APPENDIX K. REPORT ON THE HYGIENE OF THE MERCANTILE MARINE WITH RECOMMENDATIONS. BY P. H. BAILHACHE, M. D., Surgeon U. S. M. H. S. REPORT ON THE HYGIENE OF THE MERCANTILE MARINE AND WHAT LEGISLATION OR OTHER MEASURES ARE DESIRABLE OR EXPEDIENT TO PROMOTE THE SANITARY CONDITION OF THE MERCHANT MARINE. In accordance with the direction of the Surgeon-General of the United States Marine Hospital Service, who was requested by the National Board of Health to detail an officer for that purpose, I have prepared, and have the honor to present herewith, "a report upon the hygiene of the mercantile marine and what legislation or other measures are desirable or expedient to promote the sanitary condition of the merchant marine." As it was not practicable at the time for me to visit the various ports of the United States to obtain the desired information in preparing my report, I addressed a circular letter to the medical officers of the Marine Hospital Service, stationed at the principal ports of the United States, with a view of obtaining such facts as would lead to a practical demonstration of the necessities of the merchant service for more effective hygiene measures than at present exist. The circular letter above referred to called for the following information: a. Ventilation and general condition of passengers' quarters. b. Ventilation and general condition of officers' quarters. c. Ventilation and general condition of seamens' quarters. d. Condition and location of beds or bunks, in each of foregoing. e. Character and amount of water supply for drinking and cooking purposes. f. Character and amount of food furnished, and how prepared, including anti-scorbutics. 9. Is food inspected before going to sea? h. Tour of duty imposed on officers and men, and pay allowed. i. Relative to medicine chests, and care of seamen during a voyage. j. Provisions for safety in time of storm and shipwreck. Second. Seamen on shore. a. Character of seamen with reference to their habits, &c. b. Seamen's boarding-houses, their character, charges, &c. c. Seamen's boarding-houses with reference to food, ventilation, &c. d. Boarding-house keepers and shipping agents-do they impose certain restrictions on seamen relative to shipping, &c., requiring them to board at certain houses? e. Advance wages, and the effect thereof. f. 'Longshoremen and their relation to the mercantile marine. g. Number of seamen shipping from your port. h. Closure of navigation and its effects. Third. Preventable diseases. a. Principal diseases of a preventable character observed. b. Plan for prevention of such diseases. e. Plan for arresting their spread, if prevention is not practicable. Fourth. Physical examination of seamen. a. Plan of such examination as will meet with favor. b. Relative to a United States seaman's snug harbor for permanently disabled sea men. Fifth. Apprentices. a. How to increase the efficiency of the merchant marine. NOTE. "The Marine Hospital Service is the medical department of the mercantile marine of the United States. It was established in 1798, and is charged with the duty of preserving the health interests of the officers and seamen employed on American vessels engaged in foreign, coastwise, and inland commerce." (Reg. U. S. M. H. S., 1879.) The following was also requested: 1. Number of crew to tonnage. 2. Cubic air-space per man. 3. Superficial surface per man. 4. Hospital accommodations on passenger and on emigrant vessels, including space allowed. 5. Bathing appliances on board. 6. Locality of water-closets. 7. Any special arrangements for the accommodation of female and infant passenger. In response to my letter, reports were received from a number of the officers of the service, expressing great interest on the subject, many of them answering in detail the various questions propounded. Taking them up in regular order, under the first heading relative to ventilation, and general condition of passengers', officers' and seamen's quarters (a, b, c), there was a general concurrence of opinion, viz: the condition of passengers' and officers' quarters was usually "fair to good," but those of the seamen were reported as "miserably deficient, damp, dark, and unhealthy; only ventilation is through a companionway, or through a small window by 12 inches; quarters close and confined, almost unventilated, generally poorly lighted, as a rule, miserable dens with little cubic airspace per man, and imperfectly ventilated." A few exceptions were made in the case of steamers of well-known popular lines, and of such other vessels as have placed houses on their forward deck. d. The condition and location of beds and bunks of passengers and officers were usually found to be in accordance with law and tolerably satisfactory; but those of the seamen were variously represented from "indifferent" to "very bad," and from "very bad" to "none at all being provided in good sized vessels." "Seamen are are always expected to furnish their own bedding (dunnage), tin dishes, &c., but frequently go to sea unprovided"; it is reported that on coasters "five out of every ten seamen have no beds." Their bunks, "if they have any, are usually located in the forecastle, a dark, comfortless, and illy ventilated portion of the ship"; sometimes they are placed in the amidships house or forward house, "but in either position are devoid of comfort," though in the latter places are better ventilated. In many instances "the seamen's quarters are very filthy and filled with vermin." e. The water supply is usually abundant, and in excess of the requirements of law; it is usually believed to be as pure as is generally obtained for domestic purposes on shore, but is never inspected by any authorized person. It is carried in casks or tanks, or both, and these are not inspected. In some of the large trans-Atlantic steamers, condensed water is used for culinary purposes. f. The character and amount of food is generally satisfactory, and in quantity exceeds the requirements of law; this does not always apply in case of emigrant vessels. Large vessels bound on long voyages are usually provided with lime juice and other anti-scorbutics; they also have a supply of canned meats and vegetables. g. No inspection is made of the food, either as to quality or quantity, before departure from port, except in rare instances. h. The tour of duty imposed upon seamen depends greatly upon the size and character of the vessel. On steamers and large sailing vessels the routine duties are divided into day and night watches, four hours on and four hours off, except the "dog watches" of two hours, from 4 to 6 and from 6 to 8 p. m. On coasters there is no fixed rule, as the duties depend on the length of the trip. The pay of seamen ranges from $12 to $30 per month-the former figures for boys, and the latter for good able-bodied men; mates, engineers and stewards receive from $40 to $60 per month, and captains $100 to $150; the latter figures apply to large steamers-the amount paid is sometimes in proportion to the profits of the trip, if so agreed. i. Medicine chests are carried in most instances, both by steamers and sailing vessels, if over 75 tons burden, in accordance with law, but the medicines contained in them, if they happen to have any, are usually stale, and not suited to the wants of a sick or disabled seaman during a voyage; besides, there is an imperfect knowledge of how to administer them. No regular inspection is made of these chests, as to the quality or condition of the drugs, though required by law, nor are they replenished unless the captain chooses to have them overhauled. This does not apply to the large trans-Atlantic and Pacific steamers, many of which are not only supplied with necessary medicines and appliances, but also employ a medical officer on board. The small coasters are provided with nothing in the shape of medicine except, perhaps, "bitter salts," which is poured down the men for every disease complained of. No vessels, large or small, so far as reported, are provided with accommodations for sickness or accident to seamen on board. A "sick bay," or "hospital quarters," except in very rare instances, is unknown to the merchantman, although required by law. j. Provision for the safety of passengers and crews, in time of storm or ships wreck is ample for ordinary accidents, but in case of total destruction or sinking of passenger vessels the supply of life-saving apparatus, &c., is entirely inadequate, andi n some instances the life preservers are out of order, or are in such obscure places that they cannot be found when needed, while the small boats are frequently the receptacles of odds and ends and are not available when needed; nearly all emigrant vessels are insufficiently supplied in case of total destruction of the vessel. Under the second heading, "Seamen on shore" (a), there was but one opinion expressed, and that an adverse one, as to the character and habits of seamen on foreigngoing sailing-vessels as well as on many of the coasters and steamers, though at the extreme northern ports, and one or two southern ports, and on the lakes, a better class of men usually follow the sea, and many of them are heads of families. b. Seamen's boarding-houses are of all kinds, from the lowest dens and dance houses frequented by the worst classes to quiet and respectable "homes"-the greater proportion being of the former kind. The charges range from $4 to $7 per week, and the food furnished is plain, but usually abundant, though badly cooked. c. Ventilation is a subject not considered, and the crowding of many persons into a small, dark room on shore is frequently worse than the "horrors of the forecastle." d. Boarding-house keepers and shipping agents are regarded by Surgeon H. W. Austin, U. S. M. H. S., Southern Atlantic district, as "the greatest evil to the health, prosperity, and welfare of the merchant marine that exists; they rob the sailors of their scant earnings, deprive them of their freedom, and ruin their health as well as morals; they control and furnish the majority of crews shipped, and charge the sailor from $2 to $5 for securing him employment; they board all vessels when they arrive in port, and represent to the men that they can give them the best accommodations, and will guarantee them another voyage; they will get them drunk, charge each one with all the liquors consumed and prevent their shipping again until their money is all gone, and the advance wages which they can procure by shipping them on a few weeks' voyage. When they return to port they have no money and are compelled to return to the same or a similar boarding-house in order to obtain board and again find employment. I personally know this to be true, having witnessed it." At some ports the boarding-house keepers and shipping agents form a league, in which it is agreed that seamen who do not patronize certain boarding-houses shall not be allowed to ship. These houses charge $7 per week for board, and if a seaman goes to a cheaper house, or one of his own selection, his "chance" for shipping at that port is lost, and he is forced either to leave the city or board with his worst enemy. . The advance wages" system is regarded by some as a necessary evil, but the weight of evidence shows that such "advances" generally fall into the hands of boarding-house keepers or their agents, and do not go to the family of the seaman or to his own credit, while out of employment. In the language of Assistant Surgeon John Godfrey, U. S. M. H. S., "No matter how much we deplore the condition of 'poor Jack,' made the victim as he is of sharpers on all hands, no one cares to extend the hospitalities of a home to him." Passed Assistant Surgeon J. M. Gassaway, U. S. M. H. S., District of the Pacific, writes as follows: "The subject of advance wages I approach with considerable hesitation; to my mind it presents the key note of discord between the sailor and the merchant, and the sailor and the public generally. It has proved itself abundantly to be an almost unmitigated nuisance, and on its continuance depends a continuance of the brutal atrocities on the part of boarding-house masters, which are too common to need examples here. If the sailor is ever to be made a reasoning being, he is to be made so through the abolition of the advance system. On this coast, wages are from $20 to $30 per month, and the advance paid is from one to three months' wages--more often the latter. This advance is in the form of a note, payable three days after the vessel sails, by the agent of the vessel at the port whence she sails, and is indorsed to the boarding-house master. The men who have signed the articles are put aboard at the appointed time so drunk, 80 per cent. of them, that they are useless for twentyfour or forty-eight hours. On getting to work the officers rapidly discover that of all the crew that shipped as able or ordinary seamen, less than one-half (less than onefourth in many cases) of the men who have been paid in advance for two or three months are competent to perform any of the more important duties of the grade for which they have shipped, and, as occurred at this port a few months ago, one-half of the crew shipping as ordinary seamen had never been out of sight of land in their lives before. "The effect on the crew is no less disastrous; suffering from the effects of his last debauch, brought to a more or less sudden close, sore from the beating his boarding master has deemed necessary to inflict to get him aboard, or to settle a disputed account, his earliest reflections are, that the lion's share, if not all, of his yet unearned pay for the next two or three months is in the pocket of his betrayer in liquidation of whisky bills at fabulous prices, or the purchase of some articles of his 'kit,' the worthlessness of which may be gathered from the fact that it is necessary to replenish it every voy. age. A man under such circumstances cannot perform his duty readily-sulky, ill humored, as slow as he dare be, careless, designedly inefficient, is it singular that the largest number of sea-going vessels that are wrecked are lost on their outward passage! The advance wages system is the curse of the seaman. No one profits by it except the boarding-house master and his satellite. It is a direct and powerful incentive to Scoundrelly shipping-masters to drug and intoxicate boys and old men, epileptics and maniacs (one such case having been brought to this office within a month or two), in order to get their advance. The best interests of all concerned make it imperative, in my opinion, that legislation looking to the entire abolition of the advance system be at once had. Stern necessity will teach the sailor, as it has taught the farmer, the merchant, the mechanic, the laborer in every other calling, that the wages from the last job must be husbanded until another is obtained. That an advance is not absolutely necessary may be gathered from the fact that the United States Navy and the Revenue Marine are constantly besieged by eager applicants to enlist as seamen for less pay, stricter discipline, and obligations to provide a uniform, than are found in the merchant service, and without an advance, and, he might have added, 'submit to a thorough physical examination before enlistment."" (f.) The relation of longshoremen to the merchant marine consists in their being the laborers, or loaders and unloaders of vessels, occasionally making a trip on coasters, but seldom going on deep-water voyages. Their habits, tastes, and surroundings are much the same as sailors on shore. Occasionally seamen will engage in this business to obtain ready money, but usually longshoremen are a distinct class who follow no other pursuit. On the inland waters they are called 'roustabouts' or 'rousters,' and some of them are even more deplorable in their habits than the worst old tar. (9.) The estimated number of seamen shipping on American vessels, including inland lakes and rivers, is about two hundred thousand, and the average time employed about eight months in the year. (h.) The closure of navigation, laying up for repairs, and dullness of business during certain months in the year will account for the loss of time above indicated. The effect of the closure of navigation is shown in the increased number of applicants for relief at United States marine hospitals. The total amount of sickness and disability among the merchant seamen, estimated upon the annual reports of the SurgeonGeneral of the United States Marine Hospital Service, is about 10 per cent. of the estimated number of seamen employed in the merchant marine service-or, in round numbers, twenty thousand-about as many sick and disabled annually as there are enlisted men in the entire Army of the United States. Under the third heading, among the "preventable diseases" which afflict the seamen of the merchant service, venereal diseases stand first, causing, it is believed, twenty per cent. of the cases treated by the medical officers of the Marine Hospital Service; then follow consumption, rheumatism, malarial fevers, diarrheal diseases, pneumonia, &c. Along the coast of Florida injuries to the chest from "sponge spearing" are reported as quite frequent. (b and c.) The remedies that have been suggested are physical examinations, to prevent the occurrence and spread of venereal diseases, and the more careful observance of hygienic laws on board ship and ashore to lessen the occurrence of other preventable diseases. Under the fourth heading, "The physical examination of seamen" is regarded by all from whom I have heard as not only a proper hygienic measure, but actually one of the necessary forerunners to a better sanitary condition of the mercantile marine. Assistant Surgeon John Godfrey, U. S. M. H. S., port of Mobile, says: "Certainly every seaman, when shipping, should be compelled to furnish or present a certificate of physical soundness, and such certificate should be made out only by his best guardian-an officer of the Marine Hospital Service-for otherwise there is always in every port at least one doctor mean enough, for a consideration, to furnish a health certificate to a seaman with any affliction, from a 'Barbadoes leg' to an 'aortic aneurism.' Such fellows, too, would make out all the certificates, unless prevented by law, as the customers would be brought by boarding-house keepers, with whom they would divide. I do not see, however, how an examination by the proper officers could always be effected, unless each vessel was invariably inspected before going to sea, as many masters of vessels are opposed to having their crews examined and willing to take them without. One master confessed to me that he would prefer one or two sickly men, provided he could get them at reduced wages, as upon getting to sea he could drive the others to do their work,' and thereby make the voyage far less expensive. While such heartlessness and short-sightedness exist, you see that there is much to be done, and many obstacles in the way of doing it." The plans suggested for physical examination are generally those recommended by the writer and published in the Annual Reports of the Surgeon-General, U. S. M. H. S., 1875-76-77. They will be briefly presented in another portion of this report. [A recent circular of the Treasury Department, issued by Surgeon-General Hamilton, has inaugurated a voluntary plan of physical examination, which, it is believed, will gain friends for the measure, and eventually result in its adoption at all the principal ports. ] (b.) A United States Seaman's Snug Harbor, for aged and permanently disabled seamen, first suggested, I believe, by Surgeon-General Hamilton, is a measure so fully recognized by all persons interested in the merchant marine service, that it is only necessary for me to say that but one expression of opinion was received from all ports, and that a favorable one. Under the fifth heading, in regard to apprentices, it appears that captains will not be bothered with boys as apprentices if they can avoid it, and as the present law only provides how they shall be indentured and is not compulsory as to their employment, boys are seldom taken as apprentices; hence our American seamen, if educated at all, are self-educated in the science of seamanship, and we have to depend almost wholly on foreigners to man our ships, many of whom can neither speak nor understand our language. This, it is generally agreed, can only be remedied by amending the law so as to make it compulsory on captains to carry apprentices—a certain number to tonnage and by a new law instituting school-ships for boys. Assistant Surgeon Godfrey thinks that "unless some barrier be raised against the employment of unsound seamen apprentices will degenerate in the usual length of time into the ordinary broken down tar; those that would stand proof against corruption would, like three-fourths of the American sailors, get to be masters of vessels, leaving the crews to be made up, as they are now, of the other broken down fourth, and of second rate foreigners.""" (1.) The number of crew to tonnage varies according to the rig of vessel, and peculiar ideas of her captain. One man to each fifty tons is about a fair average for sailing-vessels of four hundred tons and upwards; smaller vessels require more men in proportion; steamers average about one man to each one hundred and twenty-five tons. (2.) Cubic air space to each man also varies from about 50 or 75 cubic feet in some forecastles to 200 in others. (3.) Superficial surface, 14 and 16 feet per man, depending on height of cabin, and in compliance with law. (4.) No hospital accommodations are furnished except in rare instances. (5.) No bathing appliances for seamen other than hand wash-basins and buckets. (6.) Water-closets on passenger-vessels are forward, amidship, or aft, and are usually in good order. On sailing vessels, aft for officers, forward (if any) for crew. On the smaller vessels, coasters, &c., no accommodations whatever exist, and more than one seaman has fallen overboard from the forechains and been drowned while attending the call of nature. (7.) No special accommodations are reported as existing on sea-going vessels for the special accommodation of female and infant passengers. I have thus briefly presented the principal points touched upon by the officers of the Marine Hospital Service, in answer to certain questions. The contributed papers of the above named officers, which have appeared from time to time in the annual reports of the chief of that service, give vivid pictures of the conditions and influences affecting the health of seamen afloat and on shore. In the report of 1873, Surgeon Heber Smith's paper, entitled "The Sailor and the Service at the port of New York," follows the sailor from his arrival in port to his departure upon another voyage, and after his capture by a landlord, who claims him "body and soul" on the ground of advance wages previously furnished, thus speaks of his boarding-house, and the effect of the advance wages system: "Situated in the very worst parts of the city, in old, dilapidated houses, reeking with filth and overrun with vermin, the sailor is shown to a bunk in a room that has as many double, and in some cases treble, tiers as it will hold, and without the sign of a convenience for the ordinary necessities of life; and that is his lodging place. In the saloon or living room of the house he is surrounded by a crowd of creatures, male and female, in various stages of intoxication; and can it be thought strange if, under such circumstances, he immediately proceeds to get as drunk as his associates? But the curse of the advance wages system does not end with the demoralization, the drunkenness and debauchery, and consequent evil to moral and physical health wrought in the boarding-house. As it seizes upon him the moment the sailor sets foot on shore, so it follows him until he is again afloat, and the world is sick of the details of the methods of shipping crews and the cruelties practiced upon them at sea. Can these evils, which are ruining our mercantile marine, which, by destroying the efficacy of the sailor, are not the least important factors in the production of avoidable shipwreck and disaster, and which are more potent than all else in filling our hospitals, can they be remedied? There has been an attempt to do so by the framers of the shipping act (1872) by placing certain restrictions on the payment of advance wages. But the restrictions are easily evaded, and have done little or no good. The disease is too serious and too deep-rooted to be overcome by half-way measures; only the most heroic treatment will avail. The testimony of all who have studied the subject practically is to the effect that there can be * First-class foreign sea men seldom ship on American vessels. |