Pestilence

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.

Antiseptics

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

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

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

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

Disorders of the Lungs

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

Consumption

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

Disorders of the Bowels

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

Flux

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

The Gripes

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

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.

The Itch

Scabies more commonly called "the Itch" is a general term for skin-diseases characterized by scabby or scaly eruption. Most often it is a contagious skin-disease, due to a parasite, Sarcoptes scabiei. The disease could have been easily avoided by regular bathing and wearing clean clothes. But what self respecting 18th century pirate is going to take a bath and wear clean clothes?

Cosimo Bonomo had discovered that the Itch was caused by parasitic louse in the late 1600s. He started a treatment using a salve containing sulfur which proved quite successful. Despite his correct diagnosis and effective treatment, most medical professionals continued to consider the disease caused but imbalance of the humors and continued to treat it by either sweating a patient or by bleeding a patient. Quacks on the other hand followed Bonomo's effective treatments and used various salves of either mercury or sulfur to treat the Itch. It would take several years for the medical profession to admit their wrong headedness in the treatment of scabies.

An interesting tidbit to the treatment of scabies and quite possibly one reason why physicians started treating it correctly involves none-other than Benjamin Franklin. the widow Sarah Read, Franklin's mother in law, ran advertisements in the Philadelphia Gazette promoting her ointment which was supposedly had no foul odor and was guaranteed to cure the Itch. It is safe to assume that Franklin, having an open and inquisitive mind, supported this quackery by his mother in law allowing such ads to run in his paper. While supporting the quackery of hi smother in law, Franklin debunked other forms of quackery such as the use of magnets to remove harmful electric currents from the body.

Gout

In the 18th century, Gout was viewed as a disease of decadence caused by over indulgence especially of rich foods and alcoholic spirits and laziness. Most pirates, missed out on gout simply because they died young and couldn't afford the rich foods often attributed to it. However, diets high in sea food and organ meat could also lead to gout. Diets high in salt are also a problem. Port wine also was a major culprit. In the 18th century it was common to sweeten wines with sugar of lead. Sugar of lead was made from that "insipid Metal and sour salt of Vinager, has in it a sweetnesse surpassing that of common Sugar"^[1]. Basically vinegar was boiled down in a lead pot and what was left was sweet tasting syrup. The syrup caused chronic lead poisoning and this in turn brought on gout, a sign of lead poisoning.

The disease often led to severe joint pain and inflamed skin As it progressed, kidney stones could form leading to even more misery.

In sever cases, the skin would actually begin to shed form the excessive swelling. Outer joints such as toes or fingers might become so swollen that they would mortify and need to be amputated.

Today we know that gout is a form of arthritis brought on by monosodium urate crystals are deposited on the cartilage of joints. It can be controlled by diet but diet and laziness do not actually cause the disease and becoming more active will not prevent attacks of the gout.

It was most often treated through bleeding and sweating. The drug of choice was colchicine poisonous alkaloid, made from the autumn crocus or meadow saffron. Patients were also advised to stop drinking and eating sweets.

Boils

A boil is a deep abscess in the skin. This section looks at carbuncles, a type of boil caused by staph (bacteria) infections. Boils have been a common complaint throughout history and many methods of treating them have existed.

Boils can form when a small cut or insect bite gets infected. If splinters or other foreign objects get lodged under the skin, they can also cause boils. A person with a weakened immune system due to illness, poor diet, or poor hygiene is more likely to get boils.

Typically, a boil begins as a tender spot on the skin that appears red in color. Over time the tender area becomes firm, hard and painful. In the final stages, the boil fills with pus (white blood cells) and forms a head. Because the boil is a staph infection it is sometimes associated with chills and fevers.

Once the boil comes to a head it is possible to drain it. Draing the boil is a very painful procedure that usually involves squeezing the boil to force out all the pus and fluids inside. Often it may involve lancing or probing the boil with a sharp instrument to dig out dead tissue and the head of the boil. As you can imagine the procedure is very painful. If the boil is not completely drained it will most likely recur. Once the boil is completely drained, the patient usually feels instant relief.

In order to prevent the boil from coming back, 18th century physicians probably used the most common antiseptic of the time, turpentine. Turpentine would burn like crazy when applied to the boil. Afterwards, the boil would be covered with a bandage. Turpentine would probably be a re-applied for a few days or unless the patient refused to return. Mercury might also be applied but that would have been for more stubborn boils. The use of Domba oil, another natural curative would have come into use around the late 1700s, well after the peak of the Golden Age of piracy.

Disorders of the Major Organs

Disorders of 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..

Stones

Stones referes to kidney and bladder and gall stones.

Fevers

Typhoid

Typhoid or typhoid fever is illness resembling or characteristic of typhus; applied to a class of febrile diseases exhibiting symptoms similar to those of typhus, or to such symptoms themselves, esp. to a state of delirious stupor occurring in certain fevers.

Typhus: The fever

Typhus is an acute infectious fever, characterized by great prostration and a petechial eruption; chiefly occurring in crowded tenements.

The Foul Disease

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.

Tropical Fevers

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.

Malaria

The earliest records of malaria infection date to 2700 B.C. The disease was also called marsh fever and has always been associated with swamp lands and tropical forests. It was initially believed that the disease was spread by the bad air of the swamp. The name "Malaria" is actually a contraction of the two Latin words -- mala = bad and aria = air. It would be a while before people realized mosquitoes were the principal cause of the disease. In 1880 a French doctor, Charles Louis Alphonse Laveran, discovered that parasites caused the disease. It wasn't until 1898 that a British doctor, Sir Ronald Ross, linked the disease to mosquitoes.

Once a person has malaria he will have it for life. There is no cure. Besides the initial symptoms listed above, malaria also causes anemia, which would lead to fatigue. After the initial onset, depending on what type of parasite is causing the outbreak, the patient will start showing the classical symptoms which is a cyclical occurrence of sudden coldness followed by the body becoming stiff and then fever and sweating lasting four to six hours. These bouts will happen every two or three days until death or the person receives treatment. In the most severe case of malaria a person will slip into a coma after 14-16 days of infection. In the 18th century this would spell certain disaster.

Yellow Fever

Yellow fever as it was called by the British was known as vomito negro by the Spaniards. We know from written accounts by Alexander Exquemelin and Lionel Wafer, that buccaneers invading the Isthmus of Panama were plagued by Yellow Fever. Yellow fever was not always deadly and in fact many people caught mild infections and recovered without treatment. However, just about anyone who went into fever infested areas was likely to catch it. This meant that one person may get a mild case while the person next to him could get a sever case leading to death.

The patient first has flu like symptoms as described above and then seems to recovers. Shortly after this recovery , the infection may lead to shock, bleeding, and kidney and liver failure. Liver failure causes jaundice (yellowing of the skin and the whites of the eyes), which gives the disease its name. The name vomito negro (Black Vomit) is associated with the vomiting that occurs in this later stage as the patient continues to vomit bile.

The disease does not always remain isolated in the tropics. Outbreaks of the disease also decimated cities such as Havana and Philadelphia in 1793. Outbreaks in urban areas tend to be more life threatening than in the rural areas. The reason the urban yellow fever is more dangerous than jungle yellow fever is because of the way the disease spreads. Jungle yellow is usually transmitted between monkey and mosquitoes. When humans enter this natural cycle they get the disease from mosquitoes infected by the monkeys. Urban yellow fever is caused when mosquitoes pick up the disease from humans and then pass it on to another human.

There is no cure for yellow fever. Once contracted it must run its course. The usual treatment is to drink plenty of fluids and rest. bleeding a patient with yellow fever would probably hasten death or at least prolong the illness.

Dr. Benjamin Rush, the only doctor to sign the United States Declaration of Independence, actually recommended bleeding and purging as the best way to treat Yellow Fever. Despite many nay-sayers, the advice of Dr. Rush, a respected physician was practiced by many throughout the colonies. His treatment involved a mixture of calomel and jalap^[2]. Despite many critics, the so called cure was pushed on many hapless patient, adding excess misery to an already horrible disease.

Scurvy

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.

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[1] Robert Boyle, The Sceptical Chymist 1661.

[2] Jalap is a purging drug. It is a climbing, evergreen vine, that reaches about twelve feet in length , with heart-shaped leaves and trumpet-like purple flowers. It is native to Mexico. Today it is grown in Central America, parts of Peru, the West Indies, and Southeast Asia. The purgative properties of Jalap has been known for centuries. Natives of Mexico introduced it to the Spaniards who then passed it on to the rest of Europe. By 1565 it was being used by most European nations as well as their colonial counterparts for all types of illnesses. It fell out of favor in the 19th century. Calomel is mercurous chloride. In the 18th century, mercury compounds such as calomel were used to treat everything from syphilis to fevers.