PRELIMINARY REMARKS

If the services of a medical man are a great blessing on shore (and few will dispute the fact), how inestimable must they be deemed afloat, when the vessel is far removed from land and its numerous resources?

Few considerations indeed more forcibly, and at the same time more favourably, seize upon the minds of men-of-war's men, than the knowledge that the ship possesses a surgeon, whose professional skill is equalled by his unremitting attention and consolatory kindness to the sick (Men-of-war's men always appreciate medical attention).

GENERAL DIRECTIONS

EARLY DETECTION OF DISEASE.

Early detection and early treatment of disease being the first essentials towards its speedy and effectual cure, the Surgeon should particularly impress upon the minds of the petty officers, seamen, and marines, the necessity of timely intimation in all cases of complaint. (The Surgeon should interrogate such of the ship's company whose personal appearance indicate malady or predisposition to sickness. Such solicitude on the part of the Surgeon is always taken as intended, and is sure to beget "good will," and command respect for the medical office.)

FEBRILE SYMPTOMS.

Whenever, in the treatment of febrile disease, symptoms are discovered which give rise to the slightest suspicion of the complaint having been produced by infection, the Surgeon should immediately communicate the circumstance to his commander, in order that proper precautions may be promptly taken to prevent the risk of dissemination. ("When men are taken ill of fever of an infectious nature, they should immediately be stripped on entering the sick berth, and, if practicable, washed with soap and warm water; their linnen should be changed, and the patients placed in a bedding allowed for the use of the sick. Care should be taken that the clothing and bedding of the sufferer be immediately immersed in boiling water." - Instructions.)

VISITING THE SICK.

The Surgeon is required to visit the sick twice in the day. A natural anxiety and solicitude for sufferers will suggest to him the propriety of repeated visits; and he should exact from his assistants the closest attention to all patients in a precarious state, reporting to him any alteration in the symptoms of each particular case. (In all cases (for there are a variety incidental to the seaman's situation and mode of life) which depress the spirits of the patient, it should be the study, as well as the duty, of the Surgeon, to soothe and cheer the afflicted by the most humane attention, and by every expression of consolatory kindness; to bear, with patience, all complaints, and redress all real grievances. Such conduct will at once inspire the sick with confidence, exhilarate their spirits, and materially tend to hasten the restoration of health.)

SICK LIST. - This officer, after visiting the sick, is required to deliver daily to the captain a list of all those who are incapable of performing their respective duties. At the same time he should offer to the captain such suggestions as may tend to ameliorate the condition of his patients.

SICK RETURNS.

These "Returns" should accompany the "Weekly Account," and upon all occasions when it is necessary to present the latter document to a senior officer, the Surgeon should be prepared with the "sick report." (In meeting a senior officer at sea, it frequently happens that the captain is delayed in proceeding to pay his respects to his superior, in consequence of the Surgeon not having filled up the official formula required upon these occasions. In naval, as well as medical matters "delays are dangerous.")

INSPECTING THE SICK UNDER THE HALF DECK.

The practice of parading the sick under the half-deck in the presence of the captain is one that might be "more honoured in the breach than in the observance." Doubtless the custom was originally adopted with the best possible intentions, but good intentions are not always followed by good effects. Sick men seek repose, and no sympathy, however plausible in appearance, can compensate for the annoyance and worry of being disturbed.

DISCRIMINATION IN DETECTING SKULKERS.

The idea that seamen of the service are often disposed to seek surgical relief under "false pretences" is not justifiable. That the "jail birds" of former days used to impose upon medical credulity, few will attempt to deny. But the Surgeon should rather appear to believe the complainant's statement, than permit any hasty ejaculation to escape him, even though he may have strong reasons to suspect the motives of the appealing party. (If the Surgeon is not devoid of professional tact, he will adopt medical means to punish the party in a manner that will at once expose the deception, and cure the culprit. The penal part of the prescription should be kept out of sight; no martial intervention should be called in aid of medical treatment. Threats of turning the patient over to the captain, or the first lieutenant, should never be resorted to - it savours of "bad practice," and bespeaks little for the science of physic. The "Materia Medica" and the "Articles of war" are not to be pounded in the same mortar.) The Surgeon, in fact, should economize his suspicions, and keep them to himself. A medical man may be mistaken, and a solitary instance of erroneous decision is not only calculated to bring into disrepute the professional skill and sagacity of the Surgeon, but to engender a feeling of dissatisfaction afloat, and what is equally bad, to induce a general disinclination to seek medical aid, when medical aid is in reality required.

JOURNAL AND CASE BOOK.

A JOURNAL is required to be kept by the Surgeon, in which should be daily inserted the name, age, station, and disease of every individual under medical treatment, noting the description of diet, and remedies prescribed for the patient.

"A Case Book" becomes also a necessary record, which should be regarded as a register of the symptoms, treatment, and result of all extraordinary and interesting cases of disease, with such remarks as subsequent investigation or reflection may furnish. (The Surgeon will do well to impress upon the minds of his assistants, the advantages to be derived from each keeping a record of this description - to wit, "the Blane Medal.")

FIRST COMMISSIONING

INSPECTION OF INSTRUMENTS.

Upon joining his ship, after reporting himself to the captain or commanding-officer, the first duty of the Surgeon is to submit his surgical instruments to the inspection of the physician of the fleet, or to other appointed authorities. (If there be no physician of the fleet employed, the inspection of instruments will take place at the Naval Hospital, by the surgeons of that establishment.) He will also be held responsible that the instruments which his assistants are required to provide are complete and in perfect repair.

FITTING UP SICK BERTH.

The Surgeon should overlook the artificers of the dock-yard when employed in framing and fitting-up the sick berth. Various are the costless accommodations which, for the comfort and convenience of the sick, may be pointed out to the "Foreman afloat," and which may be furnished and fitted by that authority without at all infringing the much-dreaded law of "Establishment,". (The tender sympathies of the shipwright are seldom manifested in favour of the seaman, sick or sad; nevertheless, there are worse landsmen doomed to "walk the waters" than the "foreman afloat". The Surgeon should also bear in mind that shipwrights and builders "bore" when it be desired to "get at" the soft spot. This, in technical parlance is termed "tasting." May not the medical officer proceed upon the same principle, - "taste" the temper of the mortal "stuff," and "bore" gently, till he "gets at the soft spot" of the accommodating mechanist.)

EXAMINATION OF NEWLY-RAISED MEN.

The persons of newly-raised men should be carefully examined by the Surgeon. This duty is too frequently delegated to the "assistant." In cases of "survey," the Surgeon may be "called to account" touching the reception of unserviceable subjects.

ACCIDENTS.

It invariably occurs that, during the first month of the commissioning of a vessel-of-war, more accidents happen than at any other period of a ship's service. Possessed of this fact, the Surgeon, during "working hours" (though contrary to the too prevalent practice of this officer,) should not leave the ship. It should be borne in recollection, that in the two principal ports where naval hospitals are established the tide will not always admit of conveying men who may have received serious hurts in the hold, or compound fractures from falls from aloft.

IN PORT

RE-SUPPLY OF MEDICINES.

When a renewed supply of medicines and necessaries is required for the use of the sick, the Surgeon is officially instructed (Vide "Instructions.") to "take to the hospital the chest which is sought to be completed," together with its "remains". As Her Majesty's ships are now fitted with fixed dispensaries, it is presumed that the dispensor of the hospital will dispense with the necessity of landing the "remains." (This has always been held as a very inconsiderate "check" to medical relief. If a casualty occur afloat, and the "chest" be on "shore" how, be it asked, is the sufferer to benefit by the missing "remains"?). "All demands for medicines and necessaries", (excepting in cases of real emergency, the nature of which is to be expressed on the "demand") are to be made in time to prevent inconvenience to the hospital, by their being delayed till the ship is about to sail; and they are to be delivered at the hospital before three o'clock in the afternoon; and no articles are to be returned into store after that hour."

INQUIRY AFTER PATIENTS ON SHORE.

During the detention of the vessels in port, the Surgeon should avail himself of every opportunity to visit the sick of the ship, who may have been sent to the hospital, or sick quarters, for cure; and he should endeavour to ascertain, for the information of the captain, whether the patients are so convalescent as to rejoin the ship before she sails. (Independently of the necessity of ascertaining a point so essential to a ship, possibly "short-handed" already, the sick on shore will always attribute such inquiry to professional solicitude and personal kindness on the part of the Surgeon.)

OPERATIONS AT THE HOSPITAL.

This officer, when his services can be spared from the ship, should avail himself of every opportunity to attend at the naval hospital when a surgical operation is being performed. The precise period is always intimated by signal.

CONSULTATIONS.

The Surgeons of the service seldom convene for the purpose of consultation. It frequently happens that vessels-of-war are collected at the same anchorage, in a vicinity of which there is no naval hospital, nor establishment for the recovery of sick and of wounded seamen. Under these circumstances, and more particularly when severe sickness or dangerous disease prevails afloat, it is the duty of the doctor to call in medical aid. A telegraphic communication can readily announce this desire, and can always convene the Surgeons of the squadron to meet in consultation on board of the ship required. (Possibly the disinclination manifested by the faculty to consult afloat may proceed from mistaken notions of delicacy, added to the desire of sparing brother officers a "long pull," and particularly the pain of not "pulling together.")

AT SEA

DIET OF THE SICK.

In regulating the diet of the sick, the Surgeon should impress upon the mind of the patient, that the substitution of wine for spirits is not (as seamen too generally imagine) to be considered in the light of a penal draught, - but that, on the contrary, the lighter liquor is prescribed with a view to hasten, instead of to retard, the restoration of health. (Upon all occasions that fish be taken in the haul, the Surgeon should be careful that the sick be first supplied.) Should the ship be supplied with "preserved meats," the Surgeon should "demand" from the paymaster and purser a sufficient allowance for the support of patients in a delicate state.

WARMING AND VENTILATING THE SHIP.

It is the duty of the Surgeon to acquaint the captain whenever he may deem it necessary to light stoves, and otherwise ventilate the lower-deck; - Vide Carpenter - "Pump-well."

TIMELY CHANGE OF SHIP'S COMPANY'S CLOTHING.

"Change of climate, change of clothing," should be received as a medical maxim. Crews of ships returning from foreign stations frequently suffer from catarrrhal, pulmonic, and rheumatic complaints, arising solely from a deficiency in warm clothing. When the ship is destined to return from a warm to a cold climate, measures should be taken to provide an adequate stock of suitable slops.

CLEARING FOR ACTION.

Amputating operations are only to be accelerated by a ready arrangement of the required instruments and surgical "appliances." (A distinguished medical officer has recently invented a portable operating table, which is made to contain all the instruments and apparatus requisite for ready operations. It is very light, and can be carried from the cockpit to the sick bay by two men.) Care should be taken that the locality of the cockpit be perfectly clear, that a proper proportion of lights be securely placed, that a sufficient supply of fresh water be ready at hand, and that tourniquets be distributed on the different decks, and conveyed aloft to the people stationed in the tops. (On the occasion of a "general exercise," the Surgeon and his assistants are recommended to go round the different decks, for the purpose of shewing seamen and marines the utility of the tourniquet, and manner of applying it.) Should there be a paucity of tourniquets in the ship, the Surgeon should cause a temporary number to be made.