Health and Medicine at Sea, 1700-1900 (review)

This volume shows how ship's surgeons learned to pinpoint the causes of high mortality rates and to impose shipboard regimes that—if applied consistently—would measurably improve the odds of survival. The contributors represent different disciplinary backgrounds ranging across naval history, medical history, and the history of seaborne migration (voluntary and otherwise). By juxtaposing accounts of medical practices on slave trade ships, on Royal Navy vessels, on Australian transports, and on Kala Pani voyages carrying indentured workers from South Asia, this book demonstrates that contemporaries were well aware of the lessons learned and techniques perfected in other branches of maritime endeavor. After an uneven and gradual process of amelioration, these techniques yielded impressive results by the 1850s, when ten percent of emigrant ships arriving in Australia did so without losing a single passenger and two-thirds of the ships lost no more than five people in the course of the voyage. That Victorian success story, however, appears here as the refinement or culmination of a host of much earlier initiatives including the navy's fight against scurvy and the efforts of several generations of slave ship owners to lower the death rate and boost their profits on the Middle Passage. Overall, the essays reveal continuity—rather than jarring changes or abrupt transitions—between the Victorian decades and the period that preceded them. Without explicitly articulating this as a goal, Health and Medicine at Sea works to undermine facile dichotomies between the Age of Sail and the subsequent Age of Steam.

Likewise, this book helps us see that what is sometimes called, a bit derisively, the Old Navy was far from indifferent to innovative methods. A broader discussion of the navy's investments in new technology would have been illuminating here. Before textile workers found themselves reorganized into the modern factory, the navy was constructing gigantic brick buildings for rope making on an industrial scale. It was also the navy that spanned shipyards with vast roofs of corrugated iron before that technique had been adopted in the construction of train stations. Indeed, the train stations turned to retired naval officers to supervise operations, because these men already had a respect for clockwork regularity. The navy's interest in precise scientific instrumentation had been refined by eighteenth-century controversies about the exact freezing temperature of sea water and the best way to determine longitude at sea. The navy applied a similar inquisitive and experimental approach to matters of diet and provisioning. New theories about the chemistry of digestion resulted in the manufacture of the world's first carbonated beverages as a possible remedy for scurvy. The challenges of preserving food on lengthy Arctic expeditions led to the invention of the tin can, although, to the consternation of the expedition members, foresight failed to suggest the need to simultaneously invent the can opener.

With all this in mind, the achievements featured in this volume seem less surprising or unique. Navy funds sponsored medical research projects on the relationship between diet and disease in the fleet, gathering statistics and instituting some of the first modern clinical trials. The subject of study could be as elementary as whether serving broth to sick sailors made a difference or not, but once refined, this methodology could be applied to other problems and the published results made part of the permanent public record, where later generations would debate their meaning in journals like the Lancet. The formal study of tropical diseases also grew out of problems involved with treating sailors in those climates, an expensive endeavor; for example, the Sick and Hurt Board found that it had spent 400,000 in one 1795 accounting, primarily on illnesses contracted in the East and West Indies. Thus, the navy's drive to improve survival rates at sea resulted in predictable educational innovations such as the Regius Chair of Military Surgery at the University of Edinburgh, but also in the creation of the London School of...