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HEALTH STATISTICS OF THE MERCANTILE MARINE.
685 one
the
Correspondence.
of Dr. Burke’s requirements in being situated docks-ships berth not a hundred yards away. I am, Sir, yours faithfully, H. M. HANSCHELL, Pathologist
March 23rd, 1925.
"Audi alteram partem."
HEALTH STATISTICS OF THE MERCANTILE MARINE. To the Editor
Sin,—Will you permit
of THE LANCET.
me
to comment
on
Dr. E. T.
Burke’s letter, under this heading, in your last issue ? If some of us hesitate about the Board of Trade’s conscience—all of us are, unhesitatingly, with Dr. Burke on the side of the sea-farers. Everyone will agree with him that there should be in every port a V.D. treatment centre easily and quickly got at, and at any time on any day, for sea-farers. I submit this centre need not be actually in the docks. That the centre should be for the use, comfort, and aid of the sea-farer exclusively is surely unnecessary. Many years’ experience of sea-farers who had sailed to the wilderness of Zin and Ditched in Mount Hor convinces me that they are not so exclusive as all that. Moreover, there is that considerable body of men who alternate between shore, dock, and ship jobs ; they could hardly be placed in an in-and-out category in relation to treatment at the V.D. centre. The centre should have in-patient accommodation for sea-farers. With very few exceptions the sea-farer on being paid off his ship prefers not to come into hospital for V.D. treatment while his money lasts. When he has no money left he will, sometimes, ask to come into hospital to complete treatment ; but more often ha signs on a ship again and continues treatment, more irregularly than regularly, from port to port. It is reason-
able to believe that with greater facilities for treatment at home and foreign ports this would become less irregular. At foreign ports such facilities are increasing ; many of my patients inform me of the advantage they had taken of them. Actually it must be rare for a crew to be signed on a British ship in a home port unless they have passed the doctor, and my experience is that in the Port of London the doctors have keen eyes for indications of V.D. Very many of my patients have failed to pass the doctor ; some of them turn out not to have V.D. I believe Dr. Burke overestimates the docility of the sea-farer and the ingenuousness of those in control of ships. The §rst would not consent to the certification (though their confession to the hospital doctor is frank and ready) about exposure to infection and " prophylaxis." The latter would not sign on anyone, cleansed and injected, or not, about whom there was an agreed and confessed chance of developing V.D. on the voyage. Besides the possible liability for the contagion of others of the crew, there are the passengers’ susceptibilities to consider ; with any such certification scheme owners could hardly plead their masters’ ignorance of the risk of developing V.D. by the certifica,te-carrying seafarer, and V.D. is never so hateful as in its early stages and in someone else. Notices giving information about V.D. treatment centres are posted in ships and in the London Docks ; perhaps more might be done in this line. Ship-masters and surgeons are, in fact, informed of these centres. The Port of London draggles on for some fourteen miles of river. Transport between its ports is unspeakably slow and bad. Its V.D. problem is one for several centres. While hospitals in general have, in the past., spurned landsman and sea-farer suffering from non-respectable V.D. (V.D. in the communicable stage), in the Port of London the Seamen’s Hospital Society has always succoured and treated the V.D. sea-farer-even taking him into hospital. On any day and at any time the Dreadnought Hospital at Greenwich and the Seamen’s Hospital, Royal Albert Dock, have always treated, as in- and out-patients, the V.D. sea-farer of whatever race, nation, colour, or creed ; and still do so. Lastly, the second ofthese hospitals fulfils
examining
in
i/c V.D. Clinic, Seamen’s Hospital, R.A. Dock.
and M.O.
To the Edilor of THE LA!BCET. SIR,—With reference to the letter from Dr. E. T. Burke that appeared in your issue of March 21st, it is well to point out that in London the care and treatment of sailors suffering from venereal disease is not neglected. Attached to the Seamen’s Hospital Society are two venereal clinics, one at the Dreadnought, Greenwich, and the other at the Seamen’s Hospital, Albert Dock. At the former there were treated last year 1189 new patients and of this number 80 per cent. were seamen. At the latter 778 were treated, 50 per cent. of these being At Greenwich no less than 25 per cent. seamen. of the sailors were afforded the benefit of in-patient treatment, and at the Albert Dock 15 per cent. were admitted to the wards. While one realises the great advantage to be derived from placing a centre in every dock, where it is easily accessible to the incoming sailor, this would lea,d to a multiplication of clinics which would be practically impossible. Of the two clinics mentioned one lies immediately between the Albert and Victoria Docks, while the other is in ’close proximity to the Surrey Commercial Docks, and the Society is so well known that sailors gravitate to these centres, not only from every dock on the Thames, but from every outport in the Kingdom. Should the patient be forced by circumstances to go to sea again before his cure is complete he is given a transfer book detailing the treatment he has already received and instructing him where to get further treatment in other ports. It would be well to remember that this Society is a pioneer in the treatment of venereal disease, which was carried out efficiently before the Venereal Diseases Act was passed. I am. Sir. vours faithfullv. P. J. MICHELLI. Seamen’s Hospital, Greenwich, S.E., March 24th, 1925.
THE MEDICAL WITNESS. To the Editor of THE LANCET. Sm,—In your issue of Nov. 22nd last Sir William Willcox is stated to have said during the discussion .on the Medical Witness at the Hunterian Society " the expert witness should be in court during the whole of the proceedings. Indeed, it had been ruled that it was necessary for such a witness to hear the evidence." Will Sir William Willcox kindly give others and myself through your columns the reference to the ruling he quotes ? I ask this because in a recent case of criminal abortion where I was called in, when the trial came on all the witnesses were told to retire. I at once asked the magistrate if such instruction applied to the medical witness also, and he promptly replied " Yes." Of course, here in Victoria things may be different, but the geneial principle should apply. Thanking Sir William Willcox in anticipation, I am. Sir. vours faithfullv. Melbourne,
Victoria, Jan. 27th, 1925.
JAMES
BOOTH.
**We have referred Dr. Booth’s letter to Sir William Willcox and the following is his reply :" Regarding the point raised in Dr. Booth’s letter, it has been the usual custom in this country for the expert witness for the Crown to remain in court during the whole of the proceedings.I am referring, of course, to cases in which the evidence of the expert be required on any point which may arise during hearing of the case. For example, in toxico-
may the
the
Correspondence.
of Dr. Burke’s requirements in being situated docks-ships berth not a hundred yards away. I am, Sir, yours faithfully, H. M. HANSCHELL, Pathologist
March 23rd, 1925.
"Audi alteram partem."
HEALTH STATISTICS OF THE MERCANTILE MARINE. To the Editor
Sin,—Will you permit
of THE LANCET.
me
to comment
on
Dr. E. T.
Burke’s letter, under this heading, in your last issue ? If some of us hesitate about the Board of Trade’s conscience—all of us are, unhesitatingly, with Dr. Burke on the side of the sea-farers. Everyone will agree with him that there should be in every port a V.D. treatment centre easily and quickly got at, and at any time on any day, for sea-farers. I submit this centre need not be actually in the docks. That the centre should be for the use, comfort, and aid of the sea-farer exclusively is surely unnecessary. Many years’ experience of sea-farers who had sailed to the wilderness of Zin and Ditched in Mount Hor convinces me that they are not so exclusive as all that. Moreover, there is that considerable body of men who alternate between shore, dock, and ship jobs ; they could hardly be placed in an in-and-out category in relation to treatment at the V.D. centre. The centre should have in-patient accommodation for sea-farers. With very few exceptions the sea-farer on being paid off his ship prefers not to come into hospital for V.D. treatment while his money lasts. When he has no money left he will, sometimes, ask to come into hospital to complete treatment ; but more often ha signs on a ship again and continues treatment, more irregularly than regularly, from port to port. It is reason-
able to believe that with greater facilities for treatment at home and foreign ports this would become less irregular. At foreign ports such facilities are increasing ; many of my patients inform me of the advantage they had taken of them. Actually it must be rare for a crew to be signed on a British ship in a home port unless they have passed the doctor, and my experience is that in the Port of London the doctors have keen eyes for indications of V.D. Very many of my patients have failed to pass the doctor ; some of them turn out not to have V.D. I believe Dr. Burke overestimates the docility of the sea-farer and the ingenuousness of those in control of ships. The §rst would not consent to the certification (though their confession to the hospital doctor is frank and ready) about exposure to infection and " prophylaxis." The latter would not sign on anyone, cleansed and injected, or not, about whom there was an agreed and confessed chance of developing V.D. on the voyage. Besides the possible liability for the contagion of others of the crew, there are the passengers’ susceptibilities to consider ; with any such certification scheme owners could hardly plead their masters’ ignorance of the risk of developing V.D. by the certifica,te-carrying seafarer, and V.D. is never so hateful as in its early stages and in someone else. Notices giving information about V.D. treatment centres are posted in ships and in the London Docks ; perhaps more might be done in this line. Ship-masters and surgeons are, in fact, informed of these centres. The Port of London draggles on for some fourteen miles of river. Transport between its ports is unspeakably slow and bad. Its V.D. problem is one for several centres. While hospitals in general have, in the past., spurned landsman and sea-farer suffering from non-respectable V.D. (V.D. in the communicable stage), in the Port of London the Seamen’s Hospital Society has always succoured and treated the V.D. sea-farer-even taking him into hospital. On any day and at any time the Dreadnought Hospital at Greenwich and the Seamen’s Hospital, Royal Albert Dock, have always treated, as in- and out-patients, the V.D. sea-farer of whatever race, nation, colour, or creed ; and still do so. Lastly, the second ofthese hospitals fulfils
examining
in
i/c V.D. Clinic, Seamen’s Hospital, R.A. Dock.
and M.O.
To the Edilor of THE LA!BCET. SIR,—With reference to the letter from Dr. E. T. Burke that appeared in your issue of March 21st, it is well to point out that in London the care and treatment of sailors suffering from venereal disease is not neglected. Attached to the Seamen’s Hospital Society are two venereal clinics, one at the Dreadnought, Greenwich, and the other at the Seamen’s Hospital, Albert Dock. At the former there were treated last year 1189 new patients and of this number 80 per cent. were seamen. At the latter 778 were treated, 50 per cent. of these being At Greenwich no less than 25 per cent. seamen. of the sailors were afforded the benefit of in-patient treatment, and at the Albert Dock 15 per cent. were admitted to the wards. While one realises the great advantage to be derived from placing a centre in every dock, where it is easily accessible to the incoming sailor, this would lea,d to a multiplication of clinics which would be practically impossible. Of the two clinics mentioned one lies immediately between the Albert and Victoria Docks, while the other is in ’close proximity to the Surrey Commercial Docks, and the Society is so well known that sailors gravitate to these centres, not only from every dock on the Thames, but from every outport in the Kingdom. Should the patient be forced by circumstances to go to sea again before his cure is complete he is given a transfer book detailing the treatment he has already received and instructing him where to get further treatment in other ports. It would be well to remember that this Society is a pioneer in the treatment of venereal disease, which was carried out efficiently before the Venereal Diseases Act was passed. I am. Sir. vours faithfullv. P. J. MICHELLI. Seamen’s Hospital, Greenwich, S.E., March 24th, 1925.
THE MEDICAL WITNESS. To the Editor of THE LANCET. Sm,—In your issue of Nov. 22nd last Sir William Willcox is stated to have said during the discussion .on the Medical Witness at the Hunterian Society " the expert witness should be in court during the whole of the proceedings. Indeed, it had been ruled that it was necessary for such a witness to hear the evidence." Will Sir William Willcox kindly give others and myself through your columns the reference to the ruling he quotes ? I ask this because in a recent case of criminal abortion where I was called in, when the trial came on all the witnesses were told to retire. I at once asked the magistrate if such instruction applied to the medical witness also, and he promptly replied " Yes." Of course, here in Victoria things may be different, but the geneial principle should apply. Thanking Sir William Willcox in anticipation, I am. Sir. vours faithfullv. Melbourne,
Victoria, Jan. 27th, 1925.
JAMES
BOOTH.
**We have referred Dr. Booth’s letter to Sir William Willcox and the following is his reply :" Regarding the point raised in Dr. Booth’s letter, it has been the usual custom in this country for the expert witness for the Crown to remain in court during the whole of the proceedings.I am referring, of course, to cases in which the evidence of the expert be required on any point which may arise during hearing of the case. For example, in toxico-
may the