The many forms of sea sickness

The term the “age of sail” broadly defines a period from the mid-16^th to the mid-19^th centuries where ships were pre-eminent in trade and battle. For the sailors on board these ships, however, life was not so illustrious. Sailors faced arduous living and working conditions, a lack of nutrition, a lack of hygiene, and a lack of sanitation. As can be imagined, disease was rife.

Scurvy notoriously threatened the health of sailors in this period. This disease is caused by a lack of vitamin C (ascorbic acid), which is found largely in fresh fruit and vegetables. Often at sea for long periods and without the refrigeration systems we have available today, sailors did not have access to such important foods. As such, it is not difficult to see how scurvy became rampant. Initial symptoms of scurvy include weakness, fatigue and sore limbs, but the disease can progress to causing symptoms such as bleeding under the skin, loosened teeth, the slow healing of wounds, and ultimately death.

The remedial effects of citrus fruits for this disease were known in the early modern period. However, the use of citrus was officially established as a treatment method by the Scottish physician and Fellow of the Royal College of Physicians of Edinburgh, James Lind (1716-1794). Lind believed that scurvy was caused by the body’s putrefaction (rotting), and that this could be alleviated by acids.

In 1747, Lind conducted what is considered to be one of the first documented controlled clinical trials. After two months at sea on board HMS Salisbury, Lind split twelve scurvy-afflicted sailors into six pairs. They were fed the same diet, but were given different treatments to see which, if any, cured their symptoms. The sailors who received the citrus fruits, namely oranges and lemons, fared significantly better than those receiving any of the alternatives, such as cider, vinegar, and sea-water. In 1753, Lind published his Treatise of the Scurvy. This contained “an inquiry into the nature, causes, and cure, of that disease”, alongside “a critical and chronological view of what has been published on the subject”, and crucially detailed the aforementioned experiment. The RCS England Library holds a copy of this Treatise, with an interesting catalogue card hidden near the back.

Above: the title page and catalogue card for A Treatise of the Scurvy.

Lind soon after retired from the navy and became Chief Physician to the Royal Hospital at Haslar in Hampshire. The findings of his important experiment, however, had not been taken up. Indeed, Lind himself believed in other treatments for scurvy, such as fresh air and exercise. It was not until 1795, with thanks to naval medical staff, that it became compulsory for the entire naval fleet to be routinely provided with lemon juice. By 1800, this system was fully implemented, and the health of sailors improved, although the vitamin C levels of the juice were impacted by storage and preservation methods. Lemon juice was soon replaced by lime juice (hence the nickname “limey”). Limes were grown in British colonies, but contained a much smaller quantity of vitamin C as compared to lemons, and so were much less effective. The juice was frequently mixed into “grog” (alcohol) and given to the sailors to ensure its consumption.

Although steps were taken to ameliorate levels of scurvy in the Royal Navy in this way, it was not until 1867 with the advent of the Merchant Shipping Act that all ships on certain long voyages had to provide an ounce per day of lime or lemon juice to each crew member. In addition to this, the Act also stipulated that:

The owners of every ship navigating between the United Kingdom and any place out of the same shall provide and cause to be kept on board such ship a supply of medicines and medical stores in accordance with the scale appropriate to the said ship, and also a copy of the said book, or of one of the said books, containing instructions.

The book referred to in the latter part of that statement is The Ship Captain’s Medical Guide by Dr. Harry Leach. At the time of publication, Leach was resident Medical Officer to the floating hospital the Dreadnought and inspector of lime and lemon juice appointed by the Board of Trade for the Port of London.

Published in 1868, this work was the first to denote medical and surgical conditions in merchant seafarers. The guide continues to be published today, and, as of 2019, was on its twenty-third iteration.

The RCS Library holds the first and second editions of the 1868 work. Dr Leach’s guide is very thorough. Looking at the first edition, the guide opens with “general remarks” and a guide on the prevention of disease as opposed to cure. Leach then systematically works through many different accidents, poisons and diseases that can be encountered at sea, and what to do in their event.

One such accident described is the “putting out of joints, or dislocations”. Leach succinctly describes what to do in case of shoulder, elbow, finger, hip or ankle dislocations. For example, with the shoulder, Leach first describes what a dislocated shoulder looks and feels like:

There is flattening of the shoulder; a hollow is seen where there should be a rounded surface; the elbow sticks out from the side, and the patient often holds it with the other hand to ease the pain; there is often great pain and numbness of fingers, and if you put your hand into the man’s arm-pit, a round hard lump is felt.

Leach then describes, with the help of a drawing, how to treat the patient:

Put the patient on his back, take off your boot, press your heel well into the arm-pit, seize the patient’s hand, pull steadily, and the bone will slip into the socket with a loud snap. If the man be very muscular, a clove-hitch may be taken round the arm just above the elbow to aid a steady pull.

Above: a drawing from page 12 of the Guide, showing the treatment for shoulder dislocation.

There is also written and visual advice for the event of many different broken bones. Appropriate treatment can be seen for problems such as a broken jaw, a broken collar-bone and a broken thigh.

Above: drawings from the Guide, showing bandaging for a broken jaw (page 15) and a broken collar bone (p16).

Above: drawing from page 17 of the Guide, showing the use of a splint and bandages for a broken thigh.

In case of arsenic poisoning, Leach provides this advice:

If no vomiting has occurred, give the man 30 grains of sulphate of zinc in a large glass of water, or, if this be not close at hand, a large draught of very greasy water, or of warm sea water, and repeat it until he vomits. If this does not succeed quickly, the patient will probably die.

With regards to scurvy, Leach describes how to spot the disease:

Swollen and spongy gums, dark spots and blue blotches, like bruises, about the legs, and a brawny hardness about the calves of the legs and under parts of the thighs, are the outward and visible signs of this disease.

Leach advises the person treating the patient to:

Double the man’s daily allowance of limejuice, and give him any kind of vegetables, preserved or otherwise, that you have on board, with a liberal allowance of pickles, beer or wine.

However, Leach balances this advice with a statement:

If the provisions of The Merchant Shipping Act of 1867 be faithfully carried out by the government, as well as by your owners and yourselves, scurvy will soon be an unknown disease in the merchant navy of this country ; and if the article in this book headed “Prevention of Disease” be strictly followed, no serious outbreak of scurvy need be feared by the captain of any ship.

Indeed, Leach carried out crucial work on the prevention of scurvy. According to his obituary, Leach “was unwearied in his exertions in bringing the facts to the notice of the public and the Government, and was very influential in procuring those legislative improvements which have now insured a pure and regular supply of lime-juice for all merchant ships, and inspection of their provisions”. The guide even goes as far to include excerpts from the 1867 Merchant Shipping Act.

Also contained in this guide is a scale of medicines that should be carried depending on the number of sailors onboard, as well as instructions on dosage, creating mixtures and in what circumstances to use each medicine.

Above: the “Scale of Medicines” table from the Guide.

The inclusion of forms of certificates of birth and death at sea in the guide indicates that this work covered the life cycle.

Above: Sample birth and death certificates from the Guide.

Thus, Lind’s experiment, the introduction of lemon and lime juice, new legislation, and Leach’s guide, all suggest an increasing interest in the health of both Royal Navy and merchant navy sailors in this period. The RCS England Library holds a number of works concerning the navy and seafaring. The Ship Captain’s Medical Guide is available to view through the UK Medical Heritage Library. James Lind’s 1753 Treatise, and other works, including the physical version of Leach’s guide, can be viewed in our Research Room by appointment.

Further Reading

• “The Late Dr. Harry Leach”. The British Medical Journal, 2, no. 987 (1879): 870. http://www.jstor.org/stable/25252522.
• Leach, Harry. The ship captain’s medical guide. London: A.M. Walker, 1868.
• Lind, James. A treatise of the Scurvy : In three parts. Containing an inquiry into the nature, causes, and cure, of that disease. Together with a critical and chronological view of what has been published on the subject. Edinburgh: Sands, Murray, and Cochran, 1753.
• Randall, Caroline. “200 years of the Seafarers Hospital Society”. Royal Museums Greenwich. https://www.rmg.co.uk/stories/blog/hms-nhs-nautical-health-service/seafarers-hospital-society-200-years-pioneering-care.
• “Life at sea in the age of sail”. Royal Museums Greenwich. https://www.rmg.co.uk/stories/topics/life-sea-age-sail.
• White, Marcus. “James Lind: The man who helped to cure scurvy with lemons”. BBC News. https://www.bbc.co.uk/news/uk-england-37320399.