On Scurvy

On Scurvy by T. TROTTER, M,D. Trotter T. On Scurvy. Lond Med Phys J. 1816 Apr;35(206):257-260. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611004 https://pubmed.ncbi.nlm.nih.gov/30493884 This file is located at: https://doi.org/10.5281/zenodo.10931476 The original print is at the end of this file. Transformed to a modernized and easy-to-read version by Harri Hemilä, University of Helsinki. https://orcid.org/0000-0002-4710-307X https://www.mv.helsinki.fi/home/hemila Background The work of James Lind, Thomas Trotter, and Sir Gilbert Blane led the British Admiralty to require that antiscorbutic treatments are administrated to the ships of the British Navy [1-8]. Trotter wrote a few books about how to improve the health of sailors [9,10]. In this paper, Trotter briefly summarizes some experiences and what he achieved as the Physician to the Fleet. Some of the main issues of Trotter’s life are described by Porter as follows [2]: In 1779 [Trotter] joined the Navy and was appointed Surgeon’s Mate to the Berwick, a ship of seventy-four guns, at that time serving in the Channel Fleet. In the spring of 1780 the Berwick sailed for the West Indies in a squadron, but when off Bermuda the squadron was hit by a hurricane, all the ships were dismasted, and some were lost. In great distress the Berwick at last arrived back in England, the crew having suffered greatly from scurvy and dysentery; forty died during the passage back to England and over 200 required hospital treatment on reaching home… As a result of this voyage he became familiar with scurvy–a disease which was to become a major preoccupation with him and one to whose control he was to contribute much. In 1793 Trotter was appointed second physician at the Naval Hospital at Haslar and with vigour he set about making many changes in the organization of that institution… Trotter also desired a much larger medical staff for these hospitals. Haslar Hospital, when full, held over 2,000 patients for which there was a staff of 2 physicians, 2 visiting apothecaries with assistant dispensers in the wards for the physical patients, while in the surgical department there were 2 surgeons with assistant surgeons… Trotter had been appointed on 9 April 1794 by the Admiralty to be the Physician to the Channel Fleet, an appointment made, it was believed, solely on his professional ability. 1 References 1. Sheridan (1981) The Guinea Surgeons on the Middle Passage: The Provision of Medical Services in the British Slave Trade. Int J African Historical Studies. https://www.jstor.org/stable/218228 2. Porter (1963) Thomas Trotter, M.D., Naval Physician. Med Hist. https://doi.org/10.1017/S0025727300028180 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034809 3. Vogel (1933) Scurvy – “The Plague of the Sea and the Spoyle of Mariners”. Bull N Y Acad Med. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19311878 4. Taylor (1920) The founders of naval hygiene: Lind, Trotter, and Blane. U.S. Naval Medical Bulletin. https://zenodo.org/doi/10.5281/zenodo.10604304 https://archive.org/details/unitedstatesnava14unit 5. Rolleston (1919?) Thomas Trotter, M.D. Reprinted from Contributions to medical and biological research, dedicated to Sir William Osler. https://wellcomecollection.org/works/p42h3gek (pp.153-165) https://archive.org/details/b30622013 https://doi.org/10.1136/jrnms-5-412 (pp.411-419) https://wellcomecollection.org/works/rsvxejq3 https://archive.org/details/b30622037 6. Cockburn (1845) Biographical Sketch of the Late Dr Trotter, Physician to the British Fleet. Edinb Med Surg J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792981 https://archive.org/details/b30387310 7. Vale and Edwards (2011) 248 pp. Physician to the Fleet: The Life and Times of Thomas Trotter, 1760-1832 https://boydellandbrewer.com/9781843836049/physician-to-the-fleet https://www.jstor.org/stable/10.7722/j.ctt81v29 https://www.cambridge.org/core/books/physician-to-the-fleet/E11E1FC528B8F62F0463CBE65B92F7E5 8. Hemilä H. The Symptoms of Vitamin C Deficiency. 1. Observations and Descriptions by Hess, Lind, Trotter and Blane. 2024-2-20 https://zenodo.org/doi/10.5281/zenodo.10685194 9. Thomas Trotter. Observations on the Scurvy (1786/1792) 2nd edition 1792 (The History of Scurvy pp.33-70) https://archive.org/details/b3308578x_0002/page/n41/mode/2up https://archive.org/details/b3308578x_0001/page/n39/mode/2up https://archive.org/details/b21947855/page/n39/mode/2up https://archive.org/details/observationsonsc00trot/page/n43/mode/2up https://archive.org/details/bim_eighteenth-century_observations-on-the-scur_trotter-thomas-1792 https://archive.org/details/2575040R.nlm.nih.gov 10. Trotter T (1804) Medicina Nautica, 2nd ed, Vol 1. (Scurvy pp.405-430) https://archive.org/details/b21351879_001 Vol 2. https://archive.org/details/b21351879_002 Vol 3. (Scurvy pp.387-402; Citric acid pp.391-402) https://archive.org/details/b21351879_003 https://archive.org/details/b33088810_0003 2 Trotter T. On Scurvy. Lond Med Phys J. 1816 Apr;35(206):257-260. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611004 https://doi.org/ 10.5281/zenodo.10931476 For the London Medical and Physical Journal. On Scurvy; by T. TROTTER, M.D. A THIRD EDITION of my “Observations on Scurvy” has, for some time, been called for; but it was thought advisable to delay it till the conclusion of hostilities, when the whole experience obtained during the last twenty years of war might be brought into one view. It will, therefore, oblige me, by making your pages the medium of conveying my intention to such naval medical officers as may wish to favour me with their correspondence on the Prevention and Cure of Scurvy. This may be the last opportunity which may ever be offered to me of engaging in a professional enquiry connected with public service, and I should like to do it all the justice in my power. I shall ever bless Divine Providence for having placed me in the station of Physician to the Fleet when the general scurvy appeared, in every ship on the home station, in the severe winter of 1794-5. It then fell to my lot to see my own precepts exemplified on a larger scale of practice than may again happen to any succeeding physician. From this period are we to date the total extirpation of scurvy from his Majesty’s ships; and while I do justice to my own official duty, with much pleasure I shall record the faithful exertions of every naval officer, and I can never sufficiently praise the unwearied zeal and ability of the surgeons on this arduous occasion. At this time, the scene at Spithead was highly interesting, as well from its effects as from its novelty. After the most disgusting opposition from particular departments of office, I at last obtained every article in full quantity which I demanded. Lemons and oranges were sent to us by express p.258 in light waggons; and a supply of forty hundred-weight of fresh salad was obtained daily in the immediate neighbourhood of Portsmouth. Cruizing squadrons were supplied for their expected time at sea; and not a single ship was rendered inactive. From the nature of the service, in which a great part of the fleet was constantly detached upon, it was seven months before the taint of scurvy could be said to be fairly eradicated; during which time, upwards of 30,000 cases underwent the ordeal of cure, in their own ships, and without a single death! For the first time, a British fleet beheld the ceremony of an hospital ship firing a gun at noon, to dispense the stores of health to a scorbutic navy. From this time large tracts of ground, near the naval ports, were converted into gardens; and I received the discretional power from the Admiralty to order any quantity of vegetables in season for ships returning from long cruizes. A few years after this occurrence, the elegant preparation of the lemon by Mr. Coxwell, of Temple Bar, was put to the test of experiment, 3 and found to answer all the purposes of the fresh lemon in the cure of scurvy. It would have afforded me great pleasure to have contributed to Mr. Coxwell’s appointment as a naval chemist, in order to have superseded by his Concrete Acid every other form, as being easily portable, and liable to no changes by keeping;* but Lord Howe was now dead, and with him seems to have set the sun of improvement in the medical department of the royal navy. Without some arrangements of the kind mentioned above, it would have been utterly impracticable for our fleets to keep the sea for the length of time often done; or to have sustained the incessant and laborious duty of a general blockade. In the home seas, and in cold climates, the scurvy is chiefly prevalent. If we compare the extent of our naval armaments for the last twenty years, with what we have seen and heard of former wars, at a moderate calculation, not less than the lives of 80,000 seamen have been saved in scurvy only, by these changes. Besides, the strength of body and muscular power were preserved, for wielding with effect a heavy artillery in the day of battle; for it is observed in this disease, that a brave man becomes a physical coward. Thus were our ships kept full of men, p.259 while our merchant vessels were little molested by impressing, compared with former times. It is, therefore, of much importance that our successors should be informed of the horrors which the service has escaped from, that it may avoid such evils in the event of future wars. The years 1794-5 form an epoch in the medical history of the British navy. A contagion, spread from the French prisoners taken on the 1st of June, the most extensive of the kind ever known in a fleet, was subdued without exciting the smallest alarm in the country; while the means of safety were rendered familiar to the officer, and interwoven with permanent discipline. The prevention and cure of scurvy were fixt on an establishment for the supply of vegetables and fruits in season, as permanent naval stores. The royal hospital were surveyed, and searched in every department; and a new system introduced. The improvement of medical pay was begun. Regular sick apartments, with bedding and utensils, &c. were first granted. Comforts for the use of the sick in their own ships were improved to the utmost. The hospital ship of the fleet was new modelled: it carried to sea, besides the ship’s provisions, all the fruits and vegetables in season; live-stock; pickles; Seville oranges made into marmalade; Port and Lisbon wine; porter; cyder; tea, coffee, cocoa; sugar; eggs for puddings, &c.; and in 1797 a milch cow was embarked. To these may be added, the abolition of the disgraceful fine of 15s. levied on the seaman, and paid to the surgeon, for the cure of the venereal disease. On the whole, compared with former times, the sick-bed of the seaman was made a bed of comfort. *Every ship and vessel going out on foreign voyages should carry with them this Concrete Acid of Lemon. I recommended it long ago to the India Directors; but I am much afraid their ships still continue to suffer from scurvy. [Trotter wrote a separate paper about the benefits of citric acid against scurvy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611004 https://zenodo.org/doi/10.5281/zenodo.10604543 Citric acid gives no benefit againstscurvy, yet ascorbic acid was identified over a century later.] 4 I must embrace the opportunity now afforded me in this address, to remind the profession, that, during the last twenty years of war, it has been the lot of our fleets and armies to be employed in seas and countries where a British force was never before known. Now the history of health in these situations must have exhibited many facts of importance, as well as novelty. Would it not, therefore, be worthy of the glory which our arms have acquired, to preserve the knowledge thus obtained from sinking to oblivion? Having thrown out this hint for others to act upon, with much confidence I look to Sir James M‘Gregor, at the head of the army medical department, for its completion; and my friend Robert Jackson, who has just returned from another Anson-voyage, on the fevers of the West Indies. The British navy has again to bewail the direction of its medical department passing to another of the inferior boards. If the Admiralty could not find medical officers in the navy qualified to form a board of science, to watch the duties of p.260 the sick bed, it might have spared the service the mortification of seeing its surgeons put under the command of a few superannuated pursers, by taking the appointments and patronage under its own wing. What member of the profession but must view these transfers with disgust! No wonder that an officer of my rank should have been followed to retirement by the persecution of office, while such a spirit continues to direct the navy. I must beg my correspondents will be kind enough to frank their communications, for I have incurred an enormous expence from this cause since I retired. Newcastle; March, 1816. 5 6 7 8 9