above the Grate, is one of the best Contrivances
for procuring a free Circulation of Air; as the foul Air,
which is lightest, and occupies the highest Part of the Ward,
finds a free Exit by these Tubes: We have such Tubes now
fixed in several of the Wards in _St. George_'s Hospital. A
Hole cut above the Door of the Ward, or in the upper Part of
the Windows, and one of what are called the _Chamber
Ventilators_ fixed in it, will answer, where Holes cannot be
conveniently cut in the Cieling.

In Winter, Fires should be lighted in all the Wards where it can be done.

In foreign Countries, when we meet with Hospitals where there are no Places for open Fires, but only close Stoves, different Contrivances may be used to renew the Air. Ventilators of different Kinds may be used, or Openings made in the Doors and Windows. In Winter 1761-62, some of the Wards in the Hospital at _Bremen_ which I attended had such Stoves. In order to keep up a free Circulation of Air in those Wards, I directed large Holes to be cut in the lower Part of the Door in each Ward, and two Grooves to be made on the Outside of the Door, above and below the Hole, parallel to each other, in which a Board slided; by means of which, the Hole could be either quite covered or only in Part, or left entirely open; and I directed a Casement, about eight or nine Inches square, to be made in the upper Corner of each Window. After the Fires were lighted, upon removing the Board which covered the Hole in the Door, and opening the little square Windows, a Current of fresh cool Air rushed into the Ward by the Door, while the heated foul Air found an Exit by the Windows. In very cold Weather, the Opening of the small Windows was sufficient; but in mild Weather, and in Summer, it was necessary to keep both open.

The Wards should be daily fumigated by Means of Aromatics, or wetted Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or with the Steams of warm Vinegar placed in the Middle of the Ward. Dr. _Lind_ says, that although Cleanliness and a pure Air contribute much to prevent infectious Disorders, or to check them, yet that they of themselves are not always sufficient; but that he seldom or never knew a proper Application of Fire and Smoke to be unsuccessful in producing the happy Consequence of effectually purifying all tainted Places, Materials, and Substances[158].

[158] Dr. _Lind_ tells us, that the Ships of War in his
Majesty's Service are purified by Fire and Smoke, and gives
the Process by which it is done; and he says, that he never
heard of any Ship, which, after being carefully and properly
smoked, did not immediately become healthy for the Men.--See
_First Paper on Fevers and Infection_.--And he observes, that
these Steams and Smoke, which are inoffensive to the Lungs,
besides correcting the bad Quality of the Air, produce
another good Effect; which is, to make both the Patients and
Nurses desirous of opening the Doors and Windows for the
Admission of fresh Air. _Ibid._ p. 51.

In all Military Hospitals, at least in the fixed ones, one Ward ought to be always kept empty; and whenever a malignant Fever, or any other infectious Disorder, breaks out in any Ward, the Men ought to be removed into this empty one; and the foul Ward purified, by washing and cleaning it well with Soap and Water, and then with warm Vinegar; and afterwards purifying it with Smoke, in the same Manner as is practised in his Majesty's Ships of War; and Fires should be lighted daily, and the Windows kept open for some Time, before any Sick be again admitted into it.

As soon as any Patient dies, the Body ought to be removed to the Dead House; and the Bedding he lay upon should be carried away immediately, and not used again till it has been smoked, well-aired, and washed.

All the Linen of Patients in Fevers, Fluxes, and other infectious Disorders, ought to be changed often; and all the foul Linen and foul Bedding of the Hospital should be smoked with the Fumes of Brimstone, or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr. _Lind_ advises to steep them first in cold Water, or cold Soap Lees, before putting them in warm Water; as it is dangerous for any Person to receive the Steam that may at first arise, where this Precaution is not used.

All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to the Smoke House, and be well fumigated, and afterwards aired, before they are put up in the Store-House.

The next Thing to be considered about a Military Hospital is the Diet of the Patients, which should consist of good wholesome Provisions, that can be purchased easily, and at a cheap Rate[159].

[159] The _French_, and many other Nations, give their
Patients Meat Soops in acute Diseases, and after capital
Operations; and they allow them but little Bread or other
Preparations of Vegetable Substances: But these Meat Soops
without Bread do not nourish the Patient sufficiently, and
tend too much to the Putrescent; and this is one Reason why
more Sick die in the _French_ than in the _British_
Hospitals.

Good Bread[160] is a standing Article of Provisions for an Hospital in all Countries and in all Climates; and a certain Quantity of it ought to be distributed to each Man daily.

[160] On Expeditions where a Siege is expected, a Quantity of
Flour ought to be carried out, and a Number of portable Ovens
for baking bread for the Sick, which may be put up after the
Troops have made good their Landing.

The Breakfast and Supper in most Military Hospitals must be made of Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in most Places, and are very portable.--Water Gruel is in general preferable to the Rice Gruel, because most Patients nauseate the Rice Gruel, after eating it for some Days, but not the Water Gruel, as every Person, who has attended the Military Hospitals, must have experienced. Where both Rice and Oatmeal can be had, Rice Gruel may be used two or three Times a Week by Way of Variety.

But although Rice Gruel is not so proper for constant Use, yet Rice should always make an Article among the Stores for an Hospital, as it is useful for making Rice Water for Drink; and it can be boiled or ground, and made into a light Pudding, and in short may be used in a Variety of Forms to make a good and wholesome Food for the Sick.

Oatmeal is cheaper than Rice, and can be procured almost every-where in _Europe_, where Armies make Campaigns; as Oats make such a great Article in the Forage for Horses. And a sufficient Quantity can at any Time be ground into Meal for the Use of the Sick, at the Mills which are employed for making Flour for the Bakery, if there be none nearer the Hospital.

In Countries where neither Oatmeal nor Rice can be had, _Indian_ or some other Corn, which is known to be wholesome, and which the Country affords, may be employed in their Place.

When fresh Meat can be got, the Men who are on full Diet, and the Nurses and other Servants about the Hospital, should have Meat for Dinner; and the Meat that is boiled for them ought to make Broth for the Sick who are kept on a low or middle Diet. Some Barley or Rice should be added to the Broth; and a small Quantity of Carrots, Turnips, or other Vegetables, boiled along with them, will make it more agreeable to the Taste.

On Expeditions where nothing but salted Meat can be had, a Quantity of portable Soop should always be carried out for the Use of the Sick; which with Water and some Barley, and fresh Vegetables, when they can be got, will make a good Soop or Broth. On such Occasions, the Dinner ought to consist of Soop and Bread, or of light Puddings made of Flour or of Rice, of boiled Rice or Barley, or of Panado, &c.

Nurses and recovered Men may be allowed salted Meat twice or thrice a Week.

The common Drink of Military Hospitals ought to be Rice and Barley Water, with a small Proportion of Spirits and Sugar. Small Beer is a good Drink where it can be easily procured; as is Wine and Water, or a very small Negus, or very weak Punch in warm Climates.

Besides this Diet, extraordinary Indulgences may be occasionally allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the Physicians and Surgeons ought to have a discretionary Power to order a Vegetable or any other proper Diet for Patients in the Scurvy, or any other particular Complaints.

The Established Diet of a Military Hospital may be,

The daily Allowance of Bread to be one Pound to each Man.

The common Drink for those on full and middle Diet to be Rice or Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and Water, two Ounces of Wine to a Pint of Water, and a Quarter of an Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.

Those on low Diet to have Rice or Barley Water as above, with or without Wine or Brandy.

The Diet Boards hung up in the Hospitals may be made with the following Columns, nearly as they were with us in _Germany_.

When such Diet Boards are kept in an Hospital, and the Mens Names and Regiments are once wrote down, the Patients may with very little Trouble be put upon the full, middle, or low Diet, with so much of the above-mentioned Extraordinaries as may be judged proper.

If any Thing else be wanted for the Sick, the Physician ought to give a particular Order in Writing for it, the Columns here marked being only for such Things as are most frequently wanted.

It should be a general Rule in all Military Hospitals, that, when a Party of Sick arrives, every Man may have immediately a Mess of Water Gruel given him, and afterwards be put on low Diet till it is ordered otherwise by the Physician or Surgeon who attends him.

It is not to be supposed that the Diet here mentioned can be strictly kept to in all Parts of the World; for it must often be varied according to the Difference of the Climates, and to the Provision of the Countries where the Scene of War may be.

Whenever a Moveable or Flying Hospital is to attend an Army, a Quantity of Bedding, and of all Utensils for forming an Hospital, ought to be put up in the Waggons, together with Provisions of different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c. A Butcher with a Stock of live Cattle, and a Baker with a proper Quantity of Flour for making Bread ought constantly to attend; and a Number of empty Waggons should likewise be always in Readiness, to transport the Sick when the Hospital moves, or when a Party is to be sent to the fixed Hospitals.

When Troops go upon an Expedition, besides the common Hospital Ships, another Ship ought to be properly fitted up for the Reception of sick Officers[161]; and every Hospital Ship ought to be supplied with all Sorts of Provisions, and other Necessaries fit for forming an Hospital, before they leave _England_.--And one or more armed Vessels loaded with Provisions, Wine, and all Sorts of Necessaries for the Sick, ought to attend them; or if the Expedition be intended for the warm Climates, these Vessels ought to go before the Fleet to take up Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different Kinds, and a live Stock for the Use of the Sick.

[161] If there be no Ship fitted up for the Reception of sick
Officers, those who are taken ill on Expeditions must be in a
most miserable Situation; as there is no Place to receive
them in the common Hospital Ships, they must remain almost
without Assistance in a crowded Cabin amongst People in
Health; as was the Case in some of our Expeditions during the
late War.

All Hospitals attending Expeditions should carry out among their Stores a Number of large Tents for lodging the Sick and Wounded immediately on making good their Landing. Where a Siege is expected which will take up Time, and where no Accommodations for the Sick can be had till the Siege is over, a Ship or two, with Boards, and other Necessaries for building large Sheds, or temporary Hutts, for the Sick, as proposed by Dr. _Brocklesby_, ought to go along with the Fleet, or meet them at the Place of their Destination. Such thatched Sheds, or Hutts, are very necessary in the warm Climates, as the perpendicular Rays of the Sun, beating upon Canvass, make Tents intolerably hot. When any of our own Settlements happen to be near the Place attacked, a fixed Hospital may be established there; either in Houses, if proper ones can be found; or in temporary Sheds or Hutts erected for that Purpose; and some Vessels, properly fitted up, may be kept going with the Sick and Wounded, and bringing back the recovered Men.

At every Military Hospital a Serjeant's Guard ought to mount; and Centinels be placed at the Doors of the Hospital, 1. To prevent all Visitors, who have not proper Leave, from coming into the Hospitals; as such People oftentimes crowd the Wards, disturb the Sick, and are apt to catch infectious Distempers, and to spread them among the Troops. 2. To take Care the Patients do not go out of the Hospital without having a Ticket[162] of Leave for that Purpose, signed by the Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To prevent spirituous Liquors, or other Things of that Kind, being clandestinely carried into the Hospital.

[162] At every Hospital there ought to be a Number of printed
Tickets lying ready to be filled up and signed by the
Physicians and Surgeons, and no Man ought to be allowed to go
out without a Ticket so signed.

The Serjeant of the Guard, attended by the Ward Master, ought, every Morning, to go round the Wards to call a Roll, and see that every Man is in his Ward; and to do the same at Night before the Hospital Doors are shut, and at this Time to order every Person out of the Hospital who does not belong to it. And the Serjeant, every Morning, ought to report to the Physician, Surgeon, or Apothecary, every Man's Name who was found to be absent at Roll-calling; and whether he found every Thing regular and in good Order in going his Rounds.

Every large Military Hospital ought to have one Head Nurse, and a sufficient Number of other Nurses, to attend and take Care of the Sick.

Orders to the following Purport, hung up in every Military Hospital, would serve to shew the Nurses and Patients what their Duty is, and to maintain Regularity and good Order through the whole Hospital.

_Matron, or Head Nurse._

Every Matron, or Head Nurse, is to go round all the Wards of the Hospital at least twice a Day, Morning and Evening; to see that the Nurses keep their Wards clean; that they behave themselves soberly and regularly, and give due Attendance to their Patients; and to examine the Diet of the Patients, and see that it is good and well dressed; and if she finds any Thing amiss, to report the same to the Physician, Surgeon, or Apothecary, of the Hospital.

_Common Nurses._

1. The Nurses are to give due Attendance to their Patients; and to keep them always as neat and clean, as the Nature of their Distempers will admit of; to give them their Diet regularly; to be particularly careful to see them take the Medicines ordered by the Physicians, according to the Directions given; to report to the Physician, Surgeon, or Apothecary, any Faults or Irregularities which any of their Patients may have committed; and to acquaint the Ward Matter and Head Nurse of the Death of any of their Patients as soon as it happens, that proper Care may be taken of their Cloaths and Effects.

2. They are to keep their Wards extremely clean, to sprinkle them every Morning with Vinegar, and to fumigate them with the Smoke of wetted Gunpowder, or of Frankincense, or any other Aromatics that may be thought proper; in fair Weather to keep open the Windows of their Wards, twice or thrice a Day; for a longer or shorter Time, as the Weather will permit; to attend at the Steward's Room for the Provisions of the Patients at the Hours appointed for that Purpose; and to pay implicit Obedience to the Matron, or Head Nurse, in what relates to their Duty; and punctually to obey all Orders they receive from the Physician, Surgeon, or Apothecary, of the Hospital.

3. They are to keep themselves clean and decently dressed, and to observe the strictest Rules of Sobriety; remembering, that if any one is found intoxicated with Liquor, that she is immediately to be sent to the Guard, and afterwards discharged.

4. They are not to absent themselves from their Wards, unless when employed in the Discharge of their Duty; nor to go out of the Hospital to which they belong, without having a Ticket of Leave signed by the Physician, Surgeon, Apothecary, or Head Nurse, belonging to the Hospital.

5. They are not to throw Nastiness of any Kind out at the Windows, but to carry it to the common Necessaries, and to empty the Chamber Pots and Close-stools as soon as used, and be careful to wash them before they bring them back.

6. They are not, upon any Pretence whatever, to alter the Diet ordered by the Physicians or Surgeons to the Patients on the Diet Boards; nor to suffer their Patients to use any other Diet than what is allowed by the Hospital; nor are they to bring, or allow others to bring, Meat, spirituous Liquors, or other Things of that Kind, into their Wards, except what is allowed by the Physicians or Surgeons. Whenever any Thing of this Kind is found in any of the Wards, it ought immediately to be thrown into the common Necessary; and if it be found in the Custody of a Nurse, she ought to be confined in the Guard, or discharged.

7. Nurses guilty of great Neglect of Duty, or of getting drunk and using their Patients ill, or of stealing, or concealing or taking away the Effects of Men who die in the Hospital, are to be immediately sent to the Guard, and reported to the Commanding Officer of the Place, that they may be tried by a Court-Martial, and be confined, whipped, or otherwise punished, as the military Law directs; all Followers of Armies on foreign Service being equally subject to the military Law as the Soldiers themselves.

_Patients._

1. All sick Soldiers, on their Arrival at a Military Hospital, are to be washed all over with warm Water, or to go into a warm Bath; and afterwards to wash their Face and Hands every Morning, and their Feet occasionally, with warm Water and Soap, brought round every Morning by the Nurses for that Purpose; and they ought to comb their Head every Day. If they be too weak to wash and comb themselves, it is to be done by their Nurses.

2. Every Patient is to be shaved and have clean Linen twice a Week, or oftener if requisite.

3. They are punctually to obey the Directions given them, and to take the Medicines ordered by the Physician; and none to be allowed to go out of the Hospital without a Ticket of Leave signed by the Physician, Surgeon, or Apothecary, of the Hospital.

4. They must commit no Disorder or Riot, but in all Respects behave themselves well.

5. If any Man disobeys the Orders he receives from the Physicians or Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in the Hospital, or is found guilty of Theft or other Crimes, the same is to be reported to the Commanding Officer of the Place, and he to be tried by a Court-Martial, and punished as soon as his Strength will permit.

In conducting the Military Hospitals, we found that it was always right to discharge the Patients from the sick Hospitals as soon as they were recovered, and to send them either to Billet, or to a convalescent Hospital; because recovered Men are always the most riotous; besides they crowded the Hospitals, and were in Danger of catching fresh Disorders from those who were sick; and therefore the recovering Men in every Hospital ought to be reviewed once or twice a Week by the Physician or Surgeon, and the Names of such Men as are well enough, to be marked; in order that they may be sent the next Day to the convalescent Hospital, or to Billet. A Return of those marked for Billet ought immediately to be sent to the Officers on convalescent Duty.

When a convalescent Hospital is established, it ought to be put under proper Regulations; the following are those which I drew up for that established at _Osnabruck_ in _April_ 1761, and which were found to answer the Purpose intended.

_Regulations for a Convalescent Hospital._

1. That this Hospital be entirely occupied by such Men as are recovered from Diseases; that no Men be sent there but those whose Names are returned to the Purveyor's Office by the Physician or Surgeon of the Hospital.

2. That all the Patients shall be upon full Diet, unless in particular Cases it be ordered otherwise by the Physician or Surgeon.

3. That all the Patients shall breakfast, dine, and sup, at regular stated Hours, in the Hall appointed for that Purpose: Breakfast to be ready at nine, Dinner at one, and Supper at seven o'Clock in the Evening.

4. That no Patient shall carry up any Victuals into the Wards appointed for sleeping in; and if any Patient does not attend at the regular Hours of Meals, no Allowance of Victuals shall be made him in the Place of such Meals, unless he has been absent on Hospital Business, or been confined to Bed by Sickness.

5. That as soon as the Men are come down Stairs to Breakfast, the Wards in which they sleep shall be cleaned out and sprinkled with Vinegar, and the Windows opened to air them.

6. That the Doors of this Hospital shall be locked every Night at eight o'Clock, and no Man be allowed to come in or go out after that Time. The Doors to be opened again at seven o'Clock in the Morning.

7. That the said Hospital is to be visited two or three Times a Week by the Physician, Surgeon, and Apothecary, who are to see that the above Orders are complied with; to examine the Diet, and take Care that every Thing is carried on properly; and to prescribe for any little Disorders the Men may be affected with.

8. That one of the Hospital Mates be appointed to visit this Hospital daily, to administer any Medicines which may have been prescribed by the Physician; to apply any Dressings ordered by the Surgeon; and to acquaint the Physician or Surgeon if any of the Men be so bad as to require their Attendance, or to be sent back again to the Sick Hospital.

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An Account of the Diseases which were most frequent in the British military hospitals in GermanyChapter IX: Letter I: received from the Gentleman whose Care I left him (3)

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