At the beginning of our beloved series, Dr. Stephen Maturin takes up his post aboard the Sophie without fully understanding just what he’s getting into. As a physician, he of course has a strong medical education and background, but no real understanding of the types of illnesses and injuries he’s most likely to encounter at sea. After 20 novels, he becomes quite the expert, and even “writes the book” (or a book, at least) on the subject. Here is an in-depth look at the information Stephen probably wishes he had when he first steps foot on the Sophie’s deck.
Naval Medicine in 1812
By Robert Mayer
Writing in the middle of the eighteenth century, the English physician James Lind warned of the dangers of leaving one’s native environment:
Men who thus exchange their native for a distant climate, may be considered as affected in a manner somewhat analogous to plants removed into a foreign soil; where the utmost care and attention are required, to keep them in health, and to inure them to their new situation; since, thus transplanted, some change must happen in the constitutions of both. 1
The men most likely to leave their homes for a distant shore in the eighteenth century were sailors. Whether shipped aboard a merchant vessel of Liverpool, a frigate out of Boston, or an East Indiaman bound for Madras, the seafarer of the eighteenth and early nineteenth centuries had little but new experiences and unexpected sights to compensate him for his vagabond life of travel and travail.
Along with the exotic sights and sounds of the sea and distant shores, however, the sailor could also expect less pleasant discoveries. 2 Sharing an inadequately ventilated wooden hull with several hundred other ill-washed men, women, and animals; eating a diet that, though often plentiful, ignored basic nutritional needs; and exposed to people and places foreign to his constitution, the seaman of the wooden ship era fought a constant struggle against illness and disease. Often deprived of that “utmost care and attention” demanded by imminent physicians like Lind, men who made their living by long sea voyages faced the likelihood of death by fever, scurvy, or infection. Sailors on a man of war also faced the dangers of musketry, cannon balls, and especially wood splinters in addition to the more mundane threats of disease.
Given the infrequency of naval combat, and the constancy of foreign deployments and long journeys, sickness and disease remained the sailor’s deadliest foe. 3 Not only scurvy, an affliction resulting from a lack of Vitamin C which devastated whole fleets from the sixteenth to the eighteenth centuries, but also various types of fevers, dysenteries, pneumonias, and sundry other ailments made a life at sea risky at best. 4 Nor did a sailor’s chances for survival increase perceptibly once ashore. In most of the tropics, from the Mediterranean to the West Indies, from India to the Orient, the unfamiliar, hot and humid environment played havoc with the health and lives of European visitors. Indeed, some doctors of the period heartily recommended that crews of ships calling at tropical ports remain on board to avoid the dangers of fever. 5
Contemporary naval surgeons were familiar with the symptoms of diseases, and were ready and willing to offer treatment, but they lacked an adequate knowledge of causation. Skilled observers and recorders of symptoms, doctors of this period lacked the knowledge of insect vectors and vitamins that belonged to later years. 6 Consequently, their efforts to curb diseases like scurvy, yellow fever, and malaria often met with frustration. While naval doctors quite often met with success in nursing patients back to health, these successes frequently came more as a result of natural healing processes than of any particular treatment. 7 Two areas that illustrate this point most clearly are the physicians’s treatments for scurvy and tropical fevers.
Scurvy is caused by the lack of ascorbic acid (Vitamin C) in the diet, and frequently results in loss of teeth, depression, weakness, swelling and sores. Ultimately, scurvy can lead to severe internal problems 8 While scurvy usually killed relatively few men, it often incapacitated whole ships or even fleets; on long voyages, like Lord Anson’s circumnavigation in 1740-44, or Captain Cooks’s voyages, scurvy was often the source of many fatalities. 9 Medical men of the eighteenth century knew scurvy was somehow connected with diet, and recorded their observations of men afflicted with the scourge. James Lind noted that sailors with scurvy had “the most craving anxiety for green vegetables, and the fresh fruits of the earth.” 10 Louis Antoine de Bougainville, French explorer and naval officer, took every opportunity during his extended cruises to secure foods that he felt countered the dread disease. 11 American naval surgeons like William P.C. Barton echoed their European counterparts’s emphasis on diet, even going as far as to identify diet as the cause of most seamen’s diseases. 12 Barton was of the opinion that scurvy arose “from a long subsistence on salt-junk.” 13Indeed, many contemporary physicians identified the heavy reliance on salted provisions, or “salt-junk,” as a prime cause of dietary problems. De Bougainville, fighting both scurvy and venereal disease after a brief stop at Tahiti in 1768, attributed the renewal of scurvy to running out of “refreshments” and a consequent reliance on salted flesh. 14
Not everyone was so sure that salted food was the major culprit. The American doctor Benjamin Rush, in a letter to the Surgeon General of the American Army in 1798, recommended the issue of salted meat to the soldiers instead of fresh provisions. 15 When Captain David Porter, American naval hero and experienced mariner, took the U.S.S. Essex into the Pacific during the War of 1812 to harass British commerce, he was aware of the dangers of reliance on salted meat, and so he gave orders that no one was to fry his bread in the salt from the meat casks. 16 Porter, however, also noted other possible causes of scurvy, including bad water. In his journal, Porter asked rhetorically “who can say, that the ship-fever and scurvy do not originate frequently in the stinking and disgusting water, which seamen are too often driven to the necessity of drinking at sea, even when their stomachs revolt at it?” 17
Porter’s speculations were not outrageous for their time. Surgeons and sailors advanced various possible causes for scurvy, though they readily admitted that no one cause was likely to be responsible for so deadly and prevalent a disease. The captain of the British ship Queen Charlotte might have agreed with Porter’s analysis. He attributed the outbreak of severe scurvy on board an English ship he encountered off the Alaskan coast to excessive consumption of “pernicious” liquor over Christmas. 18 Barton, in addition to condemning salt-junk, blamed the damp and cold of sea voyages as contributing causes of scurvy. 19 Although British authors as early as the late sixteenth century had identified dietary remedies for scurvy, they were ignorant of its true cause and thus often resorted to a great deal of speculation. 20
Despite the debate over the causes of the disease, every mariner had a favorite way of relieving or preventing its symptoms. Barton preferred lemon acid, citing its “citrick acid” as a good antiscorbutic, recalling his own success in using lemonade and limes to cure scurvy on the U.S.S United States in 1809-10. 21 Captain Cook encouraged his crew to eat nearly anything green that they found during landfalls, and, to encourage the reluctant, he eagerly followed his own advice. 22 The French captain de Bougainville reflected the preferences of many good captains when he searched out antiscorbutics like wild parsley, celery, and water cress on the Falkland Islands. Not one to leave anything untried, de Bougainville even made beer out of spruce shrubs in the hopes it would prove an effective antiscorbutic as well as a refreshing brew 23
De Bougainville had good reason to take every opportunity to find fresh foods, for his voyage carried him across the South Pacific, through the Dutch East Indies, and across the Indian Ocean before returning to France. Despite stops at Tahiti and New Britain, de Bougainville recorded that scurvy “had made cruel havock amongst us,” with fully half of his sailors incapacitated by the disease. “The provisions which we had now left were so rotten, and had so cadaverous a smell, that the hardest moments of the sad days we passed, were those when the bell gave us notice to take in this disgusting and unwholesome food. 24 Upon reaching Boero in the Gulf of Cajeli, Dutch East Indies, de Bougainville and his crew astounded their Dutch hosts with their appetite for fresh provender. “One must have been a sailor, and reduced to the extremities which we had been for several months together, in order to form an idea of the sensation which the sight of greens and of a good supper produced in people in that condition. 25
Long voyages like de Bougainville’s, Cook’s, Anson’s, or Porter’s were particularly good breeding grounds for scurvy. As early as the Seven Years War the disease had been largely eliminated for ships stationed close to home or nearby to other sources of fresh victuals. 26 Crews of ships that spent months away from friendly ports or regular sources of supply were not so lucky. They had to rely on preserved foods and available medicines, and even if their captains had seen fit to stock up on antiscorbutics, contemporary methods of preservation often robbed the vital fruits and vegetables of their usefulness. 27
One other concern that affected not only attempts to combat scurvy but also nearly every other effort to improve the lot of sailors in the eighteenth and early nineteenth centuries, was the inevitable parsimony of the various naval establishments. William Barton was well aware that any reforms he proposed had to be acceptable on both medical and financial grounds. For example, in his plan for a naval hospital, wherein he details the facility’s construction, diets and even its linens, Barton evinced a concern for economy almost equal to his interest in medicine 28 David Porter, in a letter to Dr. Barton, expressed a preference for lemon crystals as an antiscorbutic but also complained of the prohibitive cost of such supplies. 29
Similar problems bedeviled the thinly stretched Royal Navy as well. 30 And if the navies of the day, upon which the fates of nations rested, had difficulty protecting their seamen from disease, the merchant services could not hope to do better. Noting that avaricious shippers often skimped on rations, Lind recommended that captains of merchant ships be dissuaded from buying insufficient provisions for a voyage by having the difference docked from their pay and given to the crew. 31 Despite such recommendations, it was usually the crews of both merchantmen and warships that suffered the most from a neglected diet. Officers, who could and often did supplement their diets with fresh food, suffered less than seamen who often had to rely solely on their daily ration. 32 The difficulty the average seaman had in obtaining fresh foods on his own is highlighted by the fact that de Bougainville troubled to note the unusually low prices of poultry, eggs, and fruit in the Celebes. 33 As always, rank had its privileges, though on an eighteenth-century warship some privileges were more important than others. Thus, the officers of a ship usually had the opportunity and the means to provide themselves with more and better provisions, and rarely suffered from scurvy to the same extent as the men.
With the exception of scurvy, the biggest threat facing the mariner on a distant station was fever. The generic term fever encompassed a host of afflictions, including those later identified as malaria, yellow fever, typhus, typhoid fever, jaundice, and dengue. 34 The treatment of these largely tropical diseases occupied much of the naval surgeon’s attention. Most physicians followed the same general scheme of classifying fevers by their pathological behavior. For example, Lind identified three types of fevers: intermitting, with regular intermissions; remitting, with irregular intermissions; and continual, with no intermissions. Intermitting fevers Lind classified as either quotidian, with fits of fever every day, or tertian, with fits every other day. 35 Contemporaries of Lind generally agreed. George Cleghorn, a British surgeon at Minorca from 1733 to 1749, further divided tertian fevers into simple and double tertians, each either true or spurious. 36
Beyond a general scheme of classification, though, the learned doctors rarely agreed. Causation and contagion were particularly disputatious topics. Cleghorn posited “distempered bile” as a cause of tertian fevers, or perhaps, he observed, it was the body’s attempt to rid its self of “noxious humours.” He also believed that fevers could be contagious. 37 Stubborn Benjamin Rush, however, disagreed, at least as regarded yellow fever. “It is always the offspring of putrid exhalations from dead animal and vegetable matters,” he wrote. “Beyond and out of the reach of such exhalations, a yellow fever never did exist, as an epidemic, in any age or country.” 38 Furthermore, Rush maintained yellow fever was not contagious, and that little benefit arose from separating the healthy from those afflicted with the disease. 39 On the other hand, James Lind attributed the outbreak of fever in Portsmouth in 1765 to excessive heat and standing water, which conspired to release the “putrid moisture in the soil.” 40
Naturalistic explanations for fever and most other afflictions abounded. Cleghorn, for example, not only attributed the fevers at Minorca to extreme temperature changes and hot winds but also assumed that spiders, vipers, and scorpions owed their venom to the island’s hot climate. 41 Rush, on the other hand, was sure that typhus resulted from “exhalations from sickly or filthy or half-famished human bodies.” 42 Similarly, Dr. Lind declared that the “noisome vapor” arising from the hot sands of Egypt was the cause of fever in the land of the Pharaohs, and he maintained that, in the tropics, the falling rain itself could cause disease. 43
Never one to mince words, the American physician William Barton blamed the practice of frequently and copiously washing down the decks of warships for causing typhus. “I am acquainted with no practice more pernicious to the comfort of the men, or more fraught with disease and destruction of life, than that of perpetually drenching the main, gun, and berth-decks, with water. 44Barton echoed the views of another American naval surgeon, Edward Cutbush, who also advised against the indiscriminate wetting of the decks. 45
While eighteenth-century surgeons were freer in their use of narcotics than modern physicians, they had some cures that their successors might well endorse. For instance, modern physicians would certainly sanction the use of peruvian bark, which contained quinine. Useful even in its unrefined form against malaria, the bark was very popular, and doctors used it for any fever that had malarial symptoms. 61 Lind believed that bark was effective, but he insisted that it was only safe and effective during the complete remission of a fever. In one case in 1766-1767, in which Lind used opiates and bark to cure a woman of fever, he attributed his success to the bark. Lind, however, noted that the patient in this case cooperated fully by continuing to take the bark for months afterwards, especially during a full moon when the winds blew from the east. 62 Peruvian bark made up over a quarter of all drugs prescribed by St. Medard during his Mediterranean cruise as surgeon of the New York; regardless of the specific diagnosis, he usually ordered the use of bark after about the fifth day of illness. 63 Cleghorn, with much experience treating Mediterranean fevers, likewise favored the liberal use of bark. 64 So although the bark tasted bad and caused indigestion, prompting many surgeons to powder it and mix it with wine, its effectiveness guaranteed it a prominent place in any competent naval surgeon’s medicine chest. 65
Competent or not, the naval surgeon also had to deal with the seamier side of life at sea. In addition to his struggles with scurvy and fever, and his infrequent but bloody bouts with battle casualties, the naval doctor inevitably waged a long campaign against that traditional scourge of soldiers and sailors, venereal disease. Dangerous because wide-spread infection reduced the military capacity of the fleet, venereal disease was important to doctors primarily because they could supplement their income with special fees collected for treating those who suffered from this painful and loathesome affliction. The effect of venereal disease on the efficiency of a warship that required hundreds of healthy men for its daily operation was severe. Thus in 1814, Barton recommended that naval recruiters reject men with severe venereal infection, believing they could not make an effective contribution to working the ship without a lengthy cure. 66 De Bougainville’s crew, succumbing to the allures of the South Pacific, came down with the disease shortly after leaving Tahiti and its friendly populace. 67 Before setting off on his Pacific cruise, Captain Porter discharged nine men into the hospital at Newcastle on the Delaware, including two afflicted with syphilis. 68
However painful and possibly embarrassing for the afflicted, venereal disease could nevertheless be profitable for the physician who treated it. In the United States Navy, an informal but widely observed convention allowed the treating surgeon a fee, docked from the offender’s pay. The going rate for a cure was well established. In response to an inquiry from Dr. Graham, surgeon of the U.S.S. Patapsco at Philadelphia, Secretary of the Navy Benjamin Stoddart informed the good doctor that
The compensation to be received by the surgeons in the Navy for venereal cases, cured by them on board their respective vessels, is: ten dollars for a commissioned officer, seven dollars for a warrant officer, five dollars for a petty officer, seaman or ordinary seaman, and three dollars for a marine, provided the officers and men consent thereof.69
A similar practice applied for a time in the Royal Navy, where in the middle of the eighteenth century a fee of fifteen shillings prevailed. 70
Both the Royal and American Navies hoped to deter sailors from contracting sexually transmitted diseases by making them pay for their treatment, and so allowed the custom to stand as an unwritten rule. But Dr. Barton lamented:
Sailors are thoughtless, improvident, and venturous. No experience of the fatal consequences of pleasures attended with present revelry and mirth, will ever operate sufficiently on their minds to cause any moderation in the indulgence of the like excesses. They think only of the present, and are never regardful of the consequences that are even a few hours distant. 71
Courtesy of Robert and Nancy Mayer.
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