occasional sudden demise of a patient with "typhus fever" suggests typhus exanthematicus. In those days, as now, itch and venereal diseases occupied a conspicuous position in the sick returns, and the occasional appearance of midshipmen with the latter class of disease, with the added remarks, "reported to the commodore as rheumatism," denoted a kindly intention on the part of the surgeon to shield them from the stigma attaching to these affections.

On July 15, 1810, for the first time, Dr. Barton makes extended "Remarks," at the end of the day's record, as follows: "The dysentery and diarrhoea are now and have been for the last ten days the prevailing diseases on board the ship. Most of the patients on the sick list with other diseases. are more or less afflicted with these complaints in a slight degree. Neither of these diseases, however, are of a very violent nature." This constitutes the only clinical observation of any moment which I could discover in a review of the seventeen months' record contained in these reports. It is also quite remarkable how seldom mention is made of the transfer of patients to hospital. However, considering the character of the so-called hospitals then available, it is perhaps not surprising that he preferred to retain the sick aboard ship. Later in his career he urged improvement of naval hospitals with characteristic vigor, and a critical reference in his book on "Marine Hospitals", published in 1814, with respect to the hospital at the Navy Yard, Philadelphia, was the basis of charges, made by a brother medical officer, which resulted in the court-martial of Barton. The court, however, perhaps realizing the justice of his criticism, ruled that the specification covering the alleged offense need not be answered or refuted, and thus virtually exonerated Barton of this specification of the charge. Some of the entries in the "Sick Reports" are very obscure in their clinical and pathological significance. For

instance, while there can be little question regarding the nature of the disease entered as "typhus," which caused the death of Wm. Rysela on July 6, 1809, since Barton has added "sick two months," what did James Williams, 1st, really succumb to on August 17, 1809, under the designation "nervous fever," when on the previous day he first appears as "very ill, typhus?"

Barton mentions in his work on hospitals that he checked several cases of sea-scurvy on the "United States" by the liberal administration of lime juice. He had much to say later, after his cruise abroad in the "Essex," of its virtues as an anti-scorbutic, and urged its adoption by our Navy, in an official report.

In the preface to the first edition of his work on "Marine Hospitals," Dr. Barton refers to his attempts to bring about correction of the abuses and irregularities then prevailing in the medical department, by reason of what he terms "loose administration." As his statement there fully reflects his attitude toward the problems confronting him on the frigate "United States," and his grave concern for the welfare of the sick, and the improvement of medical supplies, I cannot do better than quote it at length:

"Having entered the navy as a surgeon when very young, and having been ordered to one of the largest ships in it, with a complement of 430 men, stationed in a warm and variable climate-I soon found myself not a little embarrassed by the perplexities that I daily met with in my practice on board. The unhealthiness of the climate, operating upon a variety of different constitutions in an entirely new crew; the change of diet and mode of life; the necessary and unavoidable exposure of boats' crews to the fervid rays of a vertical sun, as well as to the damp and heavy dews of night, and at all times to the insalubrious exhalations of marsh

miasma-all combined to generate such perpetual sickness, that the frigate might almost have been called a hospital ship, the average number on the daily sicklist, of fevers and fluxes, being about 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 together with the medicine chest, had cost the government fifteen hundred dollars. There were neither beds for the sick, sheets, pillows, pillow-cases, nor nightcaps-nor was there a sufficiency of wine, brandy, chocolate, or sugar; and that portion which the storeroom contained of these articles, 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 generously allowed me all the necessaries I stood in need of, and thus enabled me to administer those comforts to my patients, which they so much required. What would have been my situation, had the ship immediately proceeded to sea, for a cruise of eight or ten months, upon my joining her, and before I had an opportunity of examining into the condition of the medicine and store chests which might have been the case, these having been reported as sufficiently furnished? What the consequence would have been must be obvious! The other ships were not better furnished than the one of which I am speaking-and I perpetually heard of complaints on this score.

"What was the cause of these abuses? The want of a regular board of medical

commissioners, whose peculiar province it should be, to order the proper proportions and quantities of medicine, comforts, and necessaries, for the publick ships, and who should have no interest, directly or indirectly, individually or collectively-in the furnishing of articles thus ordered.

"As I was at that time a perfect novice in the routine of ship duty, and having then but recently left the Pennsylvania Hospital, an institution in which order, system, and punctuality, render the practice of medicine a pleasure, I was overwhelmed with the difficulties I had to encounter in the performance of professional duties, where every species of inconvenience and disadvantage that can be imagined was opposed to the exertions of the surgeon. My feelings revolted from the idea of continuing in such a perplexing and distressing situation—and I became disgusted with the unavailing toil attendant upon ship-practice. I communicated my sentiments on this subject unreservedly to my lamented friend, the late captain Wm. Henry Allen, then first lieutenant of the ship. I ventured even at that early period of my naval service, to condemn the flagrant irregularities and abuses, that I could not but believe existed to a ruinous extent. In my conversations with him I often declared, that if such was always the deplorable condition of sick men on shipboard, I wished not longer to be their medical attendant; for my feelings were every moment in the day subjected to harassment and pain, from 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 superintending 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 not only more beneficial to the sick, but less offensive to the humane feelings of the medical officer. I never lost sight of the opinion I had conceived, that the errors of the medical department of the navy might be easily corrected, and its abuses abolished."

Surgeon Barton's relations with Commodore Decatur and with the first lieutenant of the "United States," William Henry Allen,* appeared to have been most cordial and harmonious. This is evidenced by the fact that Decatur, in 1813, applied to the Secretary of the Navy for Barton to be returned to the "United States," and in 1817 he gave him a strong letter of recommendation to the then Secretary of the Navy, and both he and Captain David Porter of the "Essex" came to his aid in support of many of the reforms he had projected. Decatur in the letter of recommendation above-mentioned testified "to the great skill and attention and success with which he (Barton) practised during the above period." (18091810) Late in 1810, however, Barton appears to have had some disagreement with certain officers on the "United States," the nature of which is not revealed, but the resulting situation made it expedient for him to leave the ship. About this time the "Essex," was preparing to sail for Europe, and since her surgeon, Dr. Stark, was on leave at some distant point inland and could not * This is the same Captain Allen who commanded the "Argus" in her encounter with the British Brig "Pelican," August 14, 1813. The "Argus" had sunk twenty-two vessels off the British coast, but was defeated and captured by the "Pelican." Allen died of his wounds at Mill-Prison Hospital, Plymouth, England.

return in time to reach the ship before sailing, with Decatur's approval, and as a convenience to Capt. Smith of the "Essex,' Barton left the "United States" and joined the "Essex." It was during this cruise that he gathered much of the information regarding naval hospitals, and naval medical practice abroad, both in the navies of Great Britain and France, which appeared later in his writings. His observations covered a wide range of subjects, including the construction and arrangement of all the principal naval hospitals of England and France, their organization and administration; sanitary matters touching the naval services; methods of training medical officers; rations; character of supplies furnished ships, their construction, etc. He appears to have visited London from Cowes, Isle of Wight, where the ship was lying, and, while there, to have met the celebrated Dr. Lettsom through an introduction from Dr. Rush, and to have inspected several hospitals. He mentions the homeward bound voyage of the "Essex," which lasted two months, and speaks of the efficacy of an effervescing mixture of lime juice and salt of tartar for seasickness. This he administered to two passengers on board with great success. Other than the above, surprisingly few details of this period of his career were to be found in available material.

On June 30, 1811, he addressed a letter to the Hon. Paul Hamilton, Secretary of the Navy, requesting relief from sea duty and assignment to the Navy Yard, Philadelphia. He mentioned that he had been on sea service without any intermission since April, 1809, and had just returned on the "Essex." He asserted his willingness to act in concert with, or subordination to, Dr. Cutbush, the surgeon in charge at Philadelphia, and although a surgeon himself, was agreeable to service in a position, which ordinarily would be assigned to a surgeon's mate. His extreme anxiety to return to Philadelphia apparently arose from a desire to establish himself in

practice there, "the accomplishment of which is his dearest wish," to supplement his income, and help support his aged father and seven brothers and sisters. This he desired to do, moreover, while his uncle (Benjamin Smith Barton), who was in a precarious state of health, was still able to take him by the hand and introduce him into practice. He refers to his uncle as a man "the tenure of whose existence is fragile indeed . . . thus there is the brightest prospect of my professional success subject to the constant shadow of a very near cloud." His family is constantly in mind, and as the eldest son, his concern for their welfare is often reflected in his letters. The pay of a surgeon at this time, including the value of two rations, was sixty-two dollars per month, a sum wholly inadequate to the value of the service performed, and of course, not sufficient to enable him to contribute materially to the support of his family. He speaks further of the difficulty aboard ship of keeping himself abreast the times professionally. "The unsettled and wandering life on board ship not only deters the gratification of professional ambition, but absolutely generates an inanition of mind very inimical to solid improvement of any kind. The sea does not subject me to any corporeal malady, but really produces a spiritless inaction and mental debility which all the resolution I have been able to exert for better than two years has not afforded me the power to overcome." His appeal, however, appears to have fallen on deaf ears, for he was not detached from the "Essex," but did manage to get leave until September 1st. A letter dated July 11, 1811, written from Baltimore, addressed to the Secretary of the Navy, refers to a bottle of lime juice which he is sending him by Lieut. Ballard for trial “in the form of a lemonade, after allowing it to settle for a day or two." This is one of four dozen bottles which Barton brought back from England and he explains that his object in sending the lime juice is to enable the Secretary to

judge of the quality of juice used in the Royal Navy, which is the kind he wishes to recommend for our own. He also mentions his intention to submit a report on this subject. This letter indicates that he had been in Washington, and was on his way to Lancaster, but had been delayed in Baltimore on account of an attack of "summer complaint." On August 26, 1811, writing from Lancaster he requests two months' extension of leave, and to be assigned to duty at the Navy Yard, Philadelphia. In this letter he makes the first reference to his intention of writing at length upon his observations abroad and upon a plan for the better government of the Medical Department of the Navy, and puts this intention forth as a reason for the change of duty requested. He also states his desire to take courses of study in the Pennsylvania Hospital. A reference is made in this letter to Mr. Latrobe, whom he has asked to see the Secretary and support his request. But it is all to no avail, for a peremptory order from the Secretary, dated August 29th, is sent to him to return as soon as possible to his ship the "Essex," at Norfolk. Barton answered this letter from Lancaster on September 4th, and voiced his disappointment at not being accorded the leisure to complete his report, but states his intention of doing so at Norfolk. This letter reveals grave discontent at being continued on duty in the "Essex," a vessel "smaller than the one he first joined when he entered the service," where "his services gave the greatest satisfaction to Commodore Decatur and the officers generally." As respects the latter, with some of whom he had been in disagreement, he states that there has been a reconciliation and he desires his transfer from the smallest frigate in the Navy, back to the

5 Benjamin Henry Latrobe, 1764-1820. An English architect who settled in this country in 1796. He became identified with the Navy Department as an engineer, and designed the first Hall of Representatives at Washington.

"United States." He endeavors to reinforce his argument by adding that, "the present surgeon of the 'United States' was a surgeon of a cutter at the time I was in the station he now occupies." It is not unlikely that he received still another order from the Secretary to expedite his return to the "Essex," for Barton wrote from Philadelphia September 18, 1811, explaining the delay in his journey to Norfolk, as being due to a continuance of the affection which overtook him at Baltimore two months previously, and that he has written Captain Porter of the "Essex" to that effect. He encloses a physician's certificate in support of his

statement.

A letter written October 25, 1811, from Norfolk, transmits to the Hon. Paul Hamilton, secretary of the Navy, a number of sheets containing a plan for the internal arrangement of marine hospitals. This evidently is a further development of his proposed report, which finally grew into the book he published in 1814. The term “marine" hospital as used frequently by him was equivalent to the naval hospital of the ent day. At that early period a distinction. such as prevails at present did not exist. There were, it is true, "Marine” hospitals for merchant seamen, available to the Navy, which became separated from the Navy by the Act of Feb. 26, 1811.

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On November 2, 1811, Dr. Barton is back in Philadelphia, on leave, in order to attend the funeral of a brother. He appears to have travelled by water from Norfolk to New York, on this occasion, in the U. S. S. "Hornet," then under command of Captain James Lawrence, thence by stage to Philadelphia, leaving Norfolk October 26, and arriving in Philadelphia November 2, which for the times was quite rapid travelling. In the preface to his 1814 publication he refers to the trip on the "Hornet" and to his visit to Washington in July, 1811, when Mr. Hamilton called upon him to submit his ideas respecting the proper rules for administration

of the service hospitals, which the Secretary was required to submit to Congress at its next session. The Act of February 26, 1811, had separated the navy from the conjoint control of marine hospitals for merchant seamen and had authorized the establishment of distinct institutions for the navy, but nothing was done until 1832 toward furnishing these hospitals, except to rent temporary structures near the principal navy yards. From that date naval hospitals slowly arose at the principal stations. It was this report containing suggestions for the internal organization and government of hospitals, requested by the Secretary, which Barton refers to in the preface of his book, as having been written "during a tempestuous passage from Norfolk to New York, in the Hornet sloop of war, with the ever to be lamented captain Lawrence, under the disadvantages, too, of sea-sickness and acute mental affliction from the recent loss of a friend a brother."

On November 18, 1811, Barton writes from Lancaster, where he had gone after his brother's funeral, renewing his request to be ordered back to the "United States," stating that his action had the approval of Commodore Decatur, and quoting from a letter received from Mr. Allen, first lieutenant, in substantiation of their desire to have him. This letter, which is addressed to the Secretary, also mentions the intention of the writer to leave Lancaster for Philadelphia on November 19th, on his way to Norfolk. His failure to return promptly to his post of duty called forth peremptory orders from the Secretary, dated November 23, and Barton replied from Philadelphia on November 27th, in effect, that he considers the Secretary's reprimand for not obeying orders as entirely unmerited, and he enters into a long explanation of the circumstances surrounding his transfer from the "United States" to the "Essex" in November, 1810. His delay at Philadelphia, he states, is due to information received