Medicine Under Sail (review)

This book begins with a brief discussion of "naval medicine" from antiquity to the nineteenth century as an introduction to short biographically focused presentations of the practice of various naval surgeons in England from the sixteenth to the nineteenth centuries, with passing comments on hospital ships, surgery, and nutrition. The following chapters address the impact of disease and theories of causation and offer comments on Nelson, scurvy, beriberi, tropical fevers, and impressment. A chapter on shipwreck survivors and another on the slave trade, as presented, do not appear relevant. The medical care in the U.S. Navy is described from the Revolution to the 1840s.

It is difficult to list all the problems with this book. The author does not understand medicine in the seventeenth to nineteenth centuries. "Miasma" explained disease transmission, not causation. Pythogenic, contingent contagionism and zymatic theories are not discussed, nor are the reasons for acid-based antiscorbutics. Epidemic and murine typhus are conflated. "Quinine" (not isolated until 1820), is continually used instead of "the bark." U.S. Civil War amputation is wrongly described. Lind's classic experiment on scurvy is compressed to half a page—and Lind is not mentioned. Lind did "target citrus fruits." Benjamin Rush's medical theory is wrongly presented. Larrey did not use the cautery. Many more medical errors could be listed. The presentist approach is distracting and could confuse a nonmedical reader.

The naval history is equally bad. St. Vincent, not Nelson, introduced hygiene and sanitation discipline to the Royal Navy. It was the Quasi War with France, not the "pseudo" war. Dutton's hot air invention is not a "pipe." St. Helena is in the South Atlantic, not the Pacific Ocean. European bribes to Barbary Coast rulers are ignored. The attack on the Philadelphia at Tripoli in 1805 makes no mention of Surgeon Heerman's inspiring letter. Nelson bought 20,000 not "50,000" gallons of lemon juice off Toulon. 1814 was not the "last war" of wooden ships. Impressment was legal, even when violently enforced. Napoleon was not "defeated by lemon juice and cannonades."

The footnotes are a disaster. Over half are incomplete; others are wrong. Some sources are both incompletely cited and not listed in the bibliography; there are a number of pass-through references. Press editing should have corrected these errors as well as removing redundant discussions. There is a very heavy reliance on the magisterial four-volume work by Keevil, Lloyd, and Coulter. The medical textbook approach by topic destroys chronology. The biographical focus and the accompanying over many snippets from books and letters prohibit a coherent narrative. Modern histories by Richman, Lewis, Goldowsky, Langley, Estes, Carpenter, and others are not used. The author, an orthopedic surgeon, says he, "has not written . . . just for the medical profession." Unfortunately the overabundance of medical and naval error prevents the book from being useful to students, physicians, and historians. It is not possible to believe that competent referees recommended publication—but even a distinguished press nods.