Having read a few of the Aubrey/Maturin novels, it seems that Dr. Maturin was a pretty skilled surgeon-but it was 1812, and the germ theory was about 60 years away. I don’t recall reading that the good doctor ever washed his hands, or sterilized his instruments. So how many of his patients would have survived? Were there a LOT of burials at sea in that era?
I do remember that in one of the later novels, Stephen remarked that one of his contemporaries was using the method of bathing the surgical wounds and the instruments in “spirits of wine”, and that that surgeon had a very good record of healing in his patients. Stephen said he had started to adopt that practice. His cure to death ratio must have improved then!
ISTR, anyway, that his biggest job was treating sailors who had “the pox”. I’m sure he didn’t (permanently) cure any of them, and that they eventually died of their disease.
Read some more of the books… the number of burials immediately post action was usually met or exceeded by the wounded dying off from gangrene or other infections later.
And there are all the others who just died of disease.
I was pretty regularly shocked by the amount of casual death in the Aubrey/Maturin novels, myself.
In one of the later books, Maturin asserts that infections are much more rare at sea than by land. I think by land he meant in a hospital where the patients are packed together and the staff overworked.
Since this concerns a novel, let’s stroll over to Cafe Society, where you can still get factual answers while discussing the Arts.
samclem Moderator, General Questions
Probably most of his patients would have died, but, on the other hand, most of them were going to kick it anyhow without his help. Surgery was really a Black Art back then, a poorly-understood field with little guidance or knowledge. It wasn’t until the Civil War in America and the almost-simultaneous discovery of Germ Theory in Europe that this changed.
Most of his surgery on-board ship was whipping off legs, which he was rightly famous for. He’d only occasionally do something cool like open the gunner’s skull and attach a 3 shilling piece. And it seemed as far as he and other physical gents (remember, he was a physician, not a naval surgeon) were concerned, if the patient lives through the surgery, what happens after is out of their hands. There are some great lines where Stephen says something like “The operation was a complete success. And I even have some hope the patient will survive.”
Stephen, to Jack: “Always this whipping off of a leg. It is my belief that for you people the whole noble art of medicine is summed up in the whipping off of a leg.”
Remember in the first book how appalled Jack is at how filthy Stephen is, in his person and in his habits? And how ridiculous Stephen finds Jack’s habit of keeping everything clean?
He may have lost many of his patients, but he probably saved more than some of his ship’s surgeon colleagues would have, since he was a trained physician. Also, he seemed very interested in learning new techniques and treatments from other doctors, rather than simply relying on what he already knew and resisting change. He was a scientist who was willing to experiment (sometimes on his own patients!), which must have given him an advantage.
Although even he admitted that some of his treatments were mere placebos.
To add to what everyone else has said, Stephen is always portrayed as being on the cutting edge for his time, doing his best to apply scientific methods to doctoring, so his results would probably be a little better than others. One thing that Stephen always admitted is that aside from amputation there was preciously little he could actually do for most of his patients. To that extent he always went out of his way to create as much of a placebo effect as possible for his patients with the various blue pills, slime draughts, and Latin speaking.
Despite these ideas that were advanced for their time, Stephen still did a lot of things typical to doctors of that era. Thus, he bleeds Jack and often comments that his humors are out of whack, etc.
It’s completely anecdotal and I don’t even have the source for the anecdote, but I read somewhere that up until penicillin, doctors killed more people than they cured. If this is an exaggeration, I would have a hard time believing that before Pasteur and attempts to sterilize things, there was anything like a more-favorable-than-not outcome rate.
Right! And in the same book, he carves their dinner using a knife still dirty from a dissection.
A Sea of Words, Third Edition: A Lexicon and Companion to the Complete Seafaring Tales of Patrick O’Brian, by Dean King, has a chapter called “Stephen Maturin and Naval Medicine in the Age of Sail”. You can read part of it here on Google Book Search.
“Medicine can do very little; surgery less. I can purge you, bleed you, worm you at a pinch, set your leg or take it off, and that is very nearly all.”
Maturin was in the habit of sunbathing aloft (naked). I wonder how this went over with the tars? Of course, having an overall tan paid off for Maturin-the polynesian women liked him (they were disgusted by Jack’s pale skin).
But, back to doctoring: that guy who Maturin operated on (removal of a blood clot from the brain)-would he have survived? I am quite certain that a sailing ship was probablya lot cleaner than hospitals ashore. were those “naval surgeons” glorified butchers?
The squalid living conditions that form an inevitable ingredient in depictions of England’s urban working class of the Georgian Age produced a shocking infant mortality rate, but many of those who managed to survive the ever-present filth, smoke and total absence of hygiene into adulthood had no doubt developed prodigious powers of immunity.
Even though the Royal Navy – obsessed with spotless decks, blindingly white duck trousers, and a general air of cleanliness and order – would seem to provide an escape from the disease-ridden conditions on shore, consider the continued stress on the human frame from the confined living (not to mention sleeping) quarters, the lack of fresh food and water, constant consumption of alcohol, a close acquaintanceship with exotic germs and diseases from every corner of the globe, exposure to the elements, unsafe (to say the least) working conditions, harsh corporal punishment, and the hazards of storm, drought, starvation, and enemy fire. Again, those who thrived in such an environment would necessarily be sturdy physical specimens.
The role of the surgeon, therefore, would be primarily as a provider of first aid in the case of injuries. A practiced hand with bandages, splints, extractors, tourniquets, and the occasional bone saw could make a great deal of difference in trauma cases by staunching bloodflow, setting broken bones, removing foreign particles, and excising diseased tissue, thus giving the body’s natural healing processes a better chance to work on their own. While the lack of modern hygiene would certainly prove fatal in many cases, the sailors’ tendency toward robust immune systems would be a powerful factor in their chances for survival.
As to diseases, some were genuinely treatable, curable or even preventable by a knowledgeable surgeon. The notorious Captain Bligh, sailing some twenty years before the events of the Aubrey/Maturin series, quite rightly considered the development of scurvy to be attributable to an improper diet, and thus inexcusable in any well-founded ship. When the men of the *Bounty *began showing symptoms of the disease, he knew exactly who to blame – his drunkard of a surgeon, Dr. Huggan. In fact, the only two members of the Bounty’s company who perished before the events of the mutiny were a crewman who was essentially neglected to death by the surgeon, and Dr. Huggan himself, no doubt a victim of acute alcoholism.
To a large extent, though, the presence of the surgeon and his homeopathic remedies seems to have had a powerful positive psychological effect on the crew. Illiterate, uneducated, and inordinately superstitious, sailors of the day believed passionately in the traditions and folklore handed down to them by their elders. Receiving a dose of a surgeon’s alchemical concoctions, a great many of which had, even at the time, been proven medicinally worthless, nonetheless tapped into the power of the subconscious, raising the spirits of the patient and, to some extent, demonstrating the placebo effect at its fullest.
Dr. Maturin’s patients, therefore, would derive a great deal of benefit from his presence aboard. Did he kill “most” of his patients? Obviously not. Being far more observant than the typical surgeon of his day (consider the qualifications of his assistant Mr. Higgins, whose sole “medicinal” skill was tooth extraction), and being a free thinker as opposed to a slavish disciple of any other authority, his series of voyages provided an excellent environment for seeing first-hand the results of his various theories put into practice. Regimens that worked would be kept and fine-tuned, while those that did not would be rejected.
He himself, however, would be the first to admit the limitations of his knowledge, shown by his frequent discomfort when his skills are the subject of the crew’s (or even Jack’s) boasting.
“He could bring you back from the dead, if the tide ain’t turned.”