Annals of the Royal College of Surgeons of England (I980) vol 62

Sir Gilbert Blane, Bart, MD FRS (1749-1832)

R D Leach FRCS Honorary Senior Registrar, Department of Surgery, St Thomas's Hospital, London

Key words: HISTORY OF MEDICINE; NAVAL MEDICINE; SCURVY; SIR GILBERT BLANE Introduction Blane was highly thought of by his contem- Gilbert Blane was a champion of many causes poraries, who elected him President of the during his medical career, the most import- Students' Medical Society in 1775. ant of which was a change in the treatment The early intention of Blane to become a of scurvy leading to the virtual removal of the clergyman had brcught him into contact with disease from the Navy. He made no startling writers and artists in Edinburgh, and it was original discoveries but impressed upon his with references from Robertson, the Scottish contemporaries those changes which he person- historian, and Blair, the author of sermons, ally knew to be effective. and the highest commendations from his Nearly 200 years after the implementation mentor, Cullen, that he set out for London in of the reforms which effectively doubled the I 776. These commendations were presented to fighting force of the Navy his name is little William Hunter, the anatomist brother of remembered except by naval physicians, who John, with good effect. Blane attended Wil- have called him a father of naval medical liam's lectures in anatomy and surgery and science. was also advised by him about the conduct of his career. On 28th August I778, having trav- Early years elled from London, Dr. Gilbert Blane was The merchants of Ayrshire in I620 included awarded his MD degree in Edinburgh. Thomas Blane, a successful man with consider- Setting up medical practice in London in able standing in the local community at Gir- the late 17th century must have been difficult, van, which was the centre of his trade. Three but Blane returned from Scotland with this generations later, in I749, Gilbert Blane and in mind. It was a great help to be recom- his wife were living at Blanefield, part of an mended for a post by an established physician estate now owned by the Marchioness of Ailsa of the town, especially with such fierce com- which is sited one mile to the east of the vil- petition for patients. When William Hunter lage of Kirkoswald. They were still merchants, recommended Blane to Lord Holderness he consolidating the family social and financial must have been apprehensive, for this was standing. On 29th August I749 a fourth son to be a test of his competence and finesse was born to them and called, after his father, as a society doctor. Holderness was chronic- Gilbert. ally ill but well thought of both for his good He was educated at Kirkoswald and May- taste and his high standing at Court. Blane bole schools, but we know little of his early gave a good account of himself in the man- life. It is worthy of note that in I753, when agement of Holderness's case and began to Blane was four, James Lind published his treat- be accepted by London society, although it ise on the treatment of scurvy, which Gilbert is possible that his abrupt, economic manner Blane was to pursue throughout his career. was not as smiled upon as it might have been. At the early age of I4 he was accepted into This aside, Sir George Rodney (Fig. i) felt him the Faculty of Arts at Ediinburgh University more than suitable to become his private phy- and was at first destined for the Church, but sician in his flagship HMS Sandwich (Fig. 2). as a man of practicalities he soon changed It was in this capacity, with no official rank courses to that of medicine. It appears that in the Navy, that Blane sailed with Rodney The winning submission for the St Thomas's and Guy's Hospital Historical Prize, I978. Sir Gilbert Blane, Bart, MD FRS (I749-1832) 233 vations of James Lind's earlier work Gilbert Blane published 'An Address to the Officers Serving in His Majesty's ships of war in the West Indies and America'. It concerned the reduction in disease in the fleet, improved methods of cleanliness, and hygiene and was published at his own expense. It was not long before he had to justify his position and treat Sir George Rodney, who suffered from gout and the stricture, two diseases not uncommon amongst naval offi- cers at that time. Rodney returned to England from the West Indies in September 178I to recover and gather reinforcements. On his return Blane successfully acquitted himself at the examination for the Licence of the Royal College of Physicians on 3rd December 178I. His stay in London was not long, for Rodney, feeling better and with his fleet reinforced, called for Blane to go to Plymouth, from where he sailed for the Wars of the American Colonies in January I782. Before leaving London Blane had drafted a memorial to the Board of the Admiralty noting that, in a fleet of 20 ships, 7I5 men out of a total of I2 OI9 had died (59 of wounds) and 862 were in hospital. One in every I 5 was on the sick list and he noted vary- ing degrees of sickness in identical ships which he thought was due to differences in clean- FIG. I Sir George Rodney. (Reproduced by kind liness in the ships. He suggested that if venti- permission of the National Maritime Museum, lation, cleanliness, and damp were not im- London.) proved and if the supplies of lemon juice (to to raise the siege of Gibraltar on Christmas prevent scurvy), soap, bedding, and medicines Eve 1779. Both for his common sense and courage Blane became greatly admired 'by the crew and officers of the flagship. Owing to the absence of an excutive officer he had delivered mess- ages to the guns during one of the six actions in which he was involved, and was slightly wounded during this action. The officers successfully petitioned that he be appointed without delay to be Physician to the Fleet. Physicians at that time had no commission in the Navy and were warrant officers enjoying low pay as well as a bad reputation amongst doctors on land. As Physician to the Fleet Blane received monthly reports from the ships' surgeons, gathering a vast amount of practical know- FIG. 2 HMS Sandwich. (Reproduced by kind ledge about the health of seamen. Upon these permission of the National Maritime Museum, reports, his own observations, and the obser- London.) 234 R D Leach

were not provided there could be little re- his treatment of sweating sickness, leprosy, duction of mortality and morbidity in the measles, venereal diseases, plague, dysentery, Navy. There was no response from the Ad- intermittent fevers, typhoid, smallpox, rickets, miralty. He was incensed and had to wait for typhus, and scurvy, noting that in I830 I5 years before he could officially put his scurvy was nearly as rare at sea as on land methods into practice as a Commissioner for owing to the improved cleanliness and gen- the Sick and Hurt Board of the Navy. eral supply of lemon juice in the Navy. He In the mean time he employed his methods also noticed that scarlet fever, consumption, in the ships of Rodney's fleet. A year later he gout, and dropsy had become more prevalent wrote again to the Lords Commissioners of at the beginning of the igth century, which the Navy that no man had died from disease he ascribed to the much greater proportion of in a six-month period and only three were the population undertaking sedentary occu- rendered sick in his ship, HMS Formidable. pations. In the whole fleet of 40 ships 350 men had Blane also mentioned the origins of St died from disease. Again there was no re- Thomas's Hospital from an almshouse run by sponse, but Rodney wrote of Blane: friars and its debt to King Edward VI and 'To his knowledge and attention it was owing William and Mary, who endowed the hospital that the English fleet was, not withstanding their with funds. The hospital was built on swampy excessive fatigue and constant service in a con- ground in Southwark, but its foundations dition always to attack and defeat the public were augmented with dry rubble, which Blane enemy. In my own ship Formidable out of goo to health. After an out- men one was buried in six months'. considered beneficial not break of fever the number of beds had been When peace came in 1783 the officers of reduced from 500 to 433, io or I2 of which Rodney's fleet wrote to the Admiralty asking were kept for emergencies. There were nine that Blane should be recompensed for his out- men's wards and six for women, as well as standing care of the men, suggesting that he three others for patients with venereal disease. be awarded a pension, to which the Commis- Admission and discharge of about 50 patients sioners for the Admiralty for once agreed. He was carried out on one day each week and was given a pension of ten shillings a day for he noted that surgical patients tended to stay life, which was doubled 20 years later. longer than medical patients owing to the protracted course of their diseases-a contrast Gilbert Blane at St Thomas's Hospital with modem-day experience. The walls were Having left the Navy, Blane busied himself whitewashed annually and to combat in- looking for backing to help an application for fection iron beds and better ventilation were appointment as physician to one of the Lon- installed. don hospitals. Lord Rodney was able to re- Sir Astley Cooper notes Blane as 'cold in commend him from his own personal experi- temperament which caused him to be known ence, as were Scotsmen Sir Walter Farquhar in the hospital as Chilblaine'. Although not and Dr W Saunders. a notable clinical teacher, he was a success Two physicians at St Thomas's Hospital had as a physician in society. In I785 he was ap- died of fever in I783 and it was for Dr John pointed Physician Extraordinary to the Prince Watkinson's post that Blane successfully of Wales, on whose instructions he had at- applied. It was apparent from the minutes of tended the Duke of Cumberland. The Prince the meeting that a unanimous decision could was thought to have been so pleased by his not be made; two ballots were taken before successful treatment of Cumberland that Blane Blane was appointed by 98 votes to 84. was made Physician to the Household of the to the Duke Gilbert Blane was to remain a physician at Prince of Wales and Physician same year that he St Thomas's Hospital for I2 years and pub- of Clarence in 1778, the Lecture on 'Muscular lished a valuable record of his experiences en- delivered the Croonian titled 'Observations on the comparative pre- movement'. valence for mortality and treatment of Gilbert Blane resigned his post at St different diseases'. In this paper he mentions Thomas's Hospital in I795. Lord Spencer, as Sir Gilbert Blane, Bart, MD FRS (1749-1832) (235 ised in the early i8th century. The humoral pathologists, after the teaching of Boerhaave, believed it to be due to foul air, poor hygiene, and dampness, while others likened it to syphilis. James Lind (Fig. 3), a Scotsman like Blane, was acutely aware of the vast numbers of sailors he had to treat for scurvy in the Navy. He divided I2 seamen with overt scurvy into pairs and to each pair he gave a different addition to their diets: a quart of cider; 25 drops of elixir of vitriol three times a day; 2 spoons of vinegar three times a day; sea water, half a pint a day; two oranges and i lemon a day; and nutmeg, mustard seed, rad. rapham, bark of Peru, and gum myrrh. The sudden and good effect of one of the first controlled dietary trials in medical history showed that the citrus fruits were the most effective cure, and Lind's results were published in A Treatise of the Scurvy in 1753. Gilbert Blane was much impressed by Lind's .. ... work and employed his treatment of scurvy in Rodney's fleet. He published Observations on the Diseases Incident to Seamen in 1785, ...... s: s ° in which he suggested better ventilation and cleanliness for seamen and says: *~~~~~~~~~~~~..:.. 'But of all the articles, either in medicine or diet, for the cure of scurvy lemons and oranges are much the greatest. They -are real specifics in that disease, if anything deserves that name.' FIG. 3 Dr James Lind. (Reproduced by courtesy of the Wellcome Trustees.) In 1795 Blane was at last able to put into practice for the Navy what he had been doing First Lord of the Admiralty, appointed him in Rodney's fleet for several years. Lemons with Dr Blair as a Commissioner of the Board and limes as well as fresh vegetables were of Sick and Hurt Sailors, on which he served loaded as routine victuals to each vessel. until 1802, when the Navy was reduced in Although British sailors became universally size after the Peace of Amiens. Blane was known as Limeys, it seems that the terms lemon now able to put into action all the changes and lime were interchangeable and that lemons which the Navy had'ignored in the past. were mostly used. Personal cleanliness was Gilbert Blane and scurvy also ordered, and after a letter from Blane to Lord Vincent was made Records of scurvy exist from Hippocrates, St soap available, Pliny, and the chronicles of the Crusades, but the cost being deducted from each man's pay. the first English account of the disease and its A calculation was submitted costing the illness due to uncleanliness as io times that of the cure with lemon juice was by Dr John Woodall in his book The Surgions Mate cost of soap. (i6io). Sir Richard Hawkins at the end of the The bilges of ships had been full of sand i6th century and Commodore Anson in the and shingle as ballast, but towards the end of middle of the I8th century lost many men the i8th century pigs of iron replaced them, from scurvy and it appears that the beneficial removing this infected mass in the lower parts effect of lemon juice had been mislaid. Many of the ship. Ventilation of the lower decks theories as to its cause and cure were popular- was much improved by a series of brass tubes 236 1? D Leach leading from the upper decks to the bilges as which was very poorly ventilated, to an area channels for fresh air; hitherto the lower just beneath the forecastle. decks had been almost unliveable when all The reforms of Blane and the Navy Com- hatches were closed in rough weather. Large missioners were impressive. In I782 i in 3.3 iron tanks were substituted for small water of the I00ooo serving seamen were on the casks, which meant that the men did not have sick list. Only i i years later i in I0.75 of to heave the casks from the hold to the deck. the I40 000 men were sick. The fewer the This greatly reduced the number of hernias sick, the more available for active service, and from the outstanding 2873 unilateral and 841 these changes in health more than doubled the bilateral in one year which Blane mentions in fighting force of the Navy. an analysis of naval disease. Blane reported in I825 that there was no Gilbert Blane as adviser more scurvy in the Navy: Blane's enquiring mind and keen power of C. . . all of which might naturally bc expected observation were much sought after by the from a deficiency of wholesome aliment and an government of the day and by commerce and absence of that active state of absorption and the advice he gave seems to have been well renewal which in health are in constant requisition received by both. for the purpose of repair. And it follows from this view of the subject that the operation of citric He advised the Turkey Company, which acid as a remedy is that of a specific stimulus controlled the bulk of the trade in the Levant, with the absorbants and not either as nutritious concerning the prevention of plague trans- matter or as a chemical antiseptic according to mitted from their ships in 1799. This advice the theories of Humoral pathology.' formed the basis of parliamentary reform Blane's phrase 'a deficiency of wholesome which later that year culminated in the cel- aliment' is one of the earliest references to the ebrated Quarantine Act. concept of vitamins which developed so much Blane's very high regard for Jenner's obser- later. vations on vaccination led to naval surgeons In addition to the treatment of scurvy being instructed in i 8oo to vaccinate any- Blane gave advice on and put into action body who requested protection against small- many other naval reforms. When consulted pox. In I8I9 he published 'A statement of by Lord Chichester, the Secretary of State for facts attending to establish an estimate of the the Home Office, on improvements in the true value of the present state of vaccination'. health on convict ships to Botany Bay Blane In this methodical article he analysed the Bills advised wind sails, air tubes, better ventilation, of MIortality in London in I 5-year periods from and hygiene, with a great reduction in mor- 1706 to i8i8 and concluded that 23 000 lives tality, which was well above 5o7o at that time. had been saved in London by vaccination in He noted that asymptomatic carriage of the last of these periods. He also noted that disease existed and often led to overt infection 70 000 people were recorded as dying from the in previously healthy prisoners: plague in the previous I50 years compared with over 300 ooo dying from smallpox, and 'There is a degree of risk in mixing two different with uncanny foresight wrote: sorts of men, even when there is no natural disease or suspicion of infection; for whether it is from '. . . but it is demonstrable, that if at the first dormant infection or merely from circumstances of moment of this singular discovery [vacciniation] at a change in air such mixtures are known from any moment since, the present or any future experiences to be productive of sickness.' moment, mankind was sufficiently wise and decided to vaccinate the whole of the human species who It had been the practice for naval surgeons had gone through the smallpox, this most loath- to provide all their medicines and equipment, some and afflicting of all diseases of humanity would instantaneously and for ever be banished but in 1796 the most important drugs were from earth'. supplied free by the Admiralty. Eight years later, in I804, all medicines were provided At the beginning of the igth century this must wvithout payment. In this Blane had been in- have seemed a far-sighted suggestion, but in strumental, as he had in moving the sick bay the light of further developments it was a cor- from the fore part of the lower gun deck, rect one. Sir Gilbert Blane, Bart, MD FRS (I749-1832) 237 Perhaps the most important assignment he developed 'senile pruritus' and diarrhoea. given to Blane was by the Anny. It had pre- He reduced his public commitments and hav- viously been unheard of for naval physicians ing lived at Culverlands, his house in Berk- to be consulted about Army matters and it is shire, moved first to Cleveland Row in I823 therefore a mark of the high regard in which and then to 8 Sackville Street, Piccadilly. Blane was held by his contemporaries that he During his illness he took large quantities of was asked on this occasion. In I809 the Army opium to reduce the pruritus, and the portrait had sent an expedition to the island of Wal- by Sir Martin Archer Shee, half completed a cheren, off Holland, but within a few days of year before Blane's death, shows the gaunt arrival it had been decimated by what is now countenance of the chronic opium user thought to have been malaria. More than half (Fig. 4). the force of I 8 ooo were incapacitated or died. Honour and high rank were awarded to Blane noted that officers suffered least from Blane by the Crown, his medical colleagues, the disease, while the rank and file, billeted on and the Navy. In addition to his baronetcy marshy ground, were worse off and also that and the Court appointments already men- the disease was more prevalent in the summer tioned, Blane became Physician in Ordinary to and autumn months. Upon his advice the King George IV on his accession. He was a expedition was withdrawn and thousands of Fellow of the Royal Societies of London, Edin- lives saved,. It is said that his report earned burgh, and G6ttingen and a Corresponding him the baronetcy bestowed upon him on Box- Member of the Imperial Academy of St Peters- ing Day I8I2 by the Prince Regent. burg and of the Institute of France. He be- Blane thought that cholera was spread by came President of the Medico-Chirurgical 'human intercourse' and he stated this in a let- Society in I8I3 and was also a member of the ter to the directors of the East India Company in January I825. His concern about cholera continued over the years until in I83I he pub- lished 'A warning and admonition to the Brit- ish Public on the subject of Indian cholera'. This was circulated to all the seaports, but popular belief held that cholera was not com- municable, despite a letter to Sir William Pym from the Royal College of Physicians advising to the contrary and that quarantine should be instituted. In I832 the authorities at Sunder- land ignored the advice and the great epidemic of cholera began. Sadly Blane's wife, Elizabeth, died of the disease in July of that year. Personal life and honours There is little record of Blane's personal life except that his manner was rather cold. In the London Medical Gazette of I834 he was said to have 'a certain sanctified, devout, death- like expression of countenance'. This fits in well with Sir Astley Cooper's comments. He married Elizabeth Gardner, the daughter of a London merchant, at 37 after he had retired from active naval service with Lord Rodney. There were six sons and two daughters of the manriage and Hugh Seymour Blane, his third FIG. 4 Sir Gilbert Blane; from an unfinished son, succeeded his father to the baronetcy portrait by Sir Martin Archer Shee. (Repro- after the death of the two elder sons. duced by kind permission of the Royal College Blane's health began to fail in I822, when of Physicians of London.) 2.38 R D Leach

FIG. 5 The Blane Medal: left, obverse; right, reverse (Reproduced by kind per- mission of the Royal Col- ~ e Zlege of Surgeons of Eng- wo= g i ~~land.)

prestigious Society for the Improvement of missions for the medals since 1832 does not Medical and Chirurgical Knowledge, founded exist. by John Hunter. In I829 he was made an Honorary Member of the Royal College of Conclusion Surgeons, and the address presented to him at that time is still in the keeping of the College. On 26th June 1834 Gilbert Blane died aged 85 at his home in Sackville Street. After The him with a silver Navy presented plate taking opium for 1 2 years he developed severe in I 82I as an appreciation from the naval diarrhoea, anasarca, oedema, and leg ulcers surgeons of his attainments during his period and his death must have been a glad release. on the Board of Commissioners for Sick and The early year-s of observation under Rod- Hurt Sailors. ney, accompanied by many frustrations, led Four years before his death Blane endowed to an understanding of the causes, of the major the 'Blane Medals' (Fig. 5). He had been a morbidity and mortality in the Navy. He knew tireless advocate of better medical standards in from his own experience that. the dietary and the Navy, not only so far as equipment and hygiene recommendations made to the Admir- food were concerned but also by raising the alty were effective in his own ship. He then medical status of the surgeons. The endowment established himself at St Thomas's Hospital of £300 was placed in the annuities at the as a respected physician, employing many ideas Royal College of Surgeons and two gold medals on land which he had found effective at sea. were presented on alternate years for the best At the, end of his I 2 years at St Thomas's Hos- submissions by naval surgeons concerning pital he was much respected and, as a Com- advancement of the science of naval medicine. missioner for Sick and Hurt Sailors, in a better Ten of the submissions were to be selected and position to put into action all his ideas which sent to him for final assessment, but he only had previously been ignored. These ideas re- adjudicated once, in I832, two years before his moved scurvy from the fleets and effectively death. On that occasion the medals were doubled the fighting power of the Navy. james awarded to John Liddell for a detailed ac- Lind had said: 'The province has been mine count of his preparations for battle in HMS to deliver precepts, the power is in others to Asia and to William Donnelly for his obser- execute'. And Blane regarded himself as no- vations of the third stage of syphilis when thing more than the executor. serving in HMS Hussar. The medal is now The references to his character are, often less awarded annually by the Presidents of the than complimentary, perhaps unfairly as he Royal College of Physicians of London and reduced naval morbidity and mortality by more the Royal College of Surgeons of England on than half and on these grounds alone must have the nomination of the Director-General of the had a deep humanity beneath his dour exterior. Medical Department of the Royal Navy. Blane His obituary states: 'The station attained may always felt that to advance the science of naval fairly be, attributed to his talents and indu-stry medicine scrupulous records should be kept, than to the possession of exteral graces and and it is sad that a compendium of the sub- artificial attractions. Sir Gilbert Blane, Bart, MD FRS (I749-I832) 239 I would like to thank Miss Hibbott and Miss Guthrie D. History of medicine. London: Nelson, Mathews of the Medical School Library, St I 963. Thomas's Hospital, for their help and tireless energy Lind J. A treatise of the scurvy. Edinburgh: Sands, in making original manuscripts available to me. I Murray, and Cochran, 1753. would also like to thank Derek Rutt and David Lind J. Diagnostics of scurvy. Medical Museum Sizeland for their advice and encouragement during I 763;2: 305- the preparation of this submission for the St Lloyd C, Coulter JLS. Medicine and the navy. Thomas's and Guy's Hospital Historical Prize, Edinburgh: Livingstone, i9,6i. 1978. McDonald D. Dr. John Woodall and his treatment Bibliography of the scurvy. Trans R Soc Trop Med Hyg 1954; Blane G. Observations on the diseases incident to 48: 36-5. seamen. London: J Cooper, I785. Meiklejohn AP. The curious obscurity of Dr James Blane G. The comparative health of the British navy. Lind. J Hist Med I9gs4;9:304-10. Medico-Chirurgical Transactions i 8I5;6:490. Rolleston HD. Sir Gilbert Blane MD FRS. J R Nav Dictionary of national biography, I908. Med Serv i9i6;2:72-8I. Dudley S. James Lind: laudatory address. Proc Nutr Woodhall J. Military and domesticke surgery. Soc 1953; 12: 202-9. London: N Boume, I639.