[BITList] In health, at sea

[John Feltham]

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Blane, Sir  Gilbert, first baronet  (1749-1834), physician, the fourth son of Gilbert Blane, was born on 29 August 1749 at Blanefield, Ayrshire, in western Scotland; the Blanes were a wealthy merchant family. Gilbert was educated at Kirkoswald and Maybole schools in Ayrshire until the age of fourteen, before attending the University of Edinburgh with the intention of beginning a career in the church. However, after five years in the faculty of arts Blane then undertook another five years in the faculty of medicine. Never one to remain inconspicuous, he was elected as a president of the students' medical society and during his term of office had the prestigious duty of presenting a speech at the laying of a foundation stone of a new hall for the society in 1775  (Authentic Memoirs, 135-45).

Blane was extremely fortunate to be acquainted with two of the most famous doctors of the late eighteenth century. Before he received his MD from the University of Glasgow on 28 August 1778, Blane studied under William Cullen who then introduced him to William Hunter in London. Blane's obvious ability quickly led to Hunter's recommendations, first to Lord Holdernesse and then to George Rodney (the future Admiral Rodney), that they should employ this young Scottish doctor as their own personal physician. It was in this capacity, rather than as a surgeon of the British navy, that Blane in 1779 sailed with Rodney to the West Indies on board the Sandwich. At the time Britain was embroiled in the American War of Independence and Blane was present at no fewer than six naval battles during which he acted far beyond his duties as a doctor-even to the point of relaying the admiral's orders to those manning the guns. In recognition of both Blane's personal bravery and his medical prowess, Rodney appointed him as physician to the West Indies fleet in 1780. Now officially recognized by the navy, Blane served in this role until the end of the war three years later. One of his first actions in his new position of authority was to compile and print at his own expense a small book entitled A short account of the most effectual means of preserving the health of seamen, particularly in the Royal Navy (1781?), which he then sent to all the surgeons who served in the fleet to use as a guideline in any provision of healthcare. He became a licentiate of the Royal College of Physicians in 1781.

At the request of Rodney, surgeons were required to collect detailed figures of morbidity and mortality on board each ship. Blane collated this information, compiled nosological tables, and then, in a manner which was to become typical for him, used statistics as a tool for justifying reforms in naval healthcare. For example, on 13 October 1781 he presented data to the Admiralty that demonstrated how one in seven men had died from disease on the West Indies station and suggested ameliorative measures including an improved diet that included fresh fruit in order to prevent scurvy, and strict sanitary measures. On 16 July 1782, less than a year after the reforms were instigated, Blane relayed the news that mortality levels were now only one in twenty. Other officers of the fleet recommended to the Admiralty that Blane should receive special recompense and he was subsequently awarded a pension in recognition of his excellent work in the West Indies fleet.

Blane's early experience at sea led him to the conclusion that prevention was better than cure, and in particular that 'cleanliness and discipline are the indispensable and fundamental means of health'  (G. BlaneObservations on the Diseases Incident to Seamen, 1785, 251). He also asked much more from naval surgeons who were to take a new role in the prevention of ill health. This encouragement effectively extended the traditional domain of surgeons serving in the British navy, and may have served to improve their status. However, surgeons were generally regarded as inferior in rank to ship officers throughout this period. At every opportunity throughout his life Blane fought for the higher status of naval surgeons, whom he saw as pivotal for good health in the British navy.

Blane's work with the navy served to introduce him to powerful patrons who ensured his success as a physician in civilian life. Blane had met the duke of Clarence while serving in the navy and this led to his being appointed physician-extraordinary to the prince of Wales in 1785. Later he became physician-in-ordinary to the prince's household and was eventually physician to the king after George IV had acceded to the throne. Another factor in Blane's meteoric success was the excellent reference provided by Lord Rodney that led to his post of physician at St Thomas's Hospital, London, where, after a close-run contest, Blane was elected on 19 September 1783 by a majority of ninety-eight votes to eighty-four. However, while in the navy it was commendable that Blane appeared unflappable when under fire, this same air of detached coolness was not appreciated by his civilian medical colleagues. Astley Cooper remarked that Blane was 'a painstaking physician, but he was so cold in temperament, that we called him "Chilblane"'  (Cooper, 306).

The revolutionary wars against France caused Blane to resign from St Thomas's in 1795 and resume his service in the navy, at the invitation of Lord Spencer, who was the first lord of the Admiralty. Blane was appointed a commissioner for sick and wounded seamen and held this powerful office until the peace of Amiens in 1802-seven strategically important years in the history of the Royal Navy. Britain was fighting for naval supremacy, upon which the empire depended. Any degree of mortality and morbidity within the navy exacerbated the perennial problem of a shortage of skilled and motivated men. Also, ships were at sea for long periods of time, covering long distances, and, when crews succumbed to tropical diseases or sickness such as scurvy, the efficiency of the ship necessarily deteriorated. During wartime this was particularly unsatisfactory. Blane's tactics to keep seamen healthy incorporated lessons he learned while serving in the West Indies fleet; his scientific approach to preserving the health of seamen was founded upon observation and statistical reporting. Every surgeon within the navy was encouraged to report the state of health for each ship by using standardized forms and medical logbooks. An estimated 634 surgeons served in the navy at the end of the eighteenth century, allowing Blane's love of statistics to be applied on a hitherto unknown scale  (Pope, 131). The use of a scientific numerical approach to finding the best way to combat disease was not unknown during this period and other naval surgeons such as Robert Robertson (1742-1829) had taken the initiative of compiling statistics in an effort to find the answers to medical problems. Blane's important contribution to the growth of medical science was that he extended the quest for data and information to all naval surgeons. He also encouraged accountability on the part of surgeons for their actions, and this, coupled with new communications with the government board for the sick and wounded, meant that the gathering of data started to become an official and centralized procedure.

Alongside the recommendations of Thomas Trotter, who was physician to the Channel Fleet, Blane was also instrumental in the issuing of lemon juice to all seamen in order to combat the eighteenth century's constant threat of scurvy, the direct result of a deficiency of vitamin C in the diet. The anti-scorbutic power of lemons had been recognized for centuries by seafarers, and Dr James Lind (1716-1794) had attracted recognition for his curative experiments first noted in his Treatise on the Scurvy (1753). Blane's contribution came with his authorization in 1795 for lemon juice to be universally distributed throughout the navy.

Although the role of medical practitioners in curing scurvy might be more marginal than traditionally assumed  (Rodger, 333-4), contemporaries of Blane deemed his pioneering measures to be highly successful, and as a result he became a figure of authority on the subject of healthcare. In 1799, when plague struck areas of the Mediterranean, an anxious British government along with merchants in the Turkey Company enlisted help from Blane and several other eminent physicians. It was under anti-plague regulations specifically dictated by Blane that the army was allowed to return from its active service in Egypt. The Home Office also consulted Blane on a number of public health matters relating to conditions inside prisons and convict ships. His recommendations of improved ventilation, of carrying fewer men, and of the provision of an adequate diet resulted in a dramatic reduction in the deaths of convicts on board the Glatten in 1802. The most striking testimony to Blane's medical expertise came when the government called upon him for advice over a medical fiasco at Walcheren. On this island off the Netherlands, troops lay totally devastated by disease. The army's medical board had performed ineptly and confidence in the army's ability to cope with the situation had evaporated. In 1810 Blane was sent out to make a report and was subsequently charged with supervising the return of the sick and wounded. He concluded that the expedition should be aborted. A baronetcy, awarded in 1812, marked the exceptional esteem placed on Blane's professional expertise.

Healthcare at sea continued to be a concern for Blane even though he had officially resigned from the navy in 1802. For example, he supported compulsory vaccination for all seamen in Elements of Medical Logick (1819), and encouraged academic study for naval surgeons. In 1829 he founded a prize medal (the Blane naval medical medal) for the best journal kept by surgeons of the Royal Navy and his express wish was that the medical knowledge of naval surgeons should be extended beyond the empirical. Using his own naval experience Blane wrote for medical journals such as the Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge. Blane continued to be a conspicuous medical figure in intellectual society through his activities as a fellow of the Royal Society in both Edinburgh (1783) and London (1784), as a proprietor of the Royal Institution, and as a member of the Imperial Academy of Sciences at St Petersburg.

Blane's personal life centred round his long marriage to Elizabeth, the only daughter of Abraham Gardner. Married on 11 July 1786, they had six sons and three daughters and lived mostly at Culverlands in Berkshire. Blane outlived his wife, who died in the cholera epidemic of 1832, and also survived all his children with the exception of two sons: Hugh Seymour (1795-1869) (who inherited his father's title) and Charles Collins (b. 1799).

The latter years of Blane's life were beleaguered by ill health. From 1821 onwards, suffering from an irritating skin disease named prurigo senilis, he resorted to using large doses of opium. This in turn caused distressing symptoms and eventually Blane died, aged eighty-five, on 27 June 1834, in his house at 8 Sackville Street, Piccadilly, London.

J. Wallace 

Sources  J. J. Keevil, J. Coulter, and C. Lloyd, Medicine and the navy, 1200-1900, 3-4 (1961-3) + GM, 2nd ser., 4 (1835), 93-4 + R. D. Leach, 'Sir Gilbert Blane MD, FRS', Annals of the Royal College of Surgeons of England, 62 (1980), 232-9 + Authentic memoirs, biographical, critical, and literary, of the most eminent physicians and surgeons of Great Britain, 2nd edn (1818), 135-45 + Munk, Roll + The health of seamen: selections from the works of Dr. James Lind, Sir Gilbert Blane and Dr. Thomas Trotter, ed. C. Lloyd, Navy RS, 107 (1965), 132-211 + E. Turner, 'Naval medical service, 1793-1815', Mariner's Mirror, 46 (1960), 119-33 + U. Trohler, 'Quantification in British medicine and surgery, 1750-1830', PhD diss., U. Lond., 1978, 72-258 + M. C. Buer, Health, wealth and population in the early days of the industrial revolution (1926) + N. A. M. Rodger, 'Medicine and science in the British navy of the eighteenth century', L'homme, la sante et la mer, ed. C. Buchet (1997), 333-44 + B. B. Cooper, The life of Sir Astley Cooper, 1 (1843) + D. Pope, Life in Nelson's navy (1981) + G. B. Mundy, The life and correspondence of the late Admiral Lord Rodney, 2 vols. (1830) + Burke, Peerage (1857) + Boase, Mod. Eng. biog.
Archives Lpool RO, papers relating to French prisoners of war + NMM, corresp. and papers + Royal Medical Society, diss. | Hants. RO, letters to James Harris, first earl of Malmesbury + NL Scot., corresp. with Lord Melville + W. Sussex RO, letters to duke of Richmond
Likenesses  M. A. Shee, oils, in or before 1833, RCP Lond. [see illus.] · Beynon & Co., lithograph, Wellcome L.




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