Ocean-Going Steamers, Disseminators of Disease - 1884

This article from 1884 in The British Medical Journal described the working conditions of the ship's sergeons.

The letter from Dr. Irwin, formerly of Manchester, and now of New York, which we published on May 24th, calls renewed attention to a subject often discussed in these columns.

At the present time, if protection governs the commercial policy of the United States, we have at least free trade with them in disease; and there can be little doubt that small-pox and other infectious diseases have been carried on several recent occasions from the Old World to the New.

Dr. F. H. Blaxall's report on the "Sanitary Aspects of Emigration and Immigration from and into the United Kingdom" throws some light on the question. It would appear from this report that, even in the best lines, the accommodation is insufficient.

Hospitals for infectious cases were only found in a few ships on the weather-deck, and even then in many cases they were situated oh a part of the deck much frequented by the steerage-passengers, and were very ill ventilated.

Dr. Blaxall reports that the hospitals for ordinary cases were usually situated on the upper passenger-deck, and were generally well lighted and ventilated, but that, unfortunately, the key of the hospital was in the hands of the steward.

There is, top, good reason for believing that first-class passengers, ship's stewards, and other members of the crew, are frequently accommodated in the hospital.

This is a distinct contravention of the provisions of the Passengers' Act (s. 24), and is also an index of the little authority left in the hands of the surgeon.

This important officer is generally overworked and underpaid; he is the mere nominee of the, owners with no rights or; privileges beyond those which they choose to, confer upon him, and with no claims beyond those contained in a contract carefully worded; in the owners' interest; he is treated, indeed, with but little consideration.

The ships surgeon is provided with very inferior accommodation, "not calculated," says Dr. Blaxall, "to invite the services of desirable men, being altogether out of keeping with the responsible position the surgeon holds in the ship as entrusted with the care of the health of hundreds of men, women, and children. In some cases, he has to stow himself away in the dispensary, surrounded by medicines and drugs, having no other place to sleep in.

In other ships, the cabin allotted to him is small, dark, and badly situated;" so that it is a matter of great difficulty for him to keep proper records of cases of sickness occurring on board, records which are of the utmost importance, especially to the people of the United States.

We have transcribed the above words from the report to the Local Government Board, because the deliberate report of an unimpassioned official contains expressions as strong as any which have been used, and comes with an authority which other utterances must lack.

It seems to have been abundantly proved that the time has come when England and America ought to combine together to form a marine medical service of competent men, responsible, not to the owners, but to the Governments of the two countries.

The carrying trade is largely in the hands of England, and it behoves her to stir herself to remedy this glaring evil; otherwise, the United States will be fully justified in taking the matter out of her hands altogether, and that shortly.

SHIP SANITATION.

SOME years ago, in consequence of a dispatch to the Foreign Office from the British Consul-General of New York, calling attention to the belief there entertained that the spread of small-pox in the United States was largely due to the importation of the disease by emigrants, the Local Government Board ordered an inquiry into the sanitary aspects of emigration and immigration.

This inquiry, which was conducted by Dr. F. H. Blaxall, with the assistance of Captain Wilson, chief emigration officer of the Board of Trade, resulted in the publication of a comprehensive report.[1]

The report showed that though much had been done for the comfort and convenience of emigrants and transmigrates (emigrants from other countries passing through Great Britain), many sanitary regulations and precautions were persistently violated or neglected.

The report contained a series of valuable recommendations, which, so far as can be ascertained, have not generally been carried out by the shipping companies.

One of these recommendations was " that infectious hospitals should be provided on the weather deck in the least frequented part of the ship ;" and another was " that the surgeons should be instructed to make daily inspection of emigrants during the voyage, and to secure the immediate isolation of cases presenting suspicious symptoms."

So far as we are aware, no returns have ever been published showing the proportion of ships in which the first of these recommendations at any rate has been adopted; it is therefore not possible to make any positive statement on the point here.

There is reason, however, to believe that it has con very generally neglected. This opinion finds support in the fact that even the best of the shipping companies do not fulfil the spirit even, if they take the trouble to obey the letter, of the clauses of the Merchant Shipping and Passenger Acts with regard to hospitals.

Dr. Blaxall's report states that he found the ship's hospital, as a rule, well placed, well ventilated, and well provided; it adds," " occasionally the key of the hospital was found to be in the hands of the steward—a circumstance which suggested the hospitals being put to other than their legitimate use, and which Captain Wilson, when doing duty at Queenstown, found to be the case in several instances—first-class passengers, ship's officers, stewards, and other members of the crew being accommodated in them in contravention of the Passengers Act (Sec. 24)."

The Cunard Company is igenerally recognised to occupy a position in the front rank of steamship companies, and i in the magnificent boats which it puts on the Atlantic trade the hospitals are sometimes used to accommodate passengers or crew, it may be safely assumed that in other companies With a lesser reputation at stake matters will not be better.

In the face of the provisions of Acts of Parliament, and of the recommendations of sanitary experts, We have been rather surprised to read an order, which a surgeon, formerly employed by the Cunard Company, has stated in a pamphlet' recently published was issued to its surgeons by that company. The order as published is in the following terms:

" The hospitals are to be under the surgeon s charge only when occupied by patients, at which time he will be responsible for their cleanliness and proper ventilation. When unoccupied they are to be at the Captain's disposal."

The phrase "at the Captain's disposal" suggests, the probability that the irregular practices observed by Captain Wilson at Queenstown have not yet ceased.

If passengers or crew are berthed in the hospital, and if there be no infections hospital, the isolation of a declared case of infectious disease must be a matter of great difficulty, requiring an appeal to the captain and the clearing of the hospital; much more must such laxness tend to discourage the surgeon from securing "the immediate isolation of cases presenting suspicious symptoms."

The Atlantic passage is now so quick that a captain may well argue with 'himself that neither he nor the company which he serves, not Wisely but _too Well, may suffer anything from the inconvenience and loss directly flowing from the exposure of a whole shipload of people to the infection of measles or small-pox.

The voyage will be over, and the emigrants scattered throng the cities and villages of the United States before the earliest symptoms of measles contracted from a fellow passenger during the Atlantic voyage would be likely to declare themselves.

The appointment of a ship's surgeon in the passenger trade must be sanctioned b the Emigration Officer of the Board of Trade; the certificate 0 approval is accompanied by certain instructions, of which the following is stated by Dr. Leet to be (for Liverpool) a correct copy:

It is desirable that Surgeons in charge of Passenger Ships should keeps record of any sickness that occurs on the voyage, whether among Saloon Passengers, Emigrants, or Crew, and should report the same to this Oflice" at the end 0! the voyage, making special mention of the following particulars :—

• Date of commencement of voyage.
• Date of termination of voyage.
• Date of the commencement of any infectious or contagious diseases, the number of cases, and the number of families affected.
• Has the Ship been disinfected?
• State the number of deaths and their causes.
• Was the ventilation sufficient? if not, state where it was defective.
• Were any complaints made by the Emigrants? if so, state what complaints, and what steps were taken in each case.

 

The report should be addressed as follows: —
O. H. M. S.
The Emigration Officer,
Board of Trade Offices,
Liverpool.

It would seem, however, that the shipping companies do not consider themselves bound to obey the wishes of the Board of Trade in this respect, for Dr. Leet publishes the following:

The omissions from the Board of Trade's order are Significant, as is also the different destination Assigned to the report. If the suspicion thus raised la unfounded, it behooves the »hipping companies to give the necessary explanations.

In conclusion, the opinion may be hazarded that the great steamship companies are following a very short-sighted policy, and that in their own interests they would do well to give greater attention to the observance of hygienic precautions.

Quite apart from the business traffic, a large number of persons now take sea voyages in search of health; the public is as yet hardly aware of the serious dangers to health which may be run, and undoubtedly are often run, even on the Atlantic liners, nor of the precarious tenure by which the shin's surgeon holds his office.

He is the only sanitary officer which the ship carries; yet he is, it would seem, forbidden to make the reports on sanitary matters to the Board of Trade, required by the regulations of that Board, and is liable to be informed after any voyage that "his services are no longer required."

The shipping companies have it in their power to obtain at no sacrifice of material advantages or of dignity a medical service consisting of thoroughly competent, trained, and seasoned men, who, if they were treated with the respect and consideration which they deserved, would be thoroughly loyal and efficient servants, co-operating in every measure designed to increase the comfort and wellbeing of passengers, and thus to further the success and popularity of the great ocean steamships.

Bibliography

"Ocean-Going Steamers, Disseminators of Disease," in The British Medical Journal, 7 June 1884, Page 1100.

"Ship Sanitation" in The British Medical Journal, 23 November 1889, p. 1180-1181.