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Treating Fluxes in the Golden Age of Piracy, Page 4

Causes of a Flux: Environment

"Again, some diseases attend one Climate, and some another. As to the Northward there are more of Agues [fevers or malaria] and the Scurvy; and to the Southward more of Fluxes and Fevers". (John Moyle, The Sea Chirurgeon, p. 2)

Artist: Ludolf Bakhuisen
Dutch Merchants in a Storm (late 17th century) The environment had long been to blame for multiple illnesses and diseases by the time of the golden age of piracy. Hippocrates wrote a whole treatise on the subject and it was dutifully carried through medicine from that time forward in reverence to medicine's premier practitioner. The fault of many illnesses was laid at the feet of 'bad air' [mal aire]. As John Woodall explains, "If this disease of the fluxe shall shew it selfe to proceede of any contagiousnesse of the aire, as sometimes it doth, this is certainely the most fearefull of the rest... it is high time for Surgeon and patient to crie unto God for his helpe and mercy, and yet not to mistrust, but to use all artificiall meanes, referring the successe to the Almighty."¹

So it is not surprising that nearly all of the surgeons and physicians who talk in depth about fluxes point a withering finger at the environment. Unlike Woodall's observation, however, their comments are focused on a few specific causes.

Causes of a Flux: Environment - Cold

Cold weather seems to be particularly popular as a cause of many fluxes. William Cockburn leads the charge against frigid conditions with a very detailed explanation of why he believes this to be so.

Artist: Caspar David Friedrich
Ship in Polar Sea (1798)

And first, cold Air is a very common Cause of a Diarrhœa; for it occasions an extraordinary Quantity of a watry Humour to be separated from the Blood in diverse Parts of the Body. By the Coldness of Air, the Pores or Passages of the Skin are contracted; and thus are rendered more impervious to the Matter of Perspiration: But the Matter of Perspiration consists of the serous Parts of the Blood, and far exceeds all other Liquors [liquids], separated from the Blood, in Quantity; but, at this time, as it is unduly voided by the Smallness of the Pores, it is on this Account secreted at other Organs of Evacuation; and the Discharges at these Organs will be increased in some Proportion to the Difference of the impeded Transpiration.²

As you can see, Cockburn returns to the his favorite underlying cause, lack of sweat, as being at the root of fluxes.

Seaman Edward Barlow cites a fairly popular belief in cold and damp conditions as the source of diarrhea in his diary, explaining that in 1692, when he came "into the latitude of 25 degrees of south latitude, I had taken a great cold by over wetting and not keeping myself warm, which brought me to a great flux and looseness, and for ten days time I was very bad, being brought very low and weak, but it pleased God the looseness and flux stopped and I recovered very well again."³

John Moyle also identifies cold and damp conditions as the origin of dysentery, noting that poor diet "together with lying in the wet and cold ...generates the unnatural Choler that gnaws and frets the tender Tunicles of the Intestines, making Ulcers and Bleeding"⁴. Internal ulceration of the intestines was thought to be a source of the blood found in stools by many surgeons and physicians when a patient had dysentery.

Causes of a Flux: Environment - Damp

Artist: George Roux
Boats & Rain, from The Lottery (1886)
You will notice that dampness was added to the cold as a cause of a flux in the previous section. Cockburn explains that when rainy weather is combined with the cold it creates "a serous Diarrhœa, in Proportion to the Greatness of the Cold and the Time it lasts. But close rainy Weather makes the worst Diarrhœa, and the greatest Quantity of Water among the Stools."⁵ Recall that Cockburn felt that watery stools were among the symptoms of the hardest diarrhea to treat. Relevant to the sailors in the Caribbean, Cockburn also relates that a "Loosness so constantly follows Rain in the Weft-Indies, that the People there say commonly, It rains a Loosness"⁶.

In his account of the activities of buccaneering and sailing around the world, William Dampier reveals that in 1684 he found that the "Country [around Guiaquil] is subject to great Rains, and very thick Fogs, especially the Valleys. For that reason it is very unwholsome and sickly. The chiefest Distempers are Fevers, violent Head-ach, Pains in the Bowels, and Fluxes. … Guiaquil is not so sickly as Quito [Ecuador] and other Towns farther within the Land, yet in Comparison with the Towns that are on the Coast of Mare Pacifico, South of Cape Blanco, it is very sickly."⁷ Fog (itself a source of dampness) is also mentioned by sea physician Thomas Aubrey who explains that fluxes "also proceed commonly from a malevolent, infectious Quality of Air, Fogs, &c."⁸

Causes of a Flux: Environment - Changes in Weather

Artist: John William Edy
Changing Seasons from 'View from Egeberg' (1800) Another popular cause identified by period sources for fluxes was changes in weather. Edward Barlow cautions that "it is the time of the rains in the parts from the beginning of June till the latter end of August, being reckoned as unhealthy time for Englishmen [in Bengal]. And there being extreme hot weather, as it is in the Rains, in the beginning of September, it changeth to very cold all upon a sudden, the northern monsoons beginning to blow; and then our Europeans, many of them being careless of themselves, catch colds, which bring them to fluxes and fevers and agues, which bring many to their last days."⁹

William Cockburn puts the official sea physician stamp of approval on weather changes as being a cause of fluxes, finding "that cold Weather, a rainy and changeable Season, precede a Diarrhœa."¹⁰

Surgeon Matthias Gottfried Purmann suggests that many people contract a "Spontaneous Loosenesses, sometimes occasioned by the change of Seasons of the year, as at Spring and Fall"¹¹. Although he doesn't specifically spell out changes in the weather as the cause, it can be inferred.

Causes of a Flux: Environment - Heat

We now come full circle; having broadly blamed the cold for causing a flux, some of the surgeons proceeded to blame the heat. John Woodall explains that "this disease is incident much to such as change the place of their abode for a farre hotter or a farre colder country, but chiefly the hotter, witness the mortality through that disease which hath often befallen our Souldiers in the warres in France, &c. As also now at Bantham, how much doth it afflict them that live there."¹² You may recall that Woodall also blamed the overindulgence in tamarinds at Bantham for causing inveterate fluxes.

Artist: Howard Pyle - Marooned (1909) However, if we are going to award prizes for blaming multiple different things as being the root of a diarrhea, Cockburn definitely wins that contest. In addition to blaming the cold, the damp, changes in weather, various foods and drinks, he blames the heat for causing dysentery.

Sultry and hot Air then rarifies [thins] the Blood, a Liquor [liquid] that admits of being greatly rarify'd: But the Blood thus rarify'd, by hot Air, distends its Vessels, and is the Cause of their bursting. This more readily happens when either the Season changes from being very cold to be very hot, and that of a sudden; or that People change their Climate from hot to cold very quickly. Now the Blood-Vessels of the Guts being naturally weak, or becoming so by the loss of their Mucus, or the Sharpness of their Liquors [liquids], the Mouths of the Arteries of the velvet Coat easily open and discharge their Blood into the Guts: And therefore Blood discharged into the Guts, especially when they are filled with liquid Excrements, is mixed with these Excrements, and is voided with them...¹³

In fairness, he is talking about a different type of flux - dysentery - than he was explaining in most of the previous cases.

¹ John Woodall, the surgions mate, p. 211; ² William Cockburn, The Nature and Cure of Fluxes, p. 58-9; ³ Edward Barlow, Barlow's Journal of his Life at Sea in King's Ships, East and West Indiamen & Other Merchantman From 1659 to 1703, p. 429; ⁴ John Moyle, The Sea Chirurgeon, p. 171; ⁵ Cockburn, p. 88; ⁵ Cockburn, p. 61; ⁷ William Dampier, Memoirs of a Buccaneer, Dampier’s New Voyage Round the World, p. 110-1; ⁸ Thomas Aubrey, The Sea-Surgeon or the Guinea Man’s Vadé Mecum., p. 77; ⁹ Barlow, p. 437-8; ¹⁰ Cockburn, p. 57; ¹¹ Matthias Gottfried Purmann, Churgia Curiosa, p. 331; ¹² Woodall, p. 208; ¹³ Cockburn, p. 272

Causes of a Flux: Internal Issues and Humors

"[1672] And not long after, we had another of our men died of the bloody 'fflukes' [flux], it being a disease that many die of in and about this island [near Java], especially cold country constitutions as English and Dutch..." (Edward Barlow, Barlow's Journal of his Life at Sea in King's Ships, East and West Indiamen & Other Merchantman From 1659 to 1703, p. 209)

Internal causes were sometimes identified as being responsible for causing a flux. In his brief discussion of the Lientery, John Woodall blames the problem on the "imbecility and weaknesse of the stomake, which may be
Artist: Jakob Suckale
Maintaining Health by Balancing the Four Humors occasioned many waies, whereby the vertue retentive is weakened; yea and sometimes the stomake reserving apostumation [an aposteme - a swelling filled with pus] is ...wholly weakened"¹.

Another common internal problem identified by period surgeons is an overabundance of yellow bile or choler. Given that the body's health was thought to depend on the balance of the four humors - blood/sanguinity, phlegm, black bile/melancholy and yellow bile/choler - it should not be surprising that an excess of bad humors gets blamed for causing a flux.

For example, in a explanation which we have seen before, John Moyle explains that dysentery is "caused by vitious Dyet, together with lying in the wet and cold, which generates the unnatural Choler [yellow bile] that gnaws and frets the tender Tunicles [internal vessels] of the Intestines, making Ulcers and Bleeding"².

¹ John Woodall, the surgions mate, p. 202; ² William Cockburn, The Nature and Cure of Fluxes, p. 58; ² John Moyle, The Sea Chirurgeon, p. 171

Causes of a Flux: Medicine

Artist: Isaac Cruikshank
Taking Physic (1801) Related to humors is a rather unusual source of diarrhea; the physician- prescribed taking of medicines. One way that physicians felt they could relieve a patient of bad humors was to purge them out. A patient could be purged upwards using emetics or medicines designed to cause the patient to vomit. He could also be purged downwards through the use of clyster syinges and medicines designed to cause the patient to contract diarrheas.

Apparently wanting to cover all his bases, William Cockburn explains that a "dangerous Loosness has been observed to follow too strong a Dose of a purging Medicine. Purging by Medicines is making a Loosness for a small time; and the Dose of a purging Medicine, when it continues the Loosness to a longer time, has certainly exceeded the Strength of the Constitution."¹

Cockburn quickly dismisses this cause of a flux, however, explaining that "every thing besides being alike, [the overdose of medicine] works it self off the soonest; and is on that Account Diarrhœa of the shortest Duration."² So there's nothing to see here; move along.

¹ William Cockburn, The Nature and Cure of Fluxes, p. 66; ² Cockburn, p. 83

Causes of a Flux: Amputation

Even more extraordinary than anything preceding is the next cause of dysentery:
An Amputated Hand, from The French Chirurgerie
by Jacques Guillimeau_p_29 (1612) Amputation. William Cockburn dryly informs his reader that "almost every Physician (even after the Discovery of the Circulation of Blood) thought a Dysentery unavoidable, after the Loss of a Limb."¹ How? He goes on to explain that these physicians felt that a flux of blood from the anus was "the readied Way to discharge the daily Provision [of blood] made for a Limb, that is now no more. Moreover, Hippocrates not only thinks a Dysentery unavoidable, but useful and necessary"².

The underlying logic as Cockburn explains, is that a "Person without a Limb eats as much, and breeds as much Blood, after an Amputation, as before he lost a Limb."³ Ergo, there must be a surfeit of blood raging around in an amputee's system that has to go somewhere.

To his credit, Cockburn applies simple logic to explain this away, even though he has to cross the revered physician Hippocrates to do so. He tells his readers that if dysentery were necessary to remove the excess blood, "it would not only be necessary to have a Dysentery, after an Amputation, but such Dysenteries ought to be repeated."⁴ So much for amputations causing the bloody flux.

¹ William Cockburn, The Nature and Cure of Fluxes, p. 279; ² Cockburn, ibid; ³ Cockburn, p. 280; ⁴ Cockburn, ibid

Causes of a Flux: Infection

"When I commanded a Packet Boat [a small boat for delivering mail, passengers and freight locally] in Jamaica, I took on board a Passenger, who, unknown to me, had the Flux, which infected the Ship’s Company, so that but one Person escaped it besides my self; but none of them died, though I had then Fifty Men." (Nathaniel Uring, A history of the voyages and travels of Capt. Nathaniel Uring, p. 168-9)

Artist: Thomas Rowlandson
A Dutch Packet Boat Under Sail (1791) The last cause of dysenteric fluxes considered by period medical authors was infection. It is indeed possible for diarrhea to be spread from via human contact, but this primarily happens by people getting the diarrhea-causing bacteria on their hands and then putting their hands in their mouths. Of course, boats put men in close quarters where hygiene was probably less than sparkling. This would be particularly true on a pirate ship where discipline was probably less strict than a naval vessel.

There was some debate among the period medical practitioners on the idea of dysentery being communicable, however. As William Cockburn puts it, "as to the Contagion of a Dysentery, we all know that Physicians widely differ as to a Dysentery being communicated from one Man to another"¹. Cockburn tells his readers that before he can explain whether he thinks this is true or not he must settle another question over types of dysenteries. Unfortunately, he never returns to the topic of communicability of dysentery, so we can't be sure of his conclusion on the topic. (Or if he even had one.)

Sea surgeon John Woodall gives a most direct opinion on the matter.

Many learned writers are of the opinion that this disease is infectious, and that the breath and excrements of this sick man may easily infect a sound man, affirming also that from putrified and diseased bowels, infectious vapors doe ascend and descend, and partly the rather by a kinde of sympathy our bodies have each with other, but lest that opinion of mine uttered may perhaps offend the courage of the young Artists, whom I seeke by all possible meanes to embolden, let them take this rule from mee, in the feare of God, I holde no disease infectious to me, in that I have a lawfull calling, and I am therefore bound to visit the diseased, which who so neglecteth, God will finde him out with that disease or a worse.²

Photographer: Peter Crossman
Wooden Bucket Recovered from Mary Rose,
A mid-16th Century Carrack Vessel While he really never tell us whether he thinks dysentery is communicable or not, he makes it pretty clear that he isn't going to get it! It is not certain whether Woodall died of a dysentery or not, but since he didn't shuffle off his mortal coil until the ripe old age of 73, we can suppose his lawful calling made God protect him during his practice. (More likely, he was just more clean in his personal hygiene than the medical men who did contract it.)

Military physician Raymund Minderer is quite definite in stating that, from his experience in military camps, "the Bloody Flux is infectious, and very catching."³ The ever-direct and workmanlike prose of sea surgeon John Moyle gets right to the point, explaining that "there is too often some degree of malignity found in this Disease [Dysentery]; for I have known Men on board a ship catch it from others, by making use of the same Bucket"⁴.

In fact, Moyle came the closest of all our period surgeons and physicians to correctly identifying the source of the problem of the infectiousness of dysentery!

Next we will examine the many different ways that period surgeons attempted to cure fluxes, diarrheas and dysenteries.

¹ William Cockburn, The Nature and Cure of Fluxes, p. 253; ² John Woodall, the surgions mate, p. 211; ³ Raymund Minderer, A Body of Military Medicines Experimented, Volume 4 of Paul Barbette's, Thesaurus Chirurgiæ, The Fourth Edition, p. 70; ⁴ John Moyle, The Sea Chirurgeon, p. 172

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