Book 9 - Treason's Harbour

by Patrick O'Brian

  The Royal College of Physicians of London received its charter in 1518 and had a monopoly over the practice of physic in London and oversight of physicians throughout England. Fellows of the College, as opposed to ordinary license holders, enjoyed certain privileges—they were for instance exempt from jury duty and military service. On the other hand, they were not allowed to engage in trade, practice surgery or compound or sell medicines. These 'pure physicians' were limited to examining patients, diagnosing disease, and prescribing (but not dispensing) medications. A Fellow of the Royal College of Physicians (FRCP) would have to resign if he chose, as Dr Maturin did, to do surgery or dispense drugs.

  The powers of the Royal College of Physicians were confirmed during the reign of Henry VIII by an Act of Parliament which declared that it was 'expedient and necessary to provide that no person . . . be suffered to exercise and practise physic but only those persons that be profound, sad and discreet, groundedly learned, and deeply studied in physic.' (Alexander M. Carr-Saunders and Paul A. Wilson, The Professions) This meant a man with a university degree and, if he were to be a Fellow, that degree had to be from either Oxford or Cambridge. Even though medical education at some Scottish and Irish universities was arguably superior, their social status was not. On rare occasions, medical degrees from Dr Maturin's (undergraduate?) Alma Mater—Trinity College Dublin—were 'incorporated' at Oxford or Cambridge, but Stephen Maturin, born on the wrong side of the blanket, was certainly not one of these favoured few from aristocratic families. Nor would he have wanted it. Fellowship in the Royal Society meant far more to him than Fellowship in the Royal College of Physicians ever could. While Maturin's connections to the Royal Society are frequently described by O'Brian, it is clear that he is not a Fellow of the Royal College of Physicians.

  Both Jack Aubrey and Stephen Maturin read papers at the meetings of the Royal Society but the latter's involvement was much more profound. For one thing, Dr Maturin and his mentor in naval intelligence, Sir Joseph Blaine, were great admirers of the long-time President of the Royal Society, Sir Joseph Banks. This admiration was probably not only for Banks's extraordinary sponsorship of scientific inquiry worldwide, but for his personal qualities as well. Banks insisted on the freest possible exchange of ideas between British and French scientists (or 'philosophers' as they were then commonly called) during the Napoleonic wars. He nonetheless despised Napoleon, kept him from being made a Fellow of the Royal Society, and even declared his condemnation of 'the cursed name of Napoleon'. In his splendid biography of Banks, O'Brian describes a social encounter between Sir Joseph and Dr Benjamin Brodie, then a 'young, unknown medical man', who eventually succeeded Banks as President of the Royal Society:

  Sir Joseph took much interest in anyone who was in any way engaged in the pursuit of science, and as I suppose partly from Home's recommendation and partly from knowing that I was occupied with him in making dissections in comparative anatomy, was led to show me much kindness and attention, such as it was very agreeable for so young a man to receive from so distinguished a person. He invited me to the meetings which were held in his library on the Sunday evenings which intervened between the meetings of the Royal Society. These meetings were of a very different kind from those larger assemblies which were held three or four times in the season by the Duke of Sussex, the Marquis of Northampton, and Lord Rosse, and they were much more useful. There was no crowding together of noblemen and philosophers, and would-be philosophers, nor any kind of magnificent display. The visitors consisted of those who were already distinguished by their scientific reputation,. of younger men who, like myself, were following those greater persons at a humble distance, of a few individuals of high station who, though not working men themselves, were regarded by Sir Joseph as patrons of science, of such foreigners of distinction as during the war were to be found in London, and of very few besides. Everything was conducted in the plainest manner. Tea was handed round to the company, and there were no other refreshments. (Patrick O'Brian, Joseph Banks: A Life)

  Clearly this was a scene in which Stephen Maturin would have felt comfortably at home.

  Many real characteristics of Sir Joseph Banks have found their way into the fictional persona of Sir Joseph Blaine. In one of his innumerable bits of whimsy, O'Brian pursues this parallel in Blaine's request to Lord Melville (with respect to the mission of the Lively) 'that in compliment to Dr Maturin . . . the temporary commission should be modelled as closely as possible upon that granted to Sir J. Banks of the Royal Society.' (Patrick O'Brian, Post Captain)

  Aubrey learns of Maturin's medical background after their first dinner together. Keen to find a replacement surgeon for the Sophie Aubrey declares:

  'Had I known you was a surgeon, sir, I do not think I could have resisted the temptation of pressing you.'

  'Surgeons are excellent fellows,' said Stephen Maturin with a touch of acerbity. 'And where should we be without them, God forbid . . . But I have not the honour of counting myself among them, sir. I am a physician.'

  'I beg your pardon, oh dear me, what a sad blunder. But even so, Doctor, even so, I think I should have had you run aboard and kept under hutches till we were at sea. My poor Sophie has no surgeon and there is no likelihood of finding her one. Come, sir, cannot I prevail upon you to go to sea?'

  Aubrey presses his appeal, citing the opportunity for a 'philosopher' on a man-of-war to see birds, fishes, natural phenomena, meteors, and of course prize money. At first Maturin demurs:

  'But I am in no way qualified to be a naval surgeon. To be sure, I have done a great deal of anatomical dissection, and I am not unacquainted with most of the usual chirurgical operations; but I know nothing of naval hygiene, nothing of the particular maladies of seamen . . .'

  'Bless you,' cried Jack, never strain at gnats of that kind. Think of what we are usually sent—surgeon's mates, wretched half-grown stunted apprentices that have knocked about an apothecary's shop just long enough for the Navy Office to give them a warrant. They know nothing of surgery, let along physic; they learn on the poor seamen as they go along, and they hope for an experienced loblolly boy or a beast-leech or a cunning-man or maybe a butcher among the hands—the press brings in all sorts. And when they have picked up a smattering of their trade, off they go into frigates and ships of the line. No, no. We should be delighted to have you—more than delighted. Do, pray, consider of it, if only for a while. I need not say,' he added, with a particularly earnest look, 'how much pleasure it would give me, was we to be shipmates.'

  Later, Aubrey gloats to the Sophie's master, Mr Marshall, of their luck in attracting a physician to be the ship's surgeon.

  'Think what a famous thing that would be for the ship's company!'

  'Indeed it would, sir. They were right upset when Mr Jackson went off to the Pallas, and to replace him with a physician would be a great stroke. There's one aboard the flagship and one at Gibraltar, but not another in the whole fleet, not that I know of. They charge a guinea a visit, by land; or so I have heard tell.'

  'Even more, Mr Marshall, even more.' (Patrick O'Brian, Master and Commander)

  Lucky Jack Aubrey's idol, Admiral Lord Horatio Nelson, was far ahead of his time and his military contemporaries in recognising the need for good medical care in the fleet. This may have been partly due to his own frail health and physical vulnerability: Nelson seems to have contracted most of the diseases known to practitioners of his day and he certainly underwent more operations than any other flag officer in the British navy. After being wounded in the eye at Corsica he said:

  We have a thousand sick and the rest are no better than phantoms: I am here a reed among oaks: I have all the diseases that there are, but there is not enough in my frame for them to fasten on. (Christopher Lloyd and Jack L. S. Coulter, Medicine and the Navy)

  From 1780 onwards, Nelson corresponded with his medical friend, Dr Benjamin Mosely, and even contributed some material to the 4th edition of Mosely's rather mediocre Treatise on Tropical Diseases. (Benjamin Mos
ely, A Treatise on Tropical Diseases, on Military Operations, and on the Climate of the West Indies) Despite their friendship though, Nelson did not always follow Mosely's medical advice him self: Mosely opposed both vaccination and bark whereas Nelson had his own daughter vaccinated and encouraged the use of bark throughout the fleet.

  Maturin admits to having had extensive experience with anatomical dissection—including presumably, dealings with grave-robbers—which proves to have taken him far beyond the expertise of most physicians, or even surgeons, of his day. Before the Anatomy Act was passed by Parliament in 1832, body-snatching had for some 50 years provided medical students with a significant means of obtaining cadavers. Dissection was widely considered a fate worse than death because it deprived the corpse of a grave (from which, presumably, it could rise on Judgement Day).

  There were riots at gallows when surgeons attempted to take the bodies of criminals for dissection, and violent disturbances erupted in graveyards and at anatomy schools when cases of grave-robbery came to light. It was not an easy time to be an anatomist. (Ruth Richardson, British Medicine in an Age of Reform)

  Furthermore, Maturin is an experienced accoucheur and possesses considerable practical knowledge of 'the usual chirurgical operations'. He has many opportunities during the course of his naval career for the practical exercise of these skills. In HMS Sophie's early encounter with a corsair, the gunner suffers a depressed cranial fracture. Aubrey is sure the man will die, but Maturin cheerily comments:

  'I think he is safe until the morning. But as soon as the sun is up I must have off the top of his skull with my little saw. You will see the gunner's brain, my dear sir,' he added with a smile. 'Or at least his dura mater.' (Patrick O'Brian, Master and Commander)

  When the Admiral, Lord Keith, hears of the doctor's successful craniotomy of the gunner, he writes out Maturin's order (a sort of commission formally appointing him to the fleet) in his own hand—something Aubrey 'never heard of in the service before'. Maturin is intensely moved by the cheers that go up when the Sophies hear that his post has been made official. Nevertheless, as he reads the document, the physician grumbles:

  'There is only one thing I do not care for, however,' he said as the order was passed reverently round the table, 'and that is this foolish insistence upon the word surgeon. "Do hereby appoint you surgeon . . . take upon you the employment of surgeon . . . together with such allowance for wages and victuals for yourself as is usual for the surgeon of the said sloop." It is a false description; and a false description is anathema to the philosophic mind.' (Patrick O'Brian, Master and Commander)

  Surgeons were at that time perceived less as scientists and more as craftsmen.

  Like physicians through the ages Maturin knew the importance of medical mystique. Some of this came naturally through his own achievements: rousting out a man's brains and setting them right. Other elements of the mystique came with the deference properly due to a physician's intellectual status and arcane knowledge. The idea that a mastery of Latin and Greek was a prerequisite to the study of medicine persisted throughout the nineteenth century. As Maturin puts it when persuading Mr Herapath to let his polylingual son become a medical student:

  'His Chinese may be a thousand years old, but you are to consider, that Greek and Latin are older still. They are required in a physician, because the wisdom of ages has found that they give a nimbleness of mind. They supple the mind, sir, they render it pliant and receptive.' (Patrick O'Brian, The Fortune of War)

  In The Wine-Dark Sea a sailor falls on the pointed end of a cut bamboo, piercing his chest and producing 'the strangest effect on one lung' (a pneumothorax). Dr Maturin discusses the case at length in Latin with his assistant, the Rev Mr Nathaniel Martin.

  [This was] to the great satisfaction of the sick-berth, where heads turned gravely from one speaker to the other, nodding from time to time, while the patient himself looked modestly down and Padeen Colman, Dr Maturin's almost monoglot Irish servant and loblolly-boy, wore his Mass-going reverential face. (Patrick O'Brian, The Wine-Dark Sea)

  Of course, doctors speaking in Latin did not always engender confidence. As Dr Maturin and a helping surgeon, Mr Cotton, prepare to repair poor Colley's shattered skull, they converse briefly in that ancient tongue.

  'Whenever they start talking foreign,' observed John Harris, forecastleman, starboard watch, 'you know they are at a stand, and that all is, as might say, in a manner of speaking, up.'

  'You ain't seen nothing, John Harris,' said Davis, the old Sophie. 'Our doctor is only tipping the civil to the one-legged cove: just you wait until he starts dashing away with his boring-iron.” (Patrick O'Brian, The Mauritius Command)

  Sure enough the operation is successful: Colley recovers with a handsome silver plate in his cranium, and Maturin's reputation for preternatural skill goes up another notch amongst the sailors.

  Nor does Dr Marturin hesitate to open, up the skull when disease requires it. The ordinary naval surgeon would never have considered such a manoeuvre in the absence of trauma; but then the ordinary surgeon would not have made the same diagnosis as Maturin in the case of Arthur Grimble in The Thirteen-Gun Salute, who suffered from a syphilitic gumma of the brain (a tumorous lesion), and whose skull was opened 'to relieve the pressure on his brain'.

  Maturin enjoyed a unique relationship with his maritime companions, not only because he was the ship's surgeon, but because of the special. condition of mutual trust that he engendered.

  [He] accepted what seamen told him about ships with the same simplicity as that with which they accepted what he told them about their bodies. 'Take this bolus,' he would say. 'It will rectify the humours amazingly,' and they, holding their noses (for he often used asafoetida) would force the rounded mass down, gasp, and feel better at once. (Patrick O'Brian, The Wine-Dark Sea)

  The sailors expected—and Maturin was resigned to it—that for a medication to be effective it should be significantly unpalatable.

  After Aubrey, this time commanding the infamous Leopard, hauls the hapless Herapath out of the sea, old hands are confident that the near-drowned swain will survive.

  'Of course he'll live,' said his messmates. 'Ain't the Doctor pumped him dry, and blown out his gaff with physic?' For it was just as much part of the natural order of things that Dr Maturin should preserve those who came under his hands: he was a physician, not one of your common surgeons—had cured Prince Billy of the marthambles, the larynx, the strong fives—had wormed Admiral Keith and had clapped a stopper over his gout—would not look at you under a guinea, five guineas, ten guineas a head, by land.” (Patrick O'Brian, Desolation Island)

  This nearly magical confidence in Dr Maturin's medical prowess was also shared by the tough but superstitious Captain Aubrey. On a long voyage in H.M.S. Surprise, the Surprise is manned in part by sailors (taken from the Racoon) who had not been ashore for four years. Aubrey suspects that some of these men—apathetic, puffy-faced, dull-eyed, poorly co-ordinated, glum, lifeless—have scurvy. Maturin confirms it, noting 'weakness, diffused muscular pain, petechia, tender gums, ill breath'. But Aubrey is not nearly as worried as he should be. He is sure that Maturin will be able to 'set them up directly.' Maturin demurs: his lime juice is dubious; the ship lacks, green vegetables. But Aubrey is undismayed:

  'It is a great comfort to me to have you aboard: it is like sailing with a piece of the True Cross.'

  'Stuff, stuff,' said Stephen peevishly. 'I do wish you would get that weak notion out of your mind. Medicine can do very little; surgery less. I can purge you, bleed you, worm you at a pinch, set your leg or take it off, and that is very nearly all. What could Hippocrates, Galen, Rhazes, what can Blane, what can Trotter do for a carcinoma, a lupus, a sarcoma?' He had often tried to eradicate Jack's simple faith; but Jack had seen him trepan the gunner of the Sophie, saw a hole in his skull and expose the brain; and Stephen, looking at Jack's knowing smile, his air of civil reserve, knew that he had not succeeded this time, either. The Sophies, to a man, ha
d known that if he chose Dr Maturin could save anyone, so long as the tide had not turned; and Jack was so thoroughly a seaman that he shared nearly all their beliefs . . . (Patrick O'Brian, H.M.S. Surprise)

  Maturin also shows himself on occasion to be a practical psychiatrist, long before the speciality was even given a name. We see it first in Master and Commander in the case of Cheslin, who is stigmatised not only with a harelip but also because the crew have learned that he was a sin-eater. The man is 'dying of inanition'; deeply depressed by his total rejection by his shipmates. Maturin saves him by making him a helper in the ship's infirmary, thereby giving him some sense of self-worth, leading to gradual acceptance by the crew and the chance finally to prove himself heroically in the boarding and capture of the Cacafuego.