Poxed & Scurvied: The story of sickness and health at sea by Kevin Brown
Seaforth Publishing, Barnsley, 2011, £25 (hb)
246 pages with 18 black and white images, bibliography, index
ISBN 978-1-84832-063-5
Kevin Brown's book is the latest, and most ambitious, example of the growing interest in maritime disease and medicine. Its purpose, as demonstrated in the sub-title – forget the ‘sexed up’ references to pox and scurvy – is to tell ‘the Story of Sickness and Health at Sea.’ Inevitably, the need to cover a period that ranges from the transportation of plague-carrying rats in the fourteenth century to the work of the SS Uganda as a hospital ship during the Falklands, presents a formidable challenge. How does one manage such an enormous historical panorama?
One of the techniques favoured by the author is to adopt a thematic rather than a strictly chronological approach in which each of the ten chapters comprises a more or less separate essay. Thus, ‘Deadly Cargoes’ deals with the transference of diseases like plague and syphilis into Europe, and smallpox and influenza out of it, in and after the Age of Exploration; ‘The Surgeon's Mate’ with maritime health from the Tudor to and Jacobean periods; ‘Sick and Hurt’ with the institutionalization of care up to the seventeenth century; ‘Plague at Sea’ with the position of surgeons, the development of hospitals and major maritime diseases during the eighteenth; England's Expectations' with the situation during the Napoleonic Wars; ‘The Middle Passage’ with the slave trade; ‘Huddled Masses’ with convict and immigrant ships in the nineteenth century; ‘Sea Airs’ with the development of luxury passenger and cruise liners; and ‘Bright and Breezy’ and ‘Stormy Waters’ with medicine in the Royal Navy from Victorian to modern times.
Another is to adopt the style of the journalist rather than the more mechanistic method of the historian. Thus, the narrative moves swiftly and deftly across the landscape, is illuminated by set piece events and dramatic quotations to provide the human dimension and is replete with anecdote and detail. As is to be expected from the Curator of the Alexander Fleming Museum at St Mary's Hospital, the underlying research is broad-ranging and, generally embraces the latest findings. One of the exceptions is the prominence still given to Gilbert Blane and the claim that he was responsible for the adoption of lemon juice by the navy in 1795 – supported by an unattributed quotation which purports to come from Blane but in fact was written by Dr Robert Blair, the Commissioner of Sick and Hurt who was actually responsible!
Although the book is comprehensive, one problem with the author's method is that the various chapters are tenuously linked and there are sometimes breaks in continuity. ‘Plague at Sea’, for example, ends its treatment of scurvy in the eighteenth century with the voyages of Captain Cook, while the next chapter, ‘England's Expectations’, jumps forward 30 years to a set piece description of the death of Nelson. The only acknowledgement of the important developments which took place in the interim is an almost off-hand reference to the fact that lemon juice had been introduced into the navy as a regular item of diet in 1795 – although this is probably the most significant single event in the conquest of the disease. True, with other themes it is possible to trace the sequence of events across chapters, but a weak index makes the task difficult.
By favouring the dramatic however the author has succeeded in making the subject accessible and in producing a series of fascinating and gripping accounts of maritime sickness and medicine that will appeal to the general reader and the specialist alike. Nevertheless, purists will feel that to generalize from the particular and to rely so heavily on contemporary quotations – sometimes from people with axes to grind – will occasionally distort as well as illuminate. Undue prominence, for example continues to be given to Roderick Random, and hanging the medical and hygienic practice of the Napoleonic War on what Nelson did obscures the fact that these methods were common and were being applied by other commanders like Howe, Hood, Gardner and St Vincent.
Some chapters would also have benefitted from a more deliberate emphasis on the wider medical and physical context. True, this is less important in the earlier period, when the scientific background was weak and can be adequately covered by brief references to Hippocrates and the four humours, and in modern times, when knowledge of is principles can be taken for granted; but it is important to an understanding of the eighteenth and nineteenth centuries. Indeed, it is ironic in view of the book's title that scurvy is the topic that suffers most from this lack of context. As a result, the reader is left with the impression that the field was dominated by the often bizarre remedies traditionally used by seamen and that doctors had no ideas as to the nature of the disease. In fact, the medical establishment had a cogent theory as to what caused scurvy and how it could be cured. Internal putrefaction, treated by drinking elixir of vitriol, was the dominant idea until the 1760s when it was succeeded by MacBride's ‘fixed air’ variant, cured by drinking huge quantities of fermenting malt and wort. Thus, Captain Cook did not choose to favour malt and wort and ignore lemons as is implied: he did so because he had been ordered to test the MacBride theory against the alternatives. Unfortunately, the medical establishment had got it wrong, and scurvy was only overcome when the navy defied current remedies in favour of the demonstrable benefits of lemon juice.
Likewise, while Brown's book is strong on atmosphere, the very scope of its coverage means that there are inevitable mistakes in detail. Continuous service for ratings was not, for example, introduced in 1823; administrative control of Haslar was not transferred to a naval officer in 1783; and the 132 slaves of the Zong were not thrown overboard because they were sick and Captain Collinwood wanted to protect the rest from infection.
Details like this may worry the specialist, but they are unlikely to be important to the general reader. The author's knowledge of the subject is wide ranging and the way he has woven an enormous amount of material into a readable and informative narrative is impressive. In spite of very minor blemishes, this book is well worth reading, value for money and a worthy and long overdue supplement to Keevil, Lloyd and Coulter's 50-year-old, and increasingly dated, Medicine and the Navy.
http://dx.doi.org/10.1080/00253359.2013.767562
© Brian Vale