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Launching the medical chest
With an estimated 100 instruments in each chest, Woodall was thorough in his list of necessary medical equipment. Image The Surgions Mate, 1639, Vaughan Evans Library
Saving lives on the 17th-century seas
In 1600, as England stood on the precipice of a new age, the nation readied itself to enter an era of dominance that would alter the world forever. Surgeon John Woodall played an integral role in raising the standards of health and safety of sailors. Myffanwy Bryant has researched Woodall’s story.
ENGLAND’S AMBITION to become a world power required no small amount of bravado, money and innovation. Impetus was provided by a disparate group of people who were anonymous cogs in the enormous machine that would become the British East India Company (EIC). One man who contributed much to the ‘machine’ was surgeon John Woodall, the first Surgeon General of the company who, in 1617, produced the first textbook for ships’ doctors and introduced a standardised list of medical supplies that should be kept on board. Woodall’s book, The Surgions Mate, became the standard reference for maritime medicine for the next 50 years, while his advice on what to stock in medical chests was followed by the Royal Navy. In February 1601, ‘four of the best merchant shippes in the kingdome’ and their 480 crew sailed under the command of James Lancaster, headed to Bantam, in the island group now known as Indonesia.1 It was a costly gamble for the newly formed EIC, with no expense spared on high-quality provisions and some of the best seamen and merchants on board. When the company’s fleet returned in September 1603, it is estimated that subscribers had made a 95 per cent return on their investment, and the voyage proved that Britain could be worthy challengers to the stronghold of the Portuguese, Spanish and Dutch. However, even though Lancaster’s voyage was a financial success, it also highlighted logistical problems that were to plague the company for years. In this period of great expansion and activity, the EIC knew it would take more than a financial commitment to keep the business expanding. Inexperience and nature are hard taskmasters. In addition to unsuitable ships, inadequate maps and adverse weather, there was a frustrating inability to keep the crew alive. On that first voyage in 1601, Lancaster had lost 60 per cent of the fleet’s crew to illness, with one ship, the Ascension, suffering a sick rate of seven out of every ten men. Before they had even reached the Cape of Good Hope, three of the vessels recorded crew being so weak that they required assistance in bringing the ships into port.
John Woodall, shown at bottom centre of this image, remained a modest doctor and is believed to have worked in the field until his death in 1643. Image The Surgions Mate, 1639, Vaughan Evans Library
There was some expectation within the EIC that this mortality was part of the cost of doing business in distant countries. However, the scale of the deaths made it morally and logistically problematic. As years went on, the voyage to the East Indies became known as the ‘widow-maker’. Sailors remained willing to gamble their lives for good pay. However, the ongoing threat of weakened complements – or even crewless ships full of cargo on an open ocean – was bad for both the EIC’s bottom line and its reputation. In 1613, the company decided that a dedicated Surgeon General be appointed to address the health of crew. Based at the company’s shipyard at Deptford, the surgeon would be:
bound to be in attendance daily from morning till night to cure any person or persons who may be hurt in the Service of this Company, and the like in all their ships riding at an anchor at Deptford and Blackwall, and at Erith, where hee shall also keepe a Deputy with his Chest furnished, to remaine there continually, until all the said ships be sayled downe from thence to Gravesend.2 Under the influence of the Governor of the EIC, Sir Thomas Smith, Barber-Surgeon John Woodall was appointed to the Surgeon General role. As a military surgeon in France, Woodall had experienced the full gamut of injuries, ailments and difficulties that faced travelling doctors tending to masses of men. As a civilian based in London, Woodall claimed to have twice survived the plague epidemic of 1603, priding himself on his dedication in remaining with patients throughout their ordeals while many fellow surgeons fled the city. Although Woodall may have hawked a self-made plague ‘cure’, he was certainly no side-alley quack. Highly literate (not a given amongst 17th-century surgeons), Woodall spoke several languages and was well travelled. His extensive practical experience had enabled him to experiment with treatments, as he continually sought to improve both the theoretical and practical aspects of surgery. No ‘guild-hall theorist’, Woodall was happy to put his tools where his advice was and advocated for junior surgeons to do the same. He urged his apprentices to ignore the social stigma that surgeons encountered, applying their hands ‘even to those parts which they esteem basest; for the most lamentable diseases of poor men require the most care of the surgeon’.3 This highly practical side of Woodall was a clear advantage in his new role with the EIC, although it seems to have had a come at a social cost. Life lived in hospitals, among soldiers and on the wharves, had left Woodall with an ‘unseemly carriage and ill language’ of which the Barber Surgeon Guild reprimanded him more than once.4 Woodall was fined and taken to court for his combativeness, but clearly his surgical expertise won the day and he went on to become a Master Warden of the guild. Despite having an impressive resume, Woodall’s underrated strength was his awareness of the faults that lay within the world of 17th-century surgeons. As a member of the Barber Surgeons Guild, Woodall had been part of an ongoing effort to redeem the reputation of the profession. Guild members were trying to distance themselves from the ‘empiricall knaves, filthy bawds and bold queanes … who dabbled in “surgery”, only to bring the practice into ‘decaye and ruine’.5 Licensed surgeons, already ranked below physicians and apothecaries in the professional hierarchy, fought hard to maintain standards and control. In an era where personal and professional honour were highly valued virtues, it was important to ensure that trained surgeons were viewed as trustworthy and learned.
Despite Woodall’s preparedness, he constantly urged that doctors use restraint, out of a ‘desire to avoid performing more harm than good’. Image The Surgions Mate, 1639, Vaughan Evans Library Woodall knew that if surgery on land was fraught with difficulty, it was infinitely worse at sea. While there is no documented evidence that Woodall served as a sea surgeon himself, he was no doubt aware that many ships’ surgeons were poorly trained, ill equipped or simply overwhelmed by the responsibility. A wry saying on the docks at the time was: a man need only sleep under a medicine-chest for a single night to become perfectly qualified for the office of ships surgeon.
6 Ill-trained surgeons became a threat not just to the crew, but also to themselves. It was recorded that on Lancaster’s 1601 voyage, the surgeon appointed to Ascension was clearly overwhelmed. A year into the voyage he had tried to commit suicide and was subsequently dismissed. As Surgeon General for the EIC, Woodall was responsible for selecting ships’ surgeons and their assistants for each voyage. Faced with isolation, unhygienic shipboard conditions and unfamiliar tropical diseases, this task was much more difficult than the fit-for-service guidelines the EIC suggested. In 1617, four years after his appointment and ‘wearied with writing for every Shippe the same
instructions a new’ Woodall published The Surgions Mate, the first English manual for ships’ doctors. Written in simple language, and with attempts at humour and rhyme, the book was easy to follow, yet covered difficult and varied terrain.
As a sign of how inexperienced some of these surgeons and their assistants were, Woodall firstly covers what it is to be a surgeon’s mate on a voyage, his basic duties and what instruments and medicines should be in the surgeon’s chest. He then outlines surgical procedures that may need to be performed onboard, from hair cutting to amputation (which he helpfully recommends as a last resort!). The book covered how to recognise and treat diseases such as fevers or dysentery, while iterating the botanicals and tonics that could provide relief for these conditions. The Surgions Mate is comprehensive and is acknowledged as having performed a public service of great importance at the time. While primarily focused for maritime medicine, much of its information could be applied onshore, particularly in the new EIC colonies, which also lacked experienced surgeons and apprentices. One of the more revolutionary elements of Woodall’s first book is his easy merging of the three worlds of surgeons, physicians and alchemists. While very strict social and professional distinctions existed on land between these groups – and could prove acrimonious at times – a sea surgeon and his mate would need to be proficient in all three fields to keep men alive. Woodall, ever the agitator, argued that ‘it is uncharitable to forbid an expert surgeon at any time or in any place, the use of instruments and medicines which are necessary to his art for the curing of his patients’.7 This exhortation applied more than ever to the new tropical diseases that were beginning to make their deadly presence felt. One malady could not be more feared than the scourge of the sea: scurvy. This great killer of men was responsible for a multitude of deaths amongst EIC seamen, and Woodall was in the spotlight to address this threat. To his credit, he made a valiant, yet forgotten, effort. Well before the highly influential work that James Lind published in 1753, Woodall advocated in The Surgions Mate that:
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01 As Surgeon General of the East India Company, Woodall and his assistants were based in the shipyard at Deptford. Image courtesy UK National Maritime Museum BHC1873
02 Knowledge of equipment and trust in his assistants enabled surgeons to save lives. Unknown artist, A Barber Surgeon Attending to a Man’s Forehead, 17th century. Image courtesy Wellcome Collection
The Chirurgeon [surgeon] or his Mate must not fail to persuade the Governor nor Purser in all places where they touch in the Indies, and may have it, to provide themselves of the juice of Oranges, limes, or lemons and at Banthame of Tamarinds, for those good helps which you shall find in the Indies do far exceed any that can be carried thither from England, and yet there is a good quantity of Juice of Lemons sent in each ship out of England by the great care of the merchants, and intended only for the relief of every poor man in his need, which is an admirable effort to poor men in that disease. Through either personal observations or Lancaster’s experiences, Woodall was adamant that citrus had a part to play in avoiding scurvy. In 1627 a special order was made for lemon juice, ‘the want of which might endanger the whole fleet’.8 For whatever reason, however, like Woodall himself, his remedies were lost to history. It would take another 100 years and many thousands of lives until Lind would come to the same conclusion.
Along with hand-picked surgeons, their assistants and the publication of The Surgions Mate, the last piece of Woodall’s plan for the EIC was the compiling of ships’ medical chests. Woodall became the first person to standardise these chests, insisting that each one was brought to the EIC’s house for a full inspection 14 days before the ships sailed. Chests contained a predetermined range of surgical instruments (thought to be more than 100), bottles of remedies, botanicals and other pharmaceutical items. Together with The Surgions Mate, Woodall ensured that inexperienced surgeons’ mates – or, at a push, even untrained crew – could make their way around the chest and stand a chance of providing aid. Viewed through today’s lens, Woodall’s chest is rudimentary, and nudging towards barbaric, but on display was centuries of medical knowledge. Medical chests at the time were capsules of current medical understanding, including ancient natural remedies. Certainly, as Woodall’s book illustrates, they contained information and the tools of cutting-edge surgery. In 1626, Britain’s Privy Council was so impressed with Woodall’s organisation of chests for the EIC that it approached the Barber Surgeons Guild to provide chests for the Royal Navy and other military forces. Woodall was assigned the role of supervising the outfitting of these chests, a job he fulfilled for nearly 20 years. Within the world of 17th-century surgeons, John Woodall was both reflective of his time and yet advanced enough to recognise and address the failings of the system he was part of. He knew that the line between curing or killing was tenuous, more so at sea. Woodall made it his duty to ensure that maritime surgeons and their mates had as much chance as possible in saving the lives of crew in their care. His book, The Surgions Mate, became the foundational English text on sea surgery and his carefully curated medical chests, were the standard adopted by the Royal Navy. Yet Woodall – pragmatic, foul-mouthed and coarse – was at heart a humanitarian and among his technical instructions and chemical compounds was his unwavering ethos to be gentle, kind in speech, and actions towards all: pitifull to them that are diseased, and diligent in ministering to them such fitting remedies as he shall receive.
Myffanwy Bryant is a Curatorial Assistant at the Australian National Maritime Museum
1 Cheryl Fury, ‘The First East India Company Voyage, 1601–1603: the Human Dimension’, Journal of Maritime History 21, no. 2 (2012), p.72. 2 John Kirkup (ed.), The Surgions Mate, 1617 by John Woodall. Kingsmead Press (1978), p.XIV. 3 Celeste Chamberland, ‘Honor, Brotherhood, and the Corporate Ethos of London’s Barber-Surgeons’ Company, 1570–1640’, Journal of the History of Medicine and Allied Sciences 64, no.3 (2009), p.316. 4 J H Appleby, ‘New Light on John Woodall, Surgeon’, Medical History 25, no. 3 (1981), p.253. 5 Chamberland, ‘Honor, Brotherhood, and the Corporate Ethos of London’s Barber-Surgeons’ Company’, p.309. 6 G M Longfield-Jones, ‘John Woodall, Surgeon General of the East India Company. Part I: Events Leading to Woodall’s Appointment’, Journal of Medical Biography 3, no. 1 (1995), p.12. 7 Geoffrey Keynes, ‘John Woodall, Surgeon, His Place in Medical History’, Journal of the Royal College of Physicians 2, no. 1 (1967), p.27. 8 Keynes, ‘John Woodall’, p.23.
