Medicine Under Sail. Friedenberg, Zachary B. 2002

Medicine Under Sail. Friedenberg, Zachary B. 2002

Friedenberg, Zachary B. 
Medicine Under Sail.
Naval Institute Press.
ISBN 1-86176-212-7. 

On all three Voyages, Cook had on board medical men called Surgeons: William Monkhouse, James Patton and William Anderson. I had wondered why they were surgeons and not just doctors, but did not find the answer until I read this book.

This book tracks the deployment of medical people on (mainly) European and American ships and the development of their knowledge and treatment of "the injured and the sick". Friedenberg points out that in ancient and medieval times there were no medical men aboard ships during short trips unless they were at war, when their role was to treat the wounded.
"By the eleventh century, barber-surgeons had taken over the task of surgery in the Mediterranean navies and… accompanied ships trading with England, and the practice of appointing barber-surgeons to ships spread to English ships." In 1540 the Company of Barber-Surgeons was formed and it examined and appointed surgeons to the Navy until 1745 when the College of Surgeons took over the role. A surgeon "held a warrant, was not even a commissioned officer… If the surgeon noted the outbreak of cases of scurvy and requested a stopover on an island to gather fresh food supplies, or if the anchorage was in an unhealthy part of the harbor and a change of anchorage indicated, he could be overruled by the captain." In addition the surgeon "had to provide medicines and procure instruments, paying for these out of his own pocket."

Friedenberg has an easy style of writing. He comprehensively describes the way the various diseases were recognised and distinguished without, in the process, losing the reader. He makes interesting the complex way the "precise causative agents of these diseases" was recognised, by those who sailed and those who pontificated from the land.
"The cause of all disease in the sixteenth to nineteenth centuries was thought to be toxic air rising from the ground in a miasmic cloud, or an effluvia of the breath of sick individuals, which contaminated the air and enveloped healthy individuals and sickened them. If large numbers of people congregated, someone in the crowd was responsible for spreading disease to others. In the absence of any suspicion of a bacterium or virus, the toxic air theory provided a reasonable explanation for contagion; the stink of putrefaction and filth contaminated the air and sickened people… To overcome these odors, ships were fumigated. Burning a tarred piece of rope, tobacco or gunpowder was used to overcome the evil odors, as well as hot vinegar, substituting one odor for another."
William Anderson on the Third Voyage often wrote in his journal entries like "Clean'd and smoak'd below".

The whole of the fourth chapter is devoted to scurvy which, says Friedenberg, "is almost totally confined to the human race and the primates, although guinea pigs also can become scorbutic." He describes its symptoms, the search over several hundred years for a cause, the partial successes and the final understanding. Lord Anson set sail in 1740 with a fleet that arrived at Brazil with "one-fifth of the crew so weakened by scurvy that they had to be carried ashore." Captain Hugh Palliser's experiments aboard HMS Sheerness are described, in which "he provided extra fresh provisions instead of salt port". Upon arrival at the Cape of Good Hope "not a man was ill with scurvy", an experience he used "to advise his friend, Captain Cook". Experiments continued, and in 1794 the men on HMS Suffolk received "two-thirds of an ounce of lemon juice mixed with grog and two ounces of sugar… it was necessary to add the lemon juice to the grog where it was certain to be drunk". When it arrived at Madras, India after 23 weeks there were no cases of scurvy.

In between times, James Lind and James Cook had been working hard. To many members of the CCS their stories are well known, and this book does them both justice. For Cook it brings together the salient parts of his journals and commands so one can see across all three voyages to study the effect of this one man's principles and guidance. "because fats and oils were thought to encourage scurvy, Cook ordered that all meat be heated to remove them; the resulting cooking grease was skimmed off and used to lubricate the blocks and riggings." Cook misunderstood which of his actions actually prevented scurvy so that his paper to the Royal Society in London on 17 March 1776 gave the wrong explanation.

Later chapters reflect on beriberi and typhus, death and disease in the slave trade, impressment and punishment, which I found just as interesting. William Bligh's epic voyage is given good coverage in the "shipwrecks and survivors" chapter and his maturing under Cook duly recognised. Whilst the subject might not appeal, at first, to everyone, Friedberg, an orthopaedic surgeon ensures that, once started, the read remains interesting and intriguing.

Ian Boreham

Originally published in Cook's Log, page 2001, volume 25, number 4 (2002).

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