ISS: Information Services and Systems

Case 4: Naval Medicine: The Naval Surgeon

Exhibition curator: Katie Sambrook

The case against immediate amputation, from:: Lancelot Haire. "Remarks on Mr Lucas's practical observations on amputations". London Medical Journal, volume. 7, part 4, 1786. [Guy's Hospital Physical Society Collection]

Lancelot Haire. "Remarks on Mr Lucas's practical observations on amputations". London Medical Journal, volume. 7, part 4, 1786.

Guy's Hospital Physical Society Collection

The naval surgeon in the late eighteenth century laboured under a number of disadvantages. His professional status was inferior to that of the ship's doctor and his opportunities for advancement were limited. He worked in cramped and difficult conditions, often under tremendous pressure; while a seaman might fall sick at any time, wounds were most likely to be sustained in wartime, and the surgeon would be called upon to perform complex operations at speed in the ship's cockpit, amid the noise and confusion of battle. Operations were generally carried out without the use of anaesthetic and, in an age when knowledge of antisepsis was limited, the rate of post-operative infection was high. That many who underwent operations survived at all is a tribute to the skill of the naval surgeons and their assistants.

Amputations of limbs shattered by gunshot were common and such operations often proved fatal. In 1786 Lancelot Haire, a young assistant surgeon at the Royal Naval Hospital, Haslar, wrote an article for the London Medical Journal, in which he argued that in many cases immediate amputation on board ship was unwise and that patients might have a higher chance of survival if the decision to amputate were delayed for at least a few hours. He also advocated the cutting short of arterial ligatures after amputation, rather than letting them hang long until they fell away naturally, the latter practice often leading to infection. This recommendation was not generally taken up for some years; when Nelson's right arm was amputated in 1797 the ligatures were left to hang loose for three months, leading to sepsis and considerable pain for the patient.

William Turnbull. The naval surgeon. London: printed for Richard Phillips, 1806

Guy's Hospital Historical Collection

A screw tourniquet, from: William Turnbull. The naval surgeon. London: printed for Richard Phillips, 1806. [Guy's Hospital Historical Collection]

Low pay, low status and the difficult and dangerous working conditions combined to bring about an acute shortage of naval surgeons in the years leading up to Trafalgar. After repeated representations from naval surgeons and in recognition of the need for action if the Navy was to be able to combat the Napoleonic threat effectively, the Admiralty in January 1805 authorised a wide-ranging series of measures designed to improve the lot of the naval surgeon and thus to make the profession more attractive to suitably qualified applicants. Rates of pay and pension levels were increased, a uniform (similar to that of a ship's physician) was introduced and surgeons no longer had to pay for drugs acquired from the ship's apothecary.

Turnbull's work, a comprehensive manual for "professional men at sea", reflects the improved status of the naval surgeon. The plate on display shows a screw tourniquet, which was used during amputations . Turnbull recommends the close study of amputation techniques, as the operation is performed more frequently on board ship than anywhere else and has a higher rate of mortality "than any other part of the business of surgery".

William Beatty. [Letter to the editors of the Medical and Physical Journal]. Medical and Physical Journal, volume. 15, January-June 1806

St. Thomas's Historical Collection

Ball that killed Nelson, from: William Beatty. [Letter to the editors of the Medical and Physical Journal]. Medical and Physical Journal, volume. 15, January-June 1806. [St. Thomas's Historical Collection]

William Beatty (1773-1842) was ship's surgeon on board HMS Victory at the Battle of Trafalgar and attended Nelson at his death. His career prior to Trafalgar had been undistinguished but it was to benefit greatly from his association with Nelson, an association upon which Beatty was not slow to capitalise, as this letter to the editors of the Medical and Physical Journal suggests. Beatty went on to take a medical degree at St. Andrews, became a Fellow of the Royal Society and was eventually knighted, ending his career as Physician to the Royal Naval Hospital, Greenwich.

Beatty was later to expand the brief account given in this letter into the full Authentic narrative of the death of Lord Nelson, published in 1807.

Alexander Copland Hutchison. Practical observations in surgery: more particularly as regards the naval and military service. Second edition. London: printed for Thomas and George Underwood, 1826

Early Science Collection RD151 HUT

Account of amputation, from: Alexander Copland Hutchison. Practical observations in surgery: more particularly as regards the naval and military service. Second edition. London: printed for Thomas and George Underwood, 1826. Early Science Collection RD151 HUT

In the introductory pages of this work, first published in 1816, Hutchison speaks of his pride in serving the Royal Navy "during a war in which its glories have been carried to an unexampled pinnacle" and commends the Napoleonic period's enlightened attitude towards the health and well-being of its seamen. Amputation, he goes on to say, has in his opinion now "approached nearer to perfection than any other operation in Surgery".

The amputation cases he goes on to cite, however, tell a different story. All were sustained at the Battle of Algiers in 1816 (Algiers was bombarded by British and Dutch forces in a successful attempt to destroy its trade in Christian slaves), shortly after the end of the Napoleonic Wars. The mortality rate of amputation cases was extremely high; of the eleven amputation cases on board HMS Impregnable, for example, only two survived. In contrast to Lancelot Haire, Hutchison advocates immediate amputation as most likely to be successful and criticises the surgeon of the Impregnable for delaying operation in some cases, so as to give his patients time to recover from shock.

United Kingdom. Admiralty. Victualling Board. [Qualifications required for the post of Assistant Surgeon in the Royal Navy]. [London]: Victualling Office, 1826

College Archives. Archives of St. Thomas's Hospital Medical School TH/FP12/1

Training required to become Assistant Surgeon, from: United Kingdom. Admiralty. Victualling Board. [Qualifications required for the post of Assistant Surgeon in the Royal Navy]. [London]: Victualling Office, 1826. College Archives. [Archives of St. Thomas's Hospital Medical School TH/FP12/1]

This document, which has been pasted onto an endpaper of the Pupils' Entry Book of St. Thomas's Hospital Medical School for 1825-1842, sets out the qualifications and knowledge required for the post of Assistant Surgeon in the Royal Navy. By 1826, when the document was issued, the professional status of naval surgeons had risen considerably and the title Surgeon's Mate had been replaced by that of Assistant Surgeon. An Assistant Surgeon was now expected to have received "a classical education, and possess in particular a competent knowledge of Latin". He was also expected to have pursued a course of medical study at one of the teaching hospitals in London, Edinburgh, Glasgow or Dublin. The preference given to candidates demonstrating "a knowledge of diseases of the Eye" suggests that in the period of commercial expansion following the end of the Napoleonic Wars an ability to deal with tropical disease and the hazards of long voyages was assuming greater importance than the speedy despatch of amputation cases caused by gunshot wounds.