From The New England Journal of Medicine
Naval Surgeon is a biography of Dr. Peter St. Medard, a French naval surgeon who began a new career as an American citizen on board U.S. Navy ships. The synopses of St. Medard's participation in the missions of the fledgling U.S. fleet during the War of Independence and on the Constitution during the Quasi-War with France are given in proper proportion to the story of his medical work. Estes explains very clearly the pathophysiologic theories of that period, including the principles of humoral therapy, which guided St. Medard's medical thinking.
Built on Estes's study of St. Medard's medical logs kept on board the frigate New-York, the narrative is reinforced by references to documents and journals of St. Medard's contemporaries. The log entries during the frigate's 14-month patrol in the Mediterranean reveal the types and patterns of disease that afflicted the crew of 350. Thirty-two deaths occurred during that period.
The ship was as close to a self-contained "biosphere" as one could design then, since in a foreign port it was either quarantined or the crew members were not allowed ashore, where they might contract new diseases. The New-York was involved only minimally in fights off the Barbary Coast, so casualties of war did not enter into the log of health statistics. The most intriguing part of St. Medard's story is how scurvy slowly ravaged the crew on the frigate's voyage back to the Potomac.
The naval surgeon's importance on a ship was not underestimated, because the captain could hardly go into battle with a crew languishing from chronic disease. Hence, chief surgeons, paid wages half to two thirds those of the ship's captain, were also entitled to prize money equal to that awarded to lieutenants. Commanders would even tolerate the surgeon's decision to limit corporal punishment, if clinically the offender could not withstand it.
St. Medard's logs rarely describe in detail the treatment of injuries (listed only as "hurt"). Estes had to infer many of St. Medard's technical abilities. Considering the use of marlin spikes, hatchets, and knives in the repair of rigging, there appear to have been very few accidents on which the naval surgeon could exercise his skills. However, Estes does weave into the saga descriptions of injuries from an accidental explosion on board and duels ashore, including one involving a naval surgeon who was killed in the course of defending his honor. In addition, St. Medard apparently was not curious about the pathologic changes that resulted from the diseases of which his patients died: he did no autopsies. Other than mentioning yellow fever, hepatitis, and malaria, Estes does not try to guess the other possible causes of "dysentery," "bilious fever," "intermitting fever," and "catarrhal cough and fever." Dental problems are also not recorded in the logs.
Although St. Medard was born and educated in France during the Enlightenment, he just missed being swept up by the challenge to physicians to debunk old theories, to observe, and to develop new ideas as, for instance, was Baron Dominique-Jean Larrey's generation, in the age of Napoleon. Despite his facility with languages and his access to foreign medical journals, St. Medard does not appear to have kept up with advances being made in Paris hospitals. He does not speak of his brother's silver medal for his work on smallpox eradication or of the requirement for vaccination in preparing recruits for sea, even though during his career, St. Medard treated patients in one outbreak of confluent smallpox, for which he recorded six deaths, and another, less serious outbreak.
If one can argue that the whole is often greater than the sum of its parts, this book proves the point and will be applauded by its readers.
Reviewed by C. Newton Peabody, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
