Campaigning for statutes on health

An anonymous article appeared in the British Medical Journal on 12 January 1867 titled ‘Report on the hygienic condition of the merchantile marine and on the preventable diseases of merchant seamen’. It was the first of four such articles and the tone was set by the first paragraph:

This summarises a debate that was raging at the time about what was wrong with merchant shipping, both in terms of its economics and its safety. Public concern had repeatedly been directed at the loss of life at sea and at the conditions suffered by seamen both when at sea and when in the sailortowns of the major ports. Activists, some motivated by concerns about the appalling record of shipwrecks and some about the conditions of labour and the lack of religious underpinning for moral and sober behaviour in the laboring classes, had been campaigning for most of the early part of the nineteenth century, and this had led to parliamentary inquiries, notably on loss of life at sea and on the conditions for emigrants aboard passenger ships.

Information on disease

The 1867 Merchant Shipping Act contained a range of provisions aimed at improving the health of seamen, but was only specific about one condition – scurvy. Here was a disease with a known remedy – lemon or other citrus juice – that, if used, was often adulterated and so not fit for purpose. What were the other health problems in seamen that this Act aimed to remedy? This is not easy information to find. It is difficult to relate the disease descriptions then used, especially by non-medical people such as ship captains and British consuls, to present-day terminology.

The most detailed records are those from hospitals treating seamen, notably the Dreadnought, but also others, for instance the British Hospital in Callau (or now more commonly Callao), Peru, which saw seafarers after arduous trans-Pacific and Cape Horn passages. There are a small number of studies based on ships' log-books and rather more covering passengers and especially emigrants, where the maintenance of a log and its presentation at the end of a voyage was a statutory requirement. Contemporary articles in medical journals can give information, while the Ship Captain's Medical Guide, although not a source of quantitative information, gives a perspective on how various diseases were viewed and categorised.

In reviewing such data many aspects must be considered in addition to the contemporary nomenclature of disease.

Dangers in ports

The health of seamen was at risk not only while at sea but possibly even more so whilst in port. The Merchant Shipping Acts could require arrangements to be made for disease prevention and treatment at sea but the seafarer ashore had no such protection. They became legitimate prey for a wide range of predators, from the disease-bearing mosquitoes of tropical ports and anchorages to the nexus of boarding-house keepers, bar owners, crimps, pimps and prostitutes in all the port cities of the world. The risks to the health of seafarers whilst in port were a pressing practical issue in terms of the provision of crews and their competence, but it was also an issue that was laden with moral overtones in the nineteenth century.

As seen, most of the information that we have on the health of seamen in the nineteenth century comes from shore-based hospitals that met their needs for care. These data show that, while a few diseases like scurvy and many accidents arose from conditions at sea, many were exotic conditions caught in foreign ports, and even some of the others, like typhoid in coaster crews, were likely to have had their origins in insanitary port areas or contaminated food or water brought aboard.

Maritime disasters have long captured the public attention; by contrast, disease and injury in merchant seamen have been neglected. This is true both in the maritime industry and among historians. While neglect by British governments, shipowners and by the seamen themselves has been the norm, there have been times when it has been expedient to take action. This has only succeeded where there is a degree of consensus among the different parties in the industry, while the actions taken have been dependent on input from those with expertise in health risks and their management.

This episodic pattern of action has had an effect on the information available to anyone preparing a historical account. There are periods when concern about particular topics leads to a detailed archival record, but long spells when the record is limited or absent. In particular there are no long-term records of patterns of injury, illness or death of the sort available from public health and from military and naval medicine that would enable comparisons to be made between the health of seamen and other groups. Thus this book uses those times and events which are recorded as a series of vignettes from which to build up a picture of maritime health and its developments in the hundred years from 1860.

Seamen at war

From the 1860s merchant seamen, and sometimes officers too, were commonly seen by shipowners and the state as a commodity to be purchased at market rates, with terms of service that were limited to a set period, usually three years in the deep-water trades. Prior to the 1850s, while seamen were still casually employed on merchant ships the state took the view that seafaring manpower should be maintained and developed as a national resource serving both naval and commercial requirements. The state intervened by requiring indentured apprentices to form part of the complement of merchant ships, on a scale dependent on the size of the vessel. In addition these apprenticeships at sea also provided a way for poor law guardians to move pauper youths off their books and into work that was no longer a charge on the poor rate. However, despite the separation of naval and merchant ship manning in the 1850s, whenever there was a war, merchant ships became part of the war effort and targets for enemy action. This was in addition to the creation of a Royal Naval Reserve based on those in the merchant service who could be called up in times of war.

The pattern of casual employment, and the attitudes of shipowners associated with it, often had a negative influence on the provision of a good diet, and decent working and living conditions, as well as on the arrangements for welfare, and for the prevention and treatment of illness and injury.

Capability and safety

The reasons for the concerns about unseaworthy seamen in the 1860s were rather diffuse, but they appeared to have their origins in the adverse consequences of illness, drunkenness and debauchery on safety at sea. Some activists also linked the causes of this lack of seaworthiness to the quality of accommodation and food or the lack of medical examinations prior to embarkation. However, with the exception of scurvy as a consequence of adulterated or poor-quality lemon juice, none of these aspects gained sufficient public or political credibility for improvements to be required until much later.

By the end of the nineteenth century the fitness and capability of seafarers was being viewed in much clearer terms: the nature of their duties was being analysed or surmised and this information was being used to evaluate their risks of ‘unseaworthiness’. The personal attributes being reviewed included competence, based on training and experience, and inherent or acquired capabilities such as vision, hearing or physical fitness. The fundamentals of capability requirements had long been recognised; for instance the ability of seamen to climb masts and set sails and the need for this to be learnt early in life had been used as an example of age-related learning by the physician and philosopher Erasmus Darwin in the eighteenth century. But most of the earlier forms of assessment of skills and abilities were informal and occurred during apprenticeships and training on the job.

Captains and doctors

A ship's captain confronted with serious illness or injury at sea had no recourse to any form of help or medical advice, but had to act on his own initiative and experience. He had to decide on diagnosis and on any treatment at a time when he had few diagnostic aids or effective medicines. He then had to see through the course of an illness or of recovery from an injury until the ship reached port, sometimes a matter of months for a sailing ship. If there were several incapacitated seamen this could affect the operation of the ship. If a condition was contagious there would be concern about other crewmembers developing the condition, or about quarantine on arrival in port. In extremis he had to read the committal service and bury the body at sea. The captain and sometimes the mates were very much alone with their responsibilities.

Only a few of the larger ships, those with more than one hundred ‘souls’ on board, carried a surgeon. Often the prime role of the surgeon was the care of passengers, and it was for this reason that surgeons were a requirement for immigrant ships; as they had been for slave, convict and troop ships from an earlier date.

Who is responsible for the health of seamen?

Prevention of illness and injury in seamen and the management of their illnesses and injuries had developed over the years such that in the early twentieth century it was the province of many different agencies, including several departments of government, individual shipowners, public health authorities and voluntary bodies. But by the 1920s there was an expectation of a co-ordinated and consistent approach and one apparently simple question had become dominant: who is responsible for the health of British seamen? It was a question that was in reality far from simple, and there were a lot of interest groups seeking to keep the issue unresolved or decently out of sight. One parliamentary exchange provides a contemporary insight:

A true and fair picture

As the hostilities of the Second World War were drawing to a close, a new conflict arose in a scientific journal that related to the frequency of illness in seamen as compared to other groups of workers. This was perhaps a reflection of the importance attached to this topic during the war, and also shows a move away from the earlier neglect of seamen's health by those in the maritime world to a new concern that any risks to their health might be exaggerated. Exaggeration would bring the dangers of public campaigns for reform – a threat to both government and shipowners – and this could in turn strengthen the hands of seafarers' organisations at a time when the nationalisation of industry and the benefits of a planned economy formed a large part of political debate.

An editorial published in the new British Journal of Industrial Medicine, a journal that was itself a product of the greater use of science to improve practice under wartime conditions, stated that the mortality rate of seamen from all causes of death was double that in the general population, while for tuberculosis it was four times higher. These figures were contested by several of the leading doctors working in the maritime industry, and this inaccuracy was discussed with Sir William Elderton, the deputy government actuary and a former statistical adviser to the Ministry of War Transport, who agreed that they were not supported by the evidence.

The maritime industry differs in many ways from onshore sectors of industry. It was the first truly global enterprise, crossing national boundaries as soon as nations were invented, and encircling the world for the last 500 years. It was the first industry to create and develop many of the methods for the financial management of business risks that are now in widespread use, for instance shared ownership of ships, with profits allocated in proportion to the share owned, and insurance for ships and cargoes as a risk-sharing device. The complex of trade, financial services, logistics and subject expertise that is now a feature of all developed economies originated in port cities. At an early stage the shipping industry gained experience of both the opportunities and abuses that can stem from every aspect of this business complex. Shipping was closely linked with the state throughout the era of European expansion around the world, which was marked, for much of the time, by a British domination of international maritime trade, with the force projected by a powerful navy ready to support it. Skilled crewmembers were seen as common to naval, merchant and fishing activities and in times of war were forcibly impressed for service with the Navy, while merchant ships were taken up from trade in many wars to meet the logistic requirements of the military.