If you asked a physician during the 18th century, I imagine he would say it does.  Back in the early days of somewhat more modern medicine (my favorite era), and well before we had any real concept of what was causing the diseases that we saw, and still sometimes see, on a daily basis, many physicians and scientists drew the conclusion that that which smells bad to you, must also be bad for you.  This theory, termed the miasmatic theory of disease, is to me, one of the most fascinating, unbelievable, yet also logical components of the history of medicine.  You’re likely thinking, “I might agree with fascinating and unbelievable, but logical?”  Absolutely!  Let’s think about it, and put it into a context which might be more relevant to your average person in modern era.  If you go into a gym locker room that is never cleaned and smells just terrible, isn’t it your primary instinct to either get out of there immediately, or at least spend as little time in there as possible?  Yes, of course you now know that the bad smells might signify microbes, bacteria, and potential infection, however, what if you had no idea that those things existed?  You spend some time in the room, likely you are fine, but then another several thousand people come in and out of there over the course of a year.  It is likely that at least a few of those individuals will get sick or receive a nasty infection.  Your average 18th century physician, having no real knowledge of bacteria, viruses, or fungi, might decide that since all the people in question went into this locker room, and in turn, since noxious fumes are instinctively avoided by humans, that the two put together must therefore lead us to disease.  Just one example of this is, of course, never enough on which to base a rather grand conjecture such as the miasmatic theory of disease, however, if we compound our one example with other such instances, then we clarify the steps which many physicians likely took to get to the point of associating noxious smells with dangerous illness.

Here is another example from the same era regarding yellow fever, an infection caused by the yellow fever virus.  Many explorers, sailors, and workers who ventured into swamplands often times found themselves or their party with a most heinous illness.  Yellow fever consists of general flu-like symptoms (headache, fever, nausea, vomiting) which often subside after some days, however, in some instances the disease can progress to a more advanced state.  This “toxic phase” is often comprised of spiking fevers, jaundice (yellowing of the skin, thus yellow fever) due to damage of the liver by the infectious organism, and finally bleeding from the eyes and anywhere along the gastrointestinal tract (i.e. from mouth to anus).  This internal bleeding can cause the vomit to turn black, a product of the blood interacting with the acids in our stomach.  This infectious disease is, as I said earlier, caused by the aptly named, yellow fever virus, whose vector is the mosquito, Aedes aegypti.  Now, it follows that since these mosquitoes can carry this virus, and that swamplands and marshes are the breeding grounds of mosquitoes, it is perfectly reasonable to assume that the chances of getting yellow fever increase considerably when we spend time in such landscapes.  However, to the physician 250 years ago, with no knowledge of vectors or viruses, a very different conclusion might take form.  Since swamps are rife with noxious fumes, compounded with the fact that many individuals who went into the swamps came out sick, we might assume it was the fumes themselves that carried the disease.  If we extrapolate this pattern to world at large, we find very similar “relationships.”  For example, many captains aboard sailing vessels felt it of utmost importance to clear the ship of noxious smells by cleaning rigorously and  often, with the result being lower rates of disease compared to ships with less meticulous cleaning regimens.  Again, we know that cleaning the ship also likely reduced the amount of harmful bacteria aboard, however wouldn’t that also cause the smell to improve since fumes from bacteria can often be the source of the bad smell?  Scurvy was thought to be caused by the sea air, cholera was though to be caused by the spread of poisonous fumes, and so on.

This theory permeated the thinking of healthcare workers for much of the age of sail, often to the detriment of the sailors.  Many suffered from scurvy, beriberi, and other such illnesses, without the proper means or understanding for a cure.  Instead, the physicians, though logically so, often focused on decreasing the amount of noxious fumes for the person instead of seeking to discover what might actually cure the illness through what we might term “rudimentary experimentation.”  That is, trying out different medications or dietary changes until one proves useful in treating the disease.  This was how the discovery of vitamin C as a cure for scurvy came to fruition.  More on that topic in future postings!
*Images courtesy of Wikipedia

You open your eyes to pitch black.  Your neck is sore; you have been leaning against this wooden wall for what seems like ages.  What time of day is it?  How long have I been here?  You put your hand out to prop yourself up and feel the slimy wall.  Your hand slips down to the floor and you feel fluid, bringing it to your face reveals it as vomit.  Is this mine? A body next to you stirs and rolls over in his sleep, and as he rolls, you hear the clink of chains and feel your leg being pulled with him.  The rusted, serrated edges of the cuff on your leg stings as it digs deeper into the wounds it created over the many weeks it has hugged your flesh.  Your wits return to you as you remember where you are and how you arrived here, as does the realization that you have not used the bathroom in some time, and you need to now.  Dysentery is an unkind affliction, and the necessity to defecate overtakes you like a storm.  You attempt to wake your mate, the one cuffed to you, vigorously yet fail to wake him despite the fact that you are now violently shaking him.  The bucket is on the other side of the hold, you know there is no way you are going to make it there in time, especially with your partner in such an obtunded state.  You go where you are, in the darkness.  You are a slave aboard a slave ship; ripped from your home in Africa, chained in the dark hold for weeks on end, only to arive in the West Indies and be traded for rum or sugar and forced into a harsh life of servitude.
These experiences, as I described above, were not uncommon in the slave trade.  These individuals were seen as subhuman, and often treated as such.  Often kept in the dark hold of a ship for weeks on end, with little in the way of nutrition and exercise.  The slave trade was often described as being a “triangular trade,” with three legs to the voyage.  The first leg was the departure of ships from their European ports (Britain, Portugal, France, etc.) to their arrival at the western coast of Africa.  Here, the slave traders would engage in a number of sordid means of acquiring slaves.  The first, and most simple, would be to go and capture them themselves.  Another, and exponentially more effective means of acquisition was to coerce the local chieftains or groups of Africans to bring the slaves, through means of force or otherwise, to the slave ships in exchange for goods of value.  This method proved to be of great efficacy for the simple reason that the local peoples were more apt to trust their own.  It is plain to see that the slave trade not only brought misery in a direct way, to those unfortunate enough to be captured and forced into the trade, but also created an atmosphere of distrust and deception that changed the fundamental ways in which Africans interacted with each other during that period.  It is nearly impossible to imagine the horror of having your child, or children, disappear with little to no trace, and not knowing what happened to them for some time, if ever.  This was compounded by the fact that, once actually aboard the ship, the slaves would have their fitness and assessed ability to work judged by the ship’s surgeon, with those deemed as too old or infirm sent back to land.  The boats filled with slaves being sent back were full of screaming individuals, not out of rejoice due to being sent back, but out of fear.  Being sent back to land, due to an inability to work, meant being slaughtered.


The second leg of the trip was from the western coast of Africa to the West Indies in the Caribbean.  This segment of the trip was where scenes like the one I described above were most likely to occur.  The hold in which the captives were interned, was something out of hell.  There were often hundreds of slaves jammed into a relatively small space with little in the way of light, if any.  The only receptacle for defecation and urination being a singular bucket, that was often overfilled, and nearly impossible to get to.  The result was that many of the slaves went to the bathroom in whatever part of the hold they could get to.  Many of them suffered from dysentery, whose most prominent symptom is diffuse, violent, watery diarrhea; we can imagine what sorts of situations may have occurred with this in mind.  The cuffs around the legs of the slaves were often the source of infections and gangrene, making moving even more painful and unlikely.  They were all usually chained in pairs, so that the fate of one would mean the fate of another.  Friedenberg, in his book, Medicine Under Sail, describes instances of slaves attempting to jump overboard, only to have their partner (to whom they were chained) drown, thus thwarting their escape.  It was an effective means of preventing such daring methods of attempted flight from captivity.  Some captains were kind enough (relatively speaking, of course) to allow the slaves time on the deck in order to get exercise and fresh air.  However, many captains were cruel and never allowed such “indulgences,” often despite the advice of the surgeon aboard the ship.
Speaking of the captains, we can imagine that the slave trade, by and large, enticed men with relatively “loose morals” to come and commandeer the ships.  It is possible that many were forced to do so, a fact I am unsure of, however, many seemed to not only feel comfortable with such a loathsome occupation, but in fact reveled in it.  The most brutal means of discipline were all that would suffice aboard many slave ships.  Attempted escapes and insurrections, if quelled, would bring down harsh punishments on the slaves involved.  Brutal lashings to the point of near-death, being tied to the riggings during harsh weather and storms, and so on.  The crew of the slave ships was not spared from the often malicious and sadistic wills of the captains.  They would undergo very similar means of punishment for crimes that many would judge to be minor.  Friedenberg tells of an elderly sailor who merely complained about the quality of the drinking water aboard the ship, and as a punishment, was forced to swallow a pump bolt.  These sailors and crew, as for all naval fleets, were often impressed into the service; poor and malnourished vagrants taken off the streets, or convicted felons, placed on a ship, forced to follow the strict guidelines and unfamiliar orders which they had never before experienced.  They were usually terrible, undisciplined sailors who deserted at the first opportunity.  This atmosphere was obviously not conducive to the honor and pride that was expected of sailors in the service of the crown (whatever crown that might be).
And what of the surgeons?  Were they as horrible as the captains in whose service they were employed?  The fact of the matter is that, despite this being a generalization, many were poor doctors right out of medical school, with little in the way of career choices at that point in time.  They took up a position on the slave ships in order to make some money and actually practice medicine, usually with their tenure not lasting more than one voyage due to the horrid conditions forced on the slaves, and the offenses to their morals.  They often tried their best to provide medical treatment and care for the slaves, though this was often in direct opposition to the orders of the captain.  Many of the diseases they came across were those that were frequently seen aboard sailing vessels of the age.  Afflictions such as scurvy and beriberi were extremely commonplace due to the poor nutrition of the slaves, and dysentery was rampant.  Gangrenous infections from the chains, or any other injurious source, were also relatively commonplace.  Yellow fever and malaria were often brought aboard by both the slaves and the crew who set foot ashore in Africa, as we know these diseases are common in hot and marshy landscapes.  Bilious fever, likely named because of jaundice suffered by victims of hepatitis, was also relatively commonplace and reported by various surgeons.  This disease is caused by viruses, the aptly named hepatitis viruses, of which there are five main identified viral subspecies (A, B, C, D, and E).  The one afflicting the slaves was most likely hepatitis A, since it is transmitted via the fecal-oral route (slaves were defecating in the hold amongst each other) through contaminated food or drinking water, and is highly contagious.  Many surgeons tried to keep careful records of the infirm and injured slaves aboard the ships, and attempted to provide proper care despite the vile conditions forced upon them.  They often spent countless hours in the hold, despite the horrid stench and prevalence of infectious disease, so that they might treat those slaves most in need.  Though it is likely that not every surgeon felt so inclined to help, it seems that many did despite the circumstances, and often had their conscience so offended that they never set foot on a slave ship again.

The third, and last, leg of the voyage involved taking the rum and sugar received in compensation for the slaves back to the European country from which the ship set sail.  All of that suffering, misery, inhumanity, and disease for an extra shot of rum at the bar and a few extra cubes of sugar in one’s tea.  The depths to which some humans will sink at times seems immeasurable.