While we socially isolate, we might spare a thought for seafarers battling the main diseases that often reached epidemic proportions among ships’ crews in the Age of Sail, a period in which the ‘miasma theory’ — that disease was contracted by inhaling foul air — still prevailed. We glimpse the theory in the laments of a former ship’s doctor writing early in the 18th century, regarding unventilated ships’ holds, in which ‘stagnant salt water’ tended to accumulated, and regarding their lower decks, in which ‘a multitude of people breathing and constantly perspiring’ were crowded together. The long-held theory is reflected in the name of that well-known scourge of tropical climes including the coast of West Africa, malaria (‘bad air’), which we, of course, know is spread by mosquitoes. But before we look briefly at epidemics involving infectious diseases, let’s look at that well-known non-communicable disease, scurvy, which had a devastating impact on seamen’s health ever since long voyages came to be undertaken.

Vice-Admiral Sir Richard Hawkins — son of the more famous Sir John — saw over a 20-year period a total of 10,000 seamen die of that disease. Scurvy killed 1051 of 1955 men who embarked with the future Lord Anson on his circumnavigation of the world (1740-44). During the 18th century wars with France and Spain far more British seamen died from scurvy than from enemy fire. As we know, scurvy is caused by a dietary lack of ascorbic acid (vitamin C). During the period under discussion it was thought to be due to some dietary indiscretion, and the belief that it was due to trapped food putrefying in the digestive tract still prevailed. Nevertheless, the curative effects of certain fruits and vegetables had long been known — to the great Portuguese navigators, for instance, to Hawkins himself, and to many herbalists. In 1617 The Surgeon’s Mate, a treatise by John Woodall, surgeon general of the East India Company, noted the benefits of such familiar leaf and root vegetables as watercress and radish, and of such herbs as sorrel, spoonwort (‘scurvy grass’) and wormwood. He also noted the value of exotic fruits available to mariners in foreign climes: oranges, lemons, limes, and tamarinds. So it does not seem particularly surprising that an anti-scorbutic recipe dated 1707 appears in the handwritten ‘Ebot Michell [sic] her book’ (the name Ebot suggests she was Cornish) discovered in Gloucestershire some years ago. She recommended pounding together three handfuls each of water cress, of ‘scurvy grass’, and of ‘brooklime’ (speedwell), one handful of bettony, and half a handful of wormwood. That concoction was to be added to a quart of white wine and left to stand for twelve hours, covered, and then bottled. Eight spoonfuls of the mixture were to be swallowed each morning along with a draught of ale and a copious amount of orange juice.

A book published in Holland in 1734 attributed the major cause of scurvy to the absence of fresh greens from the diet, but the medical man chiefly responsible for advancing a fruit- and vegetable-based diet as a means of preventing and curing scurvy — while still holding the traditional beliefs about the disease — was Scotsman Dr James Lind. While serving in 1747 as surgeon on board HMS Salisbury, he confirmed to his satisfaction through controlled experiments the value of citrus fruit in treating scurvy. He made his findings known in A Treatise on Scurvy first published in 1753. It was dedicated to Anson, who may have used his considerable influence to secure Lind’s appointment in 1758 as physician to the brand new Haslar Naval Hospital near Portsmouth. Since lemons and oranges (the citrus fruit most readily procured, it seems) were relatively scarce and therefore expensive, and since their juice quickly spoiled, other ways were tried in order to prevent scurvy on long voyages. Captain Cook’s success in keeping scurvy at bay was largely due not to lemons but to spoonwort, to taking aboard fresh provisions and vegetables whenever possible, and to forbidding salt fat skimmed from the insides of the copper pots in which food was boiled to be consumed (a Scarborough surgeon, John Travis, had warned in 1752 of the deleterious effects of copper on vegetables, and he was right, since copper ions destroy vitamin C). The benefit of green vegetables was widely heeded by officers, and sauerkraut (fermented raw cabbage), with its good keeping qualities, was a boon on ships. While chief of staff to the Channel Fleet under Admiral Sir Francis Geary, during a notable scurvy epidemic in August 1780 that forced the fleet into Spithead, Rear-Admiral Richard Kempenfelt — who found that that ‘half our people are scorbutic’ and the rest ‘somewhat tainted’ — ordered the fleet’s pursers to ensure that every sick seaman from their respective ships lying as outpatients in the grounds of Haslar received daily ‘a pound of bread, a pound of beef, plenty of vegetables and roots… ‘

Now to infections. One of the most debilitating and often deadly diseases affecting seamen was ‘jail’ or ‘ship’ fever. Common in overcrowded prisons and parish poor houses, this was typhus, of the flea-borne and lice-borne sorts. In 1735, a virulent typhus outbreak swept through ships moored at Plymouth — and reportedly at Portsmouth too — and there was a comparable occurrence in 1741. Around the time of the Seven Years’ War (1756-62) fevers, particularly typhus, were rampant. From 1 July 1758 to 1 July 1760, of 5743 admissions to Haslar 2174 were due to fevers and 1146 to scurvy, admissions due to other causes being in the low hundreds. In early autumn 1758 about 300 men belonging, all told, to several ships arriving at Spithead from what became Canada, were admitted to Haslar, some with scurvy but many more with fever. Close to 30 fever victims died. Fever took the lives of fully one-tenth of the seamen and marines raised for service during the American Revolutionary War (1775-83). Fifty men belonging to HMS Nonsuch died from fever in 1777, and before the year was out she and HMS Somerset had around 150 sufferers; 90 from the Somerset eventually succumbed, including 70 of her best seamen. HMS Venus, anchored off Rhode Island in April 1778 with her crew of 240 showing signs of sickness, had already lost about 50 men to fever, caught from prisoners of war crowded on board her. In late October 1778, Channel Fleet commander Admiral Augustus Keppel, following his indecisive battle with the enemy off Ushant near the Breton coast, took his ships into Spithead. Fever, apparently typhus, which was present in Portsmouth, soon ran rife in that fleet, and by year’s end over 3500 men had been admitted to Haslar.

The distinguished naval physician Sir Gilbert Blane recalled an outbreak of dysentery in the Caribbean in 1780, after five ships from England joined Admiral Rodney’s squadron, which ‘was then extremely healthy’ although all its ships had been stricken with illness, mainly dysentery, soon after their own arrival ‘in that climate’. The last of the five newcomers, the Intrepid, arrived with a convoy on 15 March. Dysentery broke out in April in all five, ‘and it prevailed to the greatest degree in those which had been most affected with fevers in Europe, namely, in the Terrible and Intrepid. The Sandwich and Ajax were also though in a less degree… The Intrepid, while in England, had been afflicted with fevers to a most uncommon degree; for, being one of the fleet in the Channel cruise the year before, almost the whole crew either died at sea or were sent to the hospital upon arriving at Portsmouth. This ship, after refitting, was pretty healthy for a little time; but, probably from the operation of the old adhering infection, she became extremely sickly immediately after joining our fleet and sent two hundred men to the hospital the first two months after arriving in the West Indies. Most of these were ill of the dysentery.’

The Italian word ‘influenza’ was not used in England until 1743, although it was certainly represented among catarrhal fever epidemics recorded. In May 1782 a small Channel Fleet squadron commanded by Rear-Admiral Kempenfelt in HMS Royal George sailed westward from Spithead to watch enemy movements near the entrance to the Channel. But on 29 May, while off the Cornish coast, Kempenfelt informed the Admiralty that HMS Bellona was stricken with ‘a kind of influenza, a violent cold, and slight fever’ that laid low 300 men and all the lieutenants. Accordingly, he had ordered her into Torbay, with instructions to make for Spithead if there was no sign of recovery. On 1 June, from his flagship at Torbay, which herself made for Spithead a few days later, he told of three more ‘sickly ships’. Before long his entire squadron had returned home ‘on account of the sickness that rages on board his fleet’, to quote a contemporary source dated 4 June. ‘More than 400 men have been brought to the hospital this morning. Our men drop down with it by scores at a time.’ HMS Latona reportedly had so many invalids among her crew that the officers were ‘the only hands that could work the ship’. Three weeks later a contemporary reported that with the coming of fine weather the crews of ships anchored off Portsmouth had ‘perfectly recovered from the late disorder’, signs of which had ‘also vanished from the town’. Kempenfelt’s squadron resumed its westward cruising before joining the rest of the Channel Fleet at Spithead in August preparatory to sail to the relief of Gibraltar: on 29 August the Royal George sank suddenly and sensationally, taking the admiral, most of his crew, and many other people, male and female, to watery graves.

Although the concept of germ-borne disease was still in the future, Lind and his disciples Blane and Trotter were aware from observation that disease could be passed from person to person — such as Lind’s example of a marine who having lain on the sickbed just vacated by another came down with the identical complaint — stressed the importance of personal hygiene and clean clothes and bedding in preventing contagions. For instance, typhus having broke out on HMS Vengeance in February 1793 while she awaited sailing orders at Spithead for the Leeward Islands, Trotter, her surgeon, traced the epidemic to two men, one of whom died. Both were among 200 men sent aboard in January from a frigate at the Nore, when the Vengeance, then at Chatham, was being manned. During her ‘long’ passage from Chatham to Spithead in ‘rainy and boisterous’ weather, the two carriers unknowingly spread the infection, ‘for here was everything that could render it active, a crowded ship, new raised men, badly clothed, sleeping on deck, a cold season etc. Sixty cases were sent to Haslar on the arrival at Portsmouth; some had been cured on board; and when I joined the ship [in February] there were eleven people confined to their hammocks with this fever. The disease was hitherto almost confined to the new-raised men, who were Irish landmen, dirty and ragged … the very dregs of jails in the metropolis. Men of this description, such as are often to be met with in ships, are the victims of all general sickness.’ He continued: ‘The usual precautions of purifying the ship were immediately put in execution, and additional clothing was ordered to those in want of it; at the same time care was taken to enforce personal cleanliness where it was necessary. Every man with the first symptoms of indisposition was carefully watched and sent on shore.’ On 10th March, he having advised that the crisis was over, the Vengeance set sail for the warm Caribbean.

Dubbed ‘yellow jack’, yellow fever was the major medical hazard of service in the Caribbean. Thus in 1693 a squadron under Rear-Admiral Sir Francis Wheler [sic], with 1500 troops aboard, put into Barbados, where the infection spread through his ships with deadly results. In November 1694, during a severe outbreak on Barbados, naval captains found that they could hardly press men from incoming merchant vessels quickly enough, since so many of their own naval crews were dying daily and had to be constantly replaced. Notoriously, in 1726, while blockading the Spanish at Porto Bello on the isthmus of Panama, a British squadron consisting of 20 ships and roughly 4750 men under Rear-Admiral Francis Hosier was stricken with yellow fever, which persisted in the squadron long after the latter’s removal to the Caribbean. In total, over 4000 men perished — including, in August 1727 at Jamaica, Hosier himself — along with some 50 lieutenants and up to ten officers of captain’s rank or higher, including Hosier’s immediate successors (a commodore and a vice-admiral). The epidemic was recalled in the ballad Admiral Hosier’s Ghost, written in response to Vice-Admiral Edward Vernon’s celebrated (in both senses of that word) capture of Porto Bello in 1739, with few ships at his command.

Heed, oh heed, our fatal story,

I am Hosier’s injur’d ghost,

You, who now have purchas’d glory,

At this place where I was lost;

Tho’ in Porto Bello’s ruin

You now triumph free from fears,

When you think on our undoing,

You will mix your joy with tears.

See these mournful spectres sweeping

Ghastly o’er this hated wave,

Those wan cheeks are stain’d with weeping;

These were English captains brave:

Mark those numbers pale and horrid,

Those were once my sailors bold,

Lo, each hangs his drooping forehead,

While his dismal tale is told. …

Sent in this foul clime to languish,

Think what thousands fell in vain,

Wasted with disease and anguish,

Not in glorious battle slain.

Lo, each hangs his drooping forehead,

While his dismal tale is told. …

Sent in this foul clime to languish,

Think what thousands fell in vain,

Wasted with disease and anguish,

Not in glorious battle slain.

In the British medical records of the time malaria was usually listed as ‘the agues’ and, owing to its tendency to relapse in victims, ‘intermittent’ fever. Following Vice-Admiral Sir Hyde Parker’s victory against the Dutch fleet at the Dogger Bank on 5 August 1781, badly wounded but otherwise healthy men from HMS Berwick were sent ashore for treatment at what Trotter, who was then surgeon’s mate on board her, described as a badly-run ‘sick quarters’ at Sheerness, where they all caught ‘the agues’. A few months later, owing to the transfer of a number of still-infectious patients from the hospital at Deal being sent to the Berwick to increase her complement, ‘the agues’ broke out on board. The ability of cinchona bark, which contains quinine, to alleviate fever had been known to Europeans since the 17th century, and so was used by naval doctors to treat malaria. ‘The intermittent fevers that I have met with on the coast of Africa’ — he was thinking particularly of the so-called Guinea coast — ‘were confined to the seamen employed in the boats’, wrote Trotter, who used that remedy with much success.

What Dr Lind (who was rightly described by Trotter as ‘the father of nautical medicine’) considered sensible policy on the part of captains going to the West Indies — that they choose seamen with experience of that region — presumably applied to the East Indies too. ‘[M]any hardened veteran sailors are sometimes to be met with, who enjoy a better state of health in the West Indies than in Europe, having been long seasoned and inured to that climate’, Lind observed. ‘A crew of such men not only [has] a constitution suited to the climate, but, being prepossessed in its favour, are entirely void of those apprehensions, and that dread of sickness, which prove hurtful to unseasoned Europeans.’

Further information about Kempenfelt and his ship’s fate can be found in my book Catastrophe at Spithead (London, Seaforth, 2020). For the writings of Lind, Blane and Trotter and their impact on the Royal Navy see Christopher Lloyd (ed.), The Health of Seamen (London, Navy Records Society, 1965). More generally see Charles Creighton’s three-volume A History of Epidemics in Britain (Cambridge University Press, 1894).

Catastrophe at Spithead is available here.