Richard de Grijs
Sydney, Australia

In the tight, damp quarters of historical tall ships on the open sea, pneumonia was a common occurrence. More than just an unfortunate illness, it was often a death sentence, preying upon the weakened and crowded bodies of sailors, soldiers, convicts, and emigrants. Although less sensational than scurvy and not as virulent as typhus, pneumonia haunted life at sea for centuries, from the Age of Sail to the era of steam-powered troopships.

Its persistence and complexity, and the gradual transformation of its treatment reveal much about maritime medicine and the lived experiences of those afloat. In tracing pneumonia’s maritime history, we also uncover patterns that continue to shape how respiratory illnesses spread and are managed in confined spaces today, from navy submarines to cruise ships.

The structural environment of sailing ships was a perfect incubator for respiratory infections. Constructed from absorbent wood and frequently packed with organic materials such as straw bedding and damp canvas hammocks, ships easily retained humidity and cold within their hulls. Fire hazards on wooden ships limited the use of heating beyond the galley, and ventilation was rudimentary at best. Hammocks might swing above pools of stagnant water. And worse, whereas sailors usually slept in hammocks, passengers on the lower decks often slept on soaked and sodden straw mattresses that quickly turned fetid.¹

Such conditions promoted the spread of influenza, catarrh (the build-up of mucus in one’s respiratory tract), consumption (tuberculosis), and pneumonia, particularly in cold weather or on long voyages through harsh climates—such as on expeditions passing by Tierra del Fuego or during the North Atlantic winter. Such outbreaks could affect dozens aboard a single vessel. Ships’ surgeons sometimes reported that nearly half the lower-deck complement exhibited respiratory symptoms within a fortnight of entering cold weather. 

Pneumonia, an infection of the lungs, could be triggered by bacterial (Streptococcus pneumoniae or Rickettsia), viral, or—more rarely—fungal or parasitic agents.² In most maritime cases, it developed as a secondary complication to influenza or bronchitis—diseases that proliferated in the usually crowded and unhygienic shipboard quarters of yore.³ In early surgeons’ journals, the illness was often referred to as “catarrhal fever,” “inflammation of the lungs,” or simply “chest complaints.” Ships’ surgeons observed it frequently and feared its rapid progression, as exemplified by the following record:

Convict … suffered severe pneumonia with a great determination to the brain and died the same night. Treatment included letting 70 ounces [nearly 2 liters] of blood in 3 hours. … this case exhibits as extraordinary an instance of high arterial action rapidly proceeding to a fatal termination as can be found in the annals of medicine.⁴

These tragic cases, with their aggressive and ultimately futile treatments, reflected prevailing theories of health that had yet to be seriously challenged.

Diagnosis and dismay

Maritime medicine throughout the long-eighteenth and early nineteenth centuries remained tethered to pre-modern concepts of health. Chief among those was humoral theory, in which disease arose from imbalances of bodily fluids. Standard treatment for pneumonia therefore involved attempts to “rebalance” these fluids, by bloodletting, blistering, purging, or the application of leeches, specifically of the species Hirudo medicinales.

Bleeding was often extreme. A pneumonia sufferer might be bled several times throughout a single day, the total amount of fluid extracted sometimes exceeding 900 ml.⁵ The prevailing logic was to reduce the inflammation believed to reside in the lungs. In many cases, however, it weakened the patient further and hastened death. Yet in the closed shipboard environment, where resources were scarce and disease often spread rapidly, such aggressive interventions may have felt like the only available response.

Change came slowly, and only with the rise of observational medicine did practitioners begin to question the value of such drastic measures. In the 1820s and 1830s, the French physician Pierre-Charles-Alexandre Louis (1787–1872) helped overturn the routine bloodletting approach. Through one of the earliest controlled medical trials, he demonstrated that bloodletting of pneumonia patients either had no benefit or, worse, increased mortality.⁶

His work marked the beginning of the end for bleeding as a maritime panacea, although such practices persisted aboard ships well into the later nineteenth century. Naval and merchant surgeons were often reluctant to abandon bleeding entirely, citing tradition, lack of alternative treatments, and the perceived authority of classical medical texts. As late as the 1870s, British naval medical reports still listed bleeding among recommended therapies for severe inflammation.

Pneumonia was particularly lethal when compounded by scurvy, a disease caused by sustained vitamin C deficiency. Long recognized for causing bleeding gums and lassitude (lack of energy), scurvy also left sufferers dangerously susceptible to secondary infections, especially of the lungs.⁷ Autopsies from scurvy outbreaks revealed broncho- and lobar pneumonia as common causes of death. Alfred Hess (1875–1933), an American pediatrician writing in the early twentieth century, compiled substantial evidence linking vitamin C deficiency to severe respiratory infections⁸:

Pneumonia, lobular or lobar, is one of the most frequent complications [of scurvy] and causes of death … secondary pneumonias, usually broncho-pneumonic in type, are of common occurrence, and in many [scurvy] epidemics constitute the prevailing cause of death.⁹

The suggestion that vitamin C might be useful in treating pneumonia itself began to gain traction in the 1930s. A series of small-scale German and American trials found that vitamin C supplementation could reduce the severity and duration of the illness, improve recovery, and potentially lower mortality.^10,11 Although these insights were never fully integrated into mainstream clinical practice, they reinforced the longstanding empirical observations of ships’ surgeons: pneumonia thrived when bodies were depleted in vitamin C. Nevertheless, vitamin C supplementation remained a peripheral treatment. The lack of large-scale clinical trials, combined with a pharmaceutical focus on emerging antibiotics, meant that the link between ascorbic acid (vitamin C) and pneumonia was largely overlooked in official protocols.

The human toll behind these observations is captured vividly in ships’ logs and surgeons’ journals. Surgeons were required to maintain daily journals during voyages, recording symptoms, treatments, and outcomes. These documents provide invaluable insights into the medical reasoning and emotional strain of treating the gravely ill at sea.

Death in the logbook

Surgeons’ journals are replete with records of fatal cases of pneumonia. On 24 October 1797, the captain of a Royal Navy vessel, John Young (ca. 1739–1797)—a veteran officer who had served in multiple transatlantic campaigns—came down with a violent cough and purulent expectoration (coughing up thick, discolored sputum), followed by diarrhea. He died three weeks later.¹² In 1833, surgeon-superintendent David Thomson (ca. 1788–1874) recorded eight cases of pneumonia during a convict voyage aboard the East Indiaman Stakesby, more than any other condition.¹³ The US Navy’s medical officers on the USS Constitution similarly noted pneumonia among their most common complaints, alongside diarrhea, syphilis, and scurvy.¹⁴

Pneumonia did not discriminate by rank or era. In April 1770, seaman Forby Sutherland became the first Briton to die in New Holland (Australia)—of pneumonia caught in Tierra del Fuego.¹⁵ Nearly 150 years later, in 1913, a thirty-seven-year-old sailor from HMAS Sydney was transferred to the Albany Civil Hospital (Western Australia) with “toxic pneumonia,” having likely contracted the infection during strenuous patrols off the Southern Ocean. He died eleven days later.¹⁶ Even naval heroes, such as New Jersey pilot George B. Haveron (1861–1892), succumbed to pneumonia brought on by heroic exposure: after bringing the blizzard-battered barque Fawn into port, he developed a chest infection that proved fatal.¹⁷

While the Age of Sail was notorious for disease, the advent of steam power and mass troop transport during World War I introduced new horrors. Overcrowding on troopships, poor ventilation, inadequate bedding, and minimal hospital space created the perfect conditions for respiratory epidemics to thrive. Whereas wartime troopships were vastly larger than the wooden vessels of earlier centuries, medical provisions did not scale accordingly.

The result was a recurrence of familiar patterns. Overcrowding, nutritional depletion, and insufficient ventilation led to surges in respiratory deaths despite advances in medical science. During the 1918 influenza pandemic, pneumonia struck fast—and lethally. One convoy commander reported 1,300 cases of pneumonia and influenza on board, leading to forty-nine deaths.¹⁸ Infected men arrived in France in states of collapse; some died within twenty-four hours of their first symptoms. Lungs were found to be so inflamed they had turned purple-black, a telltale sign of hemorrhagic pneumonia.¹⁹

Official reports from the American Expeditionary Forces record nearly 30,000 pneumonia cases during the war, with a fatality rate of 43.7 percent. Among British forces, the rate was similar; in French forces, even higher.²⁰ In many cases, pneumonia was the ultimate killer, not influenza itself. The experience reinforced what naval surgeons had known for centuries: pneumonia was a disease of both biology and environment. Cold, damp, overcrowding, and nutritional depletion all played exacerbating roles.

For centuries, pneumonia remained a potent killer at sea, a disease that revealed the limits of contemporary medicine and the fragility of human life in confined maritime environments. Pneumonia represented the final collapse of the body’s defenses. Its treatment evolved slowly—from bleeding to serums and finally to antibiotics—but its toll lingered in every surgeon’s log and every burial at sea.

Today, the ships have changed, but the vulnerability of our lungs to infection in tight quarters remains. The sea has long been a crucible for infectious disease—and pneumonia, silent and deadly, has always ridden the ocean wind, quiet, insidious, and all too familiar to those who sail in close company. From wooden warships to modern cruise liners and submarines, the challenge of managing respiratory illness in confined maritime spaces continues to echo the past.

References

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2. Donowitz, GR, and Mandell, GL. “Acute Pneumonia.” In: Mandell, GL, Bennett, JE, and Dolin, R (editors), Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 6^th ed. (Philadelphia: Elsevier and Churchill Livingstone, 2005).
3. Hemilä, H, “Vitamin C and infections,” Nutrients, 29, 339 (2017).
4. Worrall, M, “Ship to Shore: National Archives Project opens up Navy Surgeons’ Journals,” Ann. Roy. Coll. Surg. Engl. (Suppl.), 91, 276–277 (2009).
5. Crumplin, MKH, and Starling, P, A Surgical Artist at War. The Paintings and Sketches of Sir Charles Bell, 1809–1815 (London: Royal College of Surgeons, 2009), 75.
6. Morabia, A, “Pierre-Charles-Alexandre Louis and the evaluation of bloodletting,” J. Roy. Soc. Med., 99, 158–160 (2006).
7. Hess, AF, “Diet, nutrition and infection,” New Engl. J. Med., 207, 642–643 (1932).
8. Ibid.
9. Hess, AF, Scurvy: Past and Present (Philadelphia, PA: Lippincott, 1920), 88 and 99.
10. Hemilä, H, and Louhiala, P, “Vitamin C may affect lung infections,” J. Roy. Soc. Med., 100, 495–498 (2007).
11. Hemilä, H, and Chalker, E, “Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis,” Nutrients, 11, 708 (2019).
12. Jolliffe, J, Medical journal of the surveying sloop Pandora, for 1 January to 31 December 1853. Admiralty Papers, ADM 101/112/4: The National Archives, UK (1853).
13. Oldman, D, “Stakesby 1833,” Redcoat Settlers in Western Australia 1826–1869, https://redcoat-settlerswa.com/ships/stakesby-1833/ (2023). Accessed July 10, 2025.
14. Bodine, CE, Crawford, MJ, and Hughes, CF, “Doctors Afloat: Medical Care in Constitution in the War of 1812,” Interpreting Old Ironsides. An Illustrated Guide to USS Constitution (Washington, DC: Naval Historical Center, 2007), 59.
15. Hough, R, Captain James Cook: A Biography (London: Hodder & Stoughton, 1995), 145.
16. McDonald, JM, and Todd, EM, “The Medical Officer’s Journal: HMAS Sydney, 1913 to 1922. An Australian Naval record of surgery and anaesthesia at the time of the outbreak of World War I,” Anaesth Intensive Care, 42, 5–12 (2014).
17. Barrows, JR, “The Courage, Skill, and Sacrifice of the Sandy Hook Ship Pilots,” Monmouth Timeline, https://monmouthtimeline.org/timeline/the-courage-skill-and-sacrifice-of-the-sandy-hook-ship-pilots/ (2021). Accessed July 10, 2025.
18. Barry, JM, The Great Influenza. The Story of the Deadliest Pandemic in History (London: Penguin, 2004), 266–268.
19. US Surgeon-General, The Medical Department of the U.S. Army in the World War, IX (Washington, DC: US Government Printing Office, 1928).
20. Ibid.