Navy Medicine in Araby (Episode 2)

This is part 2 of a 7 part presentation contrasting 19th century navy medicine with the care the navy medical team gives our sailors, Marines and soldiers now:

In the early 19th century the most widely accepted general theory of disease is that it represented an imbalance of the system, either in direction of “excitement” or its opposite, “enfeeblement”. Treatments were therefore aimed at reversing these imbalances. For example, most fevers were interpreted as manifestations of too much excitement, and a common treatment was to tip the balance toward enfeeblement by bleeding the patient, often at a pint or more at a go. Other enfeebling regimens included aggressive catharsis using calomel, a mercury containing compound and inducing vomiting by use of medications like tartar emetic.[1] Very few “targeted” treatments were available, among which was calomel used with success against syphilis, Peruvian bark (which contains quinine, then effective in treating malaria, a disease manifested by cyclical fevers) for treatment of any fever, and after many fits and starts, the juice of citrus for prevention and treatment of scurvy. Interestingly, although lime juice had been part of the recipe for grog in the Royal Navy since 1747 because of its proven antiscorbutic effects, the eminent American Naval surgeon Edward Cutbush, in his 1808 treatise Observations on the Preservation of the Health of Soldiers and Sailors, seems not to have entirely bought into the idea, as he does allow that “[w]hen in countries where limes or lemons and sugar can be purchased cheap, it would be well to … issue sugar and lime …to make punch, which would counteract any tendency to scurvy that may be among the crew.[2]

The first meaningful U. S. naval force arrived in the Mediterranean, ship by ship, throughout 1802. The frigate Chesapeake was the flagship of this squadron. In her sickbay – below decks and generally devoid of natural light and fresh air – the ship’s surgeon and his assistants (an assistant surgeon or surgeon’s mate, and a loblolly boy) would care for sailors who were too ill to work, or who were convalescing from debilitating injuries. In an era when men did not have the benefit of modern scientific knowledge, deaths from disease greatly outnumbered those from combat. Yet common sense and an emerging experience led Cutbush to recommend attention to “the following leading particulars: 1st. In keeping the ship dry and properly ventilated. 2ndly. In attending to the cleanliness of the crew in their persons and clothing. 3rdly. In their avoiding cold, fatigue and intoxication. 4thly. In keeping them warm by fires in the winter season. 5thly. In preserving an exact and regular discipline, and in furnishing the crew with sound, wholesome provisions and water.

“If a contagious disease appear on board: 1st. Separate the sick from the well and prevent all unnecessary communication with the sick berth. 2ndly. Keep the ship clean, dry, and properly ventilated. 3rdly. Let the men avoid cold, fatigue and intoxication. 4thly. Dissipate moisture betwixt decks by means of fires. 5thly. Avoid depressing the spirits of the people by unnecessary severity. 6thly. Let the berth deck be frequently whitewashed with lime.”[3] Based on the principles laid down by Cutbush, we may conclude that he placed much emphasis on the prevention of disease by encouraging cleanliness of both ships and men and by providing a more healthful environment and decent food. Although medicos in the early 19th century had no idea of bacteria or viruses as the cause of disease, or of the mechanisms of contagion, they did get the public health principle of isolating the sick quite right. The beneficial effects of whitewashing appear to be limited to making a dark space like the berth deck seem brighter; that whitewash – essentially lime paint – traps dirt and insect parts, in effect promoting cleanliness, and may have mild antibacterial effects is discussed mainly in modern treatises on buildings.[4],[5],[6]

The ship’s cockpit is where the surgeon and his assistants would care for battle casualties. Such care was pretty much limited to stopping hemorrhage with tourniquets or ligature – tying off bleeding vessels – dressing wounds and amputating limbs. The commonest combat injury to sailors in this era was from flying wood splinters, and these produced terrible, shredding-type wounds. In these cases, the surgeon’s task was to remove as many of the splinters as possible, because, it was thought, these splinters were the direct cause of lockjaw[7]. The surgeon would also cleanse the wounds with water and vinegar and apply ointments and dressings. Part of the surgeon’s cockpit kit was a pail of sand that could be spread on the deck so the surgeon and his assistants might keep their footing when it became slippery from spilled blood. According to Professor Langley, American forces lost at least 181 men during the Barbary period, of whom perhaps 45 were combat-related. Three men, including two medical men and one Marine Corps lieutenant, died as a result of duals.[8]

[1] Warner, John Harley, “From Specificity to Universalism in Medical Therapeutics – Transformation in the United States in the 19th Century”, In Leavitt, Judith Walzer, and Ronald L Number, eds., “Sickness and Health in America: Readings in the History of Medicine and Public Health, Madison, University of Wisconsin Press, 3rd Edition (Revised), 1997, pp 88, 89.

[2] Cutbush, Edward, Observations on the Means of Preserving the Health of Soldiers and Sailors; and on the Duties of the Medical Department of the Army and Navy, with Remarks on Hospitals and Their Internal Arrangement, Philadelphia, Thomas Dobson, 1808, pp 119. Obtained on line at https://archive.org/details/2548038R.nlm.nih.gov, downloaded as a pdf file on 24 August 2016.

[3] Cutbush, op. cit. p 131, 132.

[4] Resilience.org, “Use Whitewash Instead of Paint for Traditional Look and No Toxins”, http://www.resilience.org/stories/2014-04-29/use-whitewash-instead-of-paint-for-traditional-look-and-no-toxins, accessed 13 September 2016.

[5] GSA, “Properties and Uses of Whitewash Paints”, http://www.gsa.gov/portal/content/112558, accessed 13 September 2016.

[6] 5 Acres & A Dream, The Blog, “Amish Whitewash”, http://www.5acresandadream.com/2014/05/amish-whitewash.html, accessed 13 September 2016. This article in particular cites two sources, from 2005 and 1919, which describe the “mild antimicrobial” effect of whitewash.

[7] Which we now know is caused by the bacterium clostridium tetani, carried into the tissues by the splinters.

[8] Langley, op. cit., p 106

(c)2017 Thomas L Snyder

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