Fumigating the ship with brimstone helps (this is a purely empirical procedure as the role of rats and fleas was not yet understood) but it is too late to halt the epidemic.
. . . when the disease struck the lower-deck it killed men faster than the plague. They gave up hope, and some times it seemed to Stephen that they would almost as soon not take his draughts, but would rather have it over as soon as might be: and soon it was, in many cases—headache, languor, a moderate rise in temperature, and despair at once, even before the rash and the appalling fever, far worse in the stifling heat, and so onwards to what he often believed an unnecessary death. (Patrick O'Brian, Desolation Island)
In Maturin's world, typhus was the most common fever in prisons, prison-ships, military camps, slums, and other miserable settings where rats and humans lived together under desperate conditions. The disease was called by many names, more relating to the circumstances or locale rather than its clinical features which were always similar. Even after scurvy and smallpox were much reduced, typhus remained the scourge of the channel fleet well into the nineteenth century. (Lloyd, Medicine and the Navy)
It was not only in the Navy that typhus was a scourge. Referring to Sir John Pringle's treatise of 1752, Chaplin tell of:
an appalling tale of serious disease constantly following in the footsteps of the Army, destroying its efficiency, and producing havoc in its ranks, compared with which losses in battle were trivial . . . Apparently hospital fever or typhus was present in every hospital where soldiers were crowded together . . . while in the open camp this disease scarcely ever attacked them. (Arnold Chaplin, Medicine in England During the Reign of George III)
The situation did not change significantly in the next sixty years. During the British army's ill-fated Walcherin Expedition of 1809, disease (mainly typhus) had 'swept off, or rendered incapable of military service, a fine army of 40,000 men' within a matter of a few weeks.
In Maturin's time, smallpox was another great destroyer of life. He and his colleagues were aware that those who survived the disease were immune, and that variolation (inoculation with pus from a smallpox victim) could produce a mild form of the disease with resulting immunity. During the 1790s Dr Edward Jenner had been advocating the use of a cow-pox (vaccinia) inoculation as a preventive of smallpox, but his results were received with scepticism. The Royal Society rejected his report, which he then defiantly published himself in 1798. Even while London doctors were rejecting Jenner's new 'vaccination', it was adopted rapidly in the United States and Europe. President Thomas Jefferson had several of his family vaccinated; Napoleon ordered all his soldiers vaccinated; the Empress of Russia urged all her subjects to be vaccinated; leading physicians in Germany, Austria and Italy followed suit. Finally in 1802 the British Parliament voted Jenner an award of £10,000 and five years later he was awarded a further £20,000. The long road toward eradication of smallpox had begun.
Elsewhere in the world, however, smallpox was still a deadly plague. It killed innumerable Indians in North and South America, and exterminated many primitive people in the Pacific as Europeans came among them. In The Nutmeg of Consolation Dr Maturin and his shipmates salvage two little girls from a South Sea island—the only survivors of smallpox. Captain Aubrey himself is deeply moved by this tragedy as he surveys the ruined native village:
Again Jack followed them as they went along, talking of the nature of the disease and of how badly it affected nations and communities that had never known it in the past—how mortal it was to Eskimos, for example, and how this particular infection must have been brought by a whaler, its visit proved by the axes. He felt a certain indignation against them, a resentment for his own unshared horror . . . (Patrick O'Brian, The Nutmeg of Consolation)
Although he was an avowed Catholic, Maturin's philosophy sometimes caused him to deviate from the religious teachings of his day. In fact, the Rev Mr Martin, a mere Protestant, is shocked when the doctor declines to revive the miserable, murderous, cuckolded gunner Homer, who has hanged himself and been cut down not quite dead. Maturin poses the question.
Have you ever brought a determined suicide back to life? Have you seen the despair on his face when he realizes that he has failed—that it is all to do again? It seems to me a strange thing to decide for another. Surely living or dying is a matter between a man and his Maker or Unmaker? (Patrick O'Brian, The Far Side of the World)
When it comes to abortion however, the doctor's position is four-square with the Church, and for that matter with every other respectable physician. While the prohibition against inducing an abortion has been removed from many modern versions of the Hippocratic oath, it was still firmly in place, during the nineteenth century. To perform an abortion in most Western countries was a serious crime. When Maturin discovers that his assistant, Higgins, has attempted—and botched—an abortion for Mrs Homer, he rages at him, 'Mr Higgins, Mr Higgins, you will hang for this, if I do not save her. You are a rash wicked bungling ignorant murderous fool.' (Patrick O'Brian, The Far Side of the World)
Maturin' s adventures reveal only passing references to his early history (he was, for instance, studying medicine in Paris when the French Revolution of 1789 began) and his developing professional status. As the years go by, we learn in tantalisingly subtle fragments that Dr Maturin's accomplishments in both 'philosophy' and medicine are making him rather famous. Although his presentations at scientific meetings are atrocious, his articles and books earn admiration and respect from those qualified to appreciate them. As a clinician, his reputation for excellence also spreads far beyond the navy: while waiting in Paris to give a lecture on the extinct birds of the Mascarenes—'he was to address the Institute, and some of the keenest, most distinguished minds in Europe would be there'—he mentally reviews his other recent activities in that great city. 'He had performed three dissections of the calcified palmar aponeurosis with Dupuytren; Corvisart had told him a great deal about his new method of auscultation . . .' (Patrick O'Brian, The Surgeon's Mate) We hear no more about these events but only the most highly esteemed foreign colleague could have strolled into Paris and been welcomed by either of these famous doctors. Baron Guillaume Dupuytren was a celebrated French surgeon whose name is attached, not only to Dupuytren's contracture of the hand (which every medical student to this day must learn) but to Dupuytren's amputation, enterotome, fracture, hydrocele, sign and splint. Baron Jean Nicolas Corvisart des Marest, was 'the premiere and outstanding physician of this period.' (Major, A History of Medicine) He defined two important cardiovascular diseases that still bear his name.
It did not apparently bother Maturin that Corvisart was Napoleon's personal physician. What counted was the man's personal qualities. 'Corvisart's fame as a teacher drew brilliant pupils who were attracted by his skill as a diagnostician, by his clarity as a lecturer, and by his frankness, fairness, independence, and generosity as a man.' (Major, A History of Medicine) It was not only Maturin who learned about auscultation of the chest from Corvisart; Rene Laennec (who studied with both Dupuytren and Corvisart, and was the latter's protégé) invented the modern stethoscope in 1816.
In creating Stephen Maturin, Patrick O'Brian has completely captured the sense of being a doctor in the time of the Napoleonic wars and brought to vivid, bright-coloured life an exciting chapter in the history of medicine. He uses his wide-ranging and authoritative knowledge to stunning effect in writing so convincingly of the era which he has made his own. Though the essence of his books is timeless, the early nineteenth century comes completely alive in the incomparable novels featuring Jack Aubrey and Dr Stephen Maturin.
Table of Contents
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Chapter Six
Chapter Seven
Chapter Eight
Chapter Nine
Chapter Ten
The Medical World of Dr Stephen Maturin
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Patrick O'Brian, Treason's Harbour
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