Medicine at sea

[William Brand]

“Yet the high survival rate of the casualties was remarkable and reflects and impressive quality of care by the surgeons. When the Victory was decommissioned in early January 1806, Beatty reported that nor more than six of the 102 convalescents had died, five on board and one in the hospital at Gibraltar and five who were transferred to the hospital ship Sussex.” (Kevin Brown, p. 90)

To lose so few is impressive, especially in the face of such significant losses in earlier years.

[Mission]

“Yet the high survival rate of the casualties was remarkable and reflects and impressive quality of care by the surgeons. When the Victory was decommissioned in early January 1806, Beatty reported that nor more than six of the 102 convalescents had died, five on board and one in the hospital at Gibraltar and five who were transferred to the hospital ship Sussex.” (Kevin Brown, p. 90)

To lose so few is impressive, especially in the face of such significant losses in earlier years.

You have facts or references I can use? I have so little on the survival rates of seamen dressed by surgeons while at sea.

[William Brand]

None at my finger tips for convalescents, but the high mortality rate aboard ships in general due to poor living conditions and scurvy made your quote stand out to me. I remember reading (I think it was in "Batavia's Graveyard") that the Dutch masters would over hire a crew for any given ship expecting to lose as much as a third of the men before reaching the tropics.

[Mission]

None at my finger tips for convalescents, but the high mortality rate aboard ships in general due to poor living conditions and scurvy made your quote stand out to me. I remember reading (I think it was in "Batavia's Graveyard") that the Dutch masters would over hire a crew for any given ship expecting to lose as much as a third of the men before reaching the tropics.

I have read that explorers and privateers over-hired somewhere too. Something like 30 - 50% if I recall that stat correctly. I believe it was in relation to scurvy, so it was probably Bown's book on scurvy. Of course, in his book Brown (not Bown) notes that the Dutch and other navies had far more problems with scurvy than the English who were (at least according to Brown) working diligently to fix the problem of scurvy.

In a related note, another interesting quote I found in that book had to do with how much worse the French and Spanish armies were about disposing of the dead than the English during the beginning of the 19th century. (There's a whole lot more info on this sort of stuff from the late 18th/early 19th than there is for the late 17th/early 18th.) While I really would like to use this info, I don't feel comfortable doing so (at least not without a giant caveat) because things of this nature may have changed dramatically in 100 years time.

“British naval surgeons were often horrified when they saw the results of the work their counterparts in the French and Spanish navies. William Shoveller, the surgeon on Leviathan at Trafalgar [1805], was not impressed by the condition of the Spanish prisoners taken aboard, many of them ‘with tourniquets on their different extremities, and which had been applied since the action, four or five days elapsing, consequently most of the limbs in a state of mortification or approaching it.’ Shoveller had to try to do something for these men to save their lives. The seaman William Robinson was also scathing about ‘the scene of carnage horrid to behold’ on a captured Spanish ship, with the dead bodies ‘in a wounded or mutilated state’ piled up in the hold, and ‘the heart-rending cries of the wounded’ on a French ship [1785], where the doctor, ‘having lost or mislaid some of his instruments, was reduced to the necessity of resorting to the use of the carpenter’s fine saw, where amputation was needful.’ Gilbert Blane castigated the French for the mangled limbs, and even whole bodies of men, were cast into the orlop or hold and lay there putrefying for some time… When, therefore, the ballast or other contents of the holds of these ships came to be stirred, and the putrid effluvia thereby let loose, there was then a visible increase of sickness.’ Not surprisingly, dysentery and typhus were rampant. Moreover, the French and Spanish fleets did not have in place any effective measures against scurvy, and suffered a loss of experienced mariners as a result of the epidemic of yellow fever that was raging through southern Spain. When Villeneuve sailed to meet Nelson at Trafalgar, there were 1,731 sick in the Combined Fleets of France and Spain.” (Kevin Brown, p. 102)

[Mission]

I found these two accounts of seamen wounded shipboard which have interesting aspects to them. They're both from James Yonge's book Currus triumphalis, è terebinthô or an Account of the many admirable Vertues of Oleum Terebinthinæ [Turpentine] from 1679:

"Anno [16]75. I was sent for to a Dutch

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Seamen, who being gotten drunk, threw himself into his Cabbin with all his Cloaths on: it unluckily fell out, that he had in his Pocket a sharp-pointed Knife, such as they usually carry, and that it lay in so ill a posture, that the weight of his body forced the point through sheath and cloaths, and run up above three inches (entring about the middle of the Thigh) obliquely towards his buttocks, so that the point might be an inch and half directly in from the skin, under which it lay; I drew it out, and found no part of it broken off; the Man complained of great pain, and there flowed much bloud: I then injected warm Oil of Turpentine, and put up above half-way, a thin Flamula [what this is is not clear to me - it sounds like a probe although flamula was a flower used in medicines] dip'd in the same: then rouled him up, drawing also about ten ounces of bloud from the Arm. The man slept well all night; and after two days, I using nothing but a Pledget and a Plaister on the Orifice, the Solution being all united, I let him walk about. I bled him because he was plethorick, and I intended to heal the Wound by sympathy. [Healing by sympathy was a rather bizarre theory that if you applied medicines to the weapon that made the wound, it would cause the wound to heal.]" (Yonge, terebinthô, p. 72-3)

"John Boddam, belonging to Captain Patrick of Yarmouth, standing in the coyle of an Halser, by which the Ship was fastned: the straps that tied it giving way, he was drawn forward, and griped therein: so that both Legs were shattered in pieces, he was brought to shore and committed to my custody. I reduced all the bones [restored the fractured bones to correct alignment] as well as could be, but when the contused flesh came away, one of them hung by a Tendon or two above the Ancle. In fine, and Amputation was inevitable; he was a florid [red-faced] young Man, and of a replete Habit [fat, or filled with food], though some of it had been rebated by the method of Phlebotomy [bloodletting], &c. used at first: after the member was severed at the usual place, I only laid on a large Pledget of Tow, dipt in hot Ol. Terebinth, [Turpentine] and the other things as is usual, whereby the flux [flow of blood] was suddenly and safely secured." (Yonge, terebinthô, p. 79)

[Mission]

Here is John Woodall's advice for newly minted surgeons from the 1639 Edition of the surgions mate. If you read this and then read the part of The Adventures of Roderic Random where a new surgeon is brought on board Random's ship when he was a surgeon's mate, you will be amused. (I've inserted paragraph breaks to make it more readable):

"The first errour some young Surgeons are possest with, from which infinite others grow, is the want of the service of God, the example whereof to their Mates is very infectious; and this bringeth with it a blaspheming the name of the Almighty, a general deboist [debauched - be sure to use it in a sentence today] and base kinde of habite on them, ready for all unprofitable, idle, and unseemly actions, and unapt for to prosecute any good thing, either in their callings, or otherwise: And if they seeme to be anything, it is in boasting and brave phrases, censuring other men in many things, but not perceiving their own wretchedness at all.

Being given and dedicated to the Pot and Tobacco-pipe in such an unreasonable measure, that thereby they become in themselves base, despising virtue and commending vice; and to their Mates they shew themselves most unkind, keeping that little knowledge they have from them, not instructing them at all in their Science, and holding them in more base subjection then their Masters ever did in the Apprentiships.

Also of a proud lasie [lazy] disposition, commanding them (without due instruction) to doe the whole businesse, when indeed themselves ought to put their hands, even to those parts of Surgery which they esteeme basest; for the most lamentable diseases of poore men require the most care of the Surgeon, as for example, the ulcerations and slidings dowone of Ani or the Ars-gut, which some in disdaining to doe their office of fomenting, comforting, and restoring thereof to the due place, most inhumanely have cut it off, when with as good a conscious they might have cut their Patient his throat: and the same I say to him that is negligent, and suffereth such to perish in their infirmities, without doing his utmost diligence." (Woodall, The Office and Duty of the Surgeons Mate, pages 3rd – 4th)

[Mission]

Now here's something you don't often think about in relationship to sea surgery. It's from John Moyle's first book Abstractum Chirurgeriæ Marinæ:

"CHAP. XVII.

How to Cure a Rheumatisme.

This Distemper called a Rheumatime, I have often Seamen to be afflicted with in ships that I have bee in: 'Tis like the Gout, but not the Gout; it siezeth about the Joynts of the Feet, or Hands, or both; and if a flatulent vaapour be stird up with it, it shifts out of one joynt to another, and is called the running Gout: There is sometimes a light readness, with small Tumour, and swoln Veins about the Joynts that it siezeth.

He that hath it, hath lamentable pain and misery, especially in the night. It never is seen to break, (although I believe by ill handling it would) for I saw that Gout broke under a Gentlemans foot by the application of Cataplasms; and together with the virulent matter, there came forth

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like white seeds in abundance, harder than the matter; by which a man may see what a prodigious humour the Gout is of.

I could never find that Purging, or Sweating would do any good in this disease, but rather exasperate it; and drinking of Wine is an Enemy to it; for most of them that I have seen have it, have got it by drinking over much raw Wine, and then lying down in the cold to sleep, whence the Humours plethorick have not had that expiration through the pores of the skin as they should, and the humours could not receive the third concoction for want of h3eat; so Nature expels the raw humour to the outward or extream parts: And at the Joynts the Crude humours make a stop, and the blood makes not so good a circulation as it should: This then is a Rheumatisme.

Now bleeding the principal remedy in this grief, not only once but often, and a good large quantity at a time. The best of Oyles or Oyntments, whether hot or cold, I could never find to do any good; and Emplasters have signified as much as nothing. Bathe the part well with Liquor ontipodagricus Minsichti, or aqu. Arthritica Quercitani: Then embrocate it with the quintissence of Colocynthidos fabri, and

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Antimony. I say, with the often bathing and chasing in of these Medicines, and frequent use of Phlebotomy; and when pain is insufferable, taking inwardly five or six grains of that excellent Nepenthae.

Rx. Quintessentia Papaveris & Hyosciami, in a little Ale, or common Water.

There will be present ease, and speedy cure; so if a man hath a fit of the Gout or Sciatica on board, although he doth not expect you to cure him, yet he would be glad of ease if you can give it him; and you have no better way than this to do it." (Moyle, Abstractum, p. 70-2)

[Mission]

And, for hangover remedies, we feature hair of the dog...

"CHAP. V.

Of a Surfeit.

Surfeits at Sea generally come by over drinking, (although indeed they may come by over-eating, or from the vitious quality of what is eaten) it is so that nature refuseth to digest the great quantity

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That a man has drank: As a man that hath a burden too heavy, doth not so much as lift at it.

Some nature sis so propitious to them, that when they are too full of drink, they vomit, but some do not; but are extream sick at stomach, and the head achs as it would split. Now if such had given them a draught of warm Water, with some {ounce}ij Oxymel of Squils in it, they would vomit and prevent a Surfeit; especially if after their vomiting they had a pint of Wine burnt, with a sprig of Mint, and a blade of Mace [from the nutmeg tree], and sweetned with fine Sugar, and so drank hot: But if it hath passed the Stomach before the man speaks to you; and the Liver doth not digest it, but lets it lye in the first passages, then there is worser pains and heat.

Now vomiting of it self will do no good: But,

Rx. Spirit. vitæ Ruiandi {dram}j Tinctura a florreguli antimo. gut. iiij. Oxim. Scil. {ounce}j.

This in a glass of Wine will work pleasantly both wayes, and free both Stomach and intestine of the superfluous humour that Nature is charged withal. Some in this case use a Clyster, Electum Cariocost.

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{ounce}j in moderately hot Wine injected, excellently draws down the excrement and noxious fumes and evacuates it to the Patients great ease and comfort.

The Body thus cleansed, let him then drink the burnt Wine [brandy] hot, and add to it a scruple of Elixir vitrioli mynsichti [Mysicht's Acid Elixir of Vitriol – a patent remedy] and then it is a powerful stomachical, and will cause digestion: But sometimes it has past the Liver, and hath not been well concocted there, but is sent as it were half digested into the Veins, and so there is no third concoction; it doth not make blood fit to nourish, and now it is a confirm'd Surfeit, and 'tis like the Surfeit spots come out; and there's a Feaver, and loathing of Food, but a great thirst, and desire of more cold drink.

Now ashore 'tis common in this case to run to the Apothecaries for Surfeit water [a digestive cordial], and when he hath drank that, and not the better; then to the Doctors, but it is commonly too late for't, for many a man loses his Life by such delayes, and by trusting to the Surfeit water only. You are here to give discussing Clysters: As,

Rx. Decoct. Com. pro Clyst {ounce}j. Eolect. Cariocostin. {ounce}j. f. enema.

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And let blood before it is too late; for abateing the great quantity of boyling blood is a great help: then purge from the most remote parts, with

Rx. Electu. Cath. regali {dram}ij. either in Bolus, or a Glass of Wine:

For this is one of the best in this case: Or, If he cannot take this: Then,

Rx. Tinctur. Cathart. Grulangij {dram}j. in a Glass of Rhenish [wine] is a good Medicine; and Pil. Ruff. {dram}f. is approv'd.

When these things are first done, then your Surfeit water will do good: The best of Surfeit water is,

Rx. Aqua papaveris composite {ounce}ij. Tinctura Croci. {ounce}j. Elix. Vitrioli {scruple}j. Thriac. Lond. Nova, {ounce}j.

Let him drink this in a glass of choice Canary, and sweat him well. These things will cure and cause a good digestion in all parts." (Jhhn Moyle, Abstractum Chirurgeriæ Marinæ, p. 104-7)