Sea Diseases

Introduction
A brief account is given of some of the great sea diseases, the means of prevention of the causes of ill-health at sea, and those pioneers in naval preventive medicine who contributed so much to improving conditions at sea, thus preserving health. This contribution was not to the Navy alone, but to the whole nation, for it must be remembered that 300 years ago so great a sea nation was Britain that half the adult population of the realm was employed at sea or at the great ports in maritime affairs. At the end of the eighteenth century it has been estimated that the proportion of seamen in the nation was as great as 1:133.

Scurvy
This was the scourge of sailors, right up to the end of the eighteenth century. It was so prevalent that it can be considered as one of the occupational diseases of seamen in those times. The incidence was largely dependent on the length of sea voyages and the long periods of blockades in wartime. It affected the men more than the officers, as the latter were able to supplement the meagre diet. On Vasco da Gama's voyage to discover a passage by the Cape of Good Hope to the East Indies in 1497, 100 out of 160 men were lost from the disease. In Anson's voyages round the world, the Centurion in 1741 buried 292 men and had only 214 of her complement remaining; and in the Gloucester two thirds of the crew died. The great debt owed to the naval surgeon James Lind for his pioneer work in the prevention of scurvy is well known. Lind entered the Navy in 1739, and during his years at sea engaged upon a series of critical observations and experiments on the causation, prevention and treatment of the disease. Scurvy had of course been recognized for a long time before, and the value of fresh fruit, including oranges and lemons, and fresh vegetables as a cure had been recognized by various captains of ships as well as naval doctors. For instance, Sir Richard Hawkins at the close of the sixteenth century, and Captain Lancaster, employed by the East India Company in 1601, used lemon juice as a preventive; and John Woodall, a surgeon to the same company, in his book Surgeon's Mate advised the use of lemon juice as a preventive and cure. There was, however, no universal agreement on the cause or the means of prevention of scurvy, and agents such as humidity, polluted air and cold were all considered to be potent factors and as important as inadequate diet. The forms of treatment were also various. It was not until 1747 that Lind, while serving as a surgeon in the 74-gun ship Salisbury, carried out a controlled experiment - a model of its kind - that demonstrated once and for all that orange and lemon juices were specific in the treatment of scurvy. This work he elaborated, and recommended the means of prevention, and advised methods of preserving the juices of fruits and other foods for use at sea. In spite of this clear demonstration of the cause of scurvy, however, it was not until much later that Lind's recommendations were generally adopted. His handbook 'A Treatise on Scurvy' was published in 1754, but not until 40 years after were administrative measures taken by the Admiralty to put his recommendations into effect.

Typhus fever
Typhus or gaol fever was another scourge of the days when men were impressed for sea service. Many came from gaols such as Newgate, lousy and in rags. There was no uniform or issue of clothing in the Navy in those days, and scarcely any means of bodily cleanliness. In the Invincible in 1795, with a crew of 594 men, 70 fell victims to typhus within the space of a month. Once again impure air, bad smells and confined spaces were thought to be the cause, and fumigation by sulphur the remedy. The transmission of the disease by the body louse from person to person was not discovered until 1909 by Nicolle, but Lind, with remarkable acuteness of observation, had realized the connection between unclean bodies and dirty clothes, and made the following pertinent recommendations to prevent the spread of the disease:

'The most effectual preservative against this infection during a press, would, perhaps, be to appoint a ship for receiving all ragged and suspected persons, before they are admitted into the receiving guardships. These ships should be furnished with slops, shirts, bedding and all the necessary articles of seamen's apparel, with soap, tubs, and proper conveniences for bathing, and with a room up on deck for fumigating of clothes. Every suspected person, whether impressed at sea, or on shore should be first put on board of her; their stay in her, however, should be short, as soon as they are stripped of their rags, well washed and cleaned, they should be supplied with new clothes and bedding and be sent on board the receiving guardships. Such of their apparel as appears tolerably good ought to be cleaned, or if necessary fumigated with brimstone, and returned to them, but it will be absolutely necessary to destroy all filthy rags and all such clothes as are brought from Newgate or other prisons.'

This was an admirable exercise in hygiene and would have made an invaluable contribution to public health.

Pulmonary tuberculosis.
This has long been recognized as an occupational disease of seamen. Gilbert Blane, another of the great pioneers in naval preventive medicine, remarked in 1830 that pulmonary inflammation, and especially pulmonary consumption were the chief sources of sickness and mortality in the Fleet at that time. The cause was of course the confined spaces in which the sailors were accommodated, with little ventilation and light, and often gross overcrowding and little hygiene. The incidence at that time was about eight per every thousand per annum. In the middle of the present century, with better living conditions and diet, and a higher standard of health required on entry, the incidence was happily reduced to about two per thousand but even so it was about double that in the Army or Royal Air Force. The incidence among officers was less than half that in ratings. There has been a further big reduction since and now it is very doubtful if the disease can any longer be considered an occupational disease of sailors.