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The journals of slave ship surgeons of the 1790s are used to address questions on the relative importance of African conditions versus those on ships, crowding, the effectiveness of Dolben's Act, and the interaction between slave and crew health. In contrast with previous work we find that most slaves who died did so near the middle of the voyage. Crowding was important to health and mortality, but the restrictions of Dolben's Act did little to reduce losses. The crew was largely isolated from patterns of disease among slaves.