Kevin Brown Historian

History of health, medicine and naval history

Reviews of Poxed and Scurvied

“… shows an attempt to address the needs of the seafarer developed wider implications for society as a whole. It also produced scientific breakthroughs that were of great benefit, the eradication of scurvy being one. The book not only details a history of naval medicine, but of a wider social health improvement.”
The Nautical Magazine

“Many years ago I visited the Royal Naval Medical School in Hampshire. Staff were playing croquet and pink gins were offered. Kevin Brown’s book captures the flavour of these relatively recent, more expansive and expensive times, as well as that of the long-distant past. His history starts with the Black Death and moves to syphilis, but primarily has a strong naval focus – making extensive use of Royal Navy records in an authoritative account of maritime medicine and diseases spread by sea. Infections either dominate or lurk just under the surface. After all, amputations during naval battles were often done in an attempt to reduce the risk of death from gangrene. The book brings this to life very well, with its lurid account of the surgery and the knives and saws, as well as covering quarantine and the great pandemics of the past.
Well-referenced, and well-written, this account is a good read as well as a useful source of in-depth information. I was particularly pleased to see the Court of the Baillies of Aberdeen minute for 24 April 1497 that ‘licht weman’ (prostitutes) should desist ‘under the pain of a brand on their cheeks’ was quoted. The stimulus for this measure – ‘to control infirmities come out of France and strange parts’ – didn’t get mentioned. Perhaps the author was being diplomatic.”
Hugh Pennington, Microbiology Today

“The impressive 36 pages of detailed notes and bibliography mean that Poxed and Scurvied will find itself at home with academics of maritime history. However, its written in such an accessible form that it should also appeal to anyone curious about life – and death – at sea in the last millennium”
Who Do You Think You Are Magazine, September 2011

“It details the devastating diseases carried by early travellers and colonists. For example, the Black Death, which killed a third of Western Europe’s population, was brought back by Genoan merchants returning from the Crimean.

There is also a chapter on emigrant and slave ships, where the need to keep the ‘cargo’ healthy while manacled for much of the voyage led to bizarre practice of forcing slaves to dance in their chains.

Poxed and Scurvied ends at the Falklands War which Brown describes as: ” The last of the colonial wars in which ships are isolated at sea”
Norwich Evening News, 23rd July 2011
“Despite its gimcrack title this is a serious work by an author well qualified in medical matters. The first half describes health problems in the Royal Navy during the sailing ship era; there is little on the mercantile marine or on foreign seafarers. It is a story of gradual improvement, but from a low base.
The main task of ships’ surgeons was treating battle casualties, usually by amputation (without anaesthetic). Arthur Devis’s painting of the death of Nelson in the gloomy cockpit of the Victory gives an idea of the conditions in which surgeons carried out their bloody task.
However, many more seamen died from sickness than in battle, and in treating disease most surgeons were even more ignorant than their counterparts on shore. Although scurvy was notorious as the scourge of the sea, its ravages were chiefly confined to long voyages, and on routine cruises typhus, dysentery and yellow fever killed many more men.
The lot of the sick and wounded at sea was appalling, as they languished below deck amid filth and stench. Reformers at sea and on land slowly introduced improvements: better diet (the Admiralty authorised the issue of lemon juice in 1795 to combat scurvy), an emphasis on cleanliness and adequate ventilation, and the building of naval hospitals on shore.
The rest of the book ranges from descriptions of the dire conditions on slaving ships and emigrant vessels to life on the passenger liners and cruise ships of the 20th century, where the doctor’s role could be more social than medicinal. In today’s navy, serious casualties are air-lifted ashore for specialist attention.
Kevin Brown’s wide reading is shown by the number of quotations that enliven his text. There is space for only one here, Nelson’s cautionary remark that ” the great thing in all military service is health, and it is easier for an officer to keep me healthy than for a physician to cure them”.
Glyn Williams, BBC History Magazine, September 2011

this book provides a fascinating picture of social improvement.
ICSM Gazette, The Medical Schools Magazine, Summer 2011

A thoroughly researched story of how mankind has kept well at sea from the earliest times to the present, written in an anecdotal style, and should interest any maritime or medical historian.
Worshipful Company of Spectacle Makers From the Master and Wardens

“A fascinating insight into the history of maritime medicine … Brown has excavated fascinating diary material … offers vivid contemporary accounts of the sick bays on warships during battle.”
Ham & High

“A fascinating and wide-ranging history of health, hygiene and the sea.
The rapid increase in global exploration and trade from the fifteenth century brought with it similarly rapid increases in the spread of diseases like the Plague, smallpox and syphilis. In effect, there was a two-way trade in such diseases – smallpox from the old world to the new and vice versa.
Lengthier voyages, as the author explains, worsened the problem of scurvy. It was not until the early nineteenth century that enough was known to prevent that dreaded disease. Typhoid, tuberculosis and even skin cancer were all diseases of the sailor.
Really, until the end of the Second World War, seafarers generally remained a “poxed and scurvied” lot. While rare examples of such diseases continue to recur, however, modern sailors seem to suffer more from psychological diseases.
This is a great narrative of an important but often hidden aspect of seafaring.”

Baird Maritime

“The author is curator of the Alexander Fleming Museum and an expert in the history of medicine. This fascinating book traces the problems of malnourishment, disease and injury faced by the seafarer from fifteenth century right up to the modern period.

The Royal Navy’s role was very significant in improving the fate of the seafarer. Brown goes into some detail about Lord Nelson’s real concern for Jack Tar’s welfare – and the specific actions he took in such areas as shipboard diet, hygiene, morale and naval hospitals ashore.

Brown also shows how in many ways attempts to address the specific needs of the seafarer developed wider implications for society as a whole; a number of scientific breakthroughs were in fact of universal benefit.”
Julian Stockwin (http://www.julianstockwin.com/BS%20Sea%20Reference.htm)

“A wide-ranging general history of disease, medicine and the sea.”

Guardian Bookshop

“Poxed and Scurvied: The Story of Sickness and Health at Sea by Kevin Brown was really great. Each chapter is a new topic (or two) but always covers disease prevention, nutrition, diet, exercise, treatment aboard and treatment ashore. Usually in that order. Brown covers from the 14th century through today.

I’m not sure if it is because I worked at the Country Doctor Museum for a year during grad school or if it is that weird fascination that most people have about tragedy, but I really enjoyed this book. I found it interesting and insightful in so many ways. For example, most scholars reference the transmission of epidemics from old world to new world and the return-favor disease of syphilis. Brown goes farther, explaining why epidemics break out on ships, the development of maritime hospitals and quarantines to deal with these diseases, and the ground breaking work of ship surgeons. He explains that ships were the ideal control group with diseases accelerated by conditions, hygiene and lack of treatment options. Also the patients were all very similar-men, youngish, and had the same diet and environmental conditions=perfect control group!

Brown doesn’t just focus on the sailors. Many have learned about the horrible conditions of slave ships. Brown presents some of those conditions and takes it further. He explains the motivating factor of money on health in the slave trade. It is cheaper to throw sick slaves into the sea before they die rather than report a sickness related death. And there is no monetary reason to treat sailors as they are less valuable than the slaves. He goes on to discuss emigrants on passenger ships-sometimes just as crowded as slave ships. He talks about the health exams before boarding, women and children’s health aboard (first time large numbers of women and children were crossing oceans), and the infamous health exams at Ellis Island.

I learned a lot, and gathered some of the missing pieces in maritime medicine! I would recommend it to anyone interested in medical history or sickness at sea.”
Whitney Rose Petrey (http://maritimeculturenews.blogspot.com/2011/11/book-review-poxed-and-scurvied-sickness.html 30 November 2011)

“A professional archivist, museum curator specializing in the history of medicine and author of The Pox: The Life and Near Death of a Very Social Disease describes the history of maritime medicine, particularly the on-board deficiency of vitamin C.”
Probook, Israel (http://www.probook.co.il/BookPage.aspx?BookId=9781591148098)

“In summary, Kevin Brown’s Poxed and Scurvied, decorated with an outstanding dustcover illustration, is a well-written scholarly work that should be a part of any serious maritime historian’s library.”
Sea History, Winter 2011

“With chapters on every malady and danger the seaman’s flesh is heir to, Poxed and Scurvied tells the story of the struggle to improve the fitness of the not always jolly jack tar, and of the various scientific breakthroughs that would be of great benefit both on the high seas and dry land.”
Family History Monthly, Feb 2012

“When British writer Samuel Johnson wrote, “No man will be a sailor who has contrivance enough to get himself into a jail; for being in a ship is being in a jail, with the chance of being drowned,” he left out other characteristics of life at sea so horrible as to make drowning an attractive alternative. Kevin Brown fills the gap in an extremely well researched examination of how sailors were kept healthy at sea. Brown’s expertise is reflected in previous works on the discovery of penicillin and the history of syphilis.”
The Historian 74/4, Winter 2012 SKMBT_60113020509050

“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.”
Mariner’s Mirror, 99:1 (2013), 105-107 00253359.2013

Kevin Brown is the Curator of th Alexander Fleming Museum at St. Mary’s Hospital, in Paddington, and the author oftwo previous books on aspects of medical history. Based on a number of archival andprinted primary sources as well as secondary works, this book focuses on the stories of people, mainly from the British Isles, afflicted with diseases associated with sea life from 1350 to 2007. It includes information on persons in the Royal Navy, the merchant service, slave ships, English prisoners transported to Australia, Europeanimmigrants to America, health travelers, and passengers on cruise ships.

Surgeons were assigned to vessels engaged in warfare in antiquity and are mentioned in Homer’s Iliad. Columbus had a surgeon on board each of his three ships on his first voyage of discovery. King Henry VIII was the first British ruler to assign surgeons to naval vessels in 1513. Surgeons were impressed into the navy to meet the threat of the Spanish Armada in 1588. After that, they were accepted and recognized as a part of life at sea, even though many lacked expertise in the field of medicine.

Changes in the design of warships resulted in larger crews and more crowded living conditions on shipboard. This environment contributed to health problems as well as influencing the diet of sailors, their exposure to extremes of weather, conditions in foreign ports and periods of warfare. Surgeons struggled to cope with diseases and injures and to discover and address the factors that caused them. Advances in medicine and technology aided them in their efforts. Coastal voyages lasting about a week were the usual pattern of commerce until the middle of the fifteenth century. As the range of activity widened, so did the exposure to diseases. Sailors brought syphilis from the new world to the old. Special hospitals to treat this disease were established in port cities, beginning with Genoa.

This is a fascinating account of the development of medical knowledge, training and regulation, the origin and administration of naval hospitals, and the role of governments in the care and treatment of the sick and wounded over several centuries. Along the way, readers learn about a number of largely unknown persons whose experience, ideas and efforts changed many lives as well as history. In more recent times, such improvements as the United Kingdom’s adoption of the National Health Service in 1948 and the end of the Cold War, as well as advances in medicine and technology, brought changes to the old order of things. Members of the armed forces and the general public were now treated in civilian hospitals. The old naval hospitals were closed.

While a broad range of subjects are noted in Brown’s book, this reader is still in doubt about some points. To what extent did naval surgeons read and/or contribute to the medical journals of their times? If they published articles about their experiences in treating some diseases, did such work help to raise their status in the eyes of their civilian colleagues? Did naval surgeons individually or collectively attempt to bring to the attention of the authorities such problems as the periodic shortage of medical officers? Why does the book’s index lack an entry for surgeons? It seems likely that most readers will not be concerned about such things. They will enjoy an intriguing narrative.”

Harold D. Langley, The Northern Mariner / Le marin du nord 22/2 (2012), 193-4

Reading this book is like sitting right there and listening to the author talk about a topic with which he is intimately familiar–health and sickness at sea. It focuses entirely on a subject that is only tangentially mentioned in most naval histories.

The prose is engaging and easy to read. The content is lively, descriptive and thorough without being too morbid or medical. It reads more like a story than a conventional history book–and for this subject–that is an excellent approach. It ushers you through the subject right up to modern times, which helps you appreciate the profound differences between then and now.

Be advised that, except for the chapters on Middle Passage and Huddled Masses, the narrative is not rigidly bound to any particular timeline or location. People, ships, governments, preventive measures, cures, wars, explorations, etc. appear and reappear as appropriate. It is almost like hearing the author say, “Oh, that reminds me…” just before the subject veers off in another direction and to another time and place. Enjoy.
Amazon Review

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