Exploration and mortification: Fragile infrastructures, imperial narratives, and the self-sufficiency of British naval "discovery" vessels, 1760-1815.

Eighteenth-century naval ships were impressive infrastructures, but subjected to extraordinary strain. To assist with their "voyage repairs," the Royal Navy gradually established numerous overseas bases, displaying the power, reach, and ruthless logistical efficiency of the British state. This article, however, is concerned with what happened where no such bases (yet) existed, in parts of the world falling in between areas of direct British administration, control, or influence. The specific restrictions imposed by technology and infrastructures have been studied by historians interested in naval strategy, but they can also help to reframe national narratives of power or observe the transnational interactions surrounding access to knowledge and resources. This paper discusses the material, cultural, and diplomatic constraints that could appear when vessels, and especially "discovery ships," sailed in strange waters or sought technical assistance in allied ports. I argue that the "mortification" of some commanders at their vessels' unfitness for service was an important - and often neglected - element on the palette of emotions undergone by voyagers, capturing their strong sense of ultimate material powerlessness. Such frustration even became embedded in imperial cartography, as shown by the case study of Matthew Flinders. This perspective highlights the limits of naval technology, complicating imperialistic "success stories" and better reintegrating the navy into the history of maritime travel and transportation, from which it is often singled out.

The Life and Death of Lord Nelson: The Leader, the Patient, the Legend.

Admiral Lord Horatio Nelson is perhaps the most renowned naval commander, who allowed Britain to have dominion over the sea for 100 years after his victory at the Battle of Trafalgar. He was able to do so despite suffering from a multitude of communicable diseases and traumatic injuries, including the functional loss of his right eye, amputation of his right arm, scalp laceration, head injury, and finally a spinal injury. These injuries had permanent consequences but did not stop him from leading the charge and allowing the British to defeat the French and Spanish fleets in the decisive Battle of Trafalgar.

Raising Boys for the Navy: Health, Welfare, and the British Sea Services, 1870-1905.

Efforts to improve the quality and quantity of seafarers in the Royal Navy and merchant service became a particular concern amidst the degeneration debates of late-Victorian Britain. Maritime reformers not only promoted fitness in adult sailors, but also particularly sought to improve health and physique of boy recruits in order to rear a new generation of healthy sailors. This article shows how both services experimented with tighter admission criteria and dietary and exercise reforms, and became early advocates of using metrical standards to exclude all but the fittest, healthiest boys from training opportunities. While the physical monitoring of boy recruits undoubtedly showed the value of early lifestyle interventions in fostering healthy development, the rising physical standards of British seafarers in this period was just as much the result of restrictive medical examinations as a commitment to welfare initiatives.

Océano, viento y soledad. Anestesia y reanimación a bordo del Buque Escuela de la Armada Española Juan Sebastián de Elcano, nuestra experiencia / Ocean, wind and loneliness. Anaesthesia and reanimation on board the Spanish Navy Training Ship Juan Sebastián de Elcano, our experience

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Five centuries of medical contributions from the Royal Navy.

Royal Naval ships' companies, isolated by hundreds of miles of sea with contacts to the outside world tightly regulated, provided perfect environments to study the epidemiology of disease. In 1747, James Lind organised one of the earliest clinical trials, demonstrating that scurvy could be treated by lemon juice. A century later, Alexander Bryson proved the value of careful epidemiological data collection and observation of infectious diseases encountered on the West Africa station. In the 20th century, Royal Navy physicians were at the cutting edge of vaccine research and antibiotic production. Nuclear submarines placed naval physicians at the forefront of nuclear medicine and environmental safety. The development of new aircraft carriers has driven a renewed interest in aviation medicine. This article reviews the contributions that Royal Navy physicians have made to medicine over the centuries, detailing some of the better known as well as some almost forgotten, but still remarkable, achievements.

A historical review of the U.S. Navy's busiest recompression chamber in the Pacific theater with a current perspective on caring for civilian divers within its area of responsibility: short communication.

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy's recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treatment facilities presents multiple issues that must be addressed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.

'Cleanse or Die': British Naval Hygiene in the Age of Steam, 1840-1900.

This article focuses on the consolidation of naval hygiene practices during the Victorian era, a period of profound medical change that coincided with the fleet's transition from sail to steam. The ironclads of the mid- to late- nineteenth century offered ample opportunities to improve preventive medicine at sea, and surgeons capitalised on new steam technologies to provide cleaner, dryer, and airier surroundings below decks. Such efforts reflected the sanitarian idealism of naval medicine in this period, inherited from the eighteenth-century pioneers of the discipline. Yet, despite the scientific thrust of Victorian naval medicine, with its emphasis on collecting measurements and collating statistics, consensus about the causes of disease eluded practitioners. It proved almost impossible to eradicate sickness at sea, and the enclosed nature of naval vessels showed the limitations - rather than the promise - of attempting to enforce absolute environmental controls. Nonetheless, sanitarian ideology prevailed throughout the steam age, and the hygienic reforms enacted throughout the fleet showed some of the same successes that attended the public health movement on land. It was thus despite shifting ideas about disease and new methods of investigation that naval medicine remained wedded to its sanitarian roots until the close of the nineteenth century.

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance.

BACKGROUND: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. METHODS: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome. RESULTS AND CONCLUSIONS: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers.

La introducción de los rayos X en España. La ciencia médica y la sanidad naval rumbo al siglo XX / The Introduction of X-rays in Spain. Medical Science and Navy Health Heading to the 20th Century

OBJETIVO: Análisis del método de diagnóstico de los rayos X adoptado por el Cuerpo de Sanidad de la Armada en los últimos años del siglo XIX y de los apoyos científicos, legales e institucionales. MATERIAL Y MÉTODO: Memorias clínicas apuntando la necesidad de creación de gabinetes radiológicos en los hospitales de la marina; documentos rescatados de los fondos del Archivo General de la Marina (Viso del Marqués, Ciudad Real). Reglamentos, legislación y apoyos del gobierno. Estudios científicos con los pros y los contras de la técnica diagnóstica de la radiología naciente. RESULTADOS: Demanda y adopción de esta técnica y su aplicación a la asistencia sanitaria en el ámbito castrense y su extensión a la población civil. Primeros pasos de los rayos X en España. CONCLUSIÓN: Implantación de la radiología como método diagnóstico en los hospitales y en los barcos de la Armada, dentro del contexto de la ciencia en España a finales del siglo XIX y comienzos del XX

OBJECTIVE: Analysis of the X-ray diagnose method adopted by the Navy Health Corps in the last few years of the 19th century and its scientific, legal and institutional support. Material and METHOD: Clinic reports referring the need to create X-ray consulting rooms in Navy hospitals; documents retrieved from the General Navy Archive (Viso del Marqués, Ciudad Real), regulations, legislation and government support. Scientific research evaluating the advantages and disadvantages of the newly- born radio diagnosis technique. RESULTS: Demand and adoption of this technique, its medical use in the military realm, and its subsequent extension to civil population. First steps of X-rays in Spain. CONCLUSION: Implementation of radiology as a diagnosis method in Navy hospitals and ships within the context of Spanish science by the end of the 19th century and the beginning of the 20th

Historical state of knowledge of the health risks of asbestos posed to seamen on merchant ships.

We examined the development of knowledge concerning the risks posed by asbestos to seamen working aboard merchant ships at sea (i.e. commercial, rather than naval vessels). Seamen were potentially exposed to "in-place" asbestos on merchant ships by performing intermittent repair and maintenance tasks. We reviewed studies measuring airborne asbestos onboard merchant ships and health outcomes of merchant seamen, as well as studies, communications, and actions of U.S. organizations with roles in maritime health and safety. Up to the 1970s, most knowledge of the health risks of asbestos was derived from studies of workers in asbestos product manufacturing and asbestos mining and milling industries, and certain end-users of asbestos products (particularly insulators). We found that attention to the potential health risks of asbestos to merchant seamen began in the mid- to late 1970s and early 1980s. Findings of pleural abnormalities in U.S. seamen elicited some concern from governmental and industry/labor organizations, but airborne asbestos concentrations aboard merchant ships were found to be <1 f/cc for most short-term repair and maintenance tasks. Responses to this evolving information served to warn seamen and the merchant shipping industry and led to increased precautions regarding asbestos exposure. Starting in the 1990s, findings of modest increases in lung cancer and/or mesothelioma in some epidemiology studies of seamen led some authors to propose that a causal link between shipboard exposures and asbestos-related diseases existed. Limitations in these studies, however, together with mostly unremarkable measures of airborne asbestos on merchant ships, preclude definitive conclusions in this regard.

Medicine, Surgery and Public Health at the epoch of Gimbernat (1734 - 1816)

The aim of this publication is to recall to memory Don Antonio de Gimbernat i Arbós on the occasion of the second centenary of his death. Gimbernat was a prominent figure in the fields of anatomy, surgery and medicine in Spain during the second half of the 18th century. Born in Cambrils (Tarragona, Spain) in 1734, he studied surgery in Cadiz, thereafter commencing his professional career in Barcelona, where he made his more important anatomical discoveries. His visits to France, England and Holland between 1774 and 1778 constituted a milestone in his life. After returning to Spain, Gimbernat founded the Royal College of San Carlos in Madrid and, with increasing fame, advanced in the Spanish medical hierarchy. In 1793 he published a memorable work on the anatomy of the rural region and the surgery of femoral hernias, which was recognized throughout Europe, being translated into English, German and French. He was also a brilliant surgeon and physician in other areas (liver diseases, ophthalmology, gynecology, urology, etc.), always regarding anatomy as the basis for his work. In the early nineteenth century he held high positions within national medical institutions, promoting inter alia the unification of the study of surgery and medicine; an important step in the modernization of Spanish medical education. The last years of his life were difficult and sad as, for political reasons, Gimbernat no longer received the recognition he deserved after a life so rich in professional successes. Gimbernat died in Madrid at the age of 82 (AU)

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Gimbernat's stay in Cadiz and his discovery of the human anatomy

The dates on which Antonio Gimbernat studied at the Navy Royal College of Surgery in Cadiz (Real Colegio de Cirugía de la Armada, RCCA) show some discrepancies between different authors. A detailed reading of the Royal College archives, especially the books of enrollments kept in the Department of History of Medicine at the University of Cadiz, allows us to clarify this issue. In this contribution we present the academic records of Gimbernat in Cadiz, as well as annotations on his participation in college life, where his remarkable vocation for anatomy is reflected. On the other hand, we will see aspects that have had influence on his curriculum during the short but productive and notable period of studies in the Royal College. Moreover, we will analyze the contents of the academic curriculum followed by Gimbernat, which was designed by Virgili, although some other aspects of the academic life of the RCCA were not supported by our honoree surgeon. Finally, through generic documents on the customs and habits of the Navy Royal College of Surgery in Cadiz we outline how Gimbernat’s life and habits were during his time as college member (AU)

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Surgeons - Anatomists of the 'camp de Tarragona'. Soldiers equipped with an academic plan

At the end of the 17th Century the university training of surgery in Spain depended on the traditional faculties of medicine in the universities. In these faculties ‘teaching continued to be conceived as an oral apprenticeship based on memory, and the theoretical principles of the Renaissance’ (Granjel, 1979). Training in surgery was dependent on the badly equipped Departments of Anatomy, where anatomy and surgery were taught. The work ‘Institutions of Surgery’ of Luis Mercado, published in 1599 by order of Felipe II, continued to be recommended. Felipe II prohibited ‘foreign travel to study or learn or reside in foreign universities or the study in their colleges …’ (Ferrer, 1968). These Departments trained many university surgeon - so called ‘Latin surgeons’ because they spoke Latin - who were ill prepared (Massons, 2002), with the result that the greater part of the population were treated by barbers or romance surgeons - surgeons without university training who had learnt from another surgeon (Vallribera i Puig, 1987). There was also much 'practice' with no training at all (Bustos Rodriguez, 1983). The evolution of a surgery eminently practical at the beginning of the 18th Century to surgical practice based on a solid training programme and scientific principals cannot be explained in Spain without the participation of an interrelated group of surgeons, all of them from the same birthplace, the ‘Camp de Tarragona’ (AU)

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