Nelson & His World

Tycho!
What a fascinating volume. A real treasure.
What it shows, I think, is that although naval surgeons, faced with the potentially catatrophic effects of scurvy on naval strength, were challenging accepted medical opinion and pushing vegetables and lemon juice; the bulk of the medical estabishment and the shore based university trained physicians were still wedded to the old theories of 'putrefaction'.
Probably Dr Elliot's treatment would have had some success. He would no doubt have attributed this to the multiple nature of the remedies prescribed to ginger up the system, viz
- "vegetable acids, fruit, cyder &c. Infusion of malt in defect of these, or liquors made of molasses or sugar....Bark and vitriolic acid..... Liquid impregnated with fixed air for common drink, and wholesome air....Chalybeates...etc"
We know better. It would have been the vegetable acids and fruits that did the trick...not the bark and fizzy drinks!

Brian

Outbreaks of plague occurred throughout the 18th century and infection on a ship must have been particularly horrific.

I am reading a very famous 18th century cookery book, 'The Art of Cookery Made Plain and Easy, Excelling any Thing of the Kind ever yet published' by Hannah Glasse. In addition to recipes, it has remedies for diseases of various kinds including one for 'Plague Water' which requires no fewer than 48 roots, flowers and seeds. She then continues: 'Sea-drink, a good handful of each of the aforesaid things; gentian root, dock-root, butter-bur root, Piony-root, Bay-berries, Juniper berries, of each of these a pound.'

She does not elaborate, so I wonder if the additional ingredients were intended to make a cure/preventative specifically for use at sea, either prescribed by ship's doctors or taken along by seamen themselves.

There is also a recipe for 'Hysterical Water', which requires two quarts of brandy, which would have made it very palatable to a ship's company - and maybe an inducement to an exhibition of hysterics.

Here is some information about 'Scurvy grass' that Dr Eliot mentions in his handbook. It is certainly well named, as it is rich in vitamin C, and 'was eaten by sailors returning from the sea.' Since it was clearly an effective cure known to seamen, it seems a pity that it was not grown in pots aboard ship for a continuing supply.

http://en.wikipedia.org/wiki/Cochlearia

Snippets from the letter of Dr Gillespie, who served under Nelson in Victory, are often quoted in biographies of Nelson. These quotations here give an interesting insight into his duties and his estimation of Nelson's qualities.

http://www.ctv.es/USERS/j.deacon/nelson.htm

In 1967, an exhibition was held at the Royal Naval Hospital at Haslar in connection with a meeting of the British Orthopaedic Association, and an accompanying monograph 'Nelson and his Surgeons' by P.D. Gordon Pugh, a naval Surgeon Commander, was published. It contains much interesting information about Nelson's various wounds and their treatment. It is well known that the silk ligatures that were used after the amputation of his arm were left long, and took many months to come away, which meant Nelson was in extreme pain. The booklet offers a comment on another method of treatment that might have been beneficial:

'Until fairly late in the eighteenth century it was the practice to leave ligature ends long and hanging out of the wound after amputation, so that, as suppuration took place and the ligatures separated by necrosis and granulation, they could be gently pulled upon until they came away, usually somewhere between the second and fourth weeks. This method was employed for Nelson's amputation in 1797. However, in 1796 Lancelot Haire, an Assistant Surgeon at Haslar, had recommended that arterial ligatures be cut short. Writing in the London Medical Journal, he said:

The ligatures sometimes become troublesome and retard the cure. An intimate friend of mine, a surgeon of great abilities, proposed to cut the ends of them off close to the knot, and thus leave them to themselves. By following this plan, we have seen stumps heal in the course of ten days. The short ligature, thus left in, commonly made its way out by a small opening, in a short time, without any trouble, or the patient being sensible of pain.

Little is known of Lancelot Haire. The London Medical Journal of 1786 described him as 'Surgeon at Southminster, Essex, Member of the Corporation of Surgeons of London and formerly Asistant Surgeon to the Royal Hospital at Haslar.'

Brian: the booklet also contains a portrait of your Dr Trotter, courtesy of the Wellcome Foundation, which you probably know about.

Admiral Augustus Hervey records in his journal that while attending to the fitting out of his ship in Portsmouth, 'he was also very ill most of April and May with a rheumatic pleurisy that was very painful.' Returning to London he consulted Dr Dawson and Dr Monsey, apparently without success as he then 'was at last persuaded to try Ward's Drop, which I did, but without any effect than reducing me very low so that I left it off, and believe only my own constitution helped me at last.'

I 'Googled' 'Ward's Drop' and discovered that, along with 'Ward's Pill', it was a quack remedy purveyed by a notorious charlatan and rogue, Joshua Ward. There was a link to the following interesting article on the difficult path to finding a prevention and cure for scurvy which mentions the dangerous composition of Ward's Drop, (balsam, wine and antimony) and the disastrous effect it had on sailors hoping that it would cure scurvy.

http://www.historyscotland.com/features ... lemon.html

There must have been many more quack remedies for scurvy and/or its after-effects, one of which was 'Gowland's Lotion' - (also recommended by the vain Sir Walter Elliott in 'Persuasion' as a treatment for freckles.)

The Times of 31 August 1790 carries a long advertisement for Gowlands Lotion, sold by 'Thomas Vincent, the real proprietor and successor to Dr Gowland.' Gowland's Wash or Lotion was said to be 'an effectual remedy for all diseases of the skin, whether from scurvy, a surfeit, or any other cause however violent or disfiguring'.

Anna!

I think it important to remember that the causes of many serious diseases in the 18th century were unknowable at the time. Typhus, yellow fever and malaria are cases in point. As a result, they were classified, described and treated in terms of their apparent symptoms eg 'intermittent and continuous fevers'. The words 'scurvy' was also used loosely - not only to describe the real vitamin C deficiency disease, but also any disorder of the skin.

It is therefore likely that the word 'scurvy' in the blurb advertising Ward's drops and pills refered to skin disorders and not 'real' scurvy against which it would visibly have had not the slightest effect. On the other hand, perhaps the blurb was designed to deceive!

It is true that self medication became a universal fad in the 18thC, affecting rich and poor alike, and there were masses of quack medicines around to satisfy the demand. But it is difficult to talk about 'quack' medicines in relation to scurvy. The problem was that, in the light of a complete ignorance of the concept of vitamin deficiency, the medical establishment and its physicians were convinced, until about 1800, that scurvy was the result of a disorder of the digestive system occasioned by a diet of salt meat, hard biscuit and bad water. The remedies coming from the medical profession (all of which were endorsed at the highest level) were therefore designed solely to 'ginger up' the digestive system by introducing fizzy drinks in the form of such things as elixir of vitriol (sulphuric acid with barley water) or an extract malt called wort. This theory was of course totally false and the medicines based on it were useless. Does this therefore put them in the category of 'quack medicine'?

The story told in the website you quote (ie that the medical profession through Lind 'proved' that lemon juice cured scurvy and that the failure to introduce it into the navy for 60 years was due to admiralty inertia and idelness) is untrue and can be disproved by documentary evidence. The fact is that scurvy was only cured when the naval surgeons and the admirals (who had been convinced by practical experience that lemon juice cured scurvy, even if they did not know why) ignored the medical establishment and insisted on introducing it into the navy as a standard issue

Brian.

Many thanks for that clarification, Brian. The link I gave was actually to a book about antiscorbutics and scurvy – a warning not to believe all you read in books!

As you rightly point out, the causes of many illnesses were unknown and the treatments offered were ineffective. However, the intentions of bona fide medical men were at least honourable. Maybe some of the charlatans of the time had faith in their products too, but the desperation of the sick allowed many crooks like Ward, cynically to exploit them and enrich themselves at their expense by selling useless or dangerous concoctions. Looking at the advertisements in the Times, you see a huge number of patent medicines making the most extravagant claims, that carry warnings to beware of fakes, so there must have been another layer of charlatans who faked the patent medicines!

It is well known that 18th century physicians would bleed patients for any number of illnesses. However, I was surprised to learn from an 18th century biography I am reading at the moment (not naval related) that a man severely injured in a duel and in danger of bleeding to death was actually then bled by the doctor who attended him.

Was it common practice for naval surgeons to bleed seamen who were victims of accidents or wounds suffered in action? If so, it must have pushed up the fatalities!

Anna!

In spite of the insights provided by the Enlightenment, the cause of much illness was unknown in the 18thC and medical practise continued to reflect the Greek idea that good health meant that the bodily humours and fluids were in balance, while illness showed they were not. Things like hign temperature, racing pulse, inflammation, apoplexy etc showed an excess of blood in the system: the answer was to bleed the patient so as to reduce the amount and calm him down. Contrarywise, weakness, pale complexion, slow pulse etc indicated weak blood: the treatment there was to feed the patient with plenty of meat, wine and strengthening medicine.

Battle injuries introduced problems. While wounds often resulted in loss of blood and dangerous physical weakness, they also caused inflammation and high temperture. The doctors therefore faced a dilemma, and it was a matter of individual judgement as to whether, and how much bleeding might be required. Good doctors got it right; bad ones got it wrong.

Typical was the guidance provided in William Northcote's "Extracts from the Marine Practice of Physic and Surgery with some brief directions to be observed by Sea Surgeons in Engagements etc including the Nature and Treatment of Gunshot Wounds" of 1776. He writes on page 121

"Where the wounded person has not suffered any great loss of blood, it will be adviseable to open a vein immediately, and take from the arm a very large quantity, and to repeat bleeding, as cicumstances may require, the second, and even the third day. This timely precaution will prevent a good deal of pain and inflammation, forward the digestion, and contribute towards obviating a long train of complicated symptoms, that are wont otherwise to interrupt the cure, miserbly harrass the poor patient, and too often endanger his life"

I'm convinced!!

Brian

Many thanks for those comments, Brian.

I never thought to have a look in the little doctor's handbook I mentioned above. Under 'Wounds', Dr Elliot gives instructions on closing and dressing the wound and adds, 'If necessary, bleed and purge; or give cordials etc. according to circumstance', which leaves much to the physician's judgment. However, he continues with roughly the same advice as Northcote regarding a wound accompanied by fever i.e. bleed:

'if there be fever, bleed, purge and give cooling febrifuges; and if inflammation, apply emollient poultices and fomentations....if the patient be low, and the wound do not go on kindly, bark or other proper cordial and strenghthening medicines, with suitable diet, should be prescribed.'

I wonder if anyone (Brian?) has any comment on the observation that the young naval surgeon, James Lowry, mentioned in his memoir of life in Nelson's navy 'Fiddler's and Whores':

'The bite of the tarantula is cured by musick, an instance of which I saw at Taranto in Naples. The fiddle had not the desired effect, but the violocello, fiddle and flute had.'

I know the dance, the Tarantella was said to cure a tarantula bite - hence it's name, I suppose.

Sorry Anna!

I have heard of the link between Tarano-the Tarantula-and the Tarantella as a way of sweating out the poison, but never seen it in a contemporary medical publication.

Brian

I see that Brian Vale's new book, co-authored with Griffith Edwards, is now available at Amazon: Physician to the Fleet: The Life and Times of Thomas Trotter, 1760-1832

This looks like a fascinating book, and I'm sure essential reading for many members of the forum. From the blurb at Amazon: Might have to raid the (grand)children's piggy banks for this one!

Thanks for the info, Tony. I recall I mentioned in a post ages ago that I hoped someone would undertake a biography of Trotter so this is a definite 'must' for me. I shall be buying a copy. It is expensive, though. Maybe we could call it The Forum Copy and lend it out on condition that a royalty is paid to the author?