David Boyd Haycock, Sally Archer, eds. Health and Medicine at Sea, 1700-1900. Woodbridge Boydell Press, 2009. xiv + 229 pp. $95.00 (cloth), ISBN 978-1-84383-522-6.
David Boyd Haycock, Sally Archer, eds. Health and Medicine at Sea, 1700-1900. Woodbridge
Boydell Press, 2009. xiv + 229
pp. $95.00 (cloth), ISBN 978-1-84383-522-6.
Reviewed by Christiane N. Fabbri (Yale University)
Published on H-Disability (January, 2013) Commissioned by Iain C. Hutchison
Surgeons, Sailors, and Slaves in the British Royal Navy:
Observations of Maritime Medicine from 1700 to 1900
Naval medicine in the context of military, colonial, and
social history has become a growing area of historical enquiry, as evidenced by
the number of publications in the field within the past decade.
The nine essays presented in this volume are based on the
2007 series of historical seminars sponsored by the National Maritime Museum in
Greenwich. Collectively, they highlight the important contribution of maritime
medicine to the development of the British Empire during the eighteenth and
nineteenth centuries. They explore the crucial role naval surgeons played
during this period in the advances in sanitation and hygiene, surgical
techniques, nutritional deficiencies, and tropical diseases. They also underscore
the growing professionalization and prominence of naval medicine, starting with
the founding in 1694 of a hospital for old and disabled seamen in Greenwich
followed by the establishment of the Sick and Hurt Board for taking care of
sick and wounded seamen and prisoners of war, through to its contributions in
the fields of Laboratory Medicine and Tropical Diseases at the end of the
Victorian era.
The book is based on extensive original research, and
includes a valuable bibliography. Its contributors come from a broad range of
fields: social and cultural history, military and
colonial history, the history of science and medicine, psychiatry, and surgery.
The nine chapters of the collection are grouped around two central
themes: the first five are devoted to the practice and
administration of naval medicine in the Royal Navy, and to the crucial
importance of sailors' health in war and maritime battles; the second four
examine health at sea in times of enforced migration, during the voyages of
slaves, convicts, and indentured or poor migrants.
The editor's introductory chapter sets the stage from the
opening of the eighteenth century when the renowned London physician Richard
Mead reflected that "medicine still deal[t] so much in conjecture that it
hardly deserves the name of a science" (p. 1), to the end of the
nineteenth century, when after Louis Pasteur's discoveries the causative
organisms of most common contemporary infectious diseases had been identified.
The first chapter, an award-winning essay by medical
historian Erica Charters, discusses the inception of what may be some of the
first large-scale clinical trials conducted for the purpose of maintaining and
improving the health of seamen by the Sick and Hurt Board during the Seven
Years War of 1756 to 1763. Historians have attributed the success of Britain
during this war to the navy's regular sending out of fresh provisions; clearly,
medical and naval officials recognized that this was key to maintaining health
and preventing disease among sailors during long periods at sea. Contemporaries
such as naval physician James Lind understood diseases like scurvy to be the
result of a lack of fresh provisions, but still explained the disease itself
with traditional medical theories of putrefaction and lack of adequate humors
rather than lack of a specific substance, namely the essential nutrient now
known as Vitamin C, or ascorbic acid. It was the initiative and systematic
investigation by the Sick and Hurt Board that led to the institution of early
standardized experiments, first in land hospitals, then at sea, where naval
surgeons were charged with evaluating the efficacy of the experiment. Their
findings led to effective new means of provisioning men at sea, such as the
issue to sailors of the widely popular "portable soup." Most likely
this empirical approach was motivated as much by strategic military concerns as
by therapeutic ones. Nevertheless, as Charters shows, in its quest to improve
the health of seamen the Sick and Hurt Board contributed significantly to the
development of standardized clinical research methodology.
John Cardwell's essay, "Royal Navy Surgeons,
1793-1815: A Collective Biography," is part of an ongoing research project
seeking to provide insight into the geographic and social origins, medical
training, and professional expertise of the naval surgeons of the French Wars.
Contemporary caricatures of "middle-aged sawbones,
driven to the Navy by alcoholism or incompetence" (p. 38) are not borne
out by the extensive data culled from multiple primary sources, including
service registers and other Admiralty archives. Indeed, the prototypical naval
surgeon of the era, in spite of his usually relatively modest background,
received considerable education and training, comparable to that of his
civilian counterparts, including apprenticeship as well as university and
teaching hospital study.
Tracing the career paths of his cohort, the author
demonstrates that a considerable number of naval surgeons developed successful
practices after their naval service, with some, such as Scottish surgeon and
naturalist Sir John Richardson, garnering lasting fame for their advancement of
nineteenth-century science and letters.
Michael Crumplin, himself a retired surgeon, focuses on
the practical challenges faced by the ship's medical officer after what, in the
author's view, was often inadequate experience or haphazard training.
He describes the training and credentialing of naval
surgeons, and provides much interesting detail of their practice setting,
including allocation by rate of ship, daily practice and record-keeping
requirements, surgical instruments needed and supplied, together with medicinal
inventories and sick-bay and dispensary plans. While most of the surgeon's
duties entailed the care of common ailments such as gastrointestinal
complaints, colds, and rheumatism, combat injuries would rapidly overwhelm a
lone practitioner with few or no assistants, no matter how sophisticated his
casualty triage system.
Until 1795, naval surgeons were able to fine their
patients fifteen shillings for presenting with venereal infections. These were
considered shameful but reportedly accounted for over 60 percent of urinary
tract complaints, and the protocol surely discouraged consultation (p. 77).
Ships medical officers were also called upon to deal with gruesome battle
wounds and perform major operations such as limb amputations under extremely
difficult conditions.
Pat Crimmin's essay sheds light on how political contexts
and cost considerations influenced the activities and therapeutic choices of
the Sick and Hurt Board. Her painstaking study of the board's archival records
helps explain some of the difficulties encountered in improving naval medicine
and sailors' health, as well as the board's own ultimate demise when it was
abruptly abolished in 1805.
The accusations were a deplorable state of its business,
financial slackness, and poor record keeping. After all, "medical men, by
their training, could not be expected to transact the business of
accounts"
(p. 106).
At the end of the Napoleonic Wars, and over the half
century following the abolition of the slave trade, the career of a Royal Navy
surgeon had become so unattractive that it deterred most volunteer candidates.
The health of the navy and the working conditions of seamen received equally
little attention. Mark Harrison's essay details how the problems of naval
antislavery operations in tropical stations, and the high death rates of the
crews of the West Africa Squadron, ultimately focused public awareness on the
plight of sailors and brought about a turning point.
Thus the fateful Niger Expedition (1841-42) not only
resulted in the development of medical topography and quinine prophylaxis
against fevers, but also led to broader reforms of naval medicine and health,
including improved conditions for its surgeons. At the end of the nineteenth
century these efforts culminated in the founding of the London School of
Tropical Medicine. The formal study of tropical diseases had grown out of what
was originally a branch of the Seamen's Hospital Society.
A second section of four essays centers on the morbidity
and mortality that befell crew and passengers onboard slave ships and during
the enforced voyages of convicts and indentured laborers. The death rates among
such migrant populations were a consequence of the often appalling and inhuman
circumstances: overcrowding and inadequate provisioning (to maximize profits)
together with filthy conditions. All this made fertile environments for the
spread of diseases such as dysentery, smallpox, and scurvy; it is estimated
that gastrointestinal diseases caused over 40 percent of such deaths.
Slave mortality during the so-called Middle Passage is
reported to have fluctuated widely, from about 10 percent to over 50 percent. In
1693, of 700 slaves bound for Barbados on the Royal Africa Company's ship
Hannibal only 480 arrived alive. Decreases in death rates in the transatlantic
slave trade by the middle of the nineteenth century reflect the direct impact
of improved health conditions and the critical role of the ships' surgeons.
Interestingly, mortality rates of the crew, likely due to malaria or yellow
fever contracted in West Africa, remained unchanged over the same period of
study.
The lessons learned by the Royal Navy of the eighteenth
century were gradually implemented during the transport of convicts and other
emigrants from Britain to Australia in the nineteenth century.
Legislation supporting strict sanitary guidelines for
surgeons and captains of government-commissioned ships resulted in much lower
passenger mortality rates during these voyages compared to those of the much
shorter, but unregulated, transatlantic crossings.
This book will be of interest to many historians,
particularly those working in the field of maritime and colonial history, and
the social history of medicine and public health. Clearly, maritime medicine in
the eighteenth and nineteenth centuries is "a rich subject, ... ripe for
further investigation" (p. 17). Navy surgeons not only played an important
role in the health of their ship's passengers, but also made incontrovertible
contributions to the development of investigational medicine and public health.
Future avenues of research might profit from greater scrutiny of the veterans
of maritime service: the numerous retired and/or disabled sailors and their
physical and emotional sufferings, post-traumatic casualties of the era.
Citation: Christiane N. Fabbri. Review of Haycock, David
Boyd; Archer, Sally, eds., _Health and Medicine at Sea, 1700-1900_.
H-Disability, H-Net Reviews. January, 2013.
This work is licensed under a Creative Commons Attribution-Noncommercial-No
Derivative Works 3.0 United States License.