Book Review: Haycock and Archer, eds., “Health and Medicine at Sea, 1700-1900

Your correspondent is serving jury duty (a murder case – could run a month), and accordingly, has not been able to do his usual research to write. Fortunately, this week, Professor Timothy Walker sent me notice if the book review below with the note “this might be of interest to members of your Society [of the history of Navy Medicine]”. I suspect it will be of interest to readers of this blog, too. Thanks to the kind Professor! As you can see, the review comes to us by way of the h-net list serv from MSU.

From: H-Net Staff <>
Date: Tue, Jan 8, 2013 at 3:19 AM
Subject: H-Net Review Publication: Fabbri on Haycock and Archer, ‘Health and Medicine at Sea, 1700-1900’

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

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