Chapter XII: Health in the Marine Service

Although from time to time there have been energetic workers in the cause of marine sanitation, there is probably no other department in which the great advances in hygiene have produced so little good result.

It must be conceded at the outset that the seamen’s lot is by no means an enviable one, and that his sanitary environment falls considerably short of modern requirements. Legislation is slow, and the lack of knowledge by the public of the requirements of the Mercantile Marine is no doubt in great measure responsible for this. At a first glance it might naturally be supposed that a life at sea was a healthy one; living in fresh air, and removed from the unhealthy conditions of large towns, it might be expected that the general health of seamen would bear favourable comparison with the corresponding class of the community on shore. But there is another side to this picture. In the first place there is practically always _local_ overcrowding on board ship, and in dealing with this question the hands of port sanitary authorities and their officers are tied by the Shipping Acts. By the Merchant Shipping Act, the minimum space allowed per head is only 72 cubic feet, and in this space a man has not only to sleep, but to feed and live when not engaged on duty. It has been contended that inasmuch as one-half of the crew is always at work, the forecastle provides double this amount of space. But this is entirely a fallacy, for while half the men are always off duty, there is practically continuous occupation, and therefore no opportunity of opening doors, skylights, and other ventilators, to admit of free perflation. Another serious difficulty to contend with is the presence of moisture. Nearly all forecastles are badly ventilated, and the greatly increased use of steel and iron in modern vessels leads to the condensation of moisture, or “sweating” due to change of temperature. It is no uncommon thing to find the bunks and bedding in the crew’s quarters saturated with water from this cause.

While it can scarcely be stated that any special diseases are associated with the sailor’s calling, there are undoubtedly many which are caused by the conditions under which he performs his duty. His work is intermittent, consequently his intervals of rest, broken by sudden and severe exertion, throw undue and violent strain upon the circulatory and respiratory organs. In steam vessels the changes of climate are rapid, and their influence trying to the system. In spite of all the improved methods of storing and preserving food for long periods, there is still much to be desired both in the actual dietary of the sailor, and still more in the rough and inefficient manner in which it is cooked for him. The loss of life from drowning and other accidents connected with casualties to the vessel is large. Again, the habits of the seaman must be taken into account. From the mere fact of his being for long periods confined on shipboard, without any amusements except those provided by his fellows, it is perhaps not surprising that on arrival in port he should give way to full indulgence in pleasure. Unfortunately, moreover, the parts of sea towns frequented by sailors are generally the lowest, and the temptations of the worst kind. This explains the frequency of alcoholism and venereal disease among our Mercantile Marine, and in addition the tendency to contract the diseases to be met with in such localities.

The principal diseases to which seamen are liable are:--

1. Those due to the special character of their employment,
such as aneurism, emphysema, hernia, and heart disease, and in
steam-ships, heat apoplexy (stokers).

2. Those due to their habits, viz., venereal disease and
alcoholism.

3. Diseases of climate, liver disease, malaria, yellow fever,
dysentery, cholera, plague, etc.

4. Diseases influenced mainly by immediate environment and
insanitary conditions, such as rheumatism, phthisis, bronchitis,
and various forms of lung disease, under which must also be
included scurvy and beriberi.

There is unfortunately no reliable record of sickness in the Mercantile Marine.

The returns of the Board of Trade show the mortality rate from all causes in 1898–99 to have been 9.60 per 1000 in the Merchant Service, while the corresponding rate in the Royal Navy was, for the year 1899, 4.91 per 1000, or practically one-half.

The returns of the Mercantile Marine show that of the 9.6 per 1000, 7.4 were from injury, and 2.2 from disease; the 4.91 per 1000 of the Royal Navy being made up of 3.56 from disease, and 1.35 from injury.

The following table shows the disease and accident mortality incidence in sailing-vessels as compared with steam-vessels.

+-----------------------------+--------+------+------+-----------+
| 1898. |Sailing.|Steam.|Total.|Percentage.|
+-----------------------------+--------+------+------+-----------+
| Wrecks and Casualties | 425 | 607 | 1032 | .58 |
| Accidents other than Wrecks | | | | |
| and Casualties | 129 | 157 | 286 | .16 |
| Disease | 149 | 249 | 398 | .22 |
+-----------------------------+--------+------+------+-----------+
| Total | 703 |1013 | 1716 | .96 |
+-----------------------------+--------+------+------+-----------+

1. _Diseases due to Employment._--The violent exertions called for at times of emergency fully account for the frequency of heart disease, especially of cardiac hypertrophy, and also of hernia, while the occurrence of aneurism may be assigned to the same cause, though doubtless greatly aided by the influence of syphilis. With the large increase in size of sailing-vessels and the consequent introduction of labour-saving appliances, this class of disease is showing a decided tendency to decrease.

Injuries are more common on sailing-vessels than on steam-ships, owing to the greater amount of work aloft, and the more laborious efforts involved in working the sails.

The “heat stroke” of stokers requires special notice. It is far more common in vessels of the Merchant Service than in those of the Royal Navy. Stokeholds in the navy are better ventilated, and forced draught, if necessary, tends to a freer supply of air. The “fireman’s frenzy” appears to be caused by the continued high temperature, coupled with insufficient ventilation, and often associated with alcoholism. Much can be done to diminish heat stroke by due attention to the ventilation of stokeholds and confined spaces in connection with them. The utmost advantage should be taken of the up-draught caused by the heat of the furnaces to remove foul and vitiated air. Men engaged in this class of work should be freely supplied with oatmeal water, as this is the most wholesome method of replacing the large quantities of fluid lost by perspiration. The same class of men are, moreover, specially liable to diseases of the eye caused by the glare of the furnaces, and the constant irritation produced by particles of coal and dust.

2. _Diseases caused by the Habits of Seamen._--Of these the two most common are alcoholism and the various forms of venereal disease. The irregularity of a sailor’s life, especially in these days of rapid transport, sufficiently explain without justifying his failings. A man whose home life is interrupted by voyages across the sea, who is thrown upon his own resources in foreign ports, and who is from the nature of his calling almost of necessity confined to the shipping quarters (invariably the lowest) of the towns he reaches, is not unlikely to seek for amusement where it is most easily obtained, and wine, women, and music occupy a considerable part of his spare time under such circumstances. Much has been done by the Board of Trade and voluntary associations to protect the sailor, by taking care of his money when first paid off (when the temptation to squander it is strongest), and enabling him to draw it at his own home, by arranging for his being sent by rail to his destination, by protecting him from “crimps” and unauthorised agents, and by providing Sailors’ Homes, where he can live at a reasonable cost, without being plundered by unscrupulous persons, but there is still much to be desired in this direction.

3. _Diseases of Climate._--To a great extent these can scarcely be avoided. Seamen suffer much from tropical diseases. No doubt their careless habits and unwillingness to take reasonable precautions in unhealthy climates are in some measure responsible for this. Simple rules for the preservation of health, greater care in dieting, and, above all, limitation of indulgence in alcohol, would be of undoubted value, and a recent suggestion to afford information on such subjects to seamen through the medium of Sailors’ Institutes and Homes would doubtless lead to good results. Diarrhœa, so common a disease in hot climates, is mainly caused by the ingestion of improper articles of food and drink. Seamen do not realise the importance of the source and purity of drinking water. One common cause of this disease is the carriage of water in casks and tanks on deck, or in places where it is easily affected by the temperature of the sun. Any simple arrangement for reducing by evaporation or other method the temperature of the water supply has considerable effect in this direction. Dysentery, so far as prevention is concerned, can be guarded against in the same manner as diarrhœa--water, however, being the main agent in causation. Cholera, yellow fever, and plague call for no special comment. Where these diseases are known to exist, shipmasters should be careful to warn their crews as to the danger, and explain how best to avoid them. Men should be kept on board as much as possible during the stay of the vessel in an infected port, and especially should they be required to return at night. A careful watch should be kept for any suspicious sickness, and medical advice sought at an early stage of any illness. The sanitary condition of the vessel itself must be the special care of the master. Malaria, now known to be due to a specific organism, conveyed by means of the bite of a species of mosquito, is much under the control of the master of a vessel, who should prevent his crew from remaining on shore in a malarial country during the night, or in the evening, when special danger exists.

4. _Diseases due to Insanitary Conditions and Environment_ form a long and important series. These are essentially the diseases which can be controlled, if not altogether prevented.

Rheumatism and its allies are mainly due to cold and exposure, and still more to the difficulty of obtaining dry clothing on board ship, and the constantly wet condition of bedding, etc., from the sweating of iron vessels. These causes can be avoided. The condensation can be prevented by the universal use of sheathing over iron decks and of a non-conducting lining over and around bunks, the proper provision of heating stoves, and the free ventilation of forecastles. There is further no reason (especially in steam-vessels) for not providing facilities for dry clothing, and preventing it being taken into the sleeping bunks. These two precautions, together with the free use of woollen underclothing, would tend to greatly reduce the “sailors’ curse,” rheumatism. Lung diseases are very common, and are caused chiefly by the close aggregation of men in confined and ill-ventilated quarters. The difficulty of the system of watches prevents the proper airing of a forecastle, and men coming off duty enter an atmosphere already fouled and polluted by those who have previously occupied it. The cubic space per head should be largely augmented. The Royal Commission on Labour has recommended that 120 cubic feet should be the minimum, and bearing in mind the special difficulties, this would seem to be a moderate figure. The present 72 cubic feet is ridiculously inadequate, and only remains the legal minimum by reason of the proverbial ignorant conservatism of the sailor.

Scurvy happily, under ordinary circumstances, is almost unknown in its acute form. During the last twenty years our ideas as to its causation have undergone considerable change, and it is no longer possible to assert that the one essential for its production is the use of salt meat, and the absence of vegetable food. In one of the recent Arctic expeditions, owing to the loss of all the stores, the crew lived for more than twelve months exclusively on fresh meat, and no symptoms of scurvy made their appearance. There is little doubt that the condition of the blood producing the symptoms we call scurvy is caused by the ingestion of food in an incipient stage of decomposition, although a free supply of natural vegetable acids will tend to delay its appearance. Slight manifestations of scurvy are still common among sailors, and there is one point of great practical importance in connection with this. More care is required in the examination of tinned meats, the date of packing should in all cases be stamped or indelibly marked upon the tin, and those tins that are found on examination to be in any degree defective, should be destroyed under official supervision, and not be allowed to pass into the hands of unscrupulous dealers.

Beriberi is a common disease among certain natives on board ship. The disease has the habit of remaining dormant in a vessel, also of recurring from time to time when conditions for its development are favourable. Though it has been ascribed at different times to malarial influences, to a deficiency of nitrogenous food, and to a definite microbe, these explanations have failed to satisfy all the requirements of the conditions under which it appears. Manson believes that it is due to a toxine, produced by a saprophyte living outside the body, and that as the soil or ship becomes infected, man is poisoned therefrom. It occurs invariably on board ship in connection with moist, overcrowded, and heated forecastles, where ventilation is deficient, and may therefore in this sense be said to be a disease caused by want of sanitation. Further, as favouring this view is the fact that patients removed to hygienic surroundings, and properly fed, rapidly recover. To prevent beriberi all that is necessary is to keep a vessel clean and dry; to see that there is no accumulation of bilge water or foul matter under the flooring of the crew’s quarters, and that these are properly ventilated and not overcrowded.[46]

Enteric fever is undoubtedly the most common disease to which seamen are liable. Thus in the port of London, out of 791 cases of infectious disease occurring on board ship from 1895 to June 1900, no fewer than 290 were enteric fever. The figures are as follows:--

---------------------+----------------+---------------+---------------
| Cases of | No. of Cases | Percentage
Year. | Enteric Fever. | of Infectious | of
| | Diseases. | Enteric Fever.
---------------------+----------------+---------------+---------------
1895 | 31 | 129 | 24.0
1896 | 53 | 145 | 35.1
1897 | 54 | 179 | 30.1
1898 | 55 | 121 | 45.4
1899 | 66 | 160 | 41.2
1900 (6 months only) | 114 | 187 | 60.31
---------------------+----------------+---------------+---------------
Total | 373 | 921 | 40.49
---------------------+----------------+---------------+---------------

The large proportion during 1900 is due to the number of cases brought from South Africa.

The causes of the large number of cases of enteric fever are three:--

1. The congregation of seamen in the unhealthy quarters of foreign ports.

2. Want of care in the selection of sources of water supply.

3. Improper methods of carriage and storage of water.

Most of the infected or dangerous sources of water supply are known, and great benefit would result if consuls and other representatives of this country abroad were instructed to warn shipmasters of the special danger. Water should always be stored on board ship in galvanised iron water tanks, which should be carried in such places that they can be easily reached for cleaning purposes. They should be provided with large manholes so situated that where possible natural light can penetrate to the bottom of the tanks when the covers are removed. They should be periodically emptied, cleaned, and coated with a cement wash.

Lastly must be mentioned the digestive troubles so common in seamen. The insufficient and monotonous dietary is of itself sufficient to cause this, and when one further considers the unsatisfactory way in which such food is ofttimes cooked, it will be at once seen how serious a matter this may become. There is no compulsory diet scale, nor theoretically is it wise that there should be. It is felt that if such were laid down by law it would speedily become a minimum beyond which the owner or master would not care to go. The Merchant Shipping Act requires that a diet scale shall be produced when men are engaged, and shall form an essential part of the contract, any departure from which shall constitute a breach of the agreement on the part of the employer. Several improvements on the old scale (still usually in vogue) have been made, but in practice these are scarcely ever adopted. In the present day there are far better opportunities for giving men fresh meat and vegetables, while the use of preserved foods should obviate to a large extent the necessity for salt meat. It can be clearly shown that a reasonable dietary can be provided at a less cost than the antiquated one generally in use, while the advantages from the improved health of the crews and the consequent increased discipline and work are beyond dispute. But even if the dietary be good, the cooking is generally bad. Here legislation is needed. At the present time the master and certain other officers of a ship are required to hold certificates, granted after training and examination, and it is equally necessary that in the case of the cook, some definite standard of knowledge of the work he undertakes should be required before appointment. In the majority of cases a man is rated as “cook” because he so describes himself, or has acted in a similar capacity before. There is no difficulty in organising a system of instruction and examination for ships’ cooks in large centres, and the result of such would be to the advantage of shipowners as regards economy of food, as well as increased efficiency on the part of their crews. This work has already been initiated in several ports, notably London, Liverpool, North Shields, and Glasgow, but the question still demands the most careful attention.

Much ill-health and disease would be avoided if more care were exercised in the selection of men for the Mercantile Marine. The Merchant Shipping Act (sect. 10) provides for the medical inspection of seamen if required, but as a matter of fact, this provision is practically a dead letter, and men are allowed to “sign on” without any inquiry as to their physical fitness for their occupation.

W. COLLINGRIDGE.