From our modern Navy, with its high physical standards, preventive medicine, and up-to-the-minute equipment for treatment of the sick and injured, it seems a far cry, indeed, to the paucity of both means and efforts made to attain these highly desirable aims during the Nelsonian era in naval warfare. The literature of that era reveals a woeful lack of appreciation of these paramount principles and an apparent callousness and often utter disregard for the ills and physical miseries of the poor seaman. It is replete with accounts of the frightful ravages of disease, staggering morbidity and mortality rates, and incredibly inadequate means afforded for the care of the sick and wounded, even far below those standards usually recognized and accepted by the medical fraternity at large during this period.
Let us in fancy go on board one of the 74’s of the time and examine the activities of the Medical Department. We find, down aft below the lower or “first deck,” where the greater part of the main battery was carried, a sort of temporary deck, not wholly planked over, called the “orlop” or “over-lap” deck. It was practically below the water line and was therefore very dark and gloomy, being illuminated only by a few tiny scuttles in the ship’s side and by ship’s lanterns or “purser’s glims” in tin sconces. Clear aft on this deck was the after “cockpit,” where the senior midshipmen, master’s mates, and surgeon’s mates were berthed. This cockpit, though at best a dingy den, was of considerable size, for here, after an action, the wounded were brought to have their wounds dressed and to suffer amputations. The mess table for this space was used as the operating table and was not supplied the mess from any generosity of the government as furniture, but with this sole view in mind. This space probably measured usually about 12 feet square and from deck to beams about 5 ½ feet, so that its tenants were required to stoop and uncover upon entering to avoid both the possibility of dashing their brains out and crushing their head gear. The atmosphere, so far below the water line, supplemented by the reek of the bilges, can scarcely be imagined in this age and gave rise to a continual pestilential stench, but little relieved by the use of a rather futile wind sail which was rigged whenever favorable weather permitted.
Adjoining this foul cavern were cabins for the junior lieutenants, staterooms for the junior surgeon or surgeon’s mates, a somewhat glorified type of apothecary, purser, captain’s steward, and the ship’s dispensary, a little cupboard for the storage of bottles and splints, ointments, etc. The surgeon supplied his own instruments and kept them carefully among his other personal effects. After an engagement, the regular habitues of the cockpit slung their hammocks elsewhere and the space was given over to such of the wounded as had survived.
The surgeon, who messed in the wardroom and berthed in a tiny cabin near by, was required to pass a kind of entrance examination before the Transport Board in addition to that imposed by Surgeon’s Hall before he could secure his “Warrant.” We see that he was not really commissioned in the full sense at this time. He was generally looked upon as the “most independent officer in the ship,” his duties being essentially different from those of the executive. He had charge of all sick and injured seamen, of the medicines and medical comforts, such as they were, and of the ship’s hygiene generally.
Upon joining a ship going in commission he was required to examine the surgeon’s stores and to see that they were securely stowed away in the medicine chests or the sea dispensary referred to above. When the new crew of raised or “pressed” men came on board he was required to “sound” and examine them, not only for their service fitness, but for any traces of infections or contagious diseases, When any “quota” men, usually jail birds, petty thieves, vagabonds, etc., were received, he caused hot water to be prepared in order that these wretches could have their heads shaved and their bodies scrubbed “from clew to earring” and their clothing boiled to rid them of vermin.
At sea it was customary, if space, time, and other circumstances permitted, to rig a “sick bay” or small sea hospital shut away from the rest of the ship by canvas screens and as a rule located in the forecastle on the starboard side, but during action this sick berth was struck below and the surgeon and his crew repaired to the after cockpit out of the reach of enemy shot. To this sick bay any seaman feeling ill reported himself to the surgeon or his assistants in the forenoon. If found to be ill, he was removed from duty and berthed in the sick bay, where he was attended by “sick-bay sentinels,” usually detailed from among the “waisters,” or least necessary members of the crew. This was the nearest approach made to our modern hospital corps. These attendants kept the place clean, well fumigated, and sprinkled with vinegar.
Evidently a surgeon’s most common duty at sea was the treatment of ulcers, to which the seamen were very subject, due in great part to exposure, salt water, and untreated abrasions and lacerations as well ns to the common practice of kneeling on the wet, sanded decks while holystoning with the small stones known as “prayer books.” It was customary for the assistant surgeon to repair daily, in the forenoon, to the space about the foremast, where his “lob-lolly boy” or dresser banged a brass or iron mortar with a pestle as a signal for those affected to gather around and have their sores dressed.
In ships newly commissioned, typhus, or “jail” or “ship” fever, was very common and the surgeons did all they could, as we have seen, to prevent it by scrubbing and shaving the men and boiling or burning all clothes of those hailing from Newgate or other suspected prisons. But in spite of their efforts, typhus carried off large numbers every year and at times became a veritable scourge.
At sea the most dreaded malady of all was scurvy, primarily occasioned by the wretched and monotonous diet of the crew. The surgeons had standing orders to examine all seamen appearing in the least dejected or sickly and they were required to inspect the different divisions each Sunday morning before captain’s inspection for traces of this complaint and to weed out suspects.
The crew disliked the sick berth and were always reluctant to report themselves ill, because those in the sick bay had to go without their grog and tobacco. Frequently the division officers would help the surgeon to pick out a sickly man before his ailment had fully declared itself, and by these various means the epidemical complaints were partly kept in hand. In case a man exhibited the slightest trace of scurvy, he received a daily dosing of lime juice, a drink then newly instituted in the Royal Navy as an antiscorbutic, although its value in this connection had been pointed out by Anson during his famous cruise years before. Some ships which had no supply of lime juice used essence of malt, or molasses, or raw potatoes.
The surgeon was expected to have a number of dressings always prepared and available in case the ship should suddenly be brought to action. He was also expected to instruct the crew in the use of the tourniquet, a forerunner of our present “First Aid” instruction, so that men with shattered stumps might have some chance of surviving until the surgeon could take up their arteries. He was also required to visit all sick and wounded men twice daily, to see that the sick-bay stove “of clear burning cinders” was kept alight and to make a careful record in a journal of all the sick treated and of means taken to “avoid infections.”
These old ships, often built of wood improperly seasoned, were always damp and foul and “tended to produce diseases, bilious humors, and infections.” The ballast was usually dirty, the bilge water always putrid, ventilation in the holds and orlops was practically non-existent and the gun decks were packed like a sardine tin with 600 or 700 men, whose hammocks had a “standard 14 inches to a man,” not all of whom were even tolerably cleanly in their habits.
It was the surgeon’s duty to ask the captain to fix a general wash day once a week, whenever there was plenty of rain water, so that the men might bathe and scrub their clothing and hammocks. “At intervals” he was to ask that all hammocks should be aired on the forecastle, the lashings removed, the blankets shaken out, and the mattresses hung in the sun.
Now and then, and when the sick rate was skyrocketing, he was expected to fumigate the ship against “fomites.” The most common method employed was by burning a preparation of gunpowder soaked in vinegar in iron pans placed about the decks. The powder sputtered away for a long time, sending out a quantity of thick, acrid smoke which was reckoned a powerful disinfectant. Burning flowers of sulphur gave good results (they would), and many found fires of fir wood to be very satisfactory. In dock, when a ship was very badly infected, as by a severe epidemic, tobacco was burned in great pans with ports and hatches closed and the men standing at their quarters for “as long as they can bear it.” Occasionally the seamen’s kit bags were hung up over pots of burning brimstone and sometimes these pots were placed between the guns and freely sprinkled with vinegar. Another “very wholesome” practice was the immersion of red-hot irons called logger- heads into buckets of tar. This last method was the one customarily employed to disinfect the sick bay or cockpit whenever there were many sick on board.
The surgeon was expected to ask the captain from time to time to cause iron fire buckets, containing burning charcoal, to be lowered into the holds, and the red embers were liberally sprinkled with brimstone and vinegar as soon as the buckets were in position. Thus the well, the bilges, and the many recesses of the hold were both dried out and disinfected at the same time. Another method of fumigation was by pouring sulphuric acid and the “powder of nitre” upon heated sand, prepared in tubs or pans. This latter plan was generally adopted about the time of Nelson’s death.
But in spite of all this heroic fumigation the ships were never free from unpleasant odors; the dank, musty smell of dry rot, the acrid and dreadful stench of bilge water, and the smells of decaying stores and long defunct rats, all added zest to the general ensemble.
During foul weather the ships were sometimes battened down for days at a stretch, till every inch of timber dripped with salt water and the condensation of the breath and sweat of several hundred men. One who sailed in these old ships has testified that “there was always more or less stench” aboard even the best regulated ship, but that it was less penetrating and the dangers of “infections” always slighter in those vessels which were frequently dried out by portable fires.
Making due allowance for the customs of the times, the sick and wounded were treated with comparative humanity. Once officially sick, they were furnished nightcaps, hair mattresses, free vaccination against smallpox, and sheets “of real linen.” The ship’s cook was sometimes bidden to boil up some “flummery”—a sort of sweetened gruel—from the ship’s oatmeal for them. Those very sick were given soft bread and potable soup. Whenever fish were caught for the ship’s company the sick got the first helping and when the officers had any fowls or similar delicacies in the wardroom, they often sent portions to the sick, along with any wine they happened to have.
But there were, nevertheless, certain cruel regulations in force which made the lot of some of the sick sufficiently terrible. Lint was reckoned too expensive for the washing of wounds and sponges were used instead. But the supply of these was limited, and in action one sponge was often used to dress the wounds of a dozen men, which practice naturally favored the sure and rapid spread of various infections. Hence a man with a slight abrasion or cut ran an excellent chance of losing a limb, if not his life, by the indiscriminate use of these poisonous sponges. Another most barbarous restriction limited the supply of mercury as “being requisite only for complaints that might be avoided”—venereal infections. A man attacked by one of these complaints was forbidden to leave his duty, was mulcted of his pay for the medicines he drew, and no care was taken to segregate him in any way from his uninfected shipmates; surely a far cry from our present care of similar cases!
With action imminent, and at the beat °f the drums to quarters, the surgeon and iris assistants were expected to repair to the after cockpit at once and rig it for the reception of the wounded. Some of the noncombatants, such as the purser, chaplain, stewards, and captain’s clerk, accompanied him. A number of “tourniquets and pledgets for first intentions” were made ready and several of the former were distributed about the gun decks for use by the men who carried down the wounded, usually about a half dozen being told off for cockpit duty. This group came and went with the poor, maimed seamen, or else paused at the gun ports to heave a dead or dying man overboard “with no other ceremony than shoving him through the port.”
The midshipmen’s chests were drawn together into a kind of platform and a sail was thrown over them in several folds, forming a sort of couch for the maimed men. In such ships as had no table for the midshipmen’s mess, these chests were used for the operating table, though they were too low for comfortable surgical work. When the operating table had been thus prepared, some large candles, in tin sconces, were placed upon it to afford light for the surgeons. Other candles, in heavy ship’s lanterns, were hung about the bulkheads. A portable stove was lighted for the heating of oils, etc., during the operations. A kid of water was generally also kept heated, in which the surgeons could warm their saws and knives before commencing to amputate. They did this, not as a modern surgeon would do it, to sterilize the instruments by boiling, but in order to prevent the additional torture caused by the coldness of the metal against the raw flesh and bone.
At the sides of the table were ranged several kids or half tubs, some of them empty, to receive amputated limbs; some of them filled with water for the washing of the surgeon’s hands and arms and for the washing and cleansing of wounds. Close by were several opened bottles of spirits for the refreshment of those weakened by hemorrhage and pain. There were also supplies of styptics, ligatures, bandages, sponges, tourniquets, saws, scissors, knives, and the general arsenal of appliances in use at the time, all ready to hand, under a good light.
Before the actual firing began, the surgeon and his assistants stripped to their shirts, rolled up their sleeves to the shoulders and braced themselves for a very ghastly experience. A few minutes’ firing at close range would generally send from a dozen to twenty or more wounded down to the surgeons. It was the strict, inviolable rule that a wounded man should take his turn. No favor was shown to anyone, officer or swabber. The rule was equitable, but not without grave disadvantages. Many men were so tom with shot or splinters that they bled to death long before the surgeon worked his way around to them.
A ship’s cockpit during a battle must have presented a lively picture of hell. There was the small, stuffy space, shut in and cramped by the overhead beams, and but dimly lighted by the evil-smelling tallow candles. Up and down the decks outside the cockpit were rows of wounded men, lying on their blood-stained sail. Every now and then the pounding of heavy feet down the hatchway ladders announced the advent of still another sufferer. Up above was the thundering of the leaping and banging cannon, which roared irregularly, shaking the ship in every timber. Nearer at hand were the poor wounded men, some of them “stunned and chewing placidly,” others whimpering and moaning, and some screaming and cursing. Up and down these rows went the chaplain and the other “civilian” helpers with weak wine and water, lime juice, etc., for those in need of drink. In the center of the piece, bent over the table, were the operators, hard at work. There was no time for lengthy examinations or diagnoses. The wound was always self-evident, red and horrible. Its extent and seriousness had to be calculated from a glance. The surgeon’s first act was to rip off the bloody clothing with his scissors in order to fully expose the field. A single hurried look had to suffice and from that look he had to determine whether to amputate or try and save the limb, whether the wound was mortal and therefore not worth dressing, etc.
If the surgeon decided to amputate, he passed his ligatures as a man would take turns with a hammock lashing. The assistant gave the patient a good gulp of rum and thrust a leather gag into his mouth for him to bite upon in the agony of the operation. After that, it took but a moment to make the necessary sweeping incisions and to apply the saw, while one assistant held the patient’s body and another the limb or fragment of limb that was being removed.
In the days before anesthetics the surgeons were taught to work very fast and the good surgeons of the period would amputate a limb with almost unbelievable speed. But during the height of an action there really was no time for delay.
Dressings of scraped lint, teased out oakum, and linen bandages were employed, usually applied after having been soaked in a water or a mixture of vinegar and water. Healing by “first intention’ was not even expected or looked for, but the appearance of a thick, creamy, “laudable pus” met with the entire approval of the surgeon.
After an action a supply of vinegar, the universal panacea of the time, was heated for the sprinkling of the ship, to drive away the smell of blood from decks and beams. The last of the dead were thrown overboard and the wounded were made as comfortable as the circumstances allowed. In any case a ship which had been in a hot engagement and had sustained a high casualty rate, was cleaned out in every part by scrubbing, the free use of vinegar, and finally disinfected with brimstone, before the shambles smell was removed from her.
The assistant surgeon was generally a young man fresh from Surgeon’s Hall. He was required to keep a complete record of all cases brought before him, to visit the sick in the sick berth, and to do his best to cheer them. He dressed the men’s ulcers every forenoon and had control of the lighter general cases.
A first rate ship carried three assistants; other large ships—such as our 74’s—carried two; and the smaller ships, such as frigates and corvettes or sloops, one. An assistant surgeon sometimes accompanied wooding and watering parties and occasionally landing parties engaged in military operations, particularly in those places where the men were likely to be long ashore. It was his duty on these expeditions to look after the health of the seamen, to keep them from drinking “putrid” water and “eating acid fruits in the heat of the day.” In tropical climates he dosed them religiously, twice daily, with a heavy dose of “bark” (quinine) in a glass of wine.
Neither the surgeon nor his assistants wore a distinctive uniform until the beginning of 1805. The pay varied with the length of service. A surgeon who had served twenty years received the equivalent of about $4.50 a day. One who had served six years received $2.75 a day. The assistants had to serve continuously for three years before they ranked as surgeons. There were three grades of assistant surgeons, and the King’s Regulations enforced at least one year of service in each grade. The pay of the newly-fledged assistant surgeon amounted to the magnificent sum of $1.00 per day; the other two grades received $1.25. Wretched pay, indeed, but it must be remembered that the purchasing power of money was much greater then than now, and prevailing wages and fees were at a very low figure, according to our present standards. The captain of a 74 received but the equivalent of $3.40 a day, and the commander of first rate line-of-battle-ship but $5.75!
Both surgeons and assistant surgeons were required to supply their own instruments, but this was not always properly done, as we read of the wounded in one ship, at least, being operated upon with a saw borrowed from the carpenter’s stock of tools. Medicines and other supplies were furnished by the government and were obtained from contractors, who as a general rule were notorious grafters and thieves.
When not employed on board the King’s ships or in one of the King’s naval hospitals, as at Greenwich, the surgeons drew half pay and were in a sort of “waiting orders” status, further employment usually depending upon preference, influence, or reputation. If wholly incapacitated for further service by reason of wounds, etc., they could retire with half pay.
The surgeon was required to supply his own wardrobe, and before 1805, after which date Admiralty Regulations and Instructions prescribed a distinctive uniform for all officers, he wore a rather nondescript civil-nautical dress, generally consisting of a three-cornered, cocked hat, a blue coat and waistcoat with flat gilt buttons, ruffled white shirt and black silk neckcloth, white knee breeches, white stockings, and low, buckled, black shoes. No insignia of rank nor corps device was worn. The days of which we write were the days of clean shaving. Officers and men alike shaved their cheeks and upper lips. The hair was either worn rather long and flowing, or clubbed into a queue, secured by a black ribbon. Powdered hair was going out of fashion.
Probably the most unpleasant of the surgeon’s many duties was the one requiring his presence at floggings, practically a daily occurrence on most ships. He was expected to take his station to leeward, under the break of the poop, with the boatswain and his mates, who constituted the flogging party, in a little gang in front of him. Theoretically, he was expected to halt the flogging, if in his judgment the victim’s health and life were unduly jeopardized. However, he could be, and in fact often was, over-ruled by the captain, especially if the latter were a martinet or a “sun-downer.” This punishment was inflicted at six bells in the forenoon and all hands were piped aft to witness it.
After sentence had been pronounced, the carpenter “rigged the gratings,” one being placed flat upon the deck, the other upright and secured by lashings to the ship’s side or poop railings. The offender was stripped to the waist and his arms were extended and his wrists were “seized up” by strands of rope yam, securing them to the upright grating. While the Articles of War relating to the prisoner’s offense were being read by the captain, one of the boatswain’s mates undid a red baize bag and extracted therefrom the red-handled “cat.” At the order “do your duty” he advanced to the grating, drew the tails of the “cat” through his fingers, flung his arm back and commenced to flog, with his full strength and with the full sweep of his arm. Failure to show sufficient zeal laid him open to disrating and the same torture. The force of each blow was such that the recipient had the breath knocked clean out of him, “with an involuntary Ugh.” One blow would take off the skin and draw blood wherever the knots fell. Six would make the back positively raw. Twelve cut deeply into the flesh and left it a horrible, red slough, sickening to behold. Yet three dozen were a common punishment. Six dozen lashes were counted as nothing. Three hundred were frequently given for more serious offenses. Before this dreadful ordeal the sufferer’s messmates gave him their tots of grog, so he could at least be partially stupefied. After this terrible punishment the poor mangled body was taken to the sick bay and turned over to the tender mercies of the surgeon, looking like raw veal. Often those unable to stand up under a severe flogging, and who fainted or exhibited alarming symptoms before the full quota of lashes had been given, would be taken to the sick bay, and after their backs had sufficiently healed, the remainder of. the lashes due them would be given. A man’s back generally healed up, but for weeks after the victim’s life was one of agony.
In these times we are considering, should an officer be badly hurt and disqualified for further service, he was promoted and retired on half pay. Not so the poor bluejacket. He, if maimed, had nothing but Greenwich Hospital, with its shelter and tiny pension, to look for at the best, but if he could not get into the hospital he was free to starve, saying with Goldsmith’s sailor, that those who got both legs shot off, and a consequent pension, were born with golden spoons in their mouths.
It was scarcely possible for human beings to live either healthfully or contentedly under the iron regulations of a man-of-war of the time. One has but to read the literature bearing on the Navy of the period to realize the peculiar horror of the life between-decks. A lower deck of one of these old men-of-war was the home of every vice, every baseness, and every misery.
But the times of which we write were part of a rough and brutal era, and how grateful we should be for the tremendous improvements in creature comforts and humane and scientific care afforded us now; our present high standards being but a final culmination of the joint efforts and results of scientific advancement and enlightened progress. These, happily, are still on the up-grade, and with the dreadful lessons of the past, as well as its glories, as an incentive, we cannot fail to attain still further progress and higher standards of excellence in times to come.