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Salt beef and surgery
DISSECTING ROOM
Salt beef and surgery Rough Medicine: Surgeons at Sea in the Age of Sail Joan Druett. New York: Routledge, 2001. Pp 270. £16.99. ISBN 0415924510. oan Druett opens Rough Medicine: Surgeons at Sea in the Age of Sail by asking the same question as many of her subjects’ parents must have asked, on hearing of their son’s career plans: why do it? Why, when a comfortable life in general practice was theirs for the taking, sign up for a 3-year cruise in the terrible conditions of a South Sea whaler? For the ordinary sailors in the 19th century, life on board was little worse than on land, and at least it meant 3 years of guaranteed food and clothing, and a share of the profits at the end of the voyage. But the doctors went for loftier reasons: some, amateur naturalists or anthropologists, out of curiosity; some out of a lust for adventure; and one even to impress his lady love (he failed; 6 months after he sailed she married someone else). The epigraph to the book is “Killing whales is sometimes attended with bad accidents”—a quotation from a whaler surgeon. But, Moby-Dick notwithstanding, hunting the sperm whale—the largest predator in history—from open rowing boats led to remarkably few casualties. Although whaling was a
J
dangerous trade, most of the surgeon’s customers came not from the hunt but from the daily hardship of shipboard life. Druett does not make this point, but it is likely that, much as modern foot-soldiers continually swallow painkillers (or “light infantry candy”) to keep going, the daily ration of alcohol— half a pint of rum on Royal Navy vessels, and similar amounts of ale, stout, rum, or gin on the whalers— served mainly as a painkiller. Hard physical work, uncomfortable living conditions, and continuous cold and wet must have led to low-level pain from muscle strain, torn ligaments, and rheumatism. Overcrowding, poor diet, cold, damp, and poor hygiene all brought their retinue of diseases. Dropping anchor to refit and resupply also exposed the crew to tropical fevers, venereal disease (most ships had a few cases on board at all times), and dysentery. But staying at sea for too long meant risking a far more serious problem—scurvy. One of the oddest parts of medical history, which Rough Medicine covers in depth, is the lethal slowness with which
An indepth guide to ovarian cancer Ovarian Cancer, Second Edition Stephen C Rubin, Gregory P Sutton, eds. Philadelphia: Lippincott Williams and Wilkins, 2001. Pp 464. $129.00. ISBN 0781724082 he second edition of Ovarian Cancer, edited by Stephen Rubin and Gregory Sutton, is the best English textbook currently available on the subject. Other comparable books do not deal with the subject in such a comprehensive manner. The authors have gathered 42 distinguished academics with an interest in ovarian cancer and have put together a textbook that covers basic science, pathology, and the clinical features of this devastating disease. Most of the book focuses on the clinical aspects of ovarian cancer and many of the contributors are clinicians. This second edition skilfully updates the previous first and no important subject for the treating clinician is overlooked. Indeed, this book is written primarily for the treating oncologist and to a lesser extent for the subspecialist in training. Ovarian
T
1468
Cancer provides an excellent summary of our current understanding of aetiology, diagnosis, and management of epithelial, germ cell, and stromal malignancies of the ovary. The only drawback arises from the number of contributors. With so many authors, the style and organisation of each chapter varies substantially, which compromises the readability of the text. Unfortunately, the era of single author books in medicine has passed. In addition, the reproduction of black and white photographs in most of the chapters is of poor quality and contributes little to this text. In general, however, I believe this to be an informative and comprehensive treatise on ovarian cancer and I recommend it to any physician treating this disease. Philip J DiSaia e-mail: [email protected]
the profession accepted that the cure for scurvy was citrus fruit. In 1747 Dr James Lind, a naval surgeon, treated six pairs of scurvy patients with various types of diet—the results proving dramatically that oranges and lemons could transform a bedridden patient into a picture of health in only a few days; his The Treatise of Scurvy was published in 1753. The great navigator Captain Cook knew about the benefits of diet and on his 3 years in the Pacific he did not lose a single man to scurvy. But a century after Lind, as Druett describes, the whaler Hydaspe was dropping anchor off Massachusetts with only three healthy men on board—all the rest were dead or dying from scurvy— and on their arrival the local paper announced wrapping patients in fresh whale blubber was an infallible cure. Even if the surgeon knew the cure, it was not enough—whalers stayed on station as long as there were whales, and often the captain would choose to risk scurvy rather than desert a lucrative stretch of water. And the next landfall might well be at an unexplored island, where the surgeon—whose responsibilities included the crew’s diet—would be sent ashore to trade for fresh food with the natives. One surgeon was left behind by his ship twice, and on the second occasion joined a Marquesan tribe as an honorary war chief in their battles against their neighbours—tattooed like a Maori from neck to foot. His story, as Druett relates it, reads like King Solomon’s Mines and if it were not corroborated it would be almost unbelievable. As a postscript, Druett adds, he became an obstetrician—one can only imagine his patients’ reactions to seeing his unorthodox decorations. Other surgeons acted, from time to time, as chaplains, as ship’s clerk—the surgeon was sometimes almost the only fully literate man on board—as watchkeeping officer, and even as harpooner. Like its subjects, Rough Medicine attempts to perform many duties. It contains potted biographies of the eccentric, the heroic, and the frankly insane; it touches on the state of the medical art in the 19th century and its earlier history, on the practicalities of whaling, on the culture and history of the South Seas, and the strange, isolated culture of the whaling ships. Unfortunately, it is a short book, and does not really have room to explain any of these fully—a reader without some knowledge of the period would have difficulty following the stories. But, for anyone with an interest in the sea or in medical history, Rough Medicine will be a rewarding read. Alexander Campbell e-mail: [email protected]
THE LANCET • Vol 358 • October 27, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Salt beef and surgery Rough Medicine: Surgeons at Sea in the Age of Sail Joan Druett. New York: Routledge, 2001. Pp 270. £16.99. ISBN 0415924510. oan Druett opens Rough Medicine: Surgeons at Sea in the Age of Sail by asking the same question as many of her subjects’ parents must have asked, on hearing of their son’s career plans: why do it? Why, when a comfortable life in general practice was theirs for the taking, sign up for a 3-year cruise in the terrible conditions of a South Sea whaler? For the ordinary sailors in the 19th century, life on board was little worse than on land, and at least it meant 3 years of guaranteed food and clothing, and a share of the profits at the end of the voyage. But the doctors went for loftier reasons: some, amateur naturalists or anthropologists, out of curiosity; some out of a lust for adventure; and one even to impress his lady love (he failed; 6 months after he sailed she married someone else). The epigraph to the book is “Killing whales is sometimes attended with bad accidents”—a quotation from a whaler surgeon. But, Moby-Dick notwithstanding, hunting the sperm whale—the largest predator in history—from open rowing boats led to remarkably few casualties. Although whaling was a
J
dangerous trade, most of the surgeon’s customers came not from the hunt but from the daily hardship of shipboard life. Druett does not make this point, but it is likely that, much as modern foot-soldiers continually swallow painkillers (or “light infantry candy”) to keep going, the daily ration of alcohol— half a pint of rum on Royal Navy vessels, and similar amounts of ale, stout, rum, or gin on the whalers— served mainly as a painkiller. Hard physical work, uncomfortable living conditions, and continuous cold and wet must have led to low-level pain from muscle strain, torn ligaments, and rheumatism. Overcrowding, poor diet, cold, damp, and poor hygiene all brought their retinue of diseases. Dropping anchor to refit and resupply also exposed the crew to tropical fevers, venereal disease (most ships had a few cases on board at all times), and dysentery. But staying at sea for too long meant risking a far more serious problem—scurvy. One of the oddest parts of medical history, which Rough Medicine covers in depth, is the lethal slowness with which
An indepth guide to ovarian cancer Ovarian Cancer, Second Edition Stephen C Rubin, Gregory P Sutton, eds. Philadelphia: Lippincott Williams and Wilkins, 2001. Pp 464. $129.00. ISBN 0781724082 he second edition of Ovarian Cancer, edited by Stephen Rubin and Gregory Sutton, is the best English textbook currently available on the subject. Other comparable books do not deal with the subject in such a comprehensive manner. The authors have gathered 42 distinguished academics with an interest in ovarian cancer and have put together a textbook that covers basic science, pathology, and the clinical features of this devastating disease. Most of the book focuses on the clinical aspects of ovarian cancer and many of the contributors are clinicians. This second edition skilfully updates the previous first and no important subject for the treating clinician is overlooked. Indeed, this book is written primarily for the treating oncologist and to a lesser extent for the subspecialist in training. Ovarian
T
1468
Cancer provides an excellent summary of our current understanding of aetiology, diagnosis, and management of epithelial, germ cell, and stromal malignancies of the ovary. The only drawback arises from the number of contributors. With so many authors, the style and organisation of each chapter varies substantially, which compromises the readability of the text. Unfortunately, the era of single author books in medicine has passed. In addition, the reproduction of black and white photographs in most of the chapters is of poor quality and contributes little to this text. In general, however, I believe this to be an informative and comprehensive treatise on ovarian cancer and I recommend it to any physician treating this disease. Philip J DiSaia e-mail: [email protected]
the profession accepted that the cure for scurvy was citrus fruit. In 1747 Dr James Lind, a naval surgeon, treated six pairs of scurvy patients with various types of diet—the results proving dramatically that oranges and lemons could transform a bedridden patient into a picture of health in only a few days; his The Treatise of Scurvy was published in 1753. The great navigator Captain Cook knew about the benefits of diet and on his 3 years in the Pacific he did not lose a single man to scurvy. But a century after Lind, as Druett describes, the whaler Hydaspe was dropping anchor off Massachusetts with only three healthy men on board—all the rest were dead or dying from scurvy— and on their arrival the local paper announced wrapping patients in fresh whale blubber was an infallible cure. Even if the surgeon knew the cure, it was not enough—whalers stayed on station as long as there were whales, and often the captain would choose to risk scurvy rather than desert a lucrative stretch of water. And the next landfall might well be at an unexplored island, where the surgeon—whose responsibilities included the crew’s diet—would be sent ashore to trade for fresh food with the natives. One surgeon was left behind by his ship twice, and on the second occasion joined a Marquesan tribe as an honorary war chief in their battles against their neighbours—tattooed like a Maori from neck to foot. His story, as Druett relates it, reads like King Solomon’s Mines and if it were not corroborated it would be almost unbelievable. As a postscript, Druett adds, he became an obstetrician—one can only imagine his patients’ reactions to seeing his unorthodox decorations. Other surgeons acted, from time to time, as chaplains, as ship’s clerk—the surgeon was sometimes almost the only fully literate man on board—as watchkeeping officer, and even as harpooner. Like its subjects, Rough Medicine attempts to perform many duties. It contains potted biographies of the eccentric, the heroic, and the frankly insane; it touches on the state of the medical art in the 19th century and its earlier history, on the practicalities of whaling, on the culture and history of the South Seas, and the strange, isolated culture of the whaling ships. Unfortunately, it is a short book, and does not really have room to explain any of these fully—a reader without some knowledge of the period would have difficulty following the stories. But, for anyone with an interest in the sea or in medical history, Rough Medicine will be a rewarding read. Alexander Campbell e-mail: [email protected]
THE LANCET • Vol 358 • October 27, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.