- Email: [email protected]
"THE LEUCOCYTE AS THE SURGEON'S FRIEND."
690 to
84, declined last week to 74, but exceeded the number
The larvæ of muscidæ have frequently been found in the and other parts of the human body, and have naturally been washed out with weak solutions of the perchloride of mercury as the best antiseptic, which lotions, I need hardly say, are as nearly as possible inert for such a purpose. It is of course as futile as it is customary in several parts of the country to apply lotions of corrosive sublimate to sheep infested with larvæ, and this is by no means an unimportant question, in consequence of the worry, mischief, anddestruction they cause to llocks of sheep during the warlll season of the year. Several agents kill the parasites very promptly; but for general use by farmers and sheep graziers, if chloroform is too dangerous an agent to place in their hands, the chloroform water of the Pharmacopœia, strength recommends itself as being inexpensive, promptly effective, and innocuous. The larvas are not only made torpid, they are actually killed by it. The appended tabular statement shows approximately the destructive effect of different agents on the larvae ; but all the experiments as already noticed clearly prove that some of the larvæ, depending on their different degrees of develop. ment, are more resistant than others to the agents used for destroying them :Larvæ immersed in chloroform killed instantly.
in the
corresponding week of last year by 8. The causes of 44, or nearly 9 per cent., of the deaths in the eight towns last week
were
ear
not certified.
HEALTH OF DUBLIN.
The death-rate in Dublin, which had declined in the preceding three weeks from 23’8 to 17’3 per 1000, rose again to 19’4 during the week ending Sept. 20th. During the past eleven weeks of the current quarter the death-rate in the city averaged 20’2 per 1000, the rate for the same period being 18 ’2 in London and 16 ’6 in Edinburgh. in Dublin showed an increase of 14 upon the number in the previous week; they included 4 which resulted from diarrhoea,
The 131 deaths
4 from "fever," 2 from measles, 2 from whooping-cough, 1 from diphtheria, and not one either from small-pox or scarlet fever. Thus the deaths referred to the principal zymotic diseases, which had been 11 and 15 in the preceding two weeks, declined again last week to 13 ; they were equal to an annual rate of 1’9 per 1000, the rate from the same disThe eases being 2’8 in London and 1’9 in Edinburgh. deaths from diarrhœa, which had been 6 and 11 in the previous two weeks, declined last week to 4. The fatal cases of "fever," of measles, and of whooping-cough showed a slight increase upon those recorded in the preceding week. The 131 deaths in Dublin included 26 of infants under one year of age, and 32 of persons aged upwards of sixty years ; the deaths of infants showed a slight decline, while those of elderly persons exceeded those recorded in the previous week. Four inquest cases and 5 deaths from violence were registered during the week; and 41, or nearly a third, of the deaths occurred in public institutions. The causes of 18, or nearly 14 per cent., of the deaths were not certified.
chloroform Nvater P.B. killed in 5 minutes. ess. anisi )$88 minutes. acid. carbolic liq..... "8 minutes. ol. rusci 12 minutes. 1 hour. acid. liydrocyanic dil. P.B. " liq. carbonis deterg..... "1 hour. ol. month. pip ...... "1 hour.
"
........
" "
........
"
" " "
ol. eucalypti carbolic (1 in 16 olive}
"
oil)
"
"Audi alteram
3 hours. "
"4 hours.
(Some of the larvæ were dead in three
liq. hydrarg. perchlor.P.B.
hours, others were I quite active after five hours.
"
I am,
partem."
"3 hours.
......
........
"
75 minutes.
" 2 hours.
......
"
Correspondence.
"
.....
ol. huile de cade tinct. iodi sal. alembroth (1 grain} in 2 oz. distilled water) /
"
Sirs, your obedient servant, 1890. D. MACKINTOSH, M.D.
Alexander-sq., S.W., Sept. 22nd,
TENACITY OF VITALITY IN LARVÆ AND LOW FORMS OF ORGANIC LIFE. 1’0 the La2tors
of
"THE LEUCOCYTE AS THE SURGEON’S FRIEND."
THE LANCET.
SIRS,—In perusing Dr. Broadbent’s able address at To the Editors of THE LANCET. Birmingham my attention has been directed to some of the interesting if not novel facts and statements which he has SIRS,—Dr. W. J. Collins, in an eloquent letter (vide THE submitted for our consideration. That " strychnine acts LANCET, Sept. 13th), requests us to make an amende alike on all animals that have a spinal cord" is well known. honorable to the leucocyte, insinuating that the latter has But we have not been equally conversant with the statement been unwittingly injured or despised through ignorance. that "when we leave the vertebrate series strychnine ceases The is at present in a sad plight. Its proud leucocyte to be deadly." We are told that blackbeetles consume it position of an organiser and regenerator of new tissue which with impunity. Equally remarkable is the fact that "when it had arrogantly occupied for many years has been rudely dilute hydrocyanic acid is injected under the skin of a frog shaken by the savants of the Tenth International Congress. it hops about as if nothing had happened," while we know It now holds, as far as inflammation is concerned, the that a very minute quantity of strychnine-the thousandth modest which Virchow years ago assigned to it. position part of a grain-will produce tetanic convulsions in a frog, and Messrs. Ballance and Sherrington removed all the charm .
otherwise affect it in such adecided manner that the manifestations produced are justly regarded as a delicate physiological test of the presence of the poison. While engaged in verifying these experiments I have found that dipterous larvæ which feed on putrescent animal matter, more particularly the larvas of the musca vomitoria and the sarcophaga carnaria, swim about freely for about one hour in dilute hydrocyanic acid, when gradually their movements cease and they die. They live actively and apparently unaffected for fully four hours in the liquor hydrargyri perchloridi of the Pharmacopoeia, thus shaking our faith to a considerable extent in the prompt and universally deadly effect of one of the foremost of antiseptics. I should mention, however, that some of the larvæ, the more mature and fully developed, cease their more active movements in the perchloride solution in three hours; while others-the smaller, less developed, and more thread-like in appearance-possess the enormous power of resisting the destructive effect of the This circumstance solution for more than five hours. accords with our knowledge of the spores of bacteria, which resist the influence of agents destructive to their vitality for a very much longer period than the fully formed bacteria. My purpose, however, is not to try to establish any analogy between bacteria and larvae, but to describe the experiments as they occurred, in the hope that they may be more or less interesting to at least a few of the readers of THE LANCET.
which hovered around the leucocyte, and Professor Ziegler, who once raised it to the greatest power and dignity, and was its truest friend, gave it the coup de grâce. The leucocyte now clings to the title of " phagocyte," which Metchnikoff conferred on it, and which others since have always been ready to defend. In this capacity "it should be welcomed as the surgeon’s friend," so Dr. Collins pleads; however, he wisely adds-"if Metchnikoff’s researches are unambiguous." Therein the difficulty lies. A priori, especially atter a careful study of Virchow’s cellular pathology and the recent researches of Messrs. Ballance and Sherrington, we should be inclined to deny this phagocytic action. Again, good authorities believe that in the above title the" lowly leucocyte" is demanding more than is due to it. This is not the place to discuss all the points for and against this matter, but a few suggestions will show that it is by no Professor Robert Koch, versed in all means unambiguous. matters appertaining to bacillary life, is a strong opponent to Metchnikoff’s theory, and maintains that the living bacillus attacks the leucocyte, and then destroys it.l Again, Flüggeand Baumgarten3 showed that the "phago-
claiming
1 Cf. his researches on the bacillus of mouse septicæmia. 2 Zeitschr. fur Hygiene, 1888, iv. 3 Centralbl. fur Klin. Med., 1888, 29.
691 can only devour degenerated or dead anthrax bacilli, they cannot be considered in the light of destroying .agents, but only as the burial ground of the deceased organisms. Metchnikoff’s strongest argument, based on anthrax inoaulations of frogs, has been completely refuted by Petruschky.4 He showed firstly that, on injecting anthrax bacilli into the dorsal lymph sac of a coldfrog, changes of degeneration and dissolution are chiefly observed in the extra-cellular bacilli. His researches, therefore, have removed the chief support from the phagocytic theory. Petruschky further demonstrated that a frog kept at the ordinary temperature of a room remains immune against anthrax, and that the bacilli and their spores injected into the cutis or lymph-sac are killed through the action of the lymphatic fluid, and then taken up by the leucocytes. On the other hand, if after the inoculation the frog be kept at ;3, temperature of from 30° to 35° C., it has no longer immunity. Nissem,5 who worked under Fliigge’s direction, has proved that the plasma constituents of the blood are the chief agents concerned in the destruction of bacteria, and that plasma free from corpuscles possesses as great a destructive power as blood. Nutall, again, has shown that in blood, iymph, or aqueous humour, anthrax bacilli completely degenerate, without the cellular elements playing any part in the process. Lastly, an allusion should be made to Wyssokowitsch’s well-known investigations. It is thus seen that we have no right to accept Metchnikoffs theory as yet. In fact, the scientific experience seems to be rather opposed to it. It has yet to be proved that—(1) phagocytes in RufFer’s and Metchnikoff’s sense really exist ; and (2) if so, that they are really leucocytes, before we apologise to the lowly leucocyte." I am, Sirs, yours faithfully.
’cytes " -so
that
"
A. A. KANTHACK, M.B., St. Bartholomew’s Hospital, Sept. 21th, 1890.
B.S.,
F.R.C.S.
communicating
SANITATION AT SEA. To the Editors
of THE LANCET.
SIRS,—As an ex-surgeon in the mercantile marine I am much interested in your able leading article in THE LANCET of Sept. 20th relative to the sanitary arrangements as - carried out on our large steamships. Some fourteen years of surgeon in the P. and O. since I held the ’Company’s service. It was then the custom to provide medical officers in that service with printed forms to be filled up during each voyage, stating fully the sanitary condition of the ship &c. Upon arrivinghome from Calcutta in December, 1876, I received a telegram from the chief affice of the Company requesting me to present myself before one of the managing directors. I was then politely informed that as I had thought fit to report as very defec-tive the sanitary condition, especially as to ventilation, of the ship I was attached to, the Company had no further need of my services. The senior surgeon of the Company in London actually informed me that unless I withdrew my report concerning the ship he did not think I should retain my appointment. This, of course, I courteously declined to do, naturally supposing that my appointment was somethan a sinecure. Until ship surgeons are thing more the Board of Trade and made responsible to appointed by that Board alone, and perfectly independent of the shipping companies, this state of affairs must continue to flourish. I am, Sirs, yours faithfully, EDWD. A. PIGGOTT, L.R.C.P. & S.Edin. &c., Late Surgeon P. and O. Company. ,Clare, Suffolk, Sept. 22nd, 1890.
appointment
-
_.
-
To the Editors of THE LANCET. SIRS,—Your Special Commission will no doubt do good work in drawing the attention of the public to some of the insanitary conditions to which seamen and firemen are exposed. As long as the evolution of the modern steamer proceeds upon the present lines of naval construction -insanitary conditions must inevitably prevail. The accommodation for the crew being almost always in the forecastle of the ship, the difficulty of efficient ventilation in all weathers becomes enormous. Take, for instance, the case when the ship is diving into a head sea, and tons of water 4
5
Dissertation, Konigsberg, 1888. Zeitschr. fiir Hygiene, 1889, vi.
pouring over the forecastle continually; cowl ventilators of the usual kind are impossible, for they would he broken off and carried away at once, leaving so many leaks in their place. The only possible means would be by forcing in air from the engine-room, much too costly a process for anything but a war ship. But too often, however, the insanitary condition of the sailor’s surroundings is of his own creating. Sailors are not bound to foul their own nest by bringing into it such animals as monkeys &c., nor are they bound to damage their health by such reckless debauchery as they usually indulge in when on shore. Drink, venereal disease, and their results form by far the largest part of the cases of illness occurring at sea. How often such cases occur the oflicers of the ships alone know, and the general public can have no remote idea. Recruited, as they mostly are, from the most improvident and dissolute classes of our seaports, firemen will go on breaking down and dying after a few years, until a vastly different state of morality comes to prevail among them. That the fireman’s work is heavy cannot be denied, but his pay is good—£5per month, with no board and lodging to pay for, must, a tany rate, be considered good pay. But his improvident habits make I have known firemen after an even this all too little. Indian voyage earn from £15 to £30, who in three days after their arrival in England had dissipated the whole. The report of your Commission would lead to the erroneous inference that the fireman’s work is always performed under conditions of intense heat. In the Suez Canal and Red Sea or in the tropics, when there is no wind, this is certainly the case; but if there is any breeze the ventilators are trimmed to the wind, and the condition is at once altered. Indeed, as a rule, in temperate climates the volumes of air poured down into the stokehole by the enormous ventilators render it quite cool, while the adjoining engine-room may still be very hot. The door between the two has to be kept shut to prevent the strong draught blowing coal-dust all over the machinery. The system by which, as the report puts it, incompetent men are smuggled on board at the last moment is again due to the men themselves. The crew is engaged at the Board of Trade office generally a clear day before the ship sails, and the crew are ordered to be on board at a certain time. When the ship is about to leave the dock the hands are mustered, and it is generally found that there are some absentees. In the case of a steamer time is really money, and the first men available jump on board from the pier-head to replace the deserters. At sea the decks are washed every morning at 6 A.M. with the flushed out daily at hose, and the closets are this time. With regard to personal cleanliness, such a thing, as arule, never enters a fireman’s head until the end of the voyage. Firemen have told me that the coat of grease and coal-dust which they get upon their backs is as good as another garment if they have to go on deck. This may at any rate serveto explain the apparent recklessness shown by firemen in crossing the deck without adding anything to the clothing which they wear on watch. A loose open shirt is generally the only pro tection for the chest against any weather which may pre, vail on deck. While not disputing in the least the fact that firemen soon become broken down, I would suggest that your commission might investigate how much of their ill-health is really attributable to the work itself, and how much to their dissipations. As a case in point I would instance a young fireman under thirty whom I have been attending for some time, who within three months has shown symptoms of chronic rheumatism, syphilitic periostitis, violent syphilitic iritis, and granular kidney, and is incapable of any heavy work in future. One other instance out of many must suffice. Within an hour of the arrival of a steamer at Constantinople four firemen were in a state of intoxication, accompanied by maniacal excitement. They became mutinous, striking the officers, and acting like so many wild beasts, so that assistance from the shore had to be obtained to secure them. All this was caused by some vile spirit, which they had obtained from a bum-boat in exchange for their clothes. The men never really recovered from the debauch for the rest of the voyage. Reform is urgently needed, but the task is difficult, and the labour herculean. If, as a result of the attention drawn to the subject in your columns, even the slightest improvement takes place, benefit would be conferred on the whole nation. I am, Sirs, your.obedient servant, ARTHUR J. Moss, M.B. Penarth, Sept. 21sat, 1890. are
abundantly
84, declined last week to 74, but exceeded the number
The larvæ of muscidæ have frequently been found in the and other parts of the human body, and have naturally been washed out with weak solutions of the perchloride of mercury as the best antiseptic, which lotions, I need hardly say, are as nearly as possible inert for such a purpose. It is of course as futile as it is customary in several parts of the country to apply lotions of corrosive sublimate to sheep infested with larvæ, and this is by no means an unimportant question, in consequence of the worry, mischief, anddestruction they cause to llocks of sheep during the warlll season of the year. Several agents kill the parasites very promptly; but for general use by farmers and sheep graziers, if chloroform is too dangerous an agent to place in their hands, the chloroform water of the Pharmacopœia, strength recommends itself as being inexpensive, promptly effective, and innocuous. The larvas are not only made torpid, they are actually killed by it. The appended tabular statement shows approximately the destructive effect of different agents on the larvae ; but all the experiments as already noticed clearly prove that some of the larvæ, depending on their different degrees of develop. ment, are more resistant than others to the agents used for destroying them :Larvæ immersed in chloroform killed instantly.
in the
corresponding week of last year by 8. The causes of 44, or nearly 9 per cent., of the deaths in the eight towns last week
were
ear
not certified.
HEALTH OF DUBLIN.
The death-rate in Dublin, which had declined in the preceding three weeks from 23’8 to 17’3 per 1000, rose again to 19’4 during the week ending Sept. 20th. During the past eleven weeks of the current quarter the death-rate in the city averaged 20’2 per 1000, the rate for the same period being 18 ’2 in London and 16 ’6 in Edinburgh. in Dublin showed an increase of 14 upon the number in the previous week; they included 4 which resulted from diarrhoea,
The 131 deaths
4 from "fever," 2 from measles, 2 from whooping-cough, 1 from diphtheria, and not one either from small-pox or scarlet fever. Thus the deaths referred to the principal zymotic diseases, which had been 11 and 15 in the preceding two weeks, declined again last week to 13 ; they were equal to an annual rate of 1’9 per 1000, the rate from the same disThe eases being 2’8 in London and 1’9 in Edinburgh. deaths from diarrhœa, which had been 6 and 11 in the previous two weeks, declined last week to 4. The fatal cases of "fever," of measles, and of whooping-cough showed a slight increase upon those recorded in the preceding week. The 131 deaths in Dublin included 26 of infants under one year of age, and 32 of persons aged upwards of sixty years ; the deaths of infants showed a slight decline, while those of elderly persons exceeded those recorded in the previous week. Four inquest cases and 5 deaths from violence were registered during the week; and 41, or nearly a third, of the deaths occurred in public institutions. The causes of 18, or nearly 14 per cent., of the deaths were not certified.
chloroform Nvater P.B. killed in 5 minutes. ess. anisi )$88 minutes. acid. carbolic liq..... "8 minutes. ol. rusci 12 minutes. 1 hour. acid. liydrocyanic dil. P.B. " liq. carbonis deterg..... "1 hour. ol. month. pip ...... "1 hour.
"
........
" "
........
"
" " "
ol. eucalypti carbolic (1 in 16 olive}
"
oil)
"
"Audi alteram
3 hours. "
"4 hours.
(Some of the larvæ were dead in three
liq. hydrarg. perchlor.P.B.
hours, others were I quite active after five hours.
"
I am,
partem."
"3 hours.
......
........
"
75 minutes.
" 2 hours.
......
"
Correspondence.
"
.....
ol. huile de cade tinct. iodi sal. alembroth (1 grain} in 2 oz. distilled water) /
"
Sirs, your obedient servant, 1890. D. MACKINTOSH, M.D.
Alexander-sq., S.W., Sept. 22nd,
TENACITY OF VITALITY IN LARVÆ AND LOW FORMS OF ORGANIC LIFE. 1’0 the La2tors
of
"THE LEUCOCYTE AS THE SURGEON’S FRIEND."
THE LANCET.
SIRS,—In perusing Dr. Broadbent’s able address at To the Editors of THE LANCET. Birmingham my attention has been directed to some of the interesting if not novel facts and statements which he has SIRS,—Dr. W. J. Collins, in an eloquent letter (vide THE submitted for our consideration. That " strychnine acts LANCET, Sept. 13th), requests us to make an amende alike on all animals that have a spinal cord" is well known. honorable to the leucocyte, insinuating that the latter has But we have not been equally conversant with the statement been unwittingly injured or despised through ignorance. that "when we leave the vertebrate series strychnine ceases The is at present in a sad plight. Its proud leucocyte to be deadly." We are told that blackbeetles consume it position of an organiser and regenerator of new tissue which with impunity. Equally remarkable is the fact that "when it had arrogantly occupied for many years has been rudely dilute hydrocyanic acid is injected under the skin of a frog shaken by the savants of the Tenth International Congress. it hops about as if nothing had happened," while we know It now holds, as far as inflammation is concerned, the that a very minute quantity of strychnine-the thousandth modest which Virchow years ago assigned to it. position part of a grain-will produce tetanic convulsions in a frog, and Messrs. Ballance and Sherrington removed all the charm .
otherwise affect it in such adecided manner that the manifestations produced are justly regarded as a delicate physiological test of the presence of the poison. While engaged in verifying these experiments I have found that dipterous larvæ which feed on putrescent animal matter, more particularly the larvas of the musca vomitoria and the sarcophaga carnaria, swim about freely for about one hour in dilute hydrocyanic acid, when gradually their movements cease and they die. They live actively and apparently unaffected for fully four hours in the liquor hydrargyri perchloridi of the Pharmacopoeia, thus shaking our faith to a considerable extent in the prompt and universally deadly effect of one of the foremost of antiseptics. I should mention, however, that some of the larvæ, the more mature and fully developed, cease their more active movements in the perchloride solution in three hours; while others-the smaller, less developed, and more thread-like in appearance-possess the enormous power of resisting the destructive effect of the This circumstance solution for more than five hours. accords with our knowledge of the spores of bacteria, which resist the influence of agents destructive to their vitality for a very much longer period than the fully formed bacteria. My purpose, however, is not to try to establish any analogy between bacteria and larvae, but to describe the experiments as they occurred, in the hope that they may be more or less interesting to at least a few of the readers of THE LANCET.
which hovered around the leucocyte, and Professor Ziegler, who once raised it to the greatest power and dignity, and was its truest friend, gave it the coup de grâce. The leucocyte now clings to the title of " phagocyte," which Metchnikoff conferred on it, and which others since have always been ready to defend. In this capacity "it should be welcomed as the surgeon’s friend," so Dr. Collins pleads; however, he wisely adds-"if Metchnikoff’s researches are unambiguous." Therein the difficulty lies. A priori, especially atter a careful study of Virchow’s cellular pathology and the recent researches of Messrs. Ballance and Sherrington, we should be inclined to deny this phagocytic action. Again, good authorities believe that in the above title the" lowly leucocyte" is demanding more than is due to it. This is not the place to discuss all the points for and against this matter, but a few suggestions will show that it is by no Professor Robert Koch, versed in all means unambiguous. matters appertaining to bacillary life, is a strong opponent to Metchnikoff’s theory, and maintains that the living bacillus attacks the leucocyte, and then destroys it.l Again, Flüggeand Baumgarten3 showed that the "phago-
claiming
1 Cf. his researches on the bacillus of mouse septicæmia. 2 Zeitschr. fur Hygiene, 1888, iv. 3 Centralbl. fur Klin. Med., 1888, 29.
691 can only devour degenerated or dead anthrax bacilli, they cannot be considered in the light of destroying .agents, but only as the burial ground of the deceased organisms. Metchnikoff’s strongest argument, based on anthrax inoaulations of frogs, has been completely refuted by Petruschky.4 He showed firstly that, on injecting anthrax bacilli into the dorsal lymph sac of a coldfrog, changes of degeneration and dissolution are chiefly observed in the extra-cellular bacilli. His researches, therefore, have removed the chief support from the phagocytic theory. Petruschky further demonstrated that a frog kept at the ordinary temperature of a room remains immune against anthrax, and that the bacilli and their spores injected into the cutis or lymph-sac are killed through the action of the lymphatic fluid, and then taken up by the leucocytes. On the other hand, if after the inoculation the frog be kept at ;3, temperature of from 30° to 35° C., it has no longer immunity. Nissem,5 who worked under Fliigge’s direction, has proved that the plasma constituents of the blood are the chief agents concerned in the destruction of bacteria, and that plasma free from corpuscles possesses as great a destructive power as blood. Nutall, again, has shown that in blood, iymph, or aqueous humour, anthrax bacilli completely degenerate, without the cellular elements playing any part in the process. Lastly, an allusion should be made to Wyssokowitsch’s well-known investigations. It is thus seen that we have no right to accept Metchnikoffs theory as yet. In fact, the scientific experience seems to be rather opposed to it. It has yet to be proved that—(1) phagocytes in RufFer’s and Metchnikoff’s sense really exist ; and (2) if so, that they are really leucocytes, before we apologise to the lowly leucocyte." I am, Sirs, yours faithfully.
’cytes " -so
that
"
A. A. KANTHACK, M.B., St. Bartholomew’s Hospital, Sept. 21th, 1890.
B.S.,
F.R.C.S.
communicating
SANITATION AT SEA. To the Editors
of THE LANCET.
SIRS,—As an ex-surgeon in the mercantile marine I am much interested in your able leading article in THE LANCET of Sept. 20th relative to the sanitary arrangements as - carried out on our large steamships. Some fourteen years of surgeon in the P. and O. since I held the ’Company’s service. It was then the custom to provide medical officers in that service with printed forms to be filled up during each voyage, stating fully the sanitary condition of the ship &c. Upon arrivinghome from Calcutta in December, 1876, I received a telegram from the chief affice of the Company requesting me to present myself before one of the managing directors. I was then politely informed that as I had thought fit to report as very defec-tive the sanitary condition, especially as to ventilation, of the ship I was attached to, the Company had no further need of my services. The senior surgeon of the Company in London actually informed me that unless I withdrew my report concerning the ship he did not think I should retain my appointment. This, of course, I courteously declined to do, naturally supposing that my appointment was somethan a sinecure. Until ship surgeons are thing more the Board of Trade and made responsible to appointed by that Board alone, and perfectly independent of the shipping companies, this state of affairs must continue to flourish. I am, Sirs, yours faithfully, EDWD. A. PIGGOTT, L.R.C.P. & S.Edin. &c., Late Surgeon P. and O. Company. ,Clare, Suffolk, Sept. 22nd, 1890.
appointment
-
_.
-
To the Editors of THE LANCET. SIRS,—Your Special Commission will no doubt do good work in drawing the attention of the public to some of the insanitary conditions to which seamen and firemen are exposed. As long as the evolution of the modern steamer proceeds upon the present lines of naval construction -insanitary conditions must inevitably prevail. The accommodation for the crew being almost always in the forecastle of the ship, the difficulty of efficient ventilation in all weathers becomes enormous. Take, for instance, the case when the ship is diving into a head sea, and tons of water 4
5
Dissertation, Konigsberg, 1888. Zeitschr. fiir Hygiene, 1889, vi.
pouring over the forecastle continually; cowl ventilators of the usual kind are impossible, for they would he broken off and carried away at once, leaving so many leaks in their place. The only possible means would be by forcing in air from the engine-room, much too costly a process for anything but a war ship. But too often, however, the insanitary condition of the sailor’s surroundings is of his own creating. Sailors are not bound to foul their own nest by bringing into it such animals as monkeys &c., nor are they bound to damage their health by such reckless debauchery as they usually indulge in when on shore. Drink, venereal disease, and their results form by far the largest part of the cases of illness occurring at sea. How often such cases occur the oflicers of the ships alone know, and the general public can have no remote idea. Recruited, as they mostly are, from the most improvident and dissolute classes of our seaports, firemen will go on breaking down and dying after a few years, until a vastly different state of morality comes to prevail among them. That the fireman’s work is heavy cannot be denied, but his pay is good—£5per month, with no board and lodging to pay for, must, a tany rate, be considered good pay. But his improvident habits make I have known firemen after an even this all too little. Indian voyage earn from £15 to £30, who in three days after their arrival in England had dissipated the whole. The report of your Commission would lead to the erroneous inference that the fireman’s work is always performed under conditions of intense heat. In the Suez Canal and Red Sea or in the tropics, when there is no wind, this is certainly the case; but if there is any breeze the ventilators are trimmed to the wind, and the condition is at once altered. Indeed, as a rule, in temperate climates the volumes of air poured down into the stokehole by the enormous ventilators render it quite cool, while the adjoining engine-room may still be very hot. The door between the two has to be kept shut to prevent the strong draught blowing coal-dust all over the machinery. The system by which, as the report puts it, incompetent men are smuggled on board at the last moment is again due to the men themselves. The crew is engaged at the Board of Trade office generally a clear day before the ship sails, and the crew are ordered to be on board at a certain time. When the ship is about to leave the dock the hands are mustered, and it is generally found that there are some absentees. In the case of a steamer time is really money, and the first men available jump on board from the pier-head to replace the deserters. At sea the decks are washed every morning at 6 A.M. with the flushed out daily at hose, and the closets are this time. With regard to personal cleanliness, such a thing, as arule, never enters a fireman’s head until the end of the voyage. Firemen have told me that the coat of grease and coal-dust which they get upon their backs is as good as another garment if they have to go on deck. This may at any rate serveto explain the apparent recklessness shown by firemen in crossing the deck without adding anything to the clothing which they wear on watch. A loose open shirt is generally the only pro tection for the chest against any weather which may pre, vail on deck. While not disputing in the least the fact that firemen soon become broken down, I would suggest that your commission might investigate how much of their ill-health is really attributable to the work itself, and how much to their dissipations. As a case in point I would instance a young fireman under thirty whom I have been attending for some time, who within three months has shown symptoms of chronic rheumatism, syphilitic periostitis, violent syphilitic iritis, and granular kidney, and is incapable of any heavy work in future. One other instance out of many must suffice. Within an hour of the arrival of a steamer at Constantinople four firemen were in a state of intoxication, accompanied by maniacal excitement. They became mutinous, striking the officers, and acting like so many wild beasts, so that assistance from the shore had to be obtained to secure them. All this was caused by some vile spirit, which they had obtained from a bum-boat in exchange for their clothes. The men never really recovered from the debauch for the rest of the voyage. Reform is urgently needed, but the task is difficult, and the labour herculean. If, as a result of the attention drawn to the subject in your columns, even the slightest improvement takes place, benefit would be conferred on the whole nation. I am, Sirs, your.obedient servant, ARTHUR J. Moss, M.B. Penarth, Sept. 21sat, 1890. are
abundantly