Annals of the Royal College of Surgeons of England (I975) vol 57 The injuries of four centuries of naval warfare Surgeon Vice-Admiral Sir James Watt KBE QHS MD MS FRCP FRCS Medical Director-General (Naval), Ministry of Defence Introduction bowl. The College of Surgeons, after its foun- In the year I540 Henry VIII was persuaded dation in i 8oo, continued to examine surgeons by his Serjeant-Surgeon, Thomas Vicary, to on entry to the Royal Navy until I 843', found the Company of Barber-Surgeons and when the link was severed until happily re- thereby control the practice of the art, an stored in I964 by the establishment of a joint event commemorated in the fine cartoon chair in naval surgery at the Royal College by Hans Holbein which hangs in the Royal of Surgeons of England and the Royal Naval College of Surgeons of England showing Hospital, Haslar. Thomas Vicary receiving the Charter from the King's hand. The Charter granted by The fighting ship Charles I in I 629 included a requirement The year I 540 was also of importance to to examine surgeons and surgeon's mates for the Royal Navy for it marked the recom- the Navy. The Court of Examiners sub- missioning of the great ship Henry Grace a sequently assuimed the additional responsibil- Dieu after an extensive reconstruction to ac- ity of reviewing injuries sustained in naval commodate the new heavy ordnance de- actions and allowing the expenses of the cure. veloped through Henry's liaison with Hans The need to do so had been apparent no Poppenruyter, the gun maker of Mechlin, doubt from such unfortunate affairs as that whom Henry, characteristically, omitted to of Sir Martin Frobisher, who, after blockading pay. Similar guns were recovered from the Brest in 1594, had been struck by a ball from wreck of the Mary Rose in I836. They were the arquebus of a Spanish soldier which breech-loading, wrought-iron bombards lodged against the 'hucklebone'. It did not built up of longitudinal bars with en- prevent him pressing home the assault, but his circling metal rings, I0 feet in length and surgeon, who had extended the wound to ex- of 8 inch calibre. There were also muzzle- tract the ball, failed to remove the wad which loading brass cannon and culverin, similar had been carried in with it. Gas gangrene ap- to those in use at Trafalgar4, except that the pears to have determined the fatal outcome",2. I8o5 guns were of cast-iron, first introduced The Barber Surgeons' Company played a into England in I5435. key role in the provision of surgeons for the The Henry Grace a' Dieu exemplified the fleet and, in I704, Queen Anne expressed innovation which was a distinguishing fea- her appreciation by the gift of a silver punch ture of Henry's reign. When first com- Thomas Vicary Lecture delivcred on 3Ist October I974 4 Sir James Watt FIG. I 'Embarquement du Roi Henry VIII a' bord du Henry Grace-a-Dieu, I522.' Copy by Bouterwerke, I844, of a painting attributed to Vincente Volpe showing the ship lying immediately beyond the tower prior to her reconstruction. (Muse'e de la Marine, Paris.) missioned in I 5 I 4 she is shown in Volpe's injuries in action were sustained as the result painting (Fig. i) as an impressive but none- of close fights, from the arrows of archers, theless typical mediaeval clinker-built vessel from iron bars, darts, spears, and even stones with ill-assorted armament, depending chiefly hurled from the castles and, after grappling upon the bows of archers and primitive ser- and boarding, from swords, pikes, and toma- pentine guns in her high fore and after castles to rake exposed enemy decks and repel board- ers. Henry's influence, however, can be seen in ports for heavier guns in the ship's stem and side which Henry had compelled his shipwrights to breach against their better judgment. The Anthony Anthony Rolls' show that, on completion of her refit in I540, the Henry Grace a Dieu emerged with two tiers of gun ports and a formidable heavy armament (Fig. 2), the forerunner of the British broadside which was to dictate the tumblehome construction of sailing ships in order to distribute the weight of their ord- nance and to endure as the principal tactical FIG. 2 The Henry Grace-a-Dieu following weapon of surface ships until the Second her reconstruction. From the Anthony An- World War (Fig. 3). thony Rolls, I546. (Magdalene College, Prior to the introduction of guns to ships Cambridge.) The injuries of four centuries of naval warfare 5 in I588, Howard wisely exploiting the handi- ness and greater gun range of his little ships FM-f=fffml to harry and outsail the Spaniards, conscious Aormp-qr- -m 0 i m m of the danger of close action in which the I I I advantage would lie with the enemy, whose 0, D, high castles were teeming with soldiers. These .:.jjjjjjjjjjFjjp..---.----- -............... ...... ........ tactics proved successful, for the Spaniards' shot was spent before it reached the English I ships and casualties were few, 'not above one hundred', although Drake's ship was 'pierced with shot above forty times'. 'The greatest danger', wrote Sir Richard Hawkins, 'that, as I remember, they caused to any of our FIG. 3 Midship section of a fourth-rate, shipps, was to the Swallow of her majestie, i684. (National Maritime Museum.) which I had in that action under my charge, with an arrow of fire shott into her beake- hawks (Fig. 4). Head and upper extremity head, which we saw not, because of the sayle, injuries therefore predominated, but as no till it had burned a hole in the nose as bigge quarter was asked for and none given, casual- as a man's head; the arrow falling out, and ties were swept overboard into the sea and driving alongst by the shippes side'7. These there was no need for surgeons. early arrow projectiles were bound in leather to fit into the bore, but were quickly suc- The Spanish Armada ceeded by stone, then cast-iron round shot8. The arrival of the gun coincided with the The significance of that incident was not great voyages of discovery and the need to lost upon Wylliam Clowes, who appears to protect English overseas interests. The ship, have been in Howard's flagship, the Ark therefore, became a self-sufficient fighting Royal (Fig. 5), and was no doubt highlighted unit. The first test of British gunnery and for him at Gravelines when Howard sent in seamanship came with the Spanish Armada fireships to drive the terrified Spaniards to ;iitr c It m 44(191 fu fllnm fl)MWkI w n D ¢ v} -t;)¢ n [1{1X,. X . * aazlv,S:*8X>ttS U m>tXl w tt+f^t awe1naWnIx FIG. 4 A close fight at sea in the 4th century. (MSS ioE, IV. British Museum.) 6 Sir James Watt FIG. 5 The Ark Royal, Howard's flagship in the battle against the Spanish Armada, I588, bought by Queen Elizabeth from Sir Walter Raleigh. (The Mansell Collection, Lon- don.) sea in confusion. It is therefore scarcely sur- loading guns with ejection of the hot breech prising, in that Armada year, that Wylliam box, and burn wounds of the body from hot Clowes9 should publish An Approved Practice fragments of exploding cast-iron muzzle- for all Yong Chirurgians concerning Burnings loaders. with Gunpowder . Clowes distinguished Burns continued to dominate the writings of between partial and full-thickness skin loss, naval surgeons for the next century. To John using wet, cooling lotions for superficial bums Woodall'0 we owe the principle of enzym- and oily dressings or creams for full-thickness atic debridement and the important instruc- loss, with attention to fluid replacement with tion to 'take away all the powder that sticketh 'boyled water' in the initial stages and to to the flesh, for it hindereth the cure' and to nutrition during convalescence. His results John Moyle"1, who was then describing appear to have been successful and rehabilita- severe contractures following bums at sea, tion was not neglected, for the recently healed the early surgical debridement practised to- bum was gently massaged with egg yolks and day. A century later, however, Blane"2 and almond oil. Turnbull"3 were reporting a high bums mor- tality and it is interesting to speculate that Burns toxic absorption of 'cerussa', a lotion of lead The Armada drew attention to the com- dissolved in vinegar then in general use in plicated nature of bum injuries. There were the Navy as a local application, was respons- superficial flash bums from the accidental ible for this. ignition of powder horns used for priming The enormity of the bums problem was the guns or of loose powder strewn over the even more evident to the enemy as whole deck. There were localized full-thickness ships' companies disappeared in terrifying bums from sudden bulging of over-heated explosions. L'Orient at the Battle of the Nile brass culverins, bum wounds of the head and threw great burning beams over Alexander face from misfire of wrought-iron breech- and Swiftsure and John Nicol, a seaman in The injuries of four centuries of naval warfare 7 HMS Goliath, describes the scene which met (a cylindrical tin case containing small, loose, his eyes when he went on deck after iron balls), langrage (a tin filled with scrap the action: 'The whole bay was covered and iron bars), and grape or quilted shot with dead bodies, mangled, wounded and (iron balls arranged round an iron column scorched, not a bit of clothes on them except in a canvas bag).