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.
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.
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.
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.
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.
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
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.
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.
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
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".
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.
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.
Today, it is common knowledge that the most common cause of death among navies in the 18th century was not due to wounds sustained in battle but from diseases. The same was true for the common pirate. A pirate was more likely to die from food poisoning, infection, malnutrition or rat bites than a cutlass slash to the neck or cannon shot to the gut. This section discusses some of the more common diseases that pirates were likely to contract and why there was such a prevalence of such pestilence among pirate crews and navies as a whole.
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.
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.
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.
Disorders of the Skin
Disorders of the skin involve disease of the skin, fingernails, hair, etc.; disorders that present themselves most visibly on the surface of the body. The ailment is not necessarily a skin disease but its signs appear on the skin. Any many cases disorders of the skin are actually a dietary problem. Even during the 18th century many of these ailments were believed to be caused by something internal.
Disorders of the Major Organs
Disorders of the the Major Organs discusses problems with internal organs other than the digestive track and the lungs. As such it will look at the heart, liver, kidney, gall bladder, etc..
The Foul disease was also called the French Disease by the British and the Italian Disease by the French. Today the one disease is known to be two separate disease caused by the same type of behavior. The Foul Disease is actually gonorrhea and or syphilis. In the 18th Century it was believed that two diseases were one in the same with gonorrhea being an early stage of syphilis . There is no doubt that the foul disease was a very real threat to pirate crews.
It is believed that Black Beard kidnapped and held for ransom member of Charleston's most important families for medicines presumably to treat the foul disease. If this is the case, the medicines of the day would have mercury salves, ointments, and tincture of mercury which would have been taken internally.
The mercury ointments were applied liberally to the skin of the inflicted person and then the person would be wrapped in heavy blankets, forcing them to sweat out the disease. The salves would often blister the skin. The treatment would often go on for days or even weeks. Occasionally, a person would also take the mercury by mouth so as to purge the fouled disease from the person's inside. Among the various side effects from the mercury ointments was excessive salivation. causing the person to drool constantly. This was seen as a sign that the treatment was working. Other side effects were tremors, loss of balance, constant headaches, and bad stomach cramps. Again this was seen as the foul disease being forced from the body. Constant sweating, bleeding gums, and joint pain were also quite common. All of the symptoms were actually signs of mercury poisoning.
Despite the incorrect diagnosis, mercury compounds were supposedly somewhat effective in treating foul disease when caught in its early stages. It begins with a high fever followed by general aches and pains. Sometimes the patient is also vomiting. After a few days a rash begins, usually along the hairline. The rash quickly spreads, and forms little bumps which then blister and break. Those who survive the disease are scarred fro life.
Small-pox, pox, pocks
The pox or pustules on the skin which form the most characteristic feature of the acute contagious disease. It was known simply the pox until the Foul Disease entered Europe. Once venereal disease arrived they became known as "the Great Pox" and the pox became "Small-Pox"
Small pox was almost always fatal and contagious. After an incubation period of 10-14 days the disease comes on suddenly, is quite painful and would kill the patient within three weeks. After incubating, the patient usually gets a high fever, followed by general body aches and pains, and vomiting. After a few more days, a rash forms, usually starting along the hairline but spreading all about the face, and extremities. The rash them forms into blisters which burst and from scabs. The patient is in constant pain and itches all over from the scabs. Once the bumps begin to form pustules (sacks of puss) one of two things will happen. If the pustules remain separated, they will burst and the patient has a decent chance of surviving. This is called ordinary smallpox. In the case of confluent ordinary smallpox, the pustules merge together and instead of bursting push the skin away from the body, usually causing death. If the patient can survive the confluent small pox, the pustules will begin to deflate and after about 28 days the will dry up.
The worst type of small pox was the black pox which did not cause pustules to form but instead led to internal bleeding. The skin remained smooth and black spots formed under the skin from bursting blood vessels. The blood vessels in the eye would also burst causing the whites of the eye to turn red and eventually black. Eventually the internal organs would start bleeding and in almost all case the victim would die.
Sometimes the person is contagious as soon as the fever arrives but most often they becomes contagious once the rash appears. Once the scabs fall off the person is no longer contagious. For the most part direct contact with the patient or body fluids is need for the disease to spread but sometimes when smallpox infects the lungs, the disease is transmitted by breathing the same air. If the person lives through the disease, they are left scarred for life from the scabs.
Middle Eastern nations had learned to inoculate against the small pox long before the 18th Century. They did this by exposing people to the actual small pox virus through needle pricks. This caused a mild case of the disease which was survivable about 99 times out of 100. They probable learned this procedure from Far Eastern counties. The method was brought to the Europe by Lady Mary Wortley Montagu around 1716-1718 and possibly others. The procedure was always considered dangerous but when the fear of certain death swept through populations people would take the risk. Their is no cure for small pox once it is contracted and until 1799 a safe inoculation for the disease smallpox rested in the realm of quacks and old wives' tales. One such old wives' tale was a Scottish one that claimed that milk maids did not get smallpox if they had ever contracted cowpox. That story proved true and led to Jennings eventual vaccination against the disease which would eventually eradicate smallpox from the face of the Earth.
The two principal fevers that caused the most damage were Yellow Fever and Malaria. Both are mosquito born diseases and both are common in the area that was once the Spanish Main, the stomping grounds of Caribbean pirates. Both Malaria and Yellow Fever present similar symptoms on their onset. These symptoms include: high fever, chills, headache, muscle aches, vomiting, and backache. It wasn't until around 1881 that a Cuban studying Yellow Fever began to speculate that diseases were being transmitted to human through mosquito bites, The doctor was Carlos Findlay. His suspicions would be proven over the next few decades.
A vaccine for Yellow Fever was not developed until the early 20th century. Europeans learned of a treatment for Malaria around 1640 when Jesuits observed Peruvian Indians using the bark of the cinchona tree to treat people infected with malaria. Today we know that it was the quinine, which occurs naturally in the cinchona bark, that was found helpful in the treatment of malaria. Neither disease can be cured once contracted. They can only be treated. Because Yellow Fever is caused by several similar viruses, a person can catch it more than once if not vaccinated.
After the initial stages of infection, the disease behave differently. Both will be treated separately below.
Scurvy is a disease characterized by general debility of the body, extreme tenderness of the gums, foul breath, subcutaneous eruptions and pains in the limbs, induced by exposure and by a too liberal diet of salted foods
Have you ever stuck your self with a needle or stepped on a fishing hook? Have you ever cut yourself so badly that it required stitches? Imagine having someone sewing up that cut with needle and thread but not using pain killer, not even aspirin or Tylenol. Have you ever had to dig a splinter out of your finger. Imagine having to dig a bullet or a 6 inch piece of wood out your side, again without any pain killers. Imagine is you can, the pain of having a leg or arm cut off without pain killers. Fortunately with today's healthcare, few people today have had limbs removed without the benefit of anesthetics or analgesics. Unfortunately many soldiers and some civilians are the targets of Improvised Explosive Devices and mines which are often designed to blow off arms so too many people know the pain of traumatic amputation. But imagine being told you will die if your leg is not cut off and you know that there is nothing that will kill the pain of the operation or recovery; that was the state of surgery in the Golden Age of Piracy.
Amputations in the 18th Century were a risky business at best even when done by the most skillful surgeons. Until 1718, a leg amputation above the knee almost always ended in the the patient bleeding to death. In 1718, a French surgeon, Jean Louis Petit, invented the screw tourniquet this dramatically reduced deaths from bleeding to death and made it possible to successfully amputate a leg above the knee (thigh amputations). Unfortunately screw tourniquets did not stop the pain of the operation and if applied incorrectly caused mortification of the wound. The use of the screw tourniquet caught on relatively quickly among the learned surgeons but those in the outlying colonies or not schooled in a Surgeons College were less likely to know about the tourniquet or had the proper training to apply it correctly. By the time of the French and Indian War (1754) the use of the screw tourniquet was common practice among surgeons.
Blood loss was usually not the main cause of death from amputation, shock from the pain was most likely the leading cause of death from the actual amputation. Once again there was a disconnect between some common knowledge of the time and the conventional practice of the surgeon in the 18th century. Opium, a narcotic that lessens pain was well known in the 18th Century. Cocaine, another pain reducing drug was also known in the Caribbean However neither drug was seen as medicinally useful for another 100 years. The drug most commonly used to lessen pain was Strong spirits such as rum or whiskey. It was not effective for several reasons for more on pain killers see Analgesics and Anesthetics.
If the patient survived the injury that led to the need to remove a limb, survived the blood loss from the surgery and did not die from the intense pain of the operation, then he still needed to survive the almost certain infection that would follow the operation. Infection was not only common among amputees it was accepted as part of the healing process by many in the medical professionals of the time. The opinions on this progression of healing would slowly change so that by the 1770s only a very poorly taught surgeon would think infection was a necessary part of healing.
If an infection were to form, the laudable puss would show a few days after the operation. With the puss came high fevers and/or chills. After a few days of the laudable puss, fevers, and chills, if the patient responded well, the injury would start to heal and the patient would get well. If on the other hand, the patient did not start getting well, then further operations would follow or the patient would die. For more information on laudable puss see the entry on infection and mortification.
The actual procedure of amputating a limb was straight forward. Because of the lack of anesthetics speed was of the utmost importance. A good surgeon was able to remove an arm or leg in under ten minutes. In fact, even with the screw tourniquet it was necessary to remove the limb in less than 10 minutes to prevent the patient from dying from either shock or blood loss.
Up until the end of the 17th century most amputations were done with a straight cut through flesh and bone. By the end of the century and throughout the 18th century a two conical cut were made around the bone using a sharp surgeon's knife. this left the bone recessed inside the cone of flesh. In the case of remove a leg there were three major arteries that would be located and sutured closed. Afterwards a saw was employed to cut through the bone. Awash of water would follow the completion of the amputation in order to remove any bone fragments left on the exposed muscle and flesh. Once the leg or arm was removed, the cone was pushed together and sewn up to create a fleshy stub around the cut bone. Following the procedure bandages would be wrapped around the freshly amputated limb.
The major post operative problem with the surgery is sanitation was unknown and was not considered necessary. The bandage was not changed, the surgical knives and saws were not routinely cleaned, and it was not considered important to clean the wound area before or after the operation. In instances where a doctor may need to perform more than one surgery back to back, the blood of the first patient would quite often still be on the instruments when the doctor reached the second patient. The concept of spreading infection through bacteria or viruses did not exist because they had not been discovered yet. For more information on post operative infection see the entry on infection and mortification.
Two very different views of an 18th century leg amputation. The image to the left is closer to the actual scene, to the right the image as presented in a medical text of the time.
The most common anesthetics used to date are derived from opium, cocaine, or for lesser pains forms of non-steroidal anti-inflammatory drugs-NSAIDs (aspirin, acetaminophen, ibuprofen). During the Golden Age, opium and cocaine existed but were not used medicinally. NSAID's were not even invented and only a few herbalists were aware of salicylic acid, a by-product of willow tree bark , a main ingredient in aspirin. In 1899 Bayer released his famous aspirin. Aspirin was actually invented by Wilhelm Siebel and Felix Hoffmann. They made acetylsalicylic acid which combines vinegar with salicylic acid to form a more useful product.
During the 18th century there was no aspirin but we do know that the medicinal usefulness of willow tree bark was known and had been known since ancient times. It was known by the ancient Greeks and remained common knowledge throughout Europe. It is also believed that the Native Americans knew of the its usefulness even before the arrival of the first Europeans. So while the professional doctors failed to recognize its usefulness to any great extent for some time to come, Quacks were most likely already selling patented creams that could cure acne, heal small abrasions, ease the pain of bruises and if taken by mouth calm a headaches. They would have made the cream from the bark of willow trees mixed with any kind of liquid that could soften the bark and allow it to be pulverized into a paste. The drug would have been somewhat effective yet just as quickly dismissed by the professional medical community.
Opium was a major trade product of the British East India Company beginning in 1757. The Company used opium as a cash crop trading it in China for tea. Eventually this led to the Opium wars in China. We have accounts of liquid laudanum (opium) being used to settle a person's nerves but was not considered useful for surgery. It wasn't until the 1800s, long after the Golden Age that opiates were used extensively for the suppression of pain.
Cocaine was used as a local anesthetic by the ancient Incans of Peru but its usefulness as a local anesthetic was not realized by Europeans until Carl Koller used it while performing eye surgery in 1884. It was used recreationally for much of the 19th century but was not well known during the Golden Age.
The more typical drug of choice for killing pain was a shot of rum or whiskey to help steady the nerves and to deaden the pain. In the popular literature, it was not uncommon for a surgeon to have a shot of whiskey with the patient before the operation. Alcohol made a poor analgesic at best. In order to be even remotely effective a patient would need to drink to the point of passing out which could easily be enough to cause alcohol poisoning or cause him to choke on his own vomit if he were to throw up while passed out. Even after drinking such an amount, it was still quite possible that the pain of the operation would wake him up. Thus typically, only a small drink would be given before the operation and possibly a little more after the limb was removed to help steady the nerves.
Probably the main deterrent to the use of pain killers was a lack of understanding of the nervous system. The study of the nerves or neurology did not fully come into existence until around 1681. And the connection between electricity and the nervous system was not understood until the end of the 18th century. Without this solid understanding of how the nervous system worked, it was difficult if not impossible for physicians and surgeons to develop a method for pain management. Most surgeons of the time considered shock the best anesthetic. They believed that the shock of the operation would shut down the patients nervous system and would prevent him from feeling the pain. What is more, they believed it was best to do the amputation quickly after the initial injury had occurred, believing the pain of the initial injury was enough to mask any future pain caused by the surgery, thus no type of pain management was really necessary. We know today they were wrong. Surgeons of the 18th century may have also known they were wrong but not having an effective pain remedy it becomes a moot point.
At the beginning of the 18th century people were not taught to swim and most people, even mariners did not know how to swim. Artificial resuscitation was at its infancy with many experts arguing over the merits of the practice. If a sailor fell overboard and the ship was moving at any great speed, it was often thought rescue was impossible unless he managed to grab a line or some type of floatation device could be thrown to him (an empty cask or something else that might float). Falling overobard was almost certain death and it was only the most stout hearted sailor who did not fear going overboard.
What was known is that people could be brought back from the dead, so to speak after being submerged in water for an extended time; even as long as thirty minutes. It was also known that a person who had been placed under the water for even a very short time minute could seemingly recover completely only to die a few hours or even a couple days later because of the submersion.
The pathogenesis or what is happening in the body while a person is drowning is quite complex and beyond the scope of this article to be discussed in detail. This is because the reaction of a drowning victim will vary according to the victim, the environment, and the situation.
The following factors are just a few of the details that will impact
on the drowning episode
The factors and others lead to hypoxia, acidosis, and finally cardiac arrest.
Most importantly for survivors of prolonged submersion is the linings of the lungs. The the lining of the lungs can be damaged during a submersion episode which can produce decreased lung capacity (an inability to take in oxygen) and if all the foreign fluid is not removed pneumonia can set in. In some instances of drowning, the stomach contents will be regurgitated and then breathed back into the lungs creating a new set of problems for the drowning victim.
So where does all this leave a drowning victim in the early 1700s? What kind of first aid was applied for a submersion victim 200 years before the concept of first aid existed? As mentioned, artificial resuscitation was in its infancy. Two methods were thought to be effective. One is very familiar to today’s lifeguards, mouth to mouth or mouth to nose resuscitation. The other method was to slip a tube of some sort down the trachea (breathing tube) and use a bellows to pump fresh air into the lungs (endotracheal tube).
Most trained doctors thought first method was inadequate because you were blowing used air into the lungs (and the stomach) and they discouraged its use while encouraging the trach tube and bellows. However, the second method involved a skilled physician who knew how to insert a tube into the trachea and also involved blowing air in with the bellows and then removing the bellows so the air could escape. In both cases, chest compression (that is, pressing on the external chest cavity in an attempt to start the heart) was not done. When you consider the tubes were not flexible and were not normally sanitized, you can see this method had many risks.
While bellows were carried on most ships where a fire was needed, they probably were not found on all ships or were not necessarily part of a sea surgeon’s medical chest, thus despite the thought that bellows were superior and tracheal tubes, most probably relied on mouth to mouth resuscitation.
The first step taken most people would have tried would have been to turn the person on their stomach and rub the back in an attempt to eject water from the lungs. Another method would be grabbing the person around the waist and repeatedly lifting the mid-section off the ground in an attempt to pump the water from the body. If the person seemed to be breathing after these attempts were made, a doctor would probably try to wake an unconscious victim by vigorous shaking. Despite the fact that mouth to mouth resuscitation was known before 1700, the above step would have probably been the only step taken by most sea faring men, especially pirates before 1700.
After 1700, if these first steps failed, then mouth to mouth or mouth to nose resuscitation would be performed. This involved a man placing his mouth over the drowning victim’s mouth or nose and then blowing air into the lungs. This would often involve two rescuers with one man blowing into the mouth while another man pushed down on the stomach to prevent the air from entering the stomach. Depending on the damage done to the linings of the lungs during the submersion, this type of resuscitation can be quite effective. In order for resuscitation to occur the alveoli must still be functional. The alveoli are the final branchings of the respiratory tree and act as the primary gas exchange units of the lung. The gas-blood barrier between the alveolar space and the pulmonary capillaries is extremely thin, allowing for rapid gas exchange. They are easily damaged when water is aspirated into the lungs.
If the alveoli is damaged severely enough, no amount of resuscitation will be successful. In other cases a person will be resuscitated but because of damage to the alveoli they will never regain lung capacity and in still other case the damage to the alveoli will progress over time and eventually kill the victim.
There was also rudimentary information regarding hypothermia or the loss of body heat, so the victim would probably be covered with blankets in an attempt to keep them warm so once a person appeared to be recovering they would probably be wrapped in blankets.
All sea going men knew that any time spent under the water could be deadly. Often for this reason, near drowning victims would be given rest or light duty for several days after the event even if they seemed alright.
Despite what you see in the movies, in the 18th century a gunshot wound to the chest or abdomen was almost always fatal. That is to say if the bullet made it through the fat layer and entered into the actual chest cavity or intestines.
Unless the bullet could be seen or felt it was impossible to extract it. If the bullet had opened up the belly and exposed intestines, it was certain that peritonitis would follow. What was to follow was death. The only question was how long would death take and how much pain would the poor soul have to suffer. Surgery was not an option. About al the gun shot victim could do was pray and wait. On some occasions a bullet would lodge in the fatty tissue and work its way back out. In some cases no organ would be damaged and the person would go through life with a bullet lodged inside. however for most it was a slow lingering death from infection or internal bleeding.
Gun shots to the arm or leg could also prove fatal due to infection. Bullets had a nasty habit of pulling strands of filthy cloth into the body along with a note so sanitary bullet. most bullets were made of lead and often contained impurities. the act of firing the bullet from a pistol or musket did not as a common myth suggests, sanitize the bullet. They were dirty little balls of lead and would almost always lead to some kind of infection.
If the bullet hit a bone, amputation almost certainly followed. There was no way to set a bone that was shattered by a bullet, and the bone fragments were known to lead to infection. The only way to save the victims life was to take off the limb.
As for a gunshot that did not shatter a bone or injure organs, it was usually removed if the doctor could see it or feel it under the skin. Most doctors probed for bullets using their fingers. Once it was found they might use a bullet extractor or knife to cut out the bullet. Afterwards, the wound would be allowed to bleed in order to wash out any cloth and in hopes of preventing infection. Finally the wound would be sewn up, if necessary, and then bandaged.
Before you email me and tell me Myth Busters proved that splinter wounds didn't happen please read the following historically documented cases of splinter wounds:
I could go on but I don't have the time or patience to look up the numerous cases of people wounded and killed by splinter wounds. There are literally hundreds of documented cases of people receiving grievous and even mortal wounds from wood splinters during a naval engagements. As much as like Myth Busters, the historical evidence proves that splinter wounds did happen and they were known to be lethal. I'm sure not every cannon ball that hit a deck caused splinter wounds. I'm just as sure lethal splinters were produced. Multiple cannon shots were bound to weaken the structure and causing splits in the wood. Follow up shots could then dislodged large splinters and greater speed than if the wood had maintaine dit's solid integrity. Myth Busters experimented a six pound cannon ball. They mentioned it would be ten times more lethal that the three pound ball. The long nines, were the chaser guns on many fighting ships firing a nine pound ball. Ships-of-war were often armed with 24 and 32 pounders. Pirate sloops often were armed with anything from 4 to 12 pounders. A salvo of 12 pounders followed up four minutes later by a second salvo could very well produce lethal splinters simply because the integrity of the ship's hull had been compromised . The historical evidence is proof that it did happen. The inability for two TV personalities to replicate a naval battle is not sufficient to debunk the factual record of splinter occurences.
While it is open to debate if more sailors and/or pirates were killed by splinter wounds than solid cannon shot, the splintering of the decks and sides of ships was well known and was considered one of the benefits of using solid shot against sailing ships. After repeated shots, the sides of sailing ships could be beat up bad enough that large splinters, well over a foot long, could be dislodged and become lethal wooden missiles. Smaller less deadly splinters could take out eyes or cause serious lacerations. If the splinter broke off in the process of pulling them form a body, infection would almost certainly follow. Often the only way to remove some splinters was by cutting them out. If the splinter went deep into the abdomen, the only way to safely remove it was by trying to pull it out. This was not always possible. Deep splinters to the vital organs were a slow and painful death. I'm sure the men who suffered such wounds wished they would have been a myth!
It was important for both physician and surgeon to know the difference between infection and mortification. Infections could get better but mortified skin had to be removed. The most common way to remove mortified skin was through amputation when possible.
Today, we know that an infection is an invasion of a host by some foreign object. Typically this means inflammation caused by fungus, bacteria, or a virus but it can mean many other things. For instance, Colds are viral infections, athletes' foott is a fungal infection, and strep throat is a bacterial infection. Any numerous types of germs can cause wounds to become infected and in the 18th century almost all gun shot wounds would get infected to some degree. 18th Century doctors had no understanding of what caused infections. They did however know that wounds became infected. They referred to the discharge of an infection as laudable puss. Today, we know laudable puss as white blood cells in a wound fighting off an infection. In the 18th century this was considered a part of the healing process and in some ways it is. It is the body's attempt to fight off infection.
The puss was drained as part of the normal care of the wound. This was good in that they were also removing some of the infection but even draining the puss left it up to the body to fight off the infection. Laudable puss smelled foul but it did not smell like dead flesh. With luck the puss would eventually drain and the person would get better.
If the person did not get better, one of two things could happen. The infection could spread through the body via the circulatory system and the patient would die. Or the wound would mortify.
Mortification occurs when the wounded area no longer receives enough blood or air in order for the tissue to sustain itself. The most common term for mortification is gangrene. Gangrene (tissue death) is the rotting and decay of the flesh or body parts caused by infection or thrombosis or lack of blood flow. Typical sign of mortification is the stench of dead flesh, a blackening of the skin and painful swelling. The most common form of gangrene involving gun shot wounds or amputation was gas gangrene. Today we know it is caused by the clostridium perfringens bacteria. It spreads quickly and is still often fatal.
(Alternatives to Medicine in the 18th Century)
There is no doubt that by claiming quackery to be the Alternative medicine of the 18th Century, some people who practice by alternative therapies will be outraged. With that said, I will move on.
In some instance, just as today, Quacks actually did find useful remedies to health issues. However most quacks pedal ineffective medicines or therapies that had no positive effects and in some instances caused harm. One such Quack named Franz Mesmer used "magnetized rods" that were placed on the skin to cure all sorts of ills in 1734. Does this sound familiar? It should. 300 years later magnetic bracelets were being sold by the thousands despite no medical proof of actually working. Benjamin Franklin a man with a keen understanding of electricity was instrumental in debunking Mesmer's theory when it was first introduced.
Touching was a form of quackery in the 18th century. It was believed that royalty could cure disease simply by laying hands on an individual. Today the practice exist in the form of faith healers. While their are documented case of people being healed by such practice, there is no medical proof of being healed by simply by being touched. Even the Catholic Church dismisses the practice.
Other forms of quackery were more successful yet ignored by the medical profession. Today some of these quack remedies have proven to be beneficial and have been accepted as good medicine. For instance, the medicinal qualities of certain herbs are well founded today and vitamins are accepted necessary for good health.
Quacks were most successful at treating scabies which shows that even in the 18th century there were instances where the practitioners of alternative therapies were a step ahead of the established medical field. However for the most part quackery was dangerous, ill founded, and seen as the last hope of desperate patients who had no where else to turn.