While Stephen Maturin, physician extraordinaire, is depicted as something of a medical genius throughout our beloved series, medical procedures and cures during his time were not always effective. It’s simple fact that more men in the Royal Navy during the 18th and early 19th centuries died of disease than anything else. In the late 18th century, however, a real physician made sweeping changes to the medical policy of the Royal Navy. These changes laid the foundations for Patrick O’Brian’s depiction of Maturin’s medicine.
Sir Gilbert Blane’s (1749-1834) connection with the service began in 1779, when he went to sea with Rodney as his private physician. He was soon appointed as physician to the fleet, and was present in six general engagements. He presented two Memorials to the Admiralty on the health of the fleet, and the adoption of his suggestions led to very rapid general improvement, shown in a marked decrease of mortality.
His recommendation of the supply of lemon-juice for the prevention of scurvy in 1793 was adopted throughout the Navy in 1795.
Gilbert Blane, M.D., etc., Observations on the Diseases of Seamen, p. 323. Third Editions 1799.
1 Delivered to the Board of Admiralty in October, 1781.
Proposing Means for preventing the Sickness and Mortality prevailing among His Majesty’s Seamen in the West Indies.
I HAVE for the two last years attended a squadron, consisting seldom of less than twenty ships of the line, in quality of physician to the fleet at Barbadoes and the Leeward Islands. I received, by the order of the Commander in Chief, a monthly return from the surgeon of each ship, setting forth the diseases, deaths, and other circumstances of the respective ships’ companies. I also superintended the hospital of the place where the fleet happened to lie when in port. These advantages have afforded me an intimate knowledge of the nature and causes of the sickness and mortality among the seamen, both on board of their ships and in hospitals.
It appears by my returns that there died in the course of the twelve months preceding July last, on board of ships, seven hundred and fifteen seamen and marines, of whom only fifty-nine died in battle and of wounds. There died in the same time in hospitals eight hundred and sixty-two : so that out of twelve thousand one hundred and nine men, which is the sum total of the complement of twenty ships of the line, there have perished in one year one thousand five hundred and seventy-seven, that is nearly every seventh man.
There were also sent to England in the same year, three hundred and fifty men, disabled by lameness and chronic complaints, the greater part of whom will be for ever lost to the service.
The degree of sickness is very different at different times ; but it appears, by the returns that, at a medium, there has been one man in fifteen on the sick list.
When it is considered that sickness is almost entirely confined to ships of two and three decks, and that some of these are as healthy as frigates and merchant ships, though in the same circumstances of service with others that are extremely sickly, we are led from hence to infer that sickness is not in its own nature unavoidable, and we are encouraged to hope that the attainment of general health is within the compass of human management.
I humbly and earnestly solicit attention to some of the most material observations and conclusions which have occurred in the course of a service which, though short, has been extensive; and whatever is here proposed has this recommendation, that it is easily practicable, and is no addition to the public charges.
First: I hardly ever knew a ship’s company become sickly which was well regulated in point of cleanliness and dryness. It is the custom in some ships to divide the crew into squads or divisions under the inspection of respective officers, who make a weekly review of their persons and clothing, and are answerable for the cleanliness and regularity of their several allotments. This ought to be an indispensable duty in ships of two or three decks; and when it has been practised, and at the same time ventilation, cleanliness, and dryness below and between decks have been attended to, I have never known seamen more unhealthy than other men. The neglect of such attentions is a never-failing cause of sickness.
Secondly: Scurvy is one of the principal diseases with which seamen are afflicted; and this may be infallibly prevented, or cured, by vegetables and fruit, particularly oranges, lemons, or limes. I am well convinced that more men would be saved by a purveyance of fruit and vegetables than could be raised by double the expense and trouble employed on the imprest service ; so that policy, as well as humanity, concur in recommending it. Every fifty oranges or lemons might be considered as a hand to the fleet, inasmuch as the health, and perhaps the life, of a man would thereby be saved.
(The rest of Blane’s suggestions are given in the summarised form in which he presented them at the end of the memorial.)
Thirdly, The substitution of wine for rum. (Blane’s footnote: Had I then known the salutary effects of porter and spruce beer, of which I have since been convinced, I should have proposed them as substitutes for rum.) (Captain’s note: Stephen would be all for this one! Jack… Not so much.)
Fourthly, The providing of an adequate quantity of necessaries for the sick.
Fifthly, The gratuitous supply of certain medicines.
Sixthly, The curing of certain diseases on board instead of sending them to hospitals; and,
Lastly, The preventing of filth, crowding, and the mixture of diseases in hospitals, by proper regulations, and by establishing hospital ships.
I beg leave again to call to mind that 1518 deaths from disease, besides 350 invalids, in 12,109 men, in the course of one year, is an alarming waste of British seamen, being a number that would man three of His Majesty’s ships of the line.
Supplement to the Memorial delivered last Year to the Board of Admiralty (p. 334).
SINCE my return to my duty on this station, additional experience has afforded me farther practical confirmation of the utility of the former proposals.
The great squadron employed on this station has, by the attention of the Commissioners of Victualling; and also of the Commander in Chief, been supplied with most of the articles recommended, in such quantities as to prove their efficacy; and indeed the small degree of mortality in comparison of former times is a sufficient demonstration of this.
I beg leave to give an instance, in the Formidable, of the great and salutary effects of the proposed improvements. This ship left England, furnished not only with sour kraut and molasses, in common with most others in the squadron, but what was peculiar to herself was an entire supply of good wine in place of spirits; and an experiment has been made in this instance, under my own eyes, to ascertain what degree of health it was possible to attain in a great ship in this climate. With the above advantages together with good discipline and medical care, no man 1 died of disease from December, 1781, to May, 1782, and only thirteen were sent to hospitals, whose complaints were small-pox and ulcers. In the months of May and June last, when at Jamaica, there died of disease in this ship three men, and seventeen were sent to the hospital, most of whom had contracted their sickness on board of French prizes.
In the rest of the fleet the health was in proportion to the wine and other refreshments, and the cleanliness, good order, and discipline observed.
In the squadron I attended the last five months, which seldom consisted, during the last three months of that time, of less than forty ships of the line, there have died of disease about 350 men, and about 1000 have been sent to hospitals; a degree of sickness and mortality which, though not greater than what frequently prevails in Europe, I am persuaded would have been still less, had the improvements proposed been complied with in a manner more extensive and complete, and had the general rules of discipline and cleanliness been kept up with due and equal strictness throughout the fleet.
At Port Royal, Jamaica,
July 16, 1782.
1 The authenticity of this fact, as well as every other assertion in this work relating to the mortality in the fleet, may be proved from the ship’s books, deposited at the Navy Office. (Blane’s foot-note.)
The sick and wounded of the Navy were first received into Haslar hospital in the year 1754, and it was completed about two years afterwards. Plymouth hospital began first to be occupied in 1760, but was not completed till 1764.
The most remarkable point of comparison exhibited in this table 1 is that of the late war 2 with France, which lasted five years, with the five by, by-past years 3 of the present war. It appears that in these two hospitals alone, there were upwards of 27,000 more patients admitted in the former than the latter period, though a greater naval force is now kept up than was ever known in this country, and a greater proportion of it on home service than in the late war. The principal causes of this seem to be : 1st, That the navy at the commencement of this war was manned with less impressing than on the like occasions in former wars. The foul air produced by the crowding, and bad accommodation attending the methods of securing impressed men, previous to their distribution, has already been stated as the principal cause of the general infection prevailing in the beginning of wars. 2dly, The greater observance of cleanliness and dryness, and the stricter enforcement of discipline, in consequence of the conviction now entertained by officers, of the indispensable necessity of these to the health of the men under their command. 3dly, The general use of lemon juice, so judiciously and liberally allowed to ships at sea for the three last years. 4thly, The late increase of encouragement to surgeons, and the operation of the regulations established and put in force by the medical board of the navy.
1 `Table showing the number of men admitted, and who have died at Haslar and Plymouth Hospitals, from the year 1755 to the year 1797′
2 The American War.
3 1793-7, inclusive.
We may consider all water kept in wooden vessels as more or less liable to putrefaction ; but there is a substance, which is neither rare nor costly, that effectually preserves it sweet. This is quick lime, with which every ship should be provided, in order to put a pint of it into each butt when it is filled. In the year 1779 several ships of the line arrived in the West Indies from England, and they were all afflicted with the flux, except the Stirling Castle, which was the only ship in which quick lime was put into the water; nor does it spoil the water for any culinary purpose.
It would certainly be for the benefit of the service that a uniform should be established for the common men as well as for the officers. This would oblige them at all times to have in their possession a quantity of decent apparel, subject to the inspection of their superiors. It would also be less easy to dispose of their clothes for money without detection, and desertion would also thereby be rendered more difficult.
The greatest evil connected with clothing is the infection generated by wearing it too long without shifting, for the jail, hospital, or ship fever seems to be more owing to this than to close air.
The great degree of health at this time1 enjoyed by the ship’s company of the Agamemnon deserves particular attention, as it seemed to be owing to a circumstance in the mode of victualling which might, without any expense, and with little trouble, be rendered general in the navy. This consisted in the use of soft bread, that ship having been supplied about this time with flour in place of biscuit. For thirteen weeks the whole ship’s company had no bread but what was baked on board, and a certain proportion of it from that time till her arrival in England, in May, 1783, at which time there was not a sick man on the list.
1 December, 1782.