In the late 17th and early 18th-centuries, England began to emerge as a dominant naval power whose fleet rivaled, and eventually surpassed those of the Dutch, Spanish, Portuguese, and French armadas. However, this dramatic surge in naval prowess also coincided with, and in many ways depended upon, the emergence of a much lesser discussed aspect of waging war at sea; the caretaking of wounded sailors. In his 2024 work Early Modern Naval Health Care in England, 1650 – 1750, author and military historian Matthew Neufeld explores the transition which occurred over this roughly one hundred year period from primarily individual and outsourced caretaking of sailors, to government sanctioned hospitals and organized treatment efforts. In doing so he demonstrates how this responsibility evolved from oftentimes voluntary and highly gendered roles, toward modern medical systems and practices. While this topic happens to fall within the scope of the military, I would classify this work as more of a social history than anything else, given his focus on non-professionals and everyday individuals. In his own words “Rather than giving most of its attention to medical professionals, this book strives to recapture the significance of the people who did the majority of caring for injured and sick sailors.” (p12)
Early Modern Naval Health Care in England, 1650 – 1750 follows a generally chronological timeline, and Neufeld breaks down many of his chapters by conflicts such as the 9 years war, Queen Anne’s war, and the wars with Spain and France. Although I would consider this to be a social history, the first part of this work reads more as a history of medical practices of the late 17th-century. He does this primarily to establish the longstanding conditions that sailors were expected to endure when it came to hygiene, surgery, and treatment out at sea. If a sailor managed to survive his wounds long enough to return to England, he could then begin the process of care and recovery, a role that was typically (though not always) performed by women of coastal towns and cities.
From the onset, Neufeld states that “Women were responsible for much of what naval health care did right during the later half of the 1740s, and in previous conflicts. At the time, this truth was not acknowledged widely. This book aims in part to right that wrong.” (p18) He points out that despite having the funds to construct massive fleets of warships, providing care for injured sailors proved initially to be somewhat of a low priority for the British admiralty, and oftentimes they simply forced the responsibility of caring for the infirmed onto ordinary citizens out of desperation. “People received sick and hurt seamen and cared for them on credit, in the belief that the navy would honour its debts in a reasonably short period of time. (p20) When the navy failed to fulfill the promises it had made to these individuals, it often led to the straining of relationships or even outright protests. Despite this tension, Neufeld asserts that this should not discredit the overall success of these early systems of care and the foundations for later systems they ultimately established.
Another theme of this work which is central to Neufeld’s argument is the intertwining of moral and economic advantages that this early system provided to both the government and the people. Using treasury and auditor’s records following the Glorious Revolution, he shows that the navy had spent almost 30,000 pounds on caring for sick and wounded sailors by 1690, and was in desperate need of funds to pay off their debts.(p45) Although some individuals protested by refusing to take in injured sailors altogether, it was still seen as a moral duty by the majority of English people who continued to work without compensation. Neufeld goes so far as to argue that “The patience of care providers and care workers prevented naval health care from total collapse during the Nine Years’ War.”(p46) These financial difficulties were in part what made Navy officials consider establishing a more organized system and eventually led to the construction of the first hospital for sailors.
By the start of Queen Anne’s war, the navy had established a formal health care administration which performed these duties better than previous decades due to increased finances from the South Seas trade.(p69) Neufeld draws the readers’ attention to several key differences between this period and the early years of naval care such as clear instructions for treatment which contain areas of both change and continuity. These new guidelines placed a much greater emphasis on the centralization of care in key coastal cities, as well as the importance of qualitative and quantitative data regarding wounded sailors, however they still failed to account for the compensation of widows and family members.(p72) By the Georgian Era, the cost of healthcare for injured seamen had become a standard expense as evidenced by annual parliamentary session reports. Neufeld argues “The fact that the system of naval health care continued uninterrupted past the end of Queen Anne’s War is one of the most important aspects of its early modern development,” and served as a turning point from when health care provisions ended once fighting stopped.
In his conclusion, Neufeld echoes his earlier points about the simultaneous aspects of both continuity and change that existed within the English naval health care system by referencing contrasting first hand accounts of the later 18th-century. In some instances, sailors received treatment at large state-sanctioned hospitals where medical professionals attended to their needs, while in other cases they were looked after in private sick-quarters by caretakers who were mostly women. Although hospitals had begun to shoulder more and more of the burden once placed on private individuals, in Neufeld’s opinion… “Early-modern naval health care did not end with the emergence of permanent hospitals for seamen.” (p188)
On a more personal note, I thoroughly enjoyed reading this work; not only because it was a topic of my own choosing, but because Neufeld has a literary style that is very easy to follow and heavily reinforced by first hand evidence. While he states in his introduction that the focus was solely on England because that was where naval healthcare was the “most decisive for the system’s emergence and transformation,”(p15) I do wish he spent a bit more time discussing what that experience was like for sailors who were treated in foreign colonies. Furthermore, although he does not engage as much as some of the other authors we have read with the existing historiography, he is ultimately very honest about his own methodology. In his words… “while not discounting the limitations of such sources, nor claiming that my reading of them is “unbiased,” I hope the story that follows is a valuable and true interpretation of the past. To claim something as true makes it possible for others to point out features of it that are in fact wrong. Indeed, this book will have succeeded if it encourages other historians to prove my story wrong.”(p13)