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Health, Medicine and the Sea: Australian Voyages, c. 1815-60

by Katherine Foxhall Manchester University Press
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Hbk 264 pages
AU$199.00 NZ$205.22
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During the nineteenth century, over 1.5 million migrants set sail from the British Isles to begin new lives in the Australian colonies. Health, medicine and the sea follows these people on a fascinating journey around half the globe to give a rich account of the creation of lay and professional medical knowledge in an ever-changing maritime environment. From consumptive convicts who pleaded that going to sea was their only chance of recovery, to sailors who performed macabre 'medical' rituals during equatorial ceremonies off the African coast, to surgeons' formal experiments with scurvy in the southern hemisphere oceans, to furious letters from quarantined emigrants just a few miles from Sydney, this wide-ranging and evocative study brings the experience and meaning of voyaging to life. Katherine Foxhall makes an important contribution to the history of medicine, imperialism and migration which will appeal to students and researchers alike.

1: Problems of departure
2: Steaming ships
Voyage I: Eliza Baldwinson
3: Geographies of the tropical Atlantic
4: Such concealed mischief: scurvy and imprisonment
5: Trust and authority below the hatches
Voyage II: Henry Wellings
6: From emigrants to immigrants: quarantine and the colony

Health, Medicine and the Sea is a triumph.Alison Bashford, Journal of Colonialism and Colonial History, Volume 14, Number 2 A fascinating history, providing a perceptive analysis 'Health, Medicine and the Sea' has contributed valuably to both the history of medicine and the historiography of global connectionAlexander Cameron-Smith, Social History of Medicine Vol. 26, No. 3

In Health, Medicine and the Sea, Katherine Foxhall challenges the view that improvements in the health of convicts and migrants on the voyage to Australia resulted solely from the growing authority and medical knowledge of surgeon-superintendents. Far from being a ‘silent cargo’ (223), convicts and migrants, she argues, ‘actively invested in and shaped the meanings and outcomes of voyages’ (223). The notion of convicts and migrants as a silent cargo is something of an Aunt Sally and numerous studies, from Don Charlwood's pioneering The Long Farewell (1981) to Robin Haines’ Doctors at Sea (2005), have made clear the ways in which shipboard authority was challenged and subverted. Nonetheless, Health, Medicine and the Sea remains a significant achievement and Foxhall skilfully reads surgeons’ journals against the grain in order to recover the viewpoint of convicts and migrants who, combining personal interest with vernacular knowledge, successfully challenged the medical authority of the surgeon.
As in the PhD thesis from which this project was developed, Foxhall's focus is on shipboard diseases, especially cholera, scurvy, smallpox, tuberculosis and typhus. Foxhall stresses the ways in which the diagnosis and treatment of disease reflected its context and in her chapter on scurvy, for example, she examines how the resurgence of scurvy on convict ships of the 1820s and 1830s came to be regarded as the result of imprisonment rather than the maritime environment. Or, to take another example, the chapter on smallpox shows how surgeons relied on gaining the trust of convicts and migrants in order not only to vaccinate those at risk but also to find ways of conveying the vaccine to Australia. This focus on disease understandably precludes discussion of other aspects of shipboard medicine, such as the use of leeches, bleeding and cupping, the treatment of injury, and the efficacy of the various patent medicines migrants brought with them. Nonetheless, the discussion of vernacular medical knowledge at sea would have been strengthened had it covered childbirth and the contribution of women to shipboard health generally as midwives, nurses and mothers.
Foxhall forcefully extends her analysis of the effect of context on medical practice by considering the materiality of the sea and Health, Medicine and the Sea is structured around the temporal and geographical stages of the voyage. Thus, the first chapter considers the treatment of cholera against the backdrop of the departure from the UK, with cholera coming to be associated with both the convict hulks and the immigrants who crowded into British sea ports. Scurvy occupies a later chapter when the ship was rounding southern Africa and the surgeon needed to decide whether to call into Cape Town for fresh provisions. And typhus is left to the final chapter and an examination of Australian quarantine regulations. This temporal/spatial structure dramatises the experience of the voyage while convincingly placing the treatment of disease within both shipboard and geographical space.
In the short introduction and conclusion that bookend the main chapters, Foxhall outlines how changes to medical practice in response to unstable spatial environments were constitutive of a British sense of a colonial self. Foxhall is aware of studies that reinforce such an argument, such as Alison Bashford's research into the relationship between public health and colonialism, yet there is no discussion of what is meant by colonialism and the body of the book contains only half a dozen passing references to it. The conclusion offers reflections on the suicide of the colonist and former surgeon-superintendent George Imlay in 1846 and, by ending with a death, the book itself appears to be in search of an ending, much as migrants’ journals sought symbolic endings to the voyage in order to close their narratives. In her introduction, Foxhall admits that ‘it is primarily maritime geography that propels the narrative’ (7), but whilst adopting the temporal/spatial structure of the journal enables Foxhall to place different diseases within different geographical environments, the book runs into the problem that journals progress as a series of entries rather than by cumulative argument. If Health, Medicine and the Sea is to develop the argument that the voyage turned convicts, migrants and, indeed, surgeon-superintendents into colonials, it needs to interrogate its own dependence on the narrative structure of the voyage out.
In relating disease to both shipboard and geographical space, Health, Medicine and the Sea offers a new and distinctive approach to the study of disease at sea. Its methodological significance lies perhaps more within the field of the history of medicine than within migration studies or British colonialism, but in shifting attention from the actions of the government-appointed surgeons towards the negotiated creation of medical knowledge and medical practice, Foxhall demonstrates there is still much to be learnt from a detailed study of the voyage to Australia.

University of Wollongong
Review published in Australian Historical Studies, Volume 44, Issue 3, Sept 2013 – pp. 472- 473
Katherine Foxhall is a Wellcome Trust Postdoctoral Research Fellow in History at King's College London