Monthly Archives: March 2019

From a Naval Perspective: The Parts of Medicine That Are Like Convoy Work

Before we start: today marks the 148th anniversary of the founding of the U.S. Navy Medical Corps, in which physicians automatically receive Commissions as naval officers. Prior to that time, doctors received their Commissions from individual ship commanders as they saw fit.

Now, back to our original program. In medicine, as in naval operations, the least dramatic undertakings often produce the most dramatic results. Look, for instance, at convoy operations in both World War I and World War II. Despite devastating losses due to submarine attacks on merchant shipping (Britain was only months from suing for peace in World War I due to impending starvation), senior naval officers resisted the use of convoys protected by antisubmarine-enabled escorts, because such prosaic (and both boring and dangerous) work didn’t fit the idea of dashing naval battles. Yet when the convoy system was instituted, in each war, merchant ship losses plummeted.

The story is similar in medicine. It is almost clich̩ to say that non-combat deaths (from contagion and, interestingly, scurvy) in land war exceeded combat deaths until the Franco-Prussian War (1871), when German attention to hygiene Рand vaccination against smallpox Рreversed this proportion for the first time in history. This relation held (with the notable exception of the American experience in the Spanish American War) through both World Wars, the Korean War and Vietnam. Only in the recent wars in the Middle East and Afghanistan have advanced combat casualty care and the wide use of body armor brought the proportion of combat to non-combat deaths to near parity, with accidents, not disease causing the largest number of non-combat deaths.

I’m soon to be giving a talk on what I thought would be mostly about combat casualty care – the surgeons’ work in the cockpit – in Nelson’s navy around the time of Trafalgar. As I began to research the matter, it became pretty clear, pretty quickly, that the most significant benefits from the Royal Navy’s medical establishment in the quarter century leading up to that battle were the most pedestrian imaginable, and most definitely not dramatic advances in the surgical art. Pushed by naval physicians and surgeons, and some enlightened line officers, the Royal Navy reformed its victualling to include regular supplies of sauerkraut (a fair source of vitamin C), fresh vegetables whenever possible, and citrus fruits and juices. This reduced the incidence of scurvy to almost non-existent. Surgeons and commanding officers began to demand cleanliness among the sailors (a general issue of soap to ships of the fleet was instituted only after 1795), their clothing and bedding, and of cooking and eating utensils. This reduced the incidence of fever and the fluxes* significantly.

The data are stunning: during the period of the American Revolution, prior to the institution of the reforms victualling and hygiene, non-combat deaths outnumbered KIAs by 18:1. By contrast, for the period between the Glorious First Of June battle (1794) and Trafalgar (1805), the ratio was closer to 3:1. Like boring convoy operations, boring public health measures yield outsized benefits.(1)


 *In an era before the causes of most diseases had been elucidated, “fever” was a catch-all diagnosis for any febrile illness. The most significant ones for sailors were

–“putrid” (or ship) fever – epidemic typhus – caused by rickettsia prowasecksii, spread by the bites body lice; and yellow fever and malaria, for men serving in the tropics, and

–“flux” and “bloody flux” – gastroenteritis or dysentery – caused by a variety of bacteria that grow in spoiled food and unclean cooking and eating utensils.


(1) Care is warranted in noting these numbers, as naval operations during the American Revolution ranged from the tropical Caribbean to Newfoundland. In the later period, most battles occurred in the northern latitudes. Nevertheless, the beneficial effects of good nutrition and basic cleanliness were significant. This post is based on preliminary research for my lecture project and are drawn from the classic and epic four volume medical history of the Royal Navy started by John J Keevil (Vols 1 & 2), and, following his untimely death in his mid-50s, completed by Christopher Lloyd and Jack Coulter. The material that informed this post is in: Lloyd, Christopher and Jack L. S. Coulter, Medicine and the Navy, 1200-1900, Volume III 1714-1815. London, Livingstone, 1961. Several more sources await my attention.

(c)2019 Thomas L Snyder