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British Columbia Medical Journal, December 2010 - Captain Vancouver and medicine in the Age of Sail
 

British Columbia Medical Journal, December 2010 - Captain Vancouver and medicine in the Age of Sail

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British Columbia Medical Journal, December 2010 issue

British Columbia Medical Journal, December 2010 issue

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    British Columbia Medical Journal, December 2010 - Captain Vancouver and medicine in the Age of Sail British Columbia Medical Journal, December 2010 - Captain Vancouver and medicine in the Age of Sail Document Transcript

    • special feature Captain Vancouver and medicine in the Age of Sail Captain George Vancouver’s remarkable voyage is set in its medical-historical context: An age of filthy living conditions and TB, malaria, and syphilis. Figure 1. George Vancouver, from painting in National Portrait Gallery, London, by Charles William Jefferys. Courtesy of the National Archives of Canada. Gerry Greenstone, MD Sailors’ diseases The other main infectious diseases of Life on the high seas was hard and sailors were tuberculosis, dysentery, he Age of Sail was roughly the demanding, with few pleasures or dis- malaria, yellow fever and STDs— T period from the 16th to the mid- 19th century when naval war- fare and international trade were dom- tractions. As Bown2 states, “sanitary conditions aboard ships were as bad or worse than the filthiest slums in especially syphilis. Although the origins of syphilis have been debated for centuries, there inated by sailing ships. In those times London, Amsterdam, Paris, or Seville. is no doubt that its spread was greatly illness and accidents were by far the The cramped, stifling, congested fore- increased by sailors traveling to dis- main cause of mortality among sailors, castle where the crew slept was dark tant lands. Its protean manifestations significantly outnumbering deaths and dingy. The air was clouded with and different clinical stages made it due to warfare. A study of 5183 deaths noxious bilge gases and congested very difficult for physicians to com- by the Royal Navy in 18101 revealed with the sweet cloying reek of rot and pre hend. The virulence of syphilis 81.5% were ascribed to these causes sweat.” reached its peak in the 16th and 17th whereas only 8.3% were secondary to Such conditions created a fertile centuries; it is estimated that “by the enemy action; the remaining 10.2% breeding ground for respiratory and end of the 19th century… 10% of the were miscellaneous factors. gastrointestinal infections that could population of Europe had syphilis.”3 spread easily through the crew. Also, Other conditions very common This article has been peer reviewed. the infected clothing and filthy bed- among sailors were nutritional defi- Dr Greenstone is a family physician in ding allowed the rapid spread of ty- ciencies such as pellagra and scurvy. Surrey, BC. phus, which carried a high mortality. Scurvy, manifested by swollen, bleed-534 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org
    • special featureFigure 2. A circa 1890 representation of the ships of Vancouver and Quadra at Friendly Cove, Nootka, 1792, by Charles William Jefferys. Courtesyof the National Archives of Canada.ing gums, joint pain, generalized bruis- gencies at sea. His treatments were exploration, the Spanish had laid claiming, loss of teeth, fatigue, discomfort, mostly herbal in the form of plasters, to vast areas of territory, which theand poor wound healing, was a major ointments, salts, oils, elixirs, and British found unacceptable. The dis-scourge in the Age of Sail. laxatives, but he also used minerals pute centred around Nootka Sound, Scurvy continued to decimate sea- including antimony, copper sulfate, which at the time was the main port ofmen despite that fact that remedies for lead carbonate, zinc oxide, and sever- the northwest coast. Direct conflictits prevention were known as early as al salts of mercury. was avoided when the two countries1601 when Captain James Lancaster For surgical techniques such as signed the first Nootka Convention inobserved a lack of scurvy on his ship amputations, suturing, cauterizing, and October 1790. However, the situationsupplied with lemon juice while the disimpacting, his “surgeon’s chest” was far from clarified, and the Admi-other three ships in his expedition contained about 100 instruments in- ralty decided that something had to bewithout juice had numerous deaths cluding various knives, razors, saws, done to resolve this issue.from the disease.4 In 1747 Dr James forceps, probes, spatulas, and syringes. In April 1791 Captain George Van-Lind carried out his famous experi- He was very proud of his spatulum couver (Figure 1) sailed from Englandment on board HMS Salisbury in which mondani, which he designed for severe with 153 men on two ships, the sloophe also demonstrated the curative cases of impaction. Also, Dr Woodall HMS Discovery and the tender HMSpowers of fresh citrus fruits against had his own special recipe for the Chatham. In addition to resolving thescurvy.5 However, it was Dr Gilbert important analgesic laudanum—which dispute with Spain over territorialBlane who finally convinced the contained about 25% opium. Cleverly rights, Vancouver was also chargedAdmiralty to supply naval ships with he called it “this laudable medicine,” with the task of surveying the north-lemon juice and thus dramatically and avowed that “If were upon my life west coast from Washington to Alas-reduced the incidence of this devas- tomorrow to undertake a voyage to the ka and settling the question of the exis-tating disease. East Indies in any great ship I would tence of a northwest passage from the renounce all other compositions of that Pacific to the Atlantic.7The Surgeon’s Mate kind whatsoever rather than miss it.”6 After traveling to South AfricaThe first therapeutic manual for Bri- (Cape Town), Australia, New Zealand,tish naval doctors was The Surgeon’s Vancouver’s great and Tahiti, the expedition arrived onMate by John Woodall (1556–1643), expedition the coast of North America and enter-surgeon-general to the East India Britain’s interest in the Pacific North- ed the Strait of Juan de Fuca on 29Company. Written primarily for nov- west increased considerably in the late April 1792. Vancouver decided to useice surgeons, it contained a detailed 18th century when it realized the small boats for detailed explorationinventory of the medicines and instru- area’s potential as a commercial and and surveying because it was tooments required for treating emer- strategic centre. Based upon previous Continued on page 536 www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 535
    • special feature Continued from page <None> Figure 3. Vancouver Island as charted by Captain George Vancouver. Courtesy of Department of National Defence. dangerous for the large unwieldy Inlet near present-day Anchorage, rul- Homecoming: ships. Over the next few days in two ing out the possibility of a northwest Vancouver scorned such boats he and his men charted passage. During these explorations Vancouver’s expedition was indeed many points and inlets such as Birch many locales such as inlets, bays, remarkable. “The voyage produced an Bay, Point Roberts, Point Grey, Bur- and towns were named by Vancouver. impressively accurate nautical chart rard Inlet, and Howe Sound. His lieutenants—Joseph Baker, Peter of over 1700 miles of unknown coast- After arriving back at the two larg- Puget, and Joseph Whidbey—were line and effectively disproved one of er ships they continued north through memorialized in well-known place the greatest geographical myths of the Johnstone Strait and Queen Charlotte names in the Pacific Northwest. Place era while solidifying British claims of Strait, around the north end of Van- names were also taken from ships and sovereignty against Spain.”7 couver Island and down to Nootka important personages back home: Despite this Vancouver did not Sound. There Captain Vancouver met Queen Charlotte Islands (wife of King receive much welcome upon return- Spanish Naval Captain Bodega y George III), Burrard Inlet (friend of ing to England. His great achievement Quadra (Figure 2), with whom he had Captain Vancouver), Burke Channel was overshadowed by the country’s a very cordial relationship. The two (eminent statesman), Gardner Inlet conflict with France, which had de- captains began negotiations regarding (Royal Navy rear admiral). In total clared war in 1793. And while many the sovereignty of their respective Vancouver named about 200 places in of his allies were away at sea, his ene- nations over the lands in the Pacific the Pacific Northwest during this his- mies at home were making his life Northwest but were unable to complete toric voyage. Finally, in September miserable. Thomas Pitt launched per- any agreement because of the lack of 1794, they sailed for home via Cali- sonal attacks, challenged him to a adequate instructions from home. fornia, Mexico, and Chile, then around duel, and even assaulted him on a Lon- From 1792 to 1794 Vancouver’s Cape Horn and up the Atlantic Ocean don street. In addition, the Admiralty crews explored and surveyed the Pacif- to St. Helena to arrive back in England delayed paying Vancouver for 2 years ic coast (Figure 3) as far north as Cook in October 1795. and did not even reimburse him for his536 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org
    • special featureown expenses on the voyage. So at theend of a great seafaring expeditionlasting 4 1/2 years, Captain Vancouvercame home not to fame and fortunebut to humiliation and poverty.Vancouver’s health:Diagnostic speculationThe medical record of the crews aboardHMS Discovery and HMS Chathamwas remarkable; there was only onefatality due to poisoning and one dueto dysentery on the entire voyage, andthe men arrived home in general goodhealth. Unfortunately the same couldnot be said for Captain Vancouver,who suffered numerous medical andpsychologic problems during and afterthe voyage. Vancouver’s symptoms of lethar-gy, weight gain, puffiness, coarse skin, Conclusionand hair loss strongly suggest a diag- Captain Vancouver’s account of his est Medical Mystery of the Age of Sail.nosis of hypothyroidism with possi- voyage was completed by his brother Toronto: Thomas Allen & Son; 2003:15.bly associated Addison’s disease.8 He and published in 1798.10 After his 3. Sherman IW. Twelve Diseases Thatalso suffered from episodes of “bil- death Vancouver received many hon- Changed Our World. Washington, DC:ious colic,” a term that in those days ors that eluded him in life. ASM Press; 2007:92.did not necessarily mean biliary colic Statues of Vancouver are proudly 4. Anderson MR. A Short History of Scurvy.but instead attacks of severe abdomi- displayed in his hometown of King’s 2000 www.riparia.org/Medical%20Histnal pain of any cause. Therefore he Lynn, England, at Vancouver City ory/scurvy_hx.html (accessed 2 Junelikely had irritable bowel syndrome, Hall, and atop the parliament build- 2009).gallstones, or both, while his fever and ings in Victoria, British Columbia. In 5. Hammerschmidt DE. 250 years of con-joint pain suggest the possibility of addition to the places that carry his trolled trials: Where it all began. J Labinflammatory bowel disease or con- name in the Pacific Northwest there Clin Med 2004;143:68-69.nective tissue disorder. Naish9 also is Mount Vancouver on the Yukon- 6. Druett J. Rough Medicine, New York, NY:suggests the possibility of renal dis- Alaska border, Cape Vancouver and Routledge; 2000:65.ease, which may have been secondary Vancouver Peninsula in Western Aus- 7. Bown S. Madness, Betrayal and theto a streptococcal or viral infection tralia, and Vancouver Arm in Dusky Lash: The Epic Voyage of Captain Georgecontracted during Vancouver’s earlier Sound, New Zealand. Vancouver. Vancouver, BC: Douglas &stint in the Caribbean. On 22 June 2007 a ceremony at McIntyre; 2008:232. The treatments Vancouver receiv- the Vancouver Maritime Museum 8. Watt J. The voyage of Captain Georgeed during the voyage from the ship commemorated the 250th anniversary Vancouver 1791-95: The interplay ofdoctor would likely have contained of his birth and a stamp was unveiled physical and psychological pressures.toxic substances such as mercury and in his honor. Age of Sail explorer Cap- Can Bull Med Hist 1987;4:33-51.arsenic, so one must also consider tain George Vancouver had finally 9. Naish JM. The Interwoven Lives ofiatrogenic factors as another cause of received the recognition he deserved. George Vancouver, Archibald Menzies,his medical problems. Whatever the Joseph Whidbey and Peter Puget.exact clinical diagnoses, it is very like- References Lewiston, NY: The Edwin Mellen Press;ly that the psychological stresses that 1. Broadside: Life, Death and Health in the 1996:371-372.Vancouver suffered contributed sig- Navy. www.nelsonsnavy.co.uk/broad 10. Vancouver Captain G. A Voyage of Dis-nificantly to his physical deterioration side2.html (accessed 30 May 2009). covery to the North Pacific Ocean andand eventual death on 12 May 1798. 2. Bown S. Scurvy: How a Surgeon, A Mar- Round the World. London: GG & J Robin- iner and a Gentleman Solved the Great- son; 1798. www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 537