Comments re my Medical History
The history of medicine is fascinating and we often lose sight of how little we knew before the last 50 or 100 years. I've written a few short articles and I'm web-publishing a few more that I've collected. I hope these are of interest. Obviously they're not to be taken as current medical practice, though it's also interesting how little the basics have changed.
Sincerely, Mark R. Anderson, M.D.
From Hammersly's Naval Encyclopedia, 1881.
This term is used for the hospital in the navies of English-speaking people. We understand by it a separate apartment, wherever situated, on board ship, for the reception and treatment of the sick and wounded.
Few single-decked vessels in our navy have any sick-bay, or hospital, at all, the sick being slung up to the beams, in their hammocks, or cots, anywhere about the berth-deck where they will be most out of the way. During the day they unavoidably suffer from noise, constant collision with their swinging-beds, and the heat and odors of cooking from the galley. At night every inch of the space about them is occupied the air is mephitic, and, when the watch is relieved, the noise and jostling of hammocks occurs. To reach a sick man in his "billet," the medical officer, or apothecary, or nurse must frequently pass under other hammocks, disturbing those well men who need their rest, or other invalids.
All frigate-built ships, and some corvettes or sloops-of-war, have sick-bays, and almost invariably these have been placed on the lowest inhabited deck, and in the extreme forward end of the vessel,- about the worst possible place for sick men.
The chief requisites for a hospital, or receptacle for sick and wounded, either ashore or afloat, are, in addition to proper shelter from the weather, the best attainable quietude, ventilation, and natural light.
These requisites have been systematically ignored in our navy, and, until quite recent times, in most other navies. In most of the latter more enlightened views now prevail, however, the French having led the advance. This being the case, it is altogether possible that our navy will, in due time, and in types of vessels permitting it, follow an excellent example, and remove the hospital from the berth-deck.
The usual position of the "sick-bay" (said to be so called because it made people sick) appears to be a traditional arrangement, derived from the galley period, through the French, and thence to us through the English, who derived many of their ideas in naval architecture from study of the vessels captured from their neighbors across the Channel.
Henry Teonge, a chaplain in the British royal navy more than two centuries ago, who kept a very minute diary, makes particular mention of sickness and mortality on board three large frigates, and yet never hints at the existence of any sick-bay or hospital. It is, therefore, to be supposed that there was no place set apart for the purpose in the English navy at that time.
Fonssagrives -- one of the best authorities upon the subject -- says that from all time the forward part of the ship Seems to have been devoted to the sick, and that it was so devoted when rude manners and ideas saw in the sick only useless encumbrances, and when "vae aegrotantibus" seemed as natural as the "vae victis" of the ancients.
These quarters were given to the sick, then, not as the most suitable for them, but with a view to isolate them, and thus to preserve the rest of the ship's company from contagion, often of plague, or of ship fever, putting them somewhere where well men would not be obliged to touch them, or pass them. The only other place where these conditions could obtain -- the stern of the vessel -- was already occupied by the commanding officer.
Jean Marteilbat, of Bergerac, tells us that in the French royal galleys of the 17th and 18th centuries, the compartment in the bows, under the low deck of the galley's prow, beneath the water-line, close, dark, and dismal, served for the combined purpose of stowing the cables and the medicine-chest, and here, upon the cables, were piled the sick, if they were allowed to leave the oar at all, -as well as those wounded in battle; so that great mortality ensued. "The wounded died like flies," he says.
M. Jal also alludes to the hospitals of fighting galleys, of an earlier period, which be says were in the forward part of the vessel, and called, at that time, "tollar," from tolerare to suffer. "It was there the sick suffered."
Smollett, writing of the Carthagena Expedition, 1741, says that the hospital of the man-of-war in which he served was three degrees more offensive and more suffocating than the cockpit, then, and long after, the quarters of the surgeon's mates, as has been the case in our navy within twenty y ears.
In the French navy of more modern times the traditional practice of placing the sick on the lower deck, forward, seems to have been first broken in upon about the year 1810, when strong remonstrances against its impropriety and impolicy-cruelty, indeed-caused important changes to be inaugurated, and these have been permanent.
It is, however, within quite recent times that the sickbay has been taken from the berth-deck, in double-decked vessels of the English navy, and it never has been done in the U. S. Navy, except in some receiving-ships, which are not in any sense seagoing vessels.
As a precaution and temporary measure, in cholera, yellow fever, and other epidemics, or in case the wounded were so numerous as to overflow the limits of the "sickbay," they have been placed upon the gun-deck or elsewhere. Still, with us, the old sickbay, in the most dismal part of the ship, is the only recognized official hospital on board. The usual position of our "sickbay" is objectionable for many reasons. Ventilation is bad, at the very best. Light is defective in the extreme. The air-ports, of which there are seldom more than two, of a few inches diameter, are seldom open, except in a calm, or in a close harbor. As a rule, candles are used to examine patients, and even to perform important operations. Ether must be used with care in artificial light, otherwise there is danger to the ship and all on board.
The chains are worked just above the sick-bay. The ship's bell is generally so hung that its jarring tones are more distinctly beard in the sickbay than anywhere else. The chatter and noise of the berth-deck cooks, and the smell of onions, garlic, and other ingredients of nautical "scouses," is generally more perceptible in the sick bay than anywhere else.
Since the abolition of flogging prisons have become more necessary, and these are now generally built against the after part of the sickbay. Sometimes they encroach upon its scanty air-space. Here drunken, noisy men are apt at times to be confined. There is also unavoidable damp and leakage, from the working of the head; the water often trickling down the breast-hooks, or filtering down from the gundeck, after seas are shipped into the mauger, through the hawse-pipes.
At sea, or even at anchor in roadsteads and other exposed places, with fresh winds and rough water, the monotonous, pile-driving blows of the sea against the bows are almost sufficient to distract a well man, let alone a patient in hospital.
Our merchant vessels long ago removed their crews from the holes called forecastles, which answered, in most respects, to the usual position of our sick-bay.
Serious attention has been given to this important matter by many of the naval medical officers, who have made frequent and urgent reports upon the subject, especially Medical Director A. L. Gihon; while Admiral Leroy, Admiral Porter, and Commodore Shufatldt have officially recommended a change. Their exertions in this direction are worthy of all praise, and may, eventually, be successful in accomplishing a reform called for by considerations both of humanity and expediency.
With a personnel crowded in the extreme, far beyond all sanitary limits, there is, on the berth-deck of a man-of-war, a permanently contaminated atmosphere which is never very much improved during a cruise, from the impossibility of evacuating and thoroughly cleansing the deck, even in the daytime. Even if evacuation could be accomplished, the means of thoroughly renewing the air is practically, in most cases, nearly wanting.
The air-ports do not accomplish it, nor do wind-sails, and, in some cases, patent apparatus has done more harm than good, while other apparatus have been rejected on account of the expense, as if any cost could be too great for machinery which accomplished this all-important purpose. Army and navy men, and many in civil life, are continually grappling with the difficult question of the disposition of the emanations from healthy human bodies alone, and the question has not been solved. Should we, then, expose the sick to these emanations, or the well to those of the sick? Would anyone who could live elsewhere live in a damp and unventilated back cellar? And yet this is about the relative position of the sick-bay in our men-of-war, where the sick and wounded are not afforded the best chance of recovery.
As has been stated, the sick-bays in the French and English navies are now generally upon the gun-deck; either arranged with movable, latticed bulk-heads and placed amidships, or on each side, taking in about two gun-ports, the guns being slewed round, and lashed against the side, but not removed. In case of action they are readily brought into service, and their crews are exercised at other guns. A favorite way in the French navy was to have the sick-bay forward upon the gun-deck, bulk-headed with latticed windows, and embracing the bridle-ports, which, being mostly kept open, -- even at sea in fair weather-- were a fine source of light and air.
They had, generally, glass windows for these ports: to be used in cool weather. Here was light, ventilation, and cheerfulness secured. The chains, in this case, were worked by oblique hawse-pipes underneath the sick-bay.
(Nothing would be interfered with but the traditional chicken coops and live-stock in the manger, which pollute our gun-decks yet.)
In our navy the personnel of the sick-bay, besides the medical officers in charge, are the apothecary, whose dispensary, in double-deck ships, is often 100 feet or more from the sickbay, while the medical storeroom is elsewhere, either in the darkest part of the cockpit, or in the shaft-alley, probably to the great detriment of stores and medicaments which, upon a sudden emergency, may be of the highest value, and exposed, more or less, to pilfering.
The apothecary is fairly paid, and ranks as xxx a T a attendants upon the sick are now called "nurses" and "bay-men." They are generally selected from the crew, paid as landsmen, and usually without any experience, either in nursing or cooking. The apothecary, nurses, and bay-men are selected by the senior medical officer. In the case of the apothecary, he is appointed, under certain regulations, with the approval of the commanding officer. the nurses and baymen may be appointed in the same way, but this is generally not the case, they being picked up from among the landsmen.
On board ship men whose sickness is slight are only put upon the "binnacle list." In well-regulated sick-bays they are not allowed to take up the limited air-space by spending their time there, except while being prescribed for or receiving medicine.
More serious cases are put upon the "sick list," and generally allowed to have their hammocks down in the daytime, should the medical officer consider it necessary. Important cases of illness, or surgical cases of gravity, have cots slung for them, which afford a very fair degree of comfort. Standing beds, of iron, swung to upright posts, with gimbals, have been used, in some cases with approval, in our sick-bays. Fleet-Surgeon Foltz, who served in the operations under Farragut in the "Hartford," always spoke most highly of them. But there are serious objections to their use, not necessary to be entered upon here, in the confined space at present allotted to the sick-bays.
Sick-berth. A place temporarily screened off to accommodate sick men.
Sick-book (Eng.). An account of sick persons on board, or sent to the hospital.
Sick-flag. the yellow quarantine-flag. In the English service there are two other sick-flags, one yellow with a black ball, the other with a square in the centre, used to denote the presence of contagious diseases.
Sick-leave. Leave of absence given on a surgeon's certificate of disability, or on medical survey.
Sick-list. The list of sick, with their complaints and condition, sent in daily to the commanding officer by the surgeon. A duplicate list of names only, posted on the upper deck, is called the binnacle-list.
Sick-mess. The mess for the sick, partly provided by the surgeon's department.
Sick-ticket. A paper which is sent with a patient to a hospital, giving rank, description, disease, etc.