Geoffrey L. Hudson. British Military and Naval Medicine, 1600-1830. Amsterdam Rodopi, 2007. 290 pp. $57.00 (cloth), ISBN 978-90-420-2272-0.
Geoffrey L. Hudson.
British Military and Naval Medicine, 1600-1830.
Amsterdam Rodopi,
2007. 290 pp. $57.00 (cloth), ISBN 978-90-420-2272-0.
Reviewed by Caroline Nielsen (University of Newcastle)
Published on H-Disability (March, 2013) Commissioned by Iain C. Hutchison
Imperial Medicine: British Military and Naval Patients
and Their Treatment, 1600-1830
Geoffrey L. Hudson's edited volume collectively examines
the development of disease control and therapeutic experimentation in the
British military and navy during the "long eighteenth century" (ca.
1660-1830), one of the most crucial periods of British
colonial expansion. This period witnessed both a growing interest in the
physical needs of an imperial state and the development of large bureaucratic
institutions to manage a growing domestic and colonial population (often
referred to as the British "fiscal-military state").[1]
"British" is a complex term.
"Britain" refers to England, Wales, and Scotland, an area controlled
by the British government based in London after the Act of Union with Scotland in
1707. In this review, I use the term "British" to refer to the forces
controlled by this government. The 1801 Act of Union with Ireland was not
complete, especially with respect to the governance of armed forces. I
therefore refer to Britain and Ireland separately. All aspects of the British
armed forces however recruited heavily in Ireland.
Over the course of the eighteenth century, Britain's
armed forces gradually grew to an unprecedented size. The scale of British
mobilization in the early 1800s was unrivaled until the onset of conscription
in the early twentieth century.[2] British imperial medicine was driven by the
manpower needs of the nation-state, as was the provision of benefits to a small
proportion of permanently disabled veterans and former servants. This volume
also demonstrates how imperial medicine was influenced by the populace's
concerns about military service, with most residential hospitals specifically
designed to police the actions of soldiers and sailors. The contributors to
this volume use macro- and micro-studies to examine the intellectual and
institutional world of the army's, navy's, and East India Company's medical
establishments in Britain, Ireland, and its distant colonies.[3] These case
studies range from detailed investigations into the largest state-sponsored
hospitals and therapeutic initiatives to the publications of private
individuals who contributed to the international scientific community of
letters.
The aim is to understand both the constructs and
limitations that governed those who lived within these different services. The
collection examines the intellectual and physical environments of
eighteenth-century military and naval medicine from its aspirations in brick
and mortar to its role in all levels of English-language print culture.
The book is structured thematically rather than
chronologically. The first four chapters are introductory overviews of military
and naval medicine between 1600 and 1830. Hudson's introduction surveys the
existing historical scholarship with discussions of the main general and
specialist comparative works on the British and French armies and navies. This
scholarship has adopted, extended, and often challenged views of the rapid
development of the medical "gaze" during the late eighteenth century.
Instead, in this volume, the origins of this form of mass observation and
therapeutic empiricism are contextualized in the late seventeenth century. J.
D. Alsop's chapter charts the creation of a formal imperial medicine discourse.
He examines the authors, contents, and publishing histories of the main
English-language books available to interested readers between 1600 and 1800.
These books continually envisaged their experienced author-practitioners,
patients, and readers as "white, elitist, masculine and
state-centred" (p. 24). The authors adapted the general advice given to
early modern travelers with their own experiences of ships' medical bays,
before gradually expanding into detailed medical topographies of the different
British colonies. Most strikingly, British soldiers and sailors were
increasingly homogenized into one white "European" grouping, with the
internal regional tensions within Britain and Ireland being marginalized into
insignificance. Paul Kopperman and Mark Harrison contextualize the experiences
of Alsop's authors in their chapters on the medical establishments of the
British armies in North America, the West Indies, and India from about 1750 to
1830. Kopperman's study focuses on the staff and conditions in the mobile
hospitals of the British army in North America between 1755 and 1783. He
includes a thorough overview of medical hierarchies and appointment systems
that governed these institutions, in particular showing the willingness of the
War Office and of individual officers to take medical advice on ventilation and
diet. His analysis of the outbreak of scurvy in 1775-76 however shows that the
continued good health of the army depended on a number of environmental
variables. He concludes that there was significant overall improvement in the
army's health, attributing the worst mortality years to epidemic yellow fever.
Harrison examines the medical hierarchies and establishments of the East India
Company by studying their competing aetiologies of tropical fevers, a major
drain on their resources. Company surgeons' experience of hot climates and
tropical fevers led them to challenge contemporary views of bleeding as a
treatment. He further highlights that the morbidity rates of tropical fevers
were so great that they encouraged the use of drastic and "heroic"
forms of purging alongside the widespread use of mercury, a drug widely avoided
by practitioners and patients outside of the Company due to its association
with venereal disease (p. 95).
The overarching theme for the latter half of the book is
the long-term medical experiences of sailors and soldiers, including the small
percentage who were allowed to access the facilities of the purpose-built
hospitals of Greenwich, Kilmainham (Dublin, Ireland), and Chelsea after their
discharge from official service. Eric Gruber von Arni explores nursing as a
profession during the English Civil War and Interregnum period (1642-60). Von
Arni examines the work of the Commissioners for Sick and Maimed Soldiers at
parliamentarian hospitals of Ely House and the Savoy (London). His research
uncovers a wealth of information on the daily life of their wards, suggesting
that the level of care provided by the nurses, the "help nurses"
(temporary staff), and the male medical establishment was
far higher than previously assumed. This chapter also contains detailed
comparisons between these temporary military hospitals and their
well-established charitable counterparts of St. Bartholomew's and St.
Thomas's. The Savoy and Ely House also provided continued
assistance to their former patients through supplying bandages and helping with
prosthetic limbs. The patients expected a high level of continued care, and von
Arni demonstrates that both the commissioners and the hospitals took their
complaints about poor treatment seriously. The theme of continuing care for the
chronically ill and physically disabled servicemen is prominent in the chapter
by Philip Mills on the treatment of inguinal hernias. His study is one of the
first to exclusively focus on the hierarchical medical establishment of the
Royal Hospital of Chelsea, the army's subsidized residential institution for
disabled and aging soldiers. Hernias ("rupture" or "broken belly")
not only were deemed to be largely incurable, embarrassing, and potentially
dangerous, but were also a significant drain on manpower. Chelsea's infirmary
wards were used for two trials of rupture cures, alongside those of Greenwich.
The elderly Chelsea Pensioners subjected to years of these experimental cures
were quite different from the young servicemen pictured in medical texts.
Patricia Kathleen Crimmin and Margarette Lincoln focus
exclusively on naval records. Crimmin's longitudinal study of sailors' health
uses the detailed records of the Admiralty's Sick and Hurt Board, a supervisory
committee that oversaw nearly all aspects of naval health--from hospitals,
diet, and equipment, to the relief of permanently disabled men and prisoners of
war. Crimmin describes the complex tasks facing naval surgeons given the
effectively decentralized structure of the British navy. The health of men was
dependent on the views of individual captains despite the navy's authoritarian
command structure. Crimmin highlights the willingness of some medical
practitioners and interested individuals to offer their own advice on naval
health to the board. Lincoln returns to the public nature of this debate by
examining how medical discourses influenced, and were influenced by, wider
concerns about the role of the navy in British economic success. She surveys
the dominant images of the sailor in late eighteenth-century British print.
"Jack Tar"
was viewed as a valuable commodity whose health had to be
preserved at all costs in spite of the dangerous conditions on ships. He was
also a potential risk to civilian communities through his exposure to
contagious diseases and distasteful habits, and who consequently needed to be
carefully supervised by his superiors.
The final chapters by Christine Stevenson and Hudson
further examine the British state's relationship with military and naval
medicine through the discipline of the hospital. Stevenson's chapter,
"From Palace to Hut: The Architecture of Military and Naval
Medicine,"
surveys the navy and army's major hospital building
projects between
1690 and 1752. These buildings were designed with both
practical and aesthetic motivations, such as ventilation and the different
needs of the surgical case, the chronically ill, and the convalescent. This practicality
did not limit their alternative function as concrete examples of the
benevolence of the British Crown. One of the largest building projects was the
Royal Hospital of Greenwich, the naval equivalent of the Royal Hospital of
Chelsea. Hudson looks beyond the external fa??ade of Greenwich in order to
examine the experiences of its resident disabled and aged. The Royal Hospital
was both a reward for long service and a response to public concern about
disabled sailors. He compares the eighteenth-century pensioners' experiences of
medical confinement and treatment to that of their seventeenth-century
predecessors, the county pensioners. He charts the gradual medicalization of
this benevolent institution, and the gradual limitation of the pensioners' agency
and voice in their encounters with the governing officers of the hospital. In
doing so, he questions both the "historiographical arguments and cultural
traditions that celebrate Greenwich (and Chelsea) as both safe havens for the
indigent and the incarnation of progress" (p. 266).
There are several important themes running throughout the
book.
Firstly, the volume covers the role of bureaucratic
centralization in the separate medical services of the army, navy, and East
India Company. All branches of these services began to establish permanent
hospitals for their serving dependents and, in the case of the army and navy,
for a small number of their non-serving men. These institutions subsequently
facilitated the gradual evolution of different ideas about disease, climate,
therapeutics, and preventative regimes. These were based on their trials and
observation of substantial numbers of servicemen patients who were
theoretically unable to have a substantial say in their treatment.
These techniques of military-style hospital discipline
and mass generalized treatments had far-reaching implications for the treatment
of and attitudes toward the poorest individuals with long-term health
conditions, in a similar manner to their early twentieth-century counterparts.[4]
Several contributors highlight the relationship between violent colonial
expansion, these medical establishments, and the corresponding growth of
medical literature on the health of young servicemen and would-be colonists.
These men needed to be disciplined both morally and physically by social
superiors and by their built environments. Several contributors highlight the
disparity between the anonymous male European patient of practitioners' formal
medical discourse, and the vocal ill-disciplined men (and occasional women and
children) who sought out and dictated their own treatments. In doing so, the
practitioners became "men of action" (in the words of Harrison); and
they legitimized their field, and therefore their own personal reputations,
justified through the growing importance of colonial expansion within British
society (p. 95). The third central theme of the book is the qualitative and
quantitative impact of these medical establishments on the overall physical
health of British servicemen between 1600 and 1830.
This book is an important contribution to the field of
seventeenth- and eighteenth-century medicine. The essays range from general
overviews of the medical services and medical texts available to the military,
to case studies of individual state-sponsored institutions in Britain, colonial
North America, the West Indies, and India. While key figures, such as Sir John
Pringle (1707-82), James Lind (1716-94), Thomas Trotter (ca. 1760-1832), and
John Hunter (1728-93), are mentioned, the intention is to contextualize their
work more as members of an international group rather than as individual
practitioners or administrators. There are clear parallels throughout all of
the essays, giving a strong cohesion to the book despite the chapters' different
source materials. At times, the book assumes that the reader has some
background knowledge of the eighteenth-century British fiscal-military state
and of eighteenth-century warfare in general. However, this is countered by the
book's extensive bibliographical endnotes, one of the strongest points of this
volume.
These allow the book to act as an introductory guide to
the complex historiography of eighteenth- and early nineteenth-century British
society and its armed forces. All chapters are based on extensive research of
complex archival collections, which are presented here in an accessible
format. The contributors' discussion and
summaries illustrate the range of recent quantitative projects on British
military and naval medicine, its patients, and its personnel. The book also
goes on to highlight the range of research still to be done for this area, and
the importance of integrating the previously "sequestered" field of
military medicine into the history of medicine. As such, this volume would be
suitable for undergraduate and postgraduate courses in the history of medicine,
and for studies in war and society during the British "long eighteenth
century."
Notes
[1]. On the development of the British imperial state in
this period, see John Brewer, _The Sinews of Power: War, Money, and the English
State, 1688-1783_ (London: Unwin Hyman, 1989; repr., London:
Routledge, 1994); and Lawrence Stone, ed., _An Imperial
State at War:
Britain from 1689 to 1815_ (London: Routledge, 1994).
[2]. On British mobilization over the course of the
eighteenth century, see Brewer, _Sinews of Power_; and_ _J. E. Cookson, _The
British Armed Nation, _1793-1815 (Oxford: Clarendon Press, 1997).
[3]. The army, navy, and East India Company were
Britain's main international armed services. The British state used a number of
smaller armed forces in particular contexts, including slaves, indentured
servants, conscripts, prisoners, volunteer groups, and mercenaries. Most of
these groups were under the remit of the War Office, navy, or East India
Company's bureaucracies. They were not automatically entitled to the same
medical provisions as their enlisted army or navy counterparts.
[4]. See, for example, Joanna Bourke, _Dismembering the
Male: Men's Bodies, Britain, and the Great War _(London: Reaktion, 1996); Seth
Koven, "Remembering and Dismemberment: Crippled Children, Wounded
Soldiers, and the Great War in Great Britain," _American Historical Review
_99, no. 4 (1994): 1167-1202; and Julie Anderson, _War, Disability and Rehabilitation
in Britain: Soul of a Nation
_(Manchester: Manchester University Press, 2011).
Citation: Caroline Nielsen. Review of Hudson, Geoffrey
L., _British Military and Naval Medicine, 1600-1830_. H-Disability, H-Net
Reviews.
March, 2013.