Ships Surgeons as Physicians and Hygienists: Health at Sea During the Seven Years’ War and Napoleonic Wars

Abstract

The rise of England as a global empire in the Seven Years’ War (1756-1763) depended on the health of the seamen in the Royal Navy. Under constant danger from combat and manning a sailing battleship in open water, their greatest risk were contagious disease and dietary deficiencies, notably scurvy. During the conflict disease and desertion resulted in nearly 100 times the deaths from direct contact with the enemy. Tasked with the treatment of grievous injuries far from land, ship’s surgeons had the greater responsibility of maintaining the general health and nutrition of the crew. Reformists like James Lind, Sir Gilbert Blane, and Thomas Trotter led to improvements in nutrition, especially the general issue of antiscorbutic fruit, fruit juice, and fresh vegetables; smallpox vaccination; and improved cleanliness of clothing and berths. The better overall health of its seamen was an important factor in the Royal Navy’s decisive victory over France at the Battle of Trafalgar (1805).

From Danish Invasions to the Seven Years’ War

The English fought naval battles since Alfred the Great repelled the Danish invasions of the nineth century. France and England battled for control of the English Channel for centuries. The Royal Navy got its start when Henry VIII assembled a fleet of ships built for battle against French attacks and blockades, launching his first flagship, the “Great Harry,” in 1514. ¹

With battleships came surgeons. In 1513, there were 32 surgeons of various ranks in the Navy. They were employed only for the duration of each engagement, which were usually brief and lasted only a few hours. Surgeons dealt with injuries incurred in battle. Sick bays in the orlop deck quickly overflowed with the dead and wounded when the fighting started. ²

Battles were in the English Channel and waters surrounding the British Isles. After the engagements ships’ captains prevailed on local officials to allow the injured and sick, many already dead and near death, to be cared for on shore by townspeople and in hospitals in the towns that had one.

Men that were expected to return to duty but needed longer confinement were transferred to a hospital ship that served as the medical command center of the fleet. The vessels were not purpose-built, but instead were former warships about to be decommissioned, its decks cleared to accommodate the sick. In 1743, the Blenheim was converted to take in 255 patients at Portsmouth with areas assigned to skin irritations, fever, dysentery, and malaria. ²

They were under the care of the physician of the fleet. Among his responsibilities was to visit each ship and assure the surgeons’ instrument and medical chests were adequately supplied. Surgeons had to pay for all drugs from their own pockets, so the unscrupulous thus had an incentive to scrimp. ³ The physician of the fleet reviewed all surgeons’ journals and prepared a weekly health summary for the admiral. He had no authority over the ship’s surgeons, who answered to the ship’s captain. He instead encouraged best practices and insisted on corrective measures when deficiencies were uncovered. ²

Landside hospitals were the final stations of care. In London, Bart’s and St Thomas’s had beds assigned for seamen. In 1705, the first naval hospital opened in Greenwich as a royal charity devoted to the care of retired sailors. The first facilities devoted to serving personnel under the Admiralty was Haslar at Portsmouth (1754) and the infirmary at Plymouth (1762). These giant facilities accommodated nearly 2,000 and 1,250 patients, respectively. Haslar in the 1780s had a physician, 2 surgeons, a dispenser or apothecary in charge of drugs, 7 surgeons’ mates, 3 assistants, and many nurses. ² “By the 1790s,” wrote David McLean, professor of history at King's College London, “the navy built and ran the most advanced hospitals anywhere available.” ³

Nostrums, Hygiene, and Nutrition

During the Seven Years’ War (1756-1763), Britain’s first global war of conquest, British regulars in the thousands were sent to North America (20,000), Caribbean (7,500), and India (4,000). The Western Squadron patrolled the Channel and blockaded French ports, keeping ships at their watery stations for months. At the peak of the conflict 80,000 men were deployed at sea.

The strategies of expeditionary amphibious forces in faraway contests and blockades in the Channel and French waters decimated crews with contagious illnesses and dietary maladies. Weeks at sea made seamen vulnerable to scurvy. “Troops on both sides were crowded into small holdings with limited provisions and fragmented sanitary and medical arrangements,” wrote Erica Charters of the University of Oxford. ⁴ The foul, filthy conditions supported the prevalent pathological concept of miasma as epidemics of fever, ague, flux, and death swept through ships. In the Seven Years’ War, the navy lost only 1,512 to direct enemy action but 133,700 from desertion or illness. ³

A ship’s surgeon thus had the challenge of the wellbeing of an entire crew. The Apothecaries’ Hall sold the mandated medications, but none were curative. Several had known benefit (opium, laudanum, ipecacuanha, Peruvian bark, aloe, silver salt), but more were mere nostrums (myrrh, capsicum, camphor, magnesia, mint oil). Some were toxic (corrosive sublimate, crude mercury, golden sulfur of antimony). ⁵

McLean pointed out that long voyages and blockade assignments forced surgeons to become physicians and hygienists.

Flying wood and metal always carried men away but deaths and wounds incurred in battle pale in significance before the numbers to coming to disease. By its nature, life at sea was hazardous. Diets were inadequate, hygiene poor, accidents common, and men exposed to ailments little understood in unfamiliar climates. ³

Men’s health depended on their nutrition, ready supplies of antiscorbutic fruit, fruit juice, and fresh vegetables, and cleanliness and hygiene on board. Captain James Cook proved the concepts after the Seven Years’ War during his long voyages into the Pacific (1768-1779). As a young officer he saw that 20% of a crew might be lost to disease during a bad Atlantic crossing. Now as captain he made sure his men were well supplied with clean water, ripe fruit, crisp vegetables, and unspoiled meat. Their clothes and bedding were inspected for cleanliness and their quarters kept as clean and dry as practicable. On his second voyage (1772-1775), he lost only one man from disease. ³

The Seven Years’ War antedated Cook’s voyages, however, and the essential nature of the health of a fighting force had not yet been ingrained as military doctrine. Admiral Edward Hawke, in command of the blockade at Quiberon Bay (1761) and future First Lord of the Admiralty (1766-1771), was frustrated by the inability—or outright refusal—of the Admiralty to provide sufficient ships to allow regular rotations on shore for rest and nourishment. The victualing sloops that shuttled food to ships at their blockade stations were habitually late and inadequate, with livestock dying and fruit and vegetables rotting before delivery. ⁴

Hawke himself felt the ill effects of months on ships, once spending 31 weeks on board during the winter of 1759-1760. “Indeed,” he wrote in early 1760 after finally reaching shore, “I have had a very long tiresome and fatigue in cruize, and as hard a piece of service to go thro with, as cou’d be put upon any Man, but thank God, I waited thro it at last.” ⁴

Creation of a Devastating Fighting Machine

Within the Admiralty the health of His Majesty’s seamen was under the Sick and Hurt Board that managed the navy’s practitioners and hospital facilities. By itself it had no authority to introduce medical initiatives. But during the Seven Years’ War the Admiralty sought its medical advice, even though it had only 2 physicians on its four-member commission. ⁴

The board took seriously the health hazards of shipboard life and sought workable solutions. To supplement the diet of seamen and address the problem of storage of foodstuffs over long periods, the board directed using leftover beef and mutton to produce small cakes of dried soup. Easily stored, dried soup was reconstituted in boiling water and served with vegetables and grains. It became part of the general issue throughout the 18th century. ⁴

When the Seven Years’ War began, James Lind’s (1716-1794) discovery that citrus fruit cured and prevented scurvy (1747) was known for more than a decade. Without a regular supply of fresh fruit and vegetables the disease was inevitable. Scurvy was thus less a medical problem, but more one of logistics.

The Sick and Hurt Board thus sought shortcuts that might avoid the need for regular requisitioning of fruit and vegetables. Dried apples failed to address scurvy in the same manner as dried soup supplemented basic nutrition. The naval hospitals trialed other purported cure-alls, but each failed. ⁴

In 1795, at the insistence of influential advocates like Admiral Hawke and medical reformers like Sir Gilbert Blane (1749-1834) and Thomas Trotter (1760-1832), lemon juice finally became part of the daily issue in the men’s grog. ⁶ Lord Nelson obtained 50,000 gallons of Sicilian lemon juice in 1805, the year of the Battle of Traflagar. ⁷

From his direct experience as ship’s surgeon in the Royal Navy and the slave trade Trotter was responsible for many health reforms. On a ship transporting enslaved persons to the West Indies, he was horrified by the inhumane conditions and the death toll from scurvy. He published the first of his observations on scurvy in 1786, a version that was later translated in German and later republished in America. His writings on scurvy in 1794, the year of his appointment as Physician to the Channel Fleet, were instrumental in supporting Blane’s campaign for the general issue of lemon juice 2 years later in 1796, the year of the latter’s appointment as commissioner to the Sick and Hurt Board. ⁶

Trotter joined the Vengeance in 1793 during a typhus outbreak. He transferred the most serious cases to Haslar and isolated the dozens that remained on board. He instituted corrective measures to counteract the pathogenic effects of miasma by fumigating below deck with sulfur and arsenic, keeping the holds dry, and cleansing the ballast water.

An inveterate writer, he published his three-volume summary of nautical medicine, Medicina Nautica, in 1797, 1799, and 1804, with sections on scurvy, contagion, typhus, yellow fever, catarrh, dysentery, and smallpox. ⁶ In contrast to the 50 year delay between Lind’s discovery and the binding order for lemon juice, only 2 years followed Edward Jenner’s creation of the smallpox vaccine in 1798 and the compulsory vaccination order in 1800 for all personnel who had not yet had the disease. ⁸

“The better health of its seamen,” wrote David Haycock, curator at the National Maritime Museum in Greenwich, “had played an important part in Britain’s victory over France.” ⁹ The work of reformers like Lind, Blane, and Trotter, in the words of Trotter biographers Brian Vale and Griffith Edwards, “helped turn the Fleet into the devastating fighting machine that routed the French at Trafalgar.” ¹⁰