Other Developments in Naval Hygiene

Water
The provision of a fresh water supply at sea was always a great problem. Distilled water to supplement the supply carried in casks, had been in use prior to 1761, but the process involved the use of chemicals, which were thought to be essential. In that year Lind invented a simple still and condenser, though he was later denied the credit for the invention which was given to a Frenchman and another naval surgeon, Dr Irving, who received a reward from Parliament. As a result of Lind's invention, a 20-gun ship, HMS DOLPHIN, in 1788 made a voyage around the world relying solely for her water supply on distilled water. Today solar stills are used for this purpose as part of the lifesaving equipment for rafts. Lind also suggested a simple method of filtration by the use of two casks, one within the other and partially filled with sand.

More of Lind
In connection with his recommendation for clean clothes, Lind advised a naval uniform. He said:

'If the seamen of His Majesty's Service were put into a uniform sea habit with some little moveable badges or variations by which it might be known to what ship they belong, they would start clean and be kept clean.'

It was Lind, too, who was the first physician to state clearly the consequence of leaving the final decision in health matters in the hands of unqualified autocrats. In an essay on tropical climatology he writes:

'A total ignorance of these important matters or inattention to them are in Commanders-in-Chief blameable, and the lives of thousands may be lost by it... one of the most sacred and indispensable duties of commanding officers consists in enforcing the means of preserving health.'

This fundamental principle will be referred to later when the lessons of the Second World War are discussed. Note Lind's phrase 'preserving the health' and not 'preventing disease', which by modern concepts is considered to be the chief function of the medical profession. Lind also advocated adequate space between patients in sick bays, frequent washing of the surgeon's hands, frequent changing of his linen and washing down of compartments where infectious cases had been nursed. Many of Lind's precepts were incorporated in another great work written in 1757 - 'An essay on the most effective means of preserving the health of seamen in the Royal Navy', which laid the foundation of naval hygiene.

Of Trotter and Jenner
Trotter was another of the great names in naval medicine in the eighteenth century. He was a firm disciple of Lind and called him 'The father of nautical medicine'. Besides many original observations on scurvy, among which was that preserved juice of lemons was very inferior to the fresh fruit in preventing scurvy - a point which had puzzled people for some time - he did a great deal to improve living conditions for the sailor, especially in improving the diet. He urged that Lind's antiscorbutic measures should be extended to the mercantile marine and this was perhaps responsible for earning the British their common nickname in America of 'limeys' (limejuicers). He also had a plan for purifying water by charring the interior of casks. In his 'Medecina Nautica' he gave a full account of the health of the Fleet between 1794 to 1798. Perhaps Trotter's most important contribution was the support he gave to Jenner in his campaign against smallpox. He was probably the first to introduce vaccination into the Navy. Under his direction it was used as early as 1798, though it was not made compulsory until the latter half of the nineteenth century. So satisfactory were these early results in the Navy that naval surgeons presented Jenner with a gold medal.

Blane
The last great name in naval medicine of the century was Gilbert Blane, who has already been mentioned in connection with pulmonary tuberculosis. Blane did not himself introduce many innovations, but, had it not been for his powerful advocacy in high quarters, Lind's and Trotter's recommendations, especially in connection with scurvy, would have taken much longer than they already had before they were eventually adopted by the Admiralty in 1795. Until then only a few enlightened executive officers, such as Captain Cook, had made the health of seamen their special concern and had adopted Lind's measures for preventing scurvy. Soon after he qualified, Blane secured introductions to London society, and this led to Admiral Rodney inviting him to accompany him as his personal physician on board HMS SANDWICH. Blane made the most of his opportunities and Rodney gained such a high opinion of his abilities that he appointed him Physician to the Fleet. In this capacity he was able to institute numerous reforms, which included all Lind's recommendations, to whom he always gave the credit. Through his 'Memorial to the Admiralty' and his 'Observations on the diseases of seamen', Blane was able to persuade the Admiralty to adopt those principles of preventive medicine by which the incidence of disease fell so dramatically in the next century. Blane said that one of the most impressive arguments that influenced the Admiralty to issue lemon juice in preventing scurvy was the voyage of the SUFFOLK in 1794 to India, which took 23 weeks. The crew was issued with 2 to 3 oz of lemon juice daily, and they arrived at Madras without one death and with no cases of scurvy. When a year later the First Lord visited Portsmouth and asked to see the pitiful victims of scurvy at Haslar, he was informed there were none. By contrast, 16 years before, 2400 cases bad been put ashore from the Fleet after ten weeks' cruise in the Channel. In his 'Brief statement of the progressive improvement of the health of the Navy', addressed to William IV in 1830, Blane tactfully wrote:

'The scurvy has been extirpated and the means of counteracting fevers has so far attained that they can never prove a serious evil under such vigilant, zealous and intelligent commanders and medical officers as now belong to the naval service.'

Elsewhere he described how the endorsement of Lind's rules enabled a fleet of the same striking force to be maintained at sea with half the number of ships, and Robert Finlayson, a naval surgeon, wrote:

'It is the opinion of the most experienced officers that the blockading system of warfare which annihilated the power of France could never have been carried on unless sea-scurvy had been subdued.'

Blane's 'Memorial to the Admiralty', which had the full support of Rodney, included the following principles for improving health:

a. Cleanliness and dryness of ships and regular inspection by officers.

b. For the prevention of scurvy: 'every 50 oranges and lemons might be considered as a hand to the Fleet.'

c. Adequate necessities for the sick.

d. Free supply of certain drugs and medicines (until then paid for by naval surgeons).

e. Better arrangements for the conduct of naval hospitals.

f. Fresh soap to seamen.

g. Removal of sick bays in ships to a better position under the forecastle.

Blane could at times be outspoken, and he did not hesitate to castigate the Admiralty on their failure to shoulder the responsibility for health measures, and said that the oversight for not carrying out all available measures to preserve the health of seamen was:

'not imputable to the inhumanity of those who conduct the Navy and the civil and military departments, but to that error of judgement by which they conceive that all that concerns the health of the man lies in the department of the medical officers, and that if they take care and provide professional gentlemen, possessed of due skill and furnished with an adequate assortment of drugs and instruments, they stand absolved from all further responsibility in what regards the health of the mariner.'

Summary
Lind, Trotter, Blane and the others who have been mentioned were great pioneers.

As Macdonald Critchley said in his Croonian lecture of 1945:

'Sea surgeons during the eighteenth century were in many respects well ahead of their colleagues ashore and their observations were pioneer efforts in preventive medicine.'

The work of these three men, with their great contemporary, the Army physician Sir John Pringle, led indirectly to the development of the Public Health Service ashore.