When European sailors began to explore the rest of the world, the problem of

keeping healthy on such long voyages became acute. Malnourishment and

crowded conditions bred disease, but they also carried epidemics that decimated

the indigenous populations they encountered – and brought back new diseases

like syphilis.

As navies developed, the well-being of crews became a dominant factor in the

success of naval operations, so it is no surprise that the Royal Navy led the way

in shipboard medical provision, and sponsored many of the advances in diet and

hygiene which by the Napoleonic Wars gave its fleets a significant advantage over

all its enemies. These improvements trickled down to the merchant service, but

the book also looks at two particularly harsh maritime environments, the slave

trade and emigrant ships, both of which required special medical arrangements.

Eventually, the struggle to improve the fitness of seamen became a national

concern, manifest in a series of far-reaching – and sometimes bizarre – public

health measures, generally directed against the effects of drunkenness and the

pox.

In this way, as in many others, an attempt to address the specific needs of the

seafarer developed wider implications for society as a whole. It also produced

scientific breakthroughs that were a universal benefit, so far from being a narrow

study of medicine at sea, this book provides a fascinating picture of social

improvement

Nominated for Mountbatten Award for Best Maritime Literature, 2011

Maritime Foundation (http://www.bmcf.org.uk/awards/)

Reviews

… shows an attempt to address the needs of the seafarer developed wider

implications for society as a whole. It also produced scientific breakthroughs that

were of great benefit, the eradication of scurvy being one. The book not only

details a history of naval medicine, but of a wider social health improvement.

The Nautical Magazine

Poxed and Scurvied

The Story of Sickness & Health at Sea

Kevin Brown Hardback 256 pages ISBN: 9781848320635 Published: 4 May 2011 US Edition: US Naval Institute Press ISBN: 159114809X Published: August 2011

£25.00

Many years ago I visited the Royal Naval Medical School in Hampshire. Staff

were playing croquet and pink gins were offered. Kevin Brown's book captures

the flavour of these relatively recent, more expansive and expensive times, as

well as that of the long-distant past. His history starts with the Black Death and

moves to syphilis, but primarily has a strong naval focus - making extensive use

of Royal Navy records in an authoritative account of maritime medicine and

diseases spread by sea. Infections either dominate or lurk just under the surface.

After all, amputations during naval battles were often done in an attempt to

reduce the risk of death from gangrene. The book brings this to life very well,

with its lurid account of the surgery and the knives and saws, as well as covering

quarantine and the great pandemics of the past.

Well-referenced, and well-written, this account is a good read as well as a useful

source of in-depth information. I was particularly pleased to see the Court of the

Baillies of Aberdeen minute for 24 April 1497 that 'licht weman' (prostitutes)

should desist 'under the pain of a brand on their cheeks' was quoted. The

stimulus for this measure - 'to control infirmities come out of France and strange

parts' - didn't get mentioned. Perhaps the author was being diplomatic.

Hugh Pennington, Microbiology Today

The impressive 36 pages of detailed notes and bibliography mean that Poxed

and Scurvied will find itself at home with academics of maritime history.

However, its written in such an accessible form that it should also appeal to

anyone curious about life – and death – at sea in the last millennium

Who Do You Think You Are Magazine, September 2011

It details the devastating diseases carried by early travellers and colonists. For

example, the Black Death, which killed a third of Western Europe's population,

was brought back by Genoan merchants returning from the Crimean.

...

There is also a chapter on emigrant and slave ships, where the need to keep the

'cargo' healthy while manacled for much of the voyage led to bizarre practice of

forcing slaves to dance in their chains.

Poxed and Scurvied ends at the Falklands War which Brown describes as: " The

last of the colonial wars in which ships are isolated at sea"

Norwich Evening News, 23rd July 2011

Despite its gimcrack title this is a serious work by an author well qualified in

medical matters. The first half describes health problems in the Royal Navy

during the sailing ship era; there is little on the mercantile marine or on foreign

seafarers. It is a story of gradual improvement, but from a low base.

The main task of ships’ surgeons was treating battle casualties, usually by

amputation (without anaesthetic). Arthur Devis’s painting of the death of Nelson

in the gloomy cockpit of the Victory gives an idea of the conditions in which surgeons carried out their bloody task.

However, many more seamen died from sickness than in battle, and in treating

disease most surgeons were even more ignorant than their counterparts on

shore. Although scurvy was notorious as the scourge of the sea, its ravages were

chiefly confined to long voyages, and on routine cruises typhus, dysentery and yellow fever killed many more men.

The lot of the sick and wounded at sea was appalling, as they languished below

deck amid filth and stench. Reformers at sea and on land slowly introduced

improvements: better diet (the Admiralty authorised the issue of lemon juice in

1795 to combat scurvy), an emphasis on cleanliness and adequate ventilation, and the building of naval hospitals on shore.

The rest of the book ranges from descriptions of the dire conditions on slaving

ships and emigrant vessels to life on the passenger liners and cruise ships of the

20th century, where the doctor’s role could be more social than medicinal. In

today’s navy, serious casualties are air-lifted ashore for specialist attention.

Kevin Brown's wide reading is shown by the number of quotations that enliven his

text. There is space for only one here, Nelson's cautionary remark that " the

great thing in all military service is health, and it is easier for an officer to keep

me healthy than for a physician to cure them".

Glyn Williams, BBC History Magazine, September 2011

this book provides a fascinating picture of social improvement.

ICSM Gazette, The Medical Schools Magazine, Summer 2011

A thoroughly researched story of how mankind has kept well at sea from the

earliest times to the present, written in an anecdotal style, and should interest

any maritime or medical historian. Worshipful Company of Spectacle Makers From the Master and Wardens

A fascinating insight into the history of maritime medicine ... Brown has

excavated fascinating diary material ... offers vivid contemporary accounts of the

sick bays on warships during battle.

Ham & High

A fascinating and wide-ranging history of health, hygiene and the sea.

The rapid increase in global exploration and trade from the fifteenth century

brought with it similarly rapid increases in the spread of diseases like the Plague,

smallpox and syphilis. In effect, there was a two-way trade in such diseases – smallpox from the old world to the new and vice versa.

Lengthier voyages, as the author explains, worsened the problem of scurvy. It

was not until the early nineteenth century that enough was known to prevent that

dreaded disease. Typhoid, tuberculosis and even skin cancer were all diseases of the sailor.

Really, until the end of the Second World War, seafarers generally remained a

“poxed and scurvied” lot. While rare examples of such diseases continue to recur,

however, modern sailors seem to suffer more from psychological diseases.

This is a great narrative of an important but often hidden aspect of seafaring.

Baird Maritime

The author is curator of the Alexander Fleming Museum and an expert in the

history of medicine. This fascinating book traces the problems of malnourishment,

disease and injury faced by the seafarer from fifteenth century right up to the

modern period.

The Royal Navy's role was very significant in improving the fate of the seafarer.

Brown goes into some detail about Lord Nelson's real concern for Jack Tar's

welfare - and the specific actions he took in such areas as shipboard diet,

hygiene, morale and naval hospitals ashore.

Brown also shows how in many ways attempts to address the specific needs of

the seafarer developed wider implications for society as a whole; a number of

scientific breakthroughs were in fact of universal benefit.

Julian Stockwin

(http://www.julianstockwin.com/BS%20Sea%20Reference.htm)

A wide-ranging general history of disease, medicine and the sea.

Guardian Bookshop

Poxed and Scurvied: The Story of Sickness and Health at Sea by Kevin Brown

was really great. At first, it seems a bit unorganized, but as you continue to read

the chapters, a pattern emerges. Each chapter is a new topic (or two) but always

covers disease prevention, nutrition, diet, exercise, treatment aboard and

treatment ashore. Usually in that order. Brown covers from the 14th century

through today.

I'm not sure if it is because I worked at the Country Doctor Museum for a year

during grad school or if it is that weird fascination that most people have about

tragedy, but I really enjoyed this book. I found it interesting and insightful in so

many ways. For example, most scholars reference the transmission of epidemics

from old world to new world and the return-favor disease of syphilis. Brown goes

farther, explaining why epidemics break out on ships, the development of

maritime hospitals and quarantines to deal with these diseases, and the ground

breaking work of ship surgeons. He explains that ships were the ideal control

group with diseases accelerated by conditions, hygiene and lack of treatment

options. Also the patients were all very similar-men, youngish, and had the same

diet and environmental conditions=perfect control group!

Brown doesn't just focus on the sailors. Many have learned about the horrible

conditions of slave ships. Brown presents some of those conditions and takes it

further. He explains the motivating factor of money on health in the slave trade.

It is cheaper to throw sick slaves into the sea before they die rather than report a

sickness related death. And there is no monetary reason to treat sailors as they

are less valuable than the slaves. He goes on to discuss emigrants on passenger

ships-sometimes just as crowded as slave ships. He talks about the health exams

before boarding, women and children's health aboard (first time large numbers of

women and children were crossing oceans), and the infamous health exams at

Ellis Island.

I learned a lot, and gathered some of the missing pieces in maritime medicine! I

would recommend it to anyone interested in medical history or sickness at

sea.

Whitney Rose Petrey

(http://maritimeculturenews.blogspot.com/2011/11/book-review-

poxed-and-scurvied-sickness.html 30 November 2011)

A professional archivist, museum curator specializing in the history of

medicine and author of The Pox: The Life and Near Death of a Very Social Disease

describes the history of maritime medicine, particularly the on-board deficiency of

vitamin C.

Probook, Israel

(http://www.probook.co.il/BookPage.aspx?BookId=9781591148098)

In summary, Kevin Brown’s Poxed and Scurvied, decorated with an

outstanding dustcover illustration, is a well-written scholarly work that should be

a part of any serious maritime historian’s library.

Sea History, Winter 2011

With chapters on every malady and danger the seaman’s flesh is heir to, Poxed and Scurvied tells the story of the struggle to improve the fitness of the not always jolly jack tar, and of the various scientific breakthroughs that would be of great benefit both on the high seas and dry

land. Family History Monthly, Feb 2012

KEVIN BROWN is the Curator of the Alexander

Fleming Museum at St Mary’s Hospital,

Paddington, and Trust Archivist at Imperial

College Healthcare NHS Trust. He is an expert

on the history of medicine. He is the author of

Penicillin Man, which tells the story of the

antibiotics revolution that began in the

laboratories he now curates, The Pox, a history

of venereal disease, and also Fighting Fit, a

history of military medicine in the wars of the

twentieth century. He lectures and speaks

widely on the history of medicine at home and

abroad.