Naval surgeon: life and death at sea in the age of sail

The author's interest was aroused when he came across a large leather bound volume in the museum of the USS Constitution, which turned out to be the Physical and chirurgical transactions ofDr Peter St. Medard on board the US Frigate New-York from 1802-1803. It provided him with "a unique opportunity to study the effect of day-to-day medical practice on an early modem population". In that respect, it is disappointing, for it proves to be an unremarkable analysis of the diagnosis and outcome of common eighteenth-century illness, lacking the insights, innovation, conclusions and recommendations characteristic of British naval medical journals of the period, though more perceptive observations appear in St Medard's reports to his captain. The great value of the book, however, lies in the way Dr Estes has exploited its historical and maritime context to provide a fascinating account of the life and times of Peter St Medard. In this task, he has been supported by an army of collaborators to whom he pays generous tribute. Pierre St Medard was born in 1755 on the Ile d'Oleron, France, and followed family tradition by joining the French merchant marine after a surgical training, probably as an apprentice of his uncle supplemented by teaching in local hospitals. In 1774, like many of his British counterparts, he entered the slave trade to gain invaluable experience and financial reward. It was a time when both slave and crew mortality rates were declining and, as surgeon's mate, St Medard appears to have had little to do. After two voyages from West Africa to the Caribbean, he sailed as surgeon of a cargo vessel which was captured by the British off the coast of Virginia and spent almost six months in a prison hulk in New York harbour. His experiences under French and British administration were enough to persuade St Medard to enter the young American navy on his release at Boston in 1778, and he served in the frigates Providence and Deane until 1781 when he married a local girl and took up private practice at Boston. In 1798, he was recalled to service in the Constitution during America's undeclared war with France and was discharged with the peace of 1801 only to join the frigate New York for America's war against the Barbary states from 1802-1804. His journal for that sixteen-month period provides the main basis for his medical practice. The early American navy followed British naval tradition in terms of routine, diet, hygiene, medical regulations and records and the list of St Medard's drugs and instruments would have been equally familiar to British naval surgeons. The only surprise in the sick list is the dearth of ulcers and hernias which had a high incidence among the British and perhaps indicates a more robust American physique. The treatment of common diseases was similar and enables the author to introduce an admirable review of eighteenth-century concepts of illness illustrated by helpful diagrams. He fails, however, to explain some fifty cases of scurvy six years after it had been eliminated from the Royal Navy. Although the reader will find little of clinical interest, the book provides a valuable commentary on the contemporary American scene, the spirit of the emerging nation, its resolution, public-spiritedness, and politics, together with an appraisal of the medical climate and early medical societies. Peter St Medard emerges as a conscientious, honest and honourable man, a conservative surgeon interested in medical advances and an upholder of family values. He died in 1827 at the age of sixty-seven years.