Patrick O'Brian and Naval Medicine and Surgery

Dr. John Rice April 15,200~

In 20 volumes published during the past 30?? years, the English author, Patrick O'Brian (Richard Patrick Russ), has created a memorable series of stories about the fictional Naval Captain, Jack Aubrey, and his ship's surgeon, Stephen Maturin (Don Esteban y Domanova), and their exploits during the tumultuous years, 1800-1815.

In those years, from the English victory at the Battle of the Nile in 1799 to Napoleon's loss at Waterloo in 1815, the French and the English were at war almost incessantly.  The English controlled the seas, especially the Mediterranean, the English Channel, and the Atlantic Ocean, and the French dominated much of Western Europe.  The English won naval victories in the Caribbean and the Mediterranean and patrolled the Channel in order to forestall the often-threatened French invasions of England.  In addition, the British Navy fought incessantly against pirates to make the waters safe for their merchant ships and the trade upon which the Island was dependent. A ship's surgeon could anticipate a great deal of rigorous work.

 Surgeon Stephen Maturin was one of the finely drawn, highly popular characters created by the novelist, the late Richard Patrick Russ whose nom de plume was Patrick O'Brian.  Russ/O'Brian may have had a touch of the charlatan in him but that does not detract from the scholarly, painstaking research in the National Maritime Museum in Greenwich that he did for each of his twenty novels.

 Don Esteban Maturin y Domanova was born March 25,Lady Day, between 1770 and 1775. His father was an Irish officer who was connected through the Fitzgerald Clan with the highest families in Ireland.  His mother was a Catalan Lady from Northeastern Spain.  Stephen spent his early years in County Clare in Ireland and after their early deaths lived with his Godfather Don Ramon Domanova in Catalonia.  His first alma mater was Trinity College in Dublin from which he received his doctorate in medicine in 1780. He saw patients at the prestigious Meath Hospital, founded in 1753 and attached to Trinity College.  Some of the famous students from its Dublin School of Medicine were Drs. Robert "Thyroid" Graves, William Stokes, John Cheyne, and Abraham Colles.  Maturin went to Paris and was at the University of Paris and the Hotel Dieu during part of the Revolution.  Two of his colleagues were Guillame Dupuytren and Dominique-Jean Larrey, who later was Chief Medical Officer under Napoleon and Founder of the Ambulance Service or "Flying Hospital.

 After a chance meeting with Captain Jack Aubrey, RN, in April 1800 in Minorca Stephen signed on as a ship's surgeon on Aubrey's new command, HMS Sophie.  He was an unusual figure in the Navy in that he was an educated physician, not just a surgeon.  In 1814,for its 130,000 men the Royal Navy medical complement consisted of 850 Surgeons 500 Assistant Surgeons, and only 14 Physicians.  His skills, high academic qualifications that included many language skills and even Latin and Greek, along with Aubrey's successes brought Maturin to the attention of the British Naval Intelligence and over the next 15 years he had double duties as both physician and spy, all of which led to numerous marvelous, often outrageous adventures -- the stuff of grand fiction.

Many of the sea battles depicted in the 20 volume Aubrey/Maturin series are based on true naval engagements.  Also, historical figures--admirals, scientists, and royalty wander in and out of the novels.  In addition, O'Brian, the son of a physician gave a great deal of attention to portraying the life and professional activities of a 19th century naval surgeon.  As ship physician, Maturin was paid 5 Pounds Sterling per month plus 5 Pounds for each 100 cases of "pox"(syphilis) treated and an allowance of 43 Pounds for equipment and he had a servant.  In reality, at that time, the physician could treat only two diseases at sea definitively: malaria, with the bark of the cinchona tree that contained quinine, and scurvy with foods containing ascorbate, usually limes and other fruit in diluted rum or "grog," for which Dr. James Lind, "Father of Nautical Medicine" had demonstrated the efficacy of fresh fruits and vegetables in the mid 1700s. (Dr. John Woodall, "Father of Sea Surgery deserves credit for including a treatise on scurvy in his "The Surgeon's Mate" published in 1617.

The ships' medical chests contained many interesting and dangerous compounds, some more than 2,000 years old, that were used to treat fevers, pains, rashes, constipation, and other maladies.  "Purge, bleed, sweat, and blister" were the commandants of enlightened physicians of that era.  When entering the tropics, Maturin bled the whole crew up to 20 ounces each to reduce friction between the blood and the vessel walls that was believed to cause fever.  The "blue pill," sublimate of mercury with rose essence and a spot of licorice was the standard treatment for syphilis and was used for other disorders also.  Its purgative effects along with salivation and drooling were precursors of the toxic renal and neural effects on vision, speech, and coordination

Obviously, those effects blurred the difference between fatal mercury poisoning and the advance of disease.

 Opium in the form of an alcoholic tincture (laudanum) was another standby. Even Maturin became addicted to it.  Two other "remedies" were the ancient, 2000 year old remedy, Methridatum, that contained an antidote from lizard's belly, and Theriac, an amalgamation of poppy gum and 50 other constituents that was developed by Nero's physician, Andromachus.

Although many physicians disdained surgery as being a manual skill that was beneath them, it could not be ignored by Maturin on a man-of war and he quickly gained a reputation as being skillful after an expert trephining of the Sophie's gunner's depressed skull fracture. He also developed as a specialist for his accomplishments with suprapubic cystostomy for calculi soon had a continental reputation and was a Fellow of the Royal College of Surgeons.

 On the ship, the surgical amphitheater was the cockpit below the decks and near the water line. Although it was removed from the confusion of battle, it was a poorly ventilated and poorly lit area and subject to the constant movement of the ship in the open sea.  Obviously, he preferred the open light of day and calm waters for delicate cranial surgery.  Aboard ship, amputations, extraction of foreign bodies, and the stabilization of fractures were the basic surgical procedures.  Amputations were common, as evidenced by Lord Nelson's loss of his right arm as well as the loss of sight in his right eye as a result of battle injuries.  The Royal Navy tradition of flogging also provided Maturin with case material.

Apart from his medical duties, Maturin enjoyed "botanizing" and was an eager taxonomist and natural scientist, as were many ships' physicians and surgeons, who often the first to describe the many plant and animal species they encountered in what were then strange lands.  Maturin sought shore time to engage in his hobbies, especially to study avian behavior and to forage for rare plants and even named a tortoise, "Testugo aubreyii," to honor his Captain.  Maturin became a Fellow of the Royal Society.

Patrick O'Brian's 20 volumes in the Aubrey/Maturin series provide fascinating reading and also an accurate view of early 19th century naval medicine.  The believable descriptive detail that O'Brian offers us is the product of his extensive research, and unlike many historical novels go lightly on romance and, instead, bring us credible detail including an accurate presentation of the speech and social customs of the particular era. O'Brian has given us a credible and informative as well as interesting record of the life of a medical man at sea during the Napoleonic Era.