As HMS Queen Elizabeth sets sail to showcase 'Global Britain', it is worth recalling the contributions of two Royal Navy surgeons to global health. It may be 250 years since James Lind and Alexander Gordon made their respective marks, but both are still relevant today.
Lind conducted the first recorded controlled trial – testing citrus fruits amongst other potential remedies to prevent scurvy. Objective assessment of new treatments was a complete novelty then, but this evolved into clinical trials and what we now know as evidence-based medicine. This is kept alive by the James Lind Library at the Royal College of Physicians of Edinburgh which shares and promotes current research from around the world.
Lind also introduced other sanitary innovations below deck to reduce the spread of disease. As a result, typhus was much lower in Royal Navy sailors than those of France, then the principal enemy. His final legacy can also be heard among the American and British aircrews now on the Queen Elizabeth – the slang term 'limey'.
Alexander Gordon was the first to advocate careful handwashing to prevent the spread of infection. He left the Navy to return to Aberdeen to practise midwifery. He had witnessed puerperal fever infecting whole wards in a London hospital, but was puzzled how it could spread relatively easily among home births. Gordon's 1795 treatise on an epidemic of childbed or puerperal fever in Aberdeen examined the records of 77 women, of whom 28 had died from sepsis. He saw a pattern – the infection appeared only after he or the midwives had come from a previous patient infected by the disease.
His advice was clear enough: 'The patient's apparel and bed-clothes ought either to be burnt, or thoroughly purified; and the nurses and physicians, who have attended patients affected with the puerperal fever, ought carefully to wash themselves, and to get their apparel properly fumigated before it be put on again'.
The trouble was that his treatise included the name of birth attendants – both himself and midwives, as well as the names and addresses of patients.
Unfortunately, this did not go down well with his colleagues. Gordon was hounded out of Aberdeen and rejoined the Navy. It took another 90 years before his advice was accepted. And it took the Navy 50 years to adopt Lind's findings – lemons were preferred to limes.
But it has taken the UK Government just nine months to drive a coach and horses through the legacies of Lind and Gordon. The backdrop is the merging of various responsibilities. The Foreign and Commonwealth Office was abolished last September clearing out all its fuddy-duddy nonsense of decency and diplomacy. It is now the Foreign and Commonwealth Development Office, incorporating the International Development Department which was far too wedded to care for the less fortunate, like the 800 women who die every day in pregnancy or childbirth for want of a midwife or access to treatment. The final push came with the Integrated Defence Review which gave the Navy the role of projecting Global Britain.
So what is going to feel the impact of spending curbs? Trident nuclear weapons which cost a mere £50 million a week to maintain will be protected. And that bill will rise as we get more of them – 260 warheads against the measly 180 we have at present. Instead, it is humanitarian aid which has been chosen as the first target for paying debts from the pandemic.
A series of recent leaks outline planned cuts. Bilateral water, sanitation and hygiene projects are the first to go down the plughole with an 80% drop in funding. Handwashing remains essential but impossible in so many parts of the world where there is no access to clean water. Next comes an 85% drop in support for the United Nations Population Fund. Estimates show the £130 million lost would have helped prevent about 250,000 maternal and child deaths, 14.6 million unintended pregnancies and 4.3 million unsafe abortions.
Over the last five years, the UK became a genuine world leader among richer countries amid growing evidence that its spending is proving highly effective. Many of these initiatives were spearheaded by Conservative ministers building on a wide cross-party consensus.
It is clear that the gargantuan costs of the pandemic and its consequences will have to be addressed. The question is why humanitarian aid has been singled out to be gleefully offered up as the first sacrifice and with immediate and devastating effect. Cynics might see a familiar strategy behind this: soften up the opposition with draconian cuts only to reduce these later. The government gets what it actually wants but can still claim that it listened.
Either way, more cuts affecting the world's poorest can be expected. We are now sailing under the flag of Cruel Britannia. The seafaring maxim of women and children first has been jettisoned. In the new Brutal Britain, it is weaponry first and women and children last.
Chris Holme is a former Herald reporter and Reuters Foundation fellow in medical journalism. He now runs the History Company