Health Problems in the Merchant Navy

Abstract

The author commences his article with a comparison of the pre-war gross tonnage of the mercantile shipping of various countries, and points out that the British Empire, with 240.25 millions, possessed 30 per cent. of the world's tonnage. The United States came next with 12 million tons, followed by Japan 50.5 millions, Norway 40.75 millions, Germany 40.25 millions, and France and the Netherlands with about 3 millions each. The pre-war personnel of the British mercantile marine did not exceed 180, 000, a large majority of whom were employed in ships without surgeons. The Merchant Shipping Act requires surgeons to be appointed only to ships having over 100 persons on board or where there are over 50 emigrants. About 75 per cent. of the total tonnage are ships below 10, 000, with less than 100 persons on board, and the seamen are consequently dependent on first aid treatment by the captain or steward. Even to-day there is no supervising medical authority to advise on crews' quarters, diet, ventilation, lighting, and other health matters. Before the change from sail to steam the mean annual death rate in the British Mercantile Marine was five times as high as that of coal mining and quarrying; this figure has now been greatly reduced, but is still in excess of coal mining and quarrying. A table is given showing the loss of life among United Kingdom merchant seamen during the years 1935, 1936, and 1937. The various causes of catastrophes at sea are enumerated, and reference is made to the good work carried out by the Ice Patrol, and the value of wireless. Fire-fighting in ships has reached a high efficiency, and the latest method of fire alarm signalling, the "Richardio, " is being installed in many new ships, " Fire alarm stations are manned day and night; alarms and signals are led by wire pipes and telephone to the bridge; and from here all valves are coupled to CO2 bottles in stores, holds, baggage and mail rooms." War-time devices have greatly assisted in, saving life at sea, particularly the " Loran, " which is used for long range navigation by wireless rays from coast stations, and which works by beam interception, plotting the position of the ship at any time, and the " Asdic, " which detects underwater objects and has a range of several miles. Medical Personnel. Board of Trade Inspectors and Lloyds Surveyors are appointed to see that the statutory regulations are observed: it rests with those companies with initiative and an enlightened sense of obligation to improve conditions such as crews quarters. The ship's surgeon should make recommendations on all matters of hygiene and health, but owing, perhaps, to lack of experience, he rarely does so except in minor matters or concerning his own sick bay and equipment. In peace-time there are about 300 permanent ship surgeons. The author considers that properly organized schemes of training should be set up under the aegis of a University; this scheme would not apply to the 1, 000 or so temporary surgeons who are employed voyage by voyage. The Board of Trade appoints medical inspectors to inspect medicines, medical stores and antiscorbutics, with which a ship is required to be provided: medical inspectors are also appointed to examine seamen. The Board of Trade requires that every foreign-going ship having 100 persons on board shall carry as part of her complement some duly qualified medical practitioner: this also applies in an emigrant ship when the number of emigrants exceeds 50. The person authorized to approve the appointment of ship surgeons is the Emigration Officer, a layman, and it is suggested that this is an example of the need for revision of the existing regulations. Hospitals and Sick Bays. The spaces set apart for hospital accommodation shall be on or above the uppermost passenger deck and shall be properly divided off from other living quarters, to the satisfaction of the Emigration Officer and the Board of Trade Medical Officer at the port of construction or clearance. These are the regulations for ships Carrying doctors. The space allotted for hospital accommodation in liners is usually far in excess of Government requirements. Isolation hospitals are still housed on the poop aft, a very unsuitable situation owing to the thrashing of the propellers, and the pitch and roll in bad weather. In freighters, ships from 1, 000 to 10, 000 tons which are not required to carry a surgeon, there is no statutory requirement for a sick bay, although some enlightened companies do provide them. In U.S.A., Norwegian, and Australian ships, there are permanent quarters for a sick bay with accommodation according to numbers. Problems of Smaller Ships. In big liners there are adequate hospitals with one or more doctors, dispensers, male orderlies, and nurses; conditions are good for medical staff and crew; but the smaller ships up to 10, 000 tons, which carry no doctor, present a real problem. Facilities for first aid vary from ship to ship, and, for the most part, are inadequate. Skilled first aid is of paramount importance in small ships owing to the difficulty of obtaining early professional assistance. The immediate and present concern should be directed to improving the medical facilities for foreign-going freighters, which comprise 75 per cent. of our tonnage. Coasters have their own problems but, usually, aid is within easy reach. Reforms must be practicable, easy to enforce, and must earn the cooperation of the owners. Changes should be acceptable to crews, and there should be an acknowledged international standard. Captains of ships are required to have the St. John or St. Andrew Ambulance Certificate, and are regarded as the persons responsible for the care of the sick and injured. This has a great disadvantage since, in times of emergency, the captain must first attend to the safety of the ship. In practice the captain usually delegates his medical obligation to one of the officers, usually the chief steward. The author suggests that the captain should be relieved of all direct responsibility for the medical and surgical care of the sailor, and that this responsibility should be given to the steward on the condition that he undergoes a three months' course similar to that of a sick-berth attendant of the Royal Navy. Another suggestion is to utilize retired Royal Navy sick bay petty officers who might combine this work with that of steward. Pre-employment Medical Examination. An unfit man, or a partially disabled man, is an unnecessary liability in a ship; engagement of a crew, therefore, becomes a matter of importance. In a major catastrophe a man with heart disease, nephritis, epilepsy, etc., is a definite embarrassment and even a menace, in a small ship's company. There should be, therefore, an adequate system of ensuring pre-employment examination, including chest radiography. Effects of the Merchant Navy Pool. The Pool in the first instance was intended as a source of manpower. The Essential Work (Merchant Navy) Order, 1941, established a definite service which men could not leave except for bad health, disablement, or serious misdemeanour.' In order to provide fit men, medical examination centres were established at the large ports. There are certain defects in this scheme, mainly due to the lack of follow-up examinations at regular intervals. The high mortality rate due to sickness is evidence of failure to eliminate applicants quite unfitted for the sea. Crews' Quarters. Adequate living quarters for the crew are of paramount importance; overcrowding in quarters is a potent factor in the spread of disease. WOOD [this Bulletin, 1942, v. 17, 623] has shown that seamen arrive for treatment for tuberculosis in a more advanced stage of the disease than do the general population: he considers that unsatisfactory living conditions, and overcrowding are the main causes. FRAZER (Ann. Rep. Liverpool Port San. Auth., 1937, p. 62) in a report to the Liverpool Port Health Authority points out that much can be done by competent inspection to improve conditions. BLACK found that in some ships built since 1937, there was some improvement in the quarters, but that in others the Regulations of the Board of Trade were being loosely enforced. Plans for quarters for new ships should be passed by a medical officer of experience before construction is started. Communication by Wireless. Ships not carrying a doctor can communicate by wireless with other ships, and can thus get advice, and even personal aid. This method of communication is now simplified by the use of code. The medical section of the International Code of Signals includes (1) quarantine, (2) case taking system, and (3) diseases and description of condition. The case taking system is a simple and clear method of sending a message in order to get a medical opinion. Communication between men speaking different languages has often given rise to absurd misunderstandings. Advice on specific treatment cannot be given through the code as the metric system is not universal. The article is illustrated by photographs of both good and bad quarters, which are reproduced by permission of Dr. W. M. FRAZER, Medical Officer of Health of the City and Port of Liverpool. Edward R. Peirce.