Care at the mercy of the voyage
A sailor who fell ill or was injured at sea was far from hospitals, with only the resources of the ship. Medical care depended on who was aboard, what supplies had been loaded, and whether the weather and the situation allowed treatment. In many merchant ships, no trained medical person sailed at all, and the captain or a mate used a medicine chest and a printed guide. Large warships and some passenger or company ships were better served, and medical practice developed there first.
Medicine in the age of sail was limited by the knowledge of the time. Germs were not understood until the second half of the nineteenth century, anaesthesia was not available until the 1840s, and antibiotics came in the twentieth century. Much of the treatment was based on older theories, such as bleeding and purging, which are now seen as ineffective or harmful. Historians stress that surgeons often did what they could with what they knew, and some of their practical skills, such as setting fractures and dealing with wounds, were useful.
The naval surgeon
In the Royal Navy, larger ships had a surgeon, with one or more assistants known as surgeon’s mates, who worked with a loblolly boy and later with sick berth attendants. Surgeons were examined before appointment, in earlier centuries by the Barber-Surgeons’ company, and later by successor bodies. The status of naval surgeons varied; they were often ranked as warrant or commissioned officers, though pay and standing were lower than for combat officers, and the profession was not always attractive. Reform in the eighteenth and nineteenth centuries gradually improved both pay and rank.
On a warship, the sick were treated in a sick berth, usually near the forward part of the ship, with the surgeon’s cabin and stores nearby. During battle, the surgeon and assistants worked in a space below the waterline, often on the orlop deck, to receive wounded men. Amputation was a standard treatment for shattered limbs, performed quickly because anaesthesia was not available. The surgeon William Beatty attended Nelson when he was fatally wounded at Trafalgar, which has become one of the best-known scenes of naval medicine, though it was a case in which little could be done.
Diseases of the ship
More sailors died of illness than of combat in most wars of the age of sail. Scurvy was the most famous problem, and it was the dominant killer of crews in scurvy at sea on long passages. But other conditions were also common: typhus, often called “ship fever” or “gaol fever” because of its link to crowded and dirty conditions; dysentery; typhoid; and, in tropical waters, malaria and yellow fever. These diseases could sweep through a crew or a fleet with severe effect.
Medical reformers pushed for better hygiene. James Lind, who is best known for scurvy, also wrote on how to protect the health of seamen and on fevers in ships, and in 1757 published an essay on preserving sailors’ health. Practices such as ventilating the lower decks, keeping ships cleaner, fumigating with smoke or vinegar, and providing clean clothing were promoted, and some of them helped even though the underlying causes of disease were not yet understood. Naval hospitals, such as the one built at Haslar near Portsmouth in the eighteenth century, offered a place to treat the sick ashore.
Merchant ships and the medicine chest
Merchant ships often had no surgeon, and the captain usually dealt with illness with a medicine chest, which contained drugs and basic instruments. Printed guides for captains described common ailments and treatments. How well this worked depended on the captain’s experience and on luck. Ships carrying large numbers of people were sometimes required by law to carry a surgeon, and examples include convict transports, which had a surgeon in charge of the health of prisoners, and many emigrant vessels as regulations developed in the nineteenth century.
On slave ships, a surgeon was commonly carried, with the aim of keeping the captives alive as a commercial cargo. The records kept by some of these surgeons are a significant source for historians of the Atlantic slave trade, and they document the appalling conditions and mortality on board. The wider history of slave trade ships is a large subject, and here only the medical side is noted.
Passengers could be even more exposed than crews. Emigrant steerage in the mid-nineteenth century saw outbreaks of disease on crowded ships, and these led to regulation and to quarantine measures at ports of arrival. Later steamship companies appointed ship’s doctors for passengers.
Steam and the changing job
Steamships changed medicine afloat. Shorter passages meant fewer voyages long enough for deficiency diseases, and better communication allowed some advice to be sought from ashore. Engine rooms created new hazards, including burns, scalds and heat exhaustion among firemen and stokers, and accidents with machinery. On the larger vessels of ocean liner history, qualified doctors were appointed and ship’s hospitals were fitted from the later nineteenth century. In the early twentieth century, wireless telegraphy allowed ships to request medical advice by radio, though the details of when and how it became routine varied with the company and the country.
Practice, belief and limits
It is easy to look back on the medicine of the period with horror, but it helps to read it in context. Surgeons worked fast and under hard conditions, and much of what they did, such as setting broken bones, binding wounds and controlling bleeding, was valuable. Beliefs about disease shaped treatment, and some of those beliefs encouraged improvements in cleanliness and ventilation. At the same time, bleeding, purging and unclean instruments often did more harm than good.
For ordinary sailors, the presence of a surgeon was a limited comfort. Many preferred to rely on shipmates, folk remedies or their own endurance, and fear of the surgeon’s saw was reportedly widespread. Even so, the long development of shipboard medicine, from the barber-surgeon to the qualified ship’s doctor, helped lay the foundation for later work in naval and public health, including studies of diet, ventilation and the prevention of disease in crowded communities.