David McLean's latest book offers a detailed account of the history of naval medicine in the nineteenth century through the lens of naval surgeons. Until recently, the history of health and medicine in the navy, much like the navy, has been overlooked, with historians relying on the seminal and authoritative four-volume history Medicine and the Navy, 1200–1900 (Edinburgh, 1957–63) written by J. J. Keevil, Christopher Lloyd, and Jack Coulter. But in the past ten years, historians have produced a variety of compelling new histories of medicine in the navy and army that have included studies of infectious diseases, war wounds, hygiene, nutrition, sanitation and architecture, and medical training, recruitment, and administration. The contribution of many of these histories has been to understand the strategic and political dimensions of good health and the extent to which contemporaries understood that medicine was crucial to naval and military success afloat and ashore.

Although many Victorians may have believed that good medicine was good strategy, David McLean shows us the difficulties and challenges that the Medical Department and individual naval surgeons faced throughout the nineteenth century to provide good medical care to sailors, whether in periods of peace or war. The challenges to ensuring good health throughout the fleet were manifold, whether from the limits of medical knowledge, wavering admiralty support, underfunded budgets, harsh physical conditions, inadequate distribution of medical staff, and recruitment problems, which were often tied to public perceptions of these other factors. Through its focus on the naval medical staff, which ranged from nurses, assistant surgeons and surgeons, inspectors, and the director general of the Medical Department, McLean considers the transformation of naval medical practice as a profession and argues that, despite repeated setbacks, medical care within the navy substantially improved by the second half of the nineteenth century.

Surgeons of the Fleet is organized into eight chapters that move thematically and chronologically from the eighteenth century to the First World War. In particular, McLean concentrates his efforts on charting the navy's medical history in the period from the Napoleonic Wars to the wake of the Crimean War. The early chapters are devoted to naval administration, early reforms in naval medicine, and the recruitment, conditions, and adventures of naval medics and surgeons. The middle chapters consider the roles of hospitals at home and across the empire in sailors’ care and overall naval efficiency. Chapters 6 and 7 examine naval medicine at war, first in China, and then in the Baltic and Crimea. The heavy casualties in both wars underscored the nineteenth-century reality that more men died from disease than from battle injury. The last chapter details the transformations in the fleet between the late 1850s and the First World War.

While the book professes to study the accounts and perspectives of surgeons’ lives, McLean provides us foremost with an engaging biographical sketch of William Burnett, whose own career within the Medical Department took off during the main period of McLean's study and whose leadership helped to professionalize the navy's medical branch. A Scotsman trained in Edinburgh, Burnett joined the fleet as an assistant surgeon in 1795. His steady rise through the medical ranks would lead to Burnett's appointment as sole medical commissioner on the Victualling Board in 1831 and his leadership of the new Medical Department in 1832. Although Surgeons of the Fleet rarely ventures to make large claims about the nature or developments of naval medicine, McLean convincingly shows the great efforts that Burnett took to reform all facets of the naval medical branch from recruitment and training of assistant surgeons to the fitting of the medical chest to ship and hospital design. In McLean's view, the navy had transformed its medical care by the early 1860s, even if the status of the naval surgeon remained low when compared with the army's counterpart.

One of McLean's implicit arguments is that Burnett set the groundwork for the further modernization of fleet medicine. As a consequence, the reader expects that there will be a fuller history from the late nineteenth and the early twentieth centuries. While the last chapter, “Modernization and 1914,” is full of good insights and details developments about naval medical care, too much is left for last, and too little space is devoted to the First World War. Clear improvements to fleet health (like the steady decline in deaths from disease), professional changes within the medical corps (like the introduction of a female nursing staff), as well as the introduction of controversial reforms (like the Contagious Diseases Acts) all get treatment, but the pace of the writing and lack of clear organization in this last chapter leaves little room for deeper analysis or clearer discernment about what all this revealed about naval medicine, the navy, or society. Given McLean's authority in these matters, it is a shame the last chapter could not have been divided into two parts.

Like many other professions, the story of the nineteenth-century naval medical service was one marked by slow but steady professionalization and modernization. In charting these advances, McLean also critiques the slow pace of naval innovation, even by the turn of the century. As McLean highlights, naval surgeons continued to lack the prestige of their army and civilian counterparts, the effect of which continued to plague recruiting in the early twentieth century. This final chapter raises many issues, like the relationship between new ship design and tuberculosis or the disturbing British rates of typhoid during the Boer War, that suggest the need for further worthwhile research. Despite the restraint of McLean's argumentation, Surgeons of the Fleet remains a significant work charting the lives of naval surgeons, detailing the experience of the naval medical service more broadly, and reminding us of medicine's central, albeit overlooked, role in naval history.