Age of sail ships were utterly reliant on the health and strength of their crews. Before the introduction of steam winches in the 19th century, the only source of power available to them were the muscles of the sailors. Some of the forces involved were enormous. Anchors, cannons and upper masts could weigh many tons. The topsail of a large frigate had an area of over three thousand square feet. Hauling it against the pressure of the wind required the combined strength of almost everyone on board. Devices such as blocks helped to spread the load, while capstans permitted several hundred men to apply their combined weight to a single rope, but ultimately it needed the crew to be up to the task. The person responsible for maintaining their health was the ship’s surgeon.
The importance of the role has long been recognised on warships. The Roman Navy under Emperor Hadrian included a surgeon aboard each of its warships, and paid them at twice the rate of the other officers. Tudor warships all carried naval surgeons, and the medical equipment recovered from the wreck of the Mary Rose, which sank in 1545, contains instruments of a design that would not be out of place in a modern operating theatre. In the Stuart navy, surgeons were pressed from hospitals ashore, in much the same way that sailors were taken from merchant ships. This often led to a variable quality of personnel, so the position was formalised, and in the 18th century every Royal Navy ship carried a Naval Surgeon who was a warrant officer appointed by the Sick and Hurt Board.
The range of patients the surgeon had to deal with was wide. With so much hauling and heavy lifting to perform, ruptures, hernias and crush injuries were common. A protracted run ashore could bring with it a spate of cases of venereal disease, for which the surgeon could claim an addition to his pay at the rate of £5 per 100 cases treated. As European powers colonised the globe, the crews of their warships were increasingly exposed to fresh hazards. Contact with the shore in the tropical waters brought the risk of diseases like Yellow Fever, which could spread quickly through a packed lower deck, leaving a ship stranded without enough crew to sail her. Long oceanic journeys came with different health issues, caused by the crews restricted diet. Scurvy, which is caused by a lack of vitamin C, killed an estimated two million sailors between Columbus’s first voyage in 1492 and the arrival of a practical cure in the late 18th century.
The busiest time for a naval surgeon was generally when his ship was in action. William McDonald, the naval surgeon on board HMS Colossus during Trafalgar, had to attend to almost two hundred casualties during the battle. The surgeon’s station was in the ship’s cockpit, a cramped, dark space below the waterline, where he could treat the wounded undisturbed by the fighting raging overhead. Iron cannon balls smashing their way through wooden ships make for horrific injuries. In an era before antibiotics, those that survived the trauma of the initial injury were highly likely to succumb to infection. The swiftest means to prevent this was to amputate the damaged limb, a procedure that was carried out without anaesthetic.
Horrific as the idea of such treatment may sound, the standard of care afloat was often considerably better than it was on land, where much of the population had no access to any medical attention. John Atkins, a naval surgeon who fought during the War of the Spanish Succession (1701-14), wrote several treaties on surgery. In them, he emphasised the importance of cleanliness, and the use of strong alcohol as an antiseptic, centuries before such practices were common ashore. As early as 1722, the French Navy opened the world’s first School of Naval Medicine at Rochefort, to train their medical personnel, while the British Admiralty opened the first purpose-built naval hospital at Haslar thirty years later.
Not all sailors were fortunate enough to receive their care from a physician with the skill of a John Atkins, however. The quality of some naval surgeons could be poor, with many unqualified or unsuitable candidates being appointed to the role. In 1758, the captain of the Elizabeth described his naval surgeon as “very idle… [and how he] …would not trust a sick dog to his care.” Even the most dedicated practitioner still had to battle with the general ignorance of the age. This was a period when medicine was dominated by the notions of the four humours derived from the ancient world. Ideas about infection, and the spread of decease were very primitive. One medical historian has estimated that it was not until the 1920s that doctors in general began saving more patients than they killed.
But slowly and steadily, the quality of care afloat did improve, thanks largely to the efforts of two Scottish, and one Cornish medical professional. Dr James Lind, a Scottish naval surgeon, is often regarded as the father of modern naval medicine. He found the cure for scurvy by carrying out the world’s first randomised medical trial when he was serving on board the Salisbury in 1747. William Northcote, the Cornishman, produced a comprehensive book called The Marine Practice of Physic and Surgery, in 1770, which provided a textbook for all naval surgeons to use. The final Scotsman, and the most influential, was Sir Gilbert Blane. Having served under Admiral Rodney as physician of the fleet, he became a reforming commissioner of the Sick and Hurt Board, where he introduced a complete overhaul of the role of the naval surgeon. It was Blane who introduced citrus fruit into the sailor’s diet, as recommended by Lind. He also produced new regulations for Royal Navy ships, which were now to be kept scrupulously clean, properly ventilated, and sailors were to be issued with adequate supplies of soap (and made to use them). He also introduced a mandatory seven years of training for all naval surgeons, followed by an exam to prove their competence prior to being appointed.
By the time of Trafalgar, the ships of the Royal Navy were staffed by naval surgeons like William McDonald on HMS Colossus, who had been trained under Blane’s reforms. The effect of their work was not just of humane benefit, but also helped to swing the battle in the Royal Navy’s favour. Research has shown that superior medical practice meant that Nelson’s sailors were considerably healthier than their opponents, and so were able to fight longer and harder.