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Comments re my Medical History

The history of medicine is fascinating and we often lose sight of how little we knew before the last 50 or 100 years. I've written a few short articles and I'm web-publishing a few more that I've collected. I hope these are of interest. Obviously they're not to be taken as current medical practice, though it's also interesting how little the basics have changed.

Sincerely, Mark R. Anderson, M.D.

Hammersly's NAVAL ENCYCLOPAEDIA, 1881, pub by Lewis Hammersly, Phila.

Hygiene, Naval.

Though the principles of hygiene are pretty much the same everywhere, the practice on board ship presents some peculiarities, some difficulties: good or pure air; pure water, and enough of it; good food, enough and of such varieties as afford proper nourishment; proper employment for mind and body, without excessive labor; good discipline and other comfortable surroundings, are all necessary. Ever since Ulysses, on his raft, removed some of his clothes to enable him to swim ashore (Odyssey), human ingenuity has been contriving means to save life and to preserve health on the ocean.

Ventilation.

-Pure air is sufficiently abundant on the wide ocean, so that proper ventilation is the main question with reference to this matter. Respired air has about the temperature of the human body, something near 37.78 C. (=100 F.); it is much warmer than the air of any habitable apartment, so that, in obedience to diminished specific gravity, it ascends, escapes by the batches; thus any small vessel is sufficiently ventilated if only the hatches can be kept open. But as the vessels increase in size the difficulties increase in such a way that the larger the vessel the more numerous the sick-list, the greater relative mortality, notwithstanding the great improvement in most other respects. The large ship is subdivided into many apartments, some of them not so well arranged as they might be, and they contain chests of dirty clothes, packages of spoiled cheese, and sometimes worse things; the air cannot remove everything bad about such things unless it has a fair chance. Devices for mechanical ventilation have been very numerous , and though each one has been useful under the careful supervision of the inventor, all of them, ancient and modern, have failed in general utility: the foul-air pump, the bellows, and the fans are all effective in moving the air that comes within their influence, but the opening of the machines cannot reach every accumulation of foul air, or rather do not; and hence, with all their labor and expense, these machine merely circulate to the next aperture the air that comes within their power. In vessels of the monitor class it has been made possible, by the use of fans propelled by steam, to introduce air at one end and discharge it at the other, and by way of variety at both ends, so as to ventilate the interior and supply air for the furnaces at the same time. Formerly there was much inconvenience from impure air caused by bilge water, and from decaying fragments of provision and cargo; but this is so well understood and so easily remedied by keeping the ship dry and clean that the matter should no longer bent much interest, except as a matter of history.

Crowd-poison and typhus.

-Poor ventilation and crowding, besides general ill health, cause typhus fever, a specific disease, and most fatal contagious pestilence. It seems that the mere perspiration of our bodies, unless promptly removed by free circulation of air, becomes very quickly a terrific poison (ochlesis, crowd-poison), which thus killed great numbers of our immigrants from Europe. Ships arriving with)crowds of passengers had many deaths, and the sick were transferred to the quarantine stations, whence the disease was communicated to physicians and nurses at the hospitals ; there were many deaths from this so-called ship-fever, until by Act of Congress (May 3, 1855), this was remedied. The law contains the following among other essential provisions :

1. The number of passengers shall not exceed 1 for each 2 tons measurement.

2. The apartments shall not be less than 6 feet in height.

3. Each passenger shall have from 14 to 18 feet of floor space, varying according to height and position, and giving about 100 cubic feet.

4. Every vessel with capacity for 100 passengers shall have 2 ventilators, 1 at each end, and 1 of them fitted with an exhausting cowl.

5. These arrangements are enforced by sufficient fines and other penalties.

Coolie ships.

-Curious as it may seem, crowds of passengers have been smothered to death on board "coolie" ships, both English and American, within the last 25 years.

Water supply.

-Pure water is essential to health and well-being; and generally there need be no difficulty in procuring it. Distilled water is even too pure, but by aeration and the slight mixture of sea-water, unavoidable, it becomes pleasant and wholesome; and, curious as it may seem, distilled water is generally cheaper than spring water. Formerly the supply of water was a difficult matter; it was carried in wooden casks, which occupied much space and spoiled the water, so that 4 or 5 pints a day was considered a liberal allowance of the disgusting fluid. The first great improvement was the introduction of iron tanks to preserve the water, and next the simple devices, not yet generally understood, for rendering distilled water palatable. The selection of springwater calls for some care and judgement. There is no need here for any elaborate chemical analysis, as in arranging for city supplies. Limpid water from the hills is pretty surely good unless it has a decidedly objectionable flavor or a bad local reputation. It is important to avoid small streams in which clothes are washed, into which dirt is thrown, and streams which drain marshy land. This caution at first sight seems superfluous, but it is curious to see with what carelessness dirt is mixed with drinking water nearly everywhere, from London to Memphls, as well as on ship-board.

Food.-

The supply of suitable food is a real difficulty; we may carry salt beef and salt pork, hard bread and dry beans, flour and dried apples, tea and coffee, but no cabbage from the garden or other green thing. The importance of fresh vegetables is quite incomprehensible. In September , 1740, Lord Anson's fleet sailed from England, and in September, 1741, three of his ships reached the island Juan Fernandez, on the west coast of South America; of the 961 man who sailed 325 ware alive; 686 had died mostly of scorbutus (seascurvy) during the passage around Cape Horn. The first boat that landed was loaded with grass and such weeds as came to hand. The poor invalids on board ate it up as delicious food, and rapidly regained their strength. This terrific record is in accordance with the experience of the time. The Spanish fleet attempting the same voyage at the same time fared about as badly, and the shattered remnant returned to Montevideo; not one of their seven vessels reached the Pacific, and about half the men died in the attempt.

Improvements.

This difficulty in long voyages being understood, there has been a steady improvement to the present time. Cook's voyages of exploration, the third of a century later, were made with very little loss of life; this is partly due to improved knowledge and hygienic care, and partly to the fact that the passages were short from one landing place to the next, and much of the time was spent about lands where fruits and fresh vegetables were procurable. At present it is no rare thing for a ship with 200 or 300 men to round Cape Horn, make a three years' cruise in the Pacific, bringing home every man that sailed in her; and there is no one or two great things to be pointed out as the cause of this great difference. There is a better and more abundant supply of food, better discipline, more thoughtfulness, more intelligent attention to small things. We can mention only a few of the more important changes.

Flogging abolished.

-The abolition of flogging, after many regulations mitigating and rendering it less necessary, came in accordance with the demands of public sentiment (1850). This gave the men spirit to think themselves somewhat better than beasts, and they behaved better accordingly. It did much to infuse new life into the degraded men; it prevented the novices from reaching such a degree of degradation; and now the other tortures invented to supply its place are gradually passing to oblivion.

The liquor ration abolished.

-The abolition of the liquor ration (1862) was still more important. This had to be gradual. For twenty years or more the allowance was reduced from time to time, with coffee and tea, and many other things experimentally supplied as substitutes. The cessation of drunken habits has rendered it possible to indulge sailors with frequent liberty on shore, without the filth and disorder formerly in fashion. There is ten times as much liberty, with perhaps one-tenth as much syphilis.

Coffee and spices.

-Furthermore this great improvement from 650 deaths per 1000 in Lord Anson's fleet to 4 or 5 per 1000 in late official reports has come by more persistent care about small things. Ground coffee, formerly supplied by contract, was a vile mixture of spoiled coffee, with beans and chicory, etc., parched and ground together. The mustard called English mustard was mostly starch and saw-dust, with potassium biebromata enough to make it pungent; the whole seeds are now purchased and manufactured under responsible supervision.

Fresh bread and early coffee.

-The hard bread on board is now varied by a constant supply of fresh bread; a competent "ship's baker," with his oven, belongs to the complement of every ship in the navy. Congressional legislation (May 23,1872), in its liberal supply of coffee, has even prescribed the proper time to use it, "an additional ration of coffee and sugar to be served at his first turning out." The man who is obliged to spend the morning hours from 5 o'clock to 8 AM. in scrubbing decks and making things neat till breakfast-time fully appreciates this preliminary bread and coffee.

Naval experience has made important contributions to medical science and general hygiene, appears by the accumulating reports of medical officers; perhaps the most important of those has reference to malarial fevers. When the distinctions between the deadly marsh fevers of the tropics and yellow fever were hardly suspected, Dr. Badenoch, July 7, 1768, read a paper on this subject before the Royal Society of Edinburgh. His ship had been at the Comore Islands (Mozambique Channel) for ten days, and a few days after sailing many man sickened and died in quick succession; of course it was generally thought to be a terrible contagious pestilence that destroyed lives in this way, but "I observed that none suffered of those who returned on board to sleep every night." All those who were on shore at night suffered; all who came aboard to sleep escaped. Lind published very similar incidents, and subsequent experience all accords with this. Hence the well-established facts: malarial poison infects only at night, and the incubation period is not less than twelve or fourteen days. If we wish to learn when or how a patient contracted his disease, we need not ask where he was last night or yesterday, but where he spent his nights two weeks ago. Even medical men of eminence do not always keep these things in remembrance; for instance, in an admirable work on military hygiene (1860) there occurs such a slip as this:

"The malaria seems to be principally active at night, as many man are attacked while on post early in the morning."

The men had probably been thus exposed every night for two weeks or more. And again (1878), we read of a national vessel at Monrovia, Liberia; in three or four days after anchoring there were numerous cases of malarial favor on board; and hence the inference that the vessel is anchored too near the marshy shore, the fact being quite neglected that two weeks previously the ship was at Porto Praya, and probably the disease was contracted there.

Bibliography.

-The most important books on this subject are the volumes of official reports of naval surgeons published by public authority nearly every year.

Armstrong, "Naval Hygiene," 1858

Blane, "Dissertations," 3d ed., 1803

Clarke, "Long Voyages," 1792

Carpenter, "Use and Abuse of Alcohol"

Dunglison, "Human Health"

Fonssagrives, "Traite' d' Hygiene Navale," 2d ed., 1877

Forget, "Naval Medicine," 1835

Gihon, "Naval Hygiene," 1873

Hammond, "Military Hygiene," 1863

Larrey, "Surgical Memoirs"

Lind, "Marsh Fevers of Bengal," liampat, 1770

Lind, James, "On Scurvy," London, 1757

Lind, James, "Diseases in Hot Climates," Philadelphia, 1811

Maher, "Hygiene Navale," 1874

Plimsoll, "Our Seamen," 1873

Turnbull, "Naval Surgeon," 1806

Turner, "Hygiene, Naval and Merchant," in Buck's "Hygiene," 1880

Wilson, "Naval Hygiene," 2d ed., 1879.

 

-- Joseph Wilson, M.D., Medical Director U.S. N.

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