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He recommended abolishing the "five-dollar perquisite" on the grounds that it actually deterred the sick from approaching the physician. By avoiding treatment a sailor could avoid paying a healthy fee, and instead seek aid from some other, cheaper source. 72 Barton believed that by eliminating the fee and by removing the penalty for seeking a cure, the Navy could encourage the men to get professional help.
The aims of Dr. Barton were not wholly altruistic, however. He made clear his desire for the Navy to pay surgeons a set fee per seaman each year to make up for the money that would be lost with the abolition of the perquisite. 73 Edward Cutbush was more civic minded, though probably no less impecunious. Speaking of men who had contracted what he called "ladies' fever," Cutbush remarked "I think they aught to pay something to the Hospital fund, as it [venereal disease] is not contracted in the line of their public duty." 74
During the era of Cutbush and Barton, a naval surgeon's pay was around fifty dollars a month, less than that of an army regimental surgeon. 75 Small wonder, then, that Cutbush made sure, in case of his demise, that his wife would get the fifteen dollars owed him by the sailors he had treated for venereal disease. 76 The sea surgeon could not easily supplement his income from private practice, as could his counterpart at a naval base or yard. A private medical practice could be lucrative, especially if the physician emulated Benjamin Rush, who advised a young doctor that "a little debt will make you industrious and furnish you with an excuse to send in your bills as soon as your patients recover." 77
 Surgeons serving in the young American Navy labored not only against disease but also frequently against the fledgling bureaucracy of the Navy Department. Barton lamented the lack of supplies and material for ships's sick bays, and attributed the problem to the absence of a "regular board of medical commissioners." 78 Such a board, he felt, would stop such circumstances as befell Amos A. Evans, surgeon of the U.S.S. Constitution in 1812. While refitting at Boston, Evans was compelled to bargain for medicine with the local apothecary in spite of his official requisition. 79 Perhaps Barton had this sort of situation in mind when he pointed out that surgeons on remote stations often had to deal with suppliers who held a virtual monopoly on medical supplies. In such a case, faced with prohibitive prices and cut off from aid from Washington, the surgeon had to choose between insolvency and inadequate care for his crew. 80 In such cases the health of the sailor often depended upon the good will and financial status of his surgeon and captain.
The Navy Department, for its part, could only point to its own sad state when faced with requests and complaints. Allowed only to appoint as many surgeons as it had vessels in commission, the Navy was thus compelled to make replacement and rotation difficult and disruptive. To enforce this limit, the number of commissions signed by the President was also restricted. In one case, for example, a shortage of commissions prompted the Secretary of the Navy to ask one prospective surgeon to return his commission in the event he chose not to accept his appointment. The Secretary would then issue the returned commission to someone else. 81 The Navy department, despite numerous threats from abroad, was living a hand to mouth existence. 82
The medical environment in the latter part of the age of sail clearly challenged the naval surgeon to perform his many duties. Not only did naval surgeons face all of the problems of doctors ashore; the also facecd the horrors of close action at sea and the attendant risks of death, mutilation, and drowning. 83 Disease, ignorance, and parsimony posed an additional threat to surgeon and patient alike, leading Barton to call the life of a naval surgeon "a perplexing and distressing situation." 84 Barton hoped that naval medicine could be "rendered not only more beneficial to the sick, but less offensive to the humane feelings of the medical officer," a sentiment no doubt shared by his patients. 85
The medical men of Barton's era, whether Americans like Benjamin Rush, Peter St. Medard, and Edward Cutbush, or Britons like George Cleghorn and James Lind, worked at their profession as seriously and studiously as their science permitted; their successes are as important as their failures. 86 Relying on observable phenomena, often harkening back to the ancients, ready to try obscure or even dangerous remedies, the eighteenth-century healer was simply searching for the best way to practice medicine in a hostile environment. The accomplishments of the navies they served illustrate their success.
 The
Ladies Medicine Chest
Naval Medicine in 1812 pages 1 | 2 | 3 | 4 | 5 | 6 | 7
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