Medicine during the Golden Age of Piracy

[Salty Dog]

While doing research on this topic I was amazed at the number of misconceptions about 18th century medicine. I think many of these misconceptions are related to the horror stories associated with the misguided practice of "bleeding" and from there it seems a picture of complete and utter incompetence is drawn concerning health care during the Golden Age of Piracy. In reality, the state of medicine and surgery was advancing dramatically throughout the 18th century. Perhaps a little less emphasis should be placed on the claims that George Washington died because he was essentially "bled to death" and some of the misguided medical treatments of Benjamin Rush. Perhaps the teachings of Thomas Moffet and Cosimo Bonomo or the theories of Henri Dran and Lorenz Heister need to be discussed in more detail. It seems it is always more enjoyable, in some morbid sense, to discuss that fallacies of medicine in the 18th century rather than embrace the strides being made to correct pestilence and pain of the time. Unfortunately this paints an incorrect picture of the state of health care during the Golden Age. This essay is will try to present a more accurate look at state of health care during the time in question.

What is considered routine medical practices and common sense today was hardly considered important during the late 17th and early 18th century. Today, many historians, medical professionals and sociologists look back at this time period and shake their heads in disbelief at the horrific treatment methods for the simplest of medical problems. This is a somewhat unfair look at the state of medicine at the time. For lack of better words, the critics of 18th century medicine are "Monday Morning Quarterbacks" it is always easy to look back at poor judgment and point out the fallacies of the situation but it is not as easy to do so before the answer presents itself.
With this said the most often valid complaint given to participants of medicine in the 18th century was that the continued to perform procedures that proved time and again to not only not work but actually cause harm and/or hasten death. The usual example is the bleeding of patients, a procedure that today is known to rarely produce any medical benefit. While the complaint is valid, it is more important to ask 'why?' Why did physicians continue to perform procedures that did not produce positive results?

The two most common answers to this question.

The Father of Medicine, Hippocrates said so!
No one had a better answer and there was a lack of effective communication within the world of medicine.

[Salty Dog]

Let's look at these two answers.

Hippocrates said so, and then Galen re-enforced the bad medicine
While many people fault the strong grip of religion on society as a root cause for a stagnant growth in medicine, this is only partly to blame. By the 17th and 18th century, Europe had entered the Enlightenment. It is true that many Christian religious leaders considered most forms of diseases and pestilence as the wrath of God, but the learned men who disregarded the views of Religious leaders embraced a philosophy of science older than Christianity. Many of the Enlightened turned their studies Classic Greek. As such much of the Enlightened Physicians of the day turned to Hippocrates and Galen in the development of healthcare.

Hippocrates felt that all the ills of mankind were due to an imbalance in the body. While he talked of Bloodletting, he preferred dietary changes. Galen went a step further and explained the imbalances occurred in what was known as the Four Humors.

What are the Four Humors, you ask? That would be blood, black bile, yellow bile, phlegm. It was taught by Galen and later accepted among the leading medical experts of the early 18th century that if the humors permeated the body and if they were out of balance then a person would become ill, insane, or in some way incapacitated The Four Humors were related directly with the four elements. (Earth, air, fire, water).

Blood was seen as related to the liver; black bile to the gallbladder; yellow bile to the spleen; and phlegm to the brain and lungs.

The way to treat a person who was ill for whatever reason was to some how bring the four humors back into balance. Blood was believed by Galen to be the biggest cause of imbalance. Unfortunately for most people, it seemed this meant the letting of blood in order to reduce fever, control delirium, eliminate infection, etc, to get things back in order. The Four Humors and Hippocratic medicine were so strongly grounded in the mind set of medicine up and through the 18th Century that if a physician disregarded his teachings the physician ran the risk of being branded a quack. Other wonderful methods of getting the humors balanced including, induced vomiting, urination and diarrhea; in short purging the body of just about any kind of fluid possible.

[Salty Dog]

So you think you have a better idea?

The procedures that most doctors relied on had been established for a long time. New methods were slow to be accepted for a number of reasons; the most common reason was the lack of proof and the lack of effective communications. Today, there are tens of thousands of medical journals that are indexed and abstracted by the National Library of Medicine and are available for anyone in the world to use. (http://www.pubmed.gov). The first scholarly journals (the way most medical breakthroughs are reported) were not published until 1665. A method of reviewing the accuracy of the information in these journals did not exist for yet another 10 years. And the first example of a controlled experiment did not happen until 1753 when James Lind did his pioneering work on scurvy. To compound the communication problems, medical information tended to be published and even relayed word of mouth in seminars, not in the common language but in Latin.

What this means is that doctors did not have a good way to share information other than word of mouth and presentations at hospitals and the occasional seminar. A prime example of how this lack of communication existed can be summed up by the treatment of smallpox. Muslim countries had been inoculating their children against the dreaded disease for centuries but the procedure failed to reach European nations until 1716, when Lady Mary Wortley Montagu traveled with her husband to the city of Adrianople in the Near East. There, she saw children being engrafted (inoculated) with live smallpox virus. The children would then become slightly ill for three or four days and then return to perfect health. It would be several more years before this unsafe method of inoculations began in Europe. The procedure would reach the Americas around 1751. A more effective method of preventing the disease would not come around for almost another fifty years; despite the fact that many people in Scotland had known for decades that milk maids who caught cow pox (a non life threatening disease) never caught smallpox! It wasn't until 1798 that Edward Jenner finally publishes his work discussing an effective inoculation (vaccination)against smallpox using the cowpox virus.

If diseases were not bad enough, the state of surgery was in an even more dismal state compared to today. Anatomy, the study of the human body was finally being taken seriously which led to some innovations in surgical procedures. At the same time, however, the ideas of sanitation and pain killers was in its infancy. Other medical breakthroughs such as X-rays to find damaged organs, foreign objects, and broken bones were completely unknown.

[Salty Dog]

Yet, despite the dismal state of medicine in the 18th Century, as seen through the eyes of today, the learned men of the 18th century looked upon the medical practice of the day as state of the art and leap and bounds ahead of the health care of previous generations. Doctors in the 18th century understood that diseases were a natural phenomenon and not a wrath from God or an act of witch craft. While they remained ignorant of bacteria and virii, they no longer feared demons. They were able to determine that certain behaviors caused certain conditions or diseases and tried methods to counter those behaviors.

In many ways the path from the Dark Ages of Medicine had been opened. Unfortunately the path to a better understanding of medicine was a bumpy one that led to some poorly conceived notions of medical treatments that lingered far longer than would have been the case, if better communication and a more open minded approach to treatment would have prevailed.
It would be tedious and disagreeable to describe the fate of every miserable object that suffered by the inhumanity and ignorance of the captain and surgeon, who so wantonly sacrificed the lives of their fellow-creatures. Many were brought up in the height of fevers, and rendered delirious by the injuries they received in the way. Some gave up the ghost in the presence of their inspectors; and others, who were ordered to their duties, languished a few days at work among their fellows, and then departed without any ceremony.

[Salty Dog]

This section focuses on the major players involved in dispensing health care in the 18th century. Of these, the midwife probably would not have had too much interaction with pirates simply because of the nature of her duty. The nurse is notably not listed. Why you may ask? the nursing profession was very much in its infancy during the Golden Age of Piracy. The role of the nurse was most often filled by religious orders such as nuns, friars, and monks. Often they had little or no actual medical training. The most valuable service of these "nurses" was in the comforting of the sick and dying. Other duties including cleaning rooms, removing the dead, and other duties commonly done by the hospital house staff in today's hospitals. It was not until near the end of the 18th century the concept of nursing profession we know today became a reality.

Apothecary: The Pharmacist

Often the Apothecary is seen as nothing more than pharmacist but in the 18th century he not only dispensed drugs but he diagnosed patients and prepared drugs from recipes (Prescriptions) . In the 18th century, Apothecaries and physicians were rivals in that both felt they could diagnose a problem and prescribe the correct remedy. In fact, in Britain, their was no real distinction between the apothecary and physician. The three major hospital in London concentrated on teaching the art of surgery and offered a minimal number of courses on medicine that last ten to twelve months. After this minimal course work, the Apothecary would be finished with his studies and be ready to practice medicine and could fill the role of a physician (but not a surgeon). English physicians who wanted to get a more substantial education in medicine would leave England for France (that is when the two countries were not at war) where physicians received a much better education in medicine.

As for the common Englander of the day, most did not see a distinction between the apothecary or the French schooled English physician and would go to whichever one was available. Surgeons also held a disdain for both and considered them both inferior men of medicine.

According to some records, pharmacist (apothecaries) would make recipes from all sorts of things. In Tobias Smollett's fictional work, Roderick Random, the pharmacist in the story would make drugs from ground up shells , flower petals and something to disguise the natural color of the concoction. Such was the state of on board medicine in the 18th Century; the necessary pharmaceutical ingredients would quickly run out or were never brought on board the ship and the ships doctor would just make do.
Pharmacists in the 18th century carried certain commonly used ingredients to make medicine. Some such ingredients were sulfur, mercury, and charcoal. Certain acids and salts were also carried. On top of these ingredients, leeches for bleeding a patient were also an item kept by pharmacists.

Just as today, an apprentice or assistant pharmacist on a ship is known as a "Pharmacist's Mate". Depending on his level of knowledge he may have been a Pharmacist 1st, 2nd or 3rd mate. If more than one pharmacist were aboard, one would be the Chief Pharmacist.

The Pestilence Section is closely related to treatment expected from Apothecaries.

Barber Chirurgions: A surgeon

There is much discussion over barbers that were surgeons. The barber-surgeon came into existence in the mid 1500s. The profession came under increased scrutiny starting near the end of the 1600s and was formally discredited in England in 1745. By the time of the Golden Age of Piracy, barber surgeons were more often relegated to lancing boils, pulling teeth and performing other types of minor surgeries. They were put out of business by the more powerful and better trained surgeons being trained in the well established Colleges of Surgery that had formed throughout Europe. By the 18th century, barber surgeon were ill trained in the more advanced methods of surgery and healthcare. They were snubbed by the university trained surgeons and physicians. Many were taught by other barber surgeons and lacked any formal training.

The Pain Section is closely related to the treatment expected from Barber Surgeons

[Salty Dog]

Chirurgion: (surgeon)


A surgeon is one who practices the art of healing by manual operation; a practitioner who treats wounds, fractures, deformities, or disorders by surgical means.

The surgeon of the 18th century would most often learn his craft at a College of Surgery, somewhere in Europe. Strangely most of the lessons were taught in Latin and thus most surgeons were fluent in that language. While some surgeons still learned their craft through an apprenticeship, it was more common for a promising apprentice to work with a surgeon for some time, earning either money or qualifications that would allow him to attend a Surgical College. By the 18th Century, England and other European countries saw the need for qualified surgeons and physicians aboard ship. Therefore it was possible for commoners with little money but great promise to attend surgical colleges, if they arrived at the college with the right recommendations. As such a promising surgeons mate may aid a ship's surgeon for several years and then be sent off to the College of Surgeons, with the understanding he would then serve several more years in the King's Navy.

It should always be understood that their was defined difference between Surgeons and Physicians. Surgeons cut people where as Physicians usually treated people with drugs and or types of therapy. During the 18th Century the divide between the two professions was very distinct and often bitter.
Like the Pharmacist the apprentice or assistant surgeon on a ship is known as a "Surgeon's Mate". Depending on his level of knowledge he may have been a Surgeon's 1st, 2nd or 3rd mate. If more than one Surgeon were aboard, one would be the Chief Surgeon.

A surgeon on a Royal (British) Navy ship or privateer was often the third highest paid officer on board. Only the ship's captain and the his lieutenants made more money. A surgeon mate however was paid about the same as carpenter's mate. This was more than a common sailor but drastically less than the surgeon. This show just how important the Surgeon was considered but at the same time showed that the surgeons mate was did not have same prestige.

The Pain Section is closely related to treatment expected from Surgeons

[Salty Dog]

Farrier: A Horse Doctor, Veterinarians

By Definition a farrier is one who shoes horses; a shoeing-smith; hence, also one who treats the diseases of horses. Veterinarians are those who are skilled in, or professionally occupied with, the medical and surgical treatment of cattle and domestic animals; a veterinary surgeon.
A pirate would not search out a vet to care for a sick horse. Farrier's or Vets were skilled in the art of setting broken bones. They also knew a thing or two about surgically removing parts of animals. As such they made a better second choice for a surgical routine than some physicians.
As can be expected as time passed and surgeons became more powerful, regulatory acts were passed to prevent farriers from practicing medicine on people.

The Pain Section is closely related to treatment expected from Farriers.

[Salty Dog]

Midwife:

The midwife is a woman who assists in the labor and delivery of newborns and the immediate postpartum care of the mother and child. For the most part during the 18th century they had no formal medical training and were not licensed by any over-seeing body.

Up until the 18th Century, the art of child birthing was almost solely in the hands of midwives (women) but this was to change as surgeons began to assert their authority over child birthing. Much of this can be attributed to the Chamberlen family. One Peter Chamberlen developed a pair of obstetric forceps that aided in the delivery of difficult births. The closely guarded family secret was used to amass a fortune for not only Peter but his later descendents. By the 1700s the Chamberlen's were birthing children for all those who could afford their service. The Chamberlen's became quite powerful in the field of child birthing and tried at various times to organize the midwives into a guild in an effort to supposedly to create a regulatory body for proper training but more likely to monopolize the practice in an effort to control all midwives and make lots of money.

While the Chamberlen's were unsuccessful in their efforts (as the Surgeons guild had been many years before) the accusations of poorly trained and uneducated midwifes helped to bring about a demise of the profession as it was known up to that time. By the end of the 18th Century, the use of midwives had decreased significantly among those with money.

Midwives were not highly regarded by other medical professions at the close of the Golden Age of Piracy. However, They also had very little in the way of formal medical education. Today, some historians look back on the practices of 18th Century midwife and see that most of the charges made by other medical professions were correct. It is unfortunate, however, that the other medical professions did not look inward to see their own unsound medical practices.

With that said, if no other medical professional were available during a medical emergency, I'd hazard to guess a desperate pirate might accept the aid of midwife. To seek out the aid of midwife might be a little harder for a pirate to do simply because of the attitudes of society during the 18th Century. It is very doubtful that the opinion of a midwife would even be considered by a college trained surgeon of physician.

Pain, Pestilence, and Quackery all relate to the treatment given by Midwives

[Salty Dog]

Physik (Physic): The Physician

The physician is one who is trained and qualified to practice medicine; esp. one who practices medicine as opposed to surgery.

No truer words were spoken in the 18th Century. Physicians were not trained to amputate and sometimes lacked the necessary skills to set a broken bone. Physicians treated diseases and infections through medicine. Often this was unfortunate for the physician captured by pirates. Pirates really weren't too concerned about what the qualifications of a captured medical man were. Thus aboard a pirate ship, the physician may find himself pressed into service as surgeon and an assistant to the cook if that is what the captain wanted and if the physician wanted to live.
This often would bode poorly for the poor pirate needing a limb removed because it was quite possible a butcher would know better how to cut off a leg than a physician.

Similar to surgeons of the 18th century, many physicians were schooled in a College of Physicians and at least had a thorough knowledge of anatomy. They would also know the difference between infections and mortification of the flesh. Physicians in Britain however were not as well schooled as those in other European countries.

Like the Pharmacist and Surgeon the apprentice or assistant physician on a ship is known as a "Physician's Mate". Depending on his level of knowledge he may have been a Physician's 1st, 2nd or 3rd mate. If more than one pharmacist were aboard, one would be the Chief Physician.
The Pestilence Section is closely related to treatment expected from Physicians

Quack:

By definition a Quack is an ignorant pretender to medical or surgical skill; one who boasts to have a knowledge of wonderful remedies; an empiric or impostor in medicine. During the Golden Age of Piracy, quacks were individuals who invented and sold so-called "patented" remedies of medicines. The main reason quacks thrived during the 18th Century is because the medicines and treatments of physicians and surgeons had a poor success rate. There were actually instances where quacks had better success at treating certain ailments than trained physicians.
As you can assume, quacks did not refer to themselves as quacks. Quacks used such titles as "Doctor" and "Professor".

As can be expected, the section on Quackery would best relate to Quacks, however Quacks looked for remedies of ailments mentioned in the Pestilence Section

[Salty Dog]

Pirate Doctors:

For the most part, doctors did not willingly volunteer to serve among pirate ships so most pirate crews sailed without the good fortune of having a doctor on board.

Privateers on the other hand, being commissioned by a government or government body, would usually secure the service of a doctor. We know from records kept during the American Revolution that doctors aboard Privateers were the third highest paid member of the crew. Only the Captain and his lieutenant (a quartermaster on a pirate ship) were paid more than the doctor.

Unlike privateers, pirates usually obtained a doctor using the same method they obtained all their other booty. When they looted a ship or sacked a town they would kidnap the doctor or person with any medical background. Pirates would offer doctors the opportunity to sign articles but most doctors would refuse. When this happened, the pirate captain would offer the doctor safe passage on the ship in return for providing medical service to the crew. The doctor would also be given a share of the loot, often off the books. These steps were done so that in the event the ship was captured by authorities the doctor could claim to be a prisoner and avoid hanging. The hope of the pirate was that by protecting the doctor from the hangman's noose (by not making him sign articles and more or less claiming him to be a prisoner), the doctor would perform his duties. Depending on the pirate captain, many doctors would be released, once their services were no longer needed, at the first safe port of call.

When it came to non-monetary booty, medical supplies probably came right after nautical charts. If pirates had boarded a ship that possessed any medical books or medicines; the pirates would take them. Any person who could read the books or had inkling of what the medicines were, might become the ship's doctor.

When a real doctor was not being pressed into service, pirate relied on other pirates to do the job. This often meant anyone who had witnessed an amputation in the past or had assisted a doctor with an amputation.

Often the job of a surgeon would fall to the person who had tools similar to those a doctor would use. This meant that some times the ships doctor was the ship's carpenter or even the cook. Both had knowledge of how to cut things. If a pirate had been a butcher before becoming a pirate he might become the ship's surgeon. (Pity the patient who had to rely on the skill of a butcher or cook to cut like a surgeon!) It is rare (if ever) that ship's articles mention the pay given to a ship's doctor. It is doubtful a non-medically trained pirate surgeon drew any extra pay unless he actually succeeded in healing a person. Due to the nature of piracy, such information is not readily available.

[Salty Dog]

Two of the most famous "Pirate Surgeons" is Alexander Exquemelin, who wrote Buccaneers in America, and Lionel Wafer, who is known as the Surgeon to the Buccaneers. Among their adventures was the attack on Porto Bello. Wafer was surgeon to Bartholomew Sharp's crew during their famous South Seas adventure in 1680. Wafer also wrote an account of his exploits as he crossed the Darien Isthmus (Isthmus of Panama). During this exploit he suffered a leg injury and spent some time among the Cuna Indians. Both men were naturalists and produced art work of their adventures that was later published. However, neither Exquemelin or Wafer were true pirates in that their adventures, were commissioned affairs sailing under Letter of Marque, making both men privateers.

There is at least one account of a pirate by the name of William Taylor who had his leg amputated by a ship’s carpenter. Little is known about the pirating career of Taylor except that his pirate captain was named Phillips and that Taylor was tried and convicted to be hanged in Boston on May 4, 1712.

Taylor’s leg was in a bad way and it was unanimously agreed upon by the ship’s officers that he would die unless the damaged part was amputated. Unfortunately the ship had no surgeon, and being pirates, they could not just pull into any port and look for a surgeon. After a brief council it was agreed that the carpenter was best suited to do the job.

According to the eyewitness testimony, the carpenter went about his task with vigor, understanding the need for a speedy operation. He grabbed Taylor’s leg under his arm and with a large saw cut the leg off as quickly as possible. The account explains that the unnamed carpenter understood the need to stench the flow of blood so using a heated blade of an axe, he cauterized the wound. Unfortunately in the process, he also damaged other skin around the wound and the leg began to mortify.

The account does not explain what steps were taken after mortification set in. Normally this would involve amputating more of the leg. It is doubtful, due to the date of the operation, that Taylor’s leg was amputated above the knee. (The screw tourniquet had not been invented yet). It is possible that Taylor was left in Boston were he was seen by a proper surgeon who performed a second operation. Or it is possible that the account referred to an infection that was fought off as gangrene.

In either case, Taylor ended up in Boston facing the gallows. According to the account he was reprieved from hanging for an unknown reason. In this case, the reprieve may have been given by a sympathetic judge who imagined Taylor had suffered enough with the recent amputation of a leg.

[Salty Dog]

The Physician's Medicine Cabinet.

To the left is an 18th century Physician's medicine cabinet. The cabinets were carried on board ship and into battle and were considered portable hospitals. Various powders, a measuring scale, and small items wrapped in oil soaked paper are visible, The cabinet is made of mahogany with brass fittings. This small cabinet was all that stood between the pirate and pestilence.


Pestilence


Hygiene and Sanitation

There are no clear numbers on how many lives could have been saved if the standards of hygiene and sanitation had been better in the 18th century. Let it suffice that many people died simply because they lived in filth. This is especially true onboard sailing ships. Personal hygiene (taking a bath, brushing teeth, shaving) often did not exist on sailing ships. The conditions were probably even worse on a pirate ship simply due to the lack of discipline. So much for democracy!

For instance, the typical toilet on a ship was usually holes cut into platforms that were mounted on the gunwales near the stern of the ship. Mariners would simply drop their trousers, sit in the appropriate location, and take care of business, so to speak. Their waste products would then find its way in the ocean after possibly bouncing off the side of the ship.

Officers may have had a little more privacy, having a chamber pot or more secluded place to finish their business but then once again the waste products would be tossed overboard.

Rodents of varying sizes and parasitic insects such as lice, fleas and ticks were also a common nuisance on board sailing ships. On a regular merchant ship or ship of the line, punishment details would be formed and these men would track down and kill annoying vermin such as rats and poisonous insects and spiders. The case was not the same on a pirate ship, where the crew could be made up of mutineers who killed their last captain because they were placed on rat detail one time too many.

Sometimes rodent problems would get totally out of control. Rats could live and breed easily on a ship because there was almost always a supply of food and many places where the little critters could hide. Even with cats aboard, there would still be an abundance of rats simply because of how quickly they breed and the fact that rats could make it into places where cats could not or would not go. Rat bites were not uncommon among pirates and other mariners, especially when the said pirate was bed-ridden from disease or injury. Rats would also leave droppings in food stores which then would become part of the pirate's diet.

Conditions on a ship were such that it is was almost impossible to keep rats and bugs out of the food. The amount of storage space also meant that food could not be thrown out simply because an occasional bug or a rat happened to have nibbled on the tasty tidbit before a human had the chance. Thus, food would be prepared complete with bugs and rat dropping and then served to the crew.

[Salty Dog]

The closest thing to a bath that a pirate would get is when he was caught above deck during a rain storm. This would also be about the only time he washed his clothes. Despite the popular belief, the lack of proper bathing confounded even some 18th century contemporaries who thought regular bathing could do wonders for a person constitution or health. Still the conventional wisdom of the time saw little or no connection between filth and squalor and disease. (This conventional wisdom may have been driven by an inability of the leaders of the day to find a way to solve the sanitation problems of the day.)

For example, we see many paradoxes between the learned people of the 18th century. We know they would use dead animals as a biological weapon against their enemies. We know they knew to bury their dead to stop the spread of various diseases. We know they thought foul air caused disease. They would write long essays on the filth among the poor and knew that it would spread diseases among the town. Yet very little was done to solve these problems.

Yet even the hospitals of the time were over-crowded and filthy. It should also be noted that the hospitals of the 18th century saw very little resemblance to hospitals of today. Most were run by religious orders or charitable groups. They were more like homeless shelters than hospitals. They provided food and a modicum of shelter for the poor classes. They provided some healthcare and occasionally did surgical procedures but for the most part, they were filthy, overcrowded, dank, smelly buildings. The administration of the building was often haphazard and often the staff were ill trained and sometimes abusive.

On board a ship, the surgeon's quarter was often located in the bow of the ship, below the water line in an unlit cramped smelly room with little or no ventilation other than door to the room. Here the sick and dying would be crammed in so tightly that sometimes a surgeon's mate would have to crawl over one patient to minister to another poor soul. The room would quickly become overcome with the odors of rotting flesh, putrid infections, body fluids, and the vomit of those who did not have a strong enough stomach to handle the smell. On top of all this, the room would be in constant motion due to its location in the bow of the ship. It was a magnet for vermin.

What might be the obvious answer to the paradox was that the people of the 18th Century knew the problems existed but were in disagreement on how to fix it. It is easy to criticize them from today's perspective but in reality they were making great strides in advances in hygiene and sanitation but these advances would not become a reality for several decades.

[Salty Dog]

Antiseptics

Strangely enough, a rudimentary understanding of antiseptics did exist in the 18th Century. What did not exist was the knowledge of bacteria and viruses. This led to some very odd treatment rituals but it also marks the beginning of an antiseptic work environment, when the proper methods were employed. Unfortunately these standards were not enforced uniformly and quite often what the surgeon knew to be the best treatment for a sick sailor was not always embraced by a ship's captain.

By 1733 the Royal Navy, often considered the leaders in nautical medicine, had passed stringent guidelines on the quartering of the sick and wounded. This included providing fresh fish (when possible) to the sick even before the rationing such food to the officers. Other requirements were for the sick to be be moved to a separate berth designed as a "sick bay". This room was to be kept clean and when possible covered buckets were to be supplied for body waste, fouled bandages, etc. The room was also to be washed down with vinegar or other suitable solutions in order to remove putrid odors. Such measures were unheard of forty years earlier.

At the end of the 17th Century, the idea of using a clean bandage was considered unnecessary. However, by 1720 the need for a clean bandage was becoming obvious. While the idea of bacteria and germs had not been realized, several prominent men of medicine were realizing that laudable puss was not a good thing. The beginning of the end of the the unchanged bandage began in 1720, when Hermann Borhaave recognized that the putrid discharge of a wound was not a good thing. By 1741, his view was widely accepted and many surgeons including Henri Dran and Lorenz Heister were prescribing methods to avoid putrefaction including the frequent changing of dressing. Col. De Villiars went even further expressing a need to change dressing at least twice a day and suggested the use of wine or balsam soaked compresses. He also devised an ointment of equal parts of wax, turpentine, and oil of hypericum (St. John’s wort), to use with compresses.

Many of the remedies being used by the surgeons had been used by Quacks or were quickly adapted by the quacks as patented medicines. Among the quacks Some of the cures worked, most did not. Many of the quack remedies were reliant on the use of brimstone (sulfur), lime (calcium carbonate) and quicksilver (mercury). Some plant remedies were also available, often relying on thyme, mints, peppers, various crushed flowers, etc. It is hard to determine what quack remedies made it into main-stream medicine in later years because most quacks did not reveal the secret ingredients of their cure-alls.

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Disorders of the Lungs

Disorders of the lungs discusses ailments of the respiratory track, including breathing problems.

Consumption

Consumption usually refers to an ailment of the lungs of breathing passages. Most typically it referred to what is known today as tuberculosis. In some instances Influenza (the flu) was also called consumption, but this is rare. Consumption was always considered a slow death sentence. Despite the magic potions pushed by quacks (which didn't work) there was no cure for consumption. Treatment consisted of change of environment and quarantine. Consumption was highly contagious, especially in crowded cities.

Disorders of the Bowels

Disorders of the Bowles includes problems of the digestive track including vomiting and diarrhea.

Flux

The Flux is/was an abnormal bloody discharge from the bowels. Today it is known as dysentery and we know it is caused by unclean living conditions. It was common for people new to the Caribbean to get "the flux". The reason was because the person's immune system was not accustomed to the new germs found in the area. The flux could be deadly especially when it was treated by purging or bleeding.

The Gripes

The gripes refers to ailments of the bowels or stomach. Most complaints of the Gripes were probably due to poorly prepared food and the a tainted water supply. In most cases, these were cases of simple food poisoning and would have eventually been cured with time, yet doctors had the uncanny ability to prolong the agony through either bleeding, purging, or sweating the patient. For the common stomach ache, a person was often given lavand (lavender water).