Handbook of Nautical Medicine

507 Pages·1984·13.813 MB·English

by  H. Schadewaldt, W. H. G. Goethe (auth.), Professor Dr. W. Hartmut G. Goethe, Dr. E. Norton Watson, Dr. Dilwyn T. Jones (eds.)

"More may be done towards the preservation of
the health and lives of seamen than is commonly
imagined; and it is a matter not only ofhumanity
and duty, but of interest and policy."*
Sir Gilbert Blane
* Observations on the Diseases of Seamen, 1789
Handbookof
N autical Medicine
Edited by:
W. H. G. Goethe . E. N. Watson . D. T.Jones
With 38 Figures and 12 Tables
Springer-Verlag
Berlin Heidelberg NewYorkTokyo 1984
Professor Dr. W. Hartrnut G. Goethe
Scientific Director
Bemhard-Nocht-Institut für Schiffs-und
Tropenkrankheiten, Abt. für Schiffahrtsmedizin,
Bemhard-Nocht-Straße 74,2000 Hamburg 4/FRG
Dr. E. Norton Watson
formerly Chief Medical Officer
General Council of British Shipping,
London/UK
The Late Dr. Dilwyn T.Jones
formerly Medical Officer Health
Port and City of London/UK
ISBN-13 :978-3-642-69417-2 e-ISBN-13 :978-3-642-69415-8
DOI: 10.1007/978-3-642-69415-8
Library of Congress Cataloging in Publication Data. Main entry under titIe:
Handbook of nautical medicine.
Bibliography: p. Includes index.
1. Medicine. Naval-Handbooks. manuals, etc. I. Goethe, W. H. G. (W. Hartrnut G.), 1923 -11. Watson, E. N.
(E. Norton), 1921 - III.Jones, D. T. (Dilwyn T.), 1927-1982 [DNLM: 1. Naval medicine-Handbooks. VG 460 H236]
RC986.H29 1984616.9'8024 84-1211
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©Springer-Verlag Berlin, Heidelberg 1984
Softcover reprint of the hardcover 1st edition 1984
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2119/3020-543210
Contributors
Anderson, W. R, MD,
Anderson Medical Group, Inc., San Pedro, California 90731, USA
Badehaus, A, Dr. med., OMD,
Port and Airport Health Authorities, Hamburg, FRG
Bäter, H., Dr. med. dent.,
Lauenburg/Elbe, FRG
Ball, Tb.,
Bernhard-Nocht-Institute for Nautical and Tropical Diseases,
Department of Nautical Medicine, Hamburg, FRG
EI Batawi, M. A, Prof. Dr. med.,
Chief Medical Officer, Office of Occupational Medicine, WHO, Geneva,
Switzerland
Boehm, H., Professor, Dr. rer. nat., Dipl.-Psych.,
Nautical School, Bremen, FRG
Cox, RAF., MA, MB, BChir, MFOM,
Medical Director, Phillips Petroleum Company Europe-Africa, London,
UK
Dolmierski, R, Professor, Dr. med.,
Director Institute of Maritime and Tropical Medicine, Gdynia, Poland
Duffy, J. c., Professor Dr.,
Assistant Surgeon General, Office ofthe Surgeon General U.S. Public
Health Service, Rockville, Md, USA
Ebert, H., OMR Doz. Dr. sc. med.,
Medical Service ofthe Transport System ofthe GDR, Rostock, GDR
Gardner, A Ward, MD, FRCPI, FFOM (Ireland), FFOM (London), DIH,
Esso Medical Centre, Fawley, Southampton, UK
Goethe, W. H. G., Professor Dr. med.,
Scientific Director
Bernhard-Nocht-Institute for Nautical and Tropical Diseases,
Department of Nautical Medicine, Hamburg, FRG
Harrington, J. M., Professor, MSc, MD, FRCP, FFOM,
Tbe University of Birmingham, Institute of Occupational Health,
Birmingham, UK
VI Contributors
Herrmann, R, Dipl.-Ing.,
Bernhard-Nocht-Institute for Nautical and Tropical Diseases,
Department of Nautical Medicine, Hamburg, FRG
Huisman, J., Professor Dr. med.,
Chief Department for Communicable Diseases and Hygiene, Municipal
Public Health Service, Rotterdam, Netherlands
Ivergard, T., PhD, ScD,
Scandinavian Airlines System (SAS), Stockholm, Sweden
Jamall, O. A., FRCS (Edin.)
Consultant Orthopaedic Surgeon, Dreadnought Seamen's Hospital,
Greenwich, London, UK
The Late D. T.Jones, BSc, MB, BCh, MFCM, DCH Eng, DPH,
formerly Medical Offker of Health, Port and City of London, UK
Low, A., Dr. med.
Bernhard-Nocht-Institute for Nautical and Tropical Diseases,
Department of Nautical Medicine, Hamburg, FRG
Milton-Thompson, G.J., Surgeon Commodore, QHP, FRCP,
Deputy Medical Director General (Naval), Ministry ofDefence, London,
UK
Naeve, W., Professor, Dr. med.,
Forensic Medical Service, Hamburg, FRG
Ohashi, N., Senior Research Fellow,
Maritime Labour Research Institute, Tokyo, Japan
Oliver, P.O., RD, MD, FFOM RCP, DPH, DIH,
Group Medical Director, Cunard Steam-Ship Company, Southampton,
UK
Pettersen, J. W. E., B. Sc. (Eng.)
Principal Research Engineer, Det Norske Veritas, H0Vik, Oslo, Norway
Renfrew, R R, MB, ChB, MFOM,
Medical Officer, Fish Docks Medical Services, Grimsby, UK
Shafran, L., MD, Dr. med. sc.
Branch of the Institute of Watertransport Hygiene, Toxicological
Laboratory, Odessa, USSR
Sobol, Z., Dr. Ing.,
Institute of Maritime and Tropical Medicine, Head of Department of
Transport Hygiene and Environment Protection, Gdynia, Poland
Schadewaldt, H., Professor Dr. med.,
Director of the Institute for History of Medicine of the University of
Düsseldorf, FRG
Stenko, J. M., Professor Dr. med.,
Director Scientific Research Institute of Water Transportation and
Hygiene, Moscow, USSR
Contributors VII
w.,
Tenfjord, O. MD, DPH,
The Medical Office for Seamen, Oslo, Norway
Tortori-Donati, B., Professor Dr.,
Finmare, Medical Department, Genova, Italy
Vollum, D., FRCP, DCH,
Consultant Dermatologist, Lewisham Hospital, London, UK
Vuksanovic, P., Dr. med. Dr. sc.,
Head of Public Health Service, Medical Center "Blaio Orlandic", Bar,
Yugoslavia
Watson, E. N., MRCS Eng, LRCP (Lond), MFOM RCP,
formerly Chief Medical Officer General Council of British Shipping,
London, UK
Williams, J.G., Surgeon Commander, MSc, MRCP,
Professor of Naval Medicine, Royal Naval Hospital, Haslar, Gosport, UK
Zorn, E., Priv. Doz. Dr. med. Dr. sc.,
formerly Senior Scientist
Bernhard-Nocht-Institute for Nautical and Tropical Diseases,
Department ofNautical Medicine, Hamburg, FRG
Foreword
International cooperation on the health of seafarers began many years ago. As early
as 1921, an international convention regarding this matter was presented to govern
ments of maritime countries for ratification. The First World Health Assembly, in
1948, recommended that WHO should establish, with the International Labour Of
fice, a Joint Committee on the hygiene of seafarers. The first session of this Com
mittee, held in 1949, defined the problems affecting the health of seamen and made
a number of recommendations.
In the opinion of this Joint Committee, the health of seamen called for interna
tional attention for a nu mb er of reasons. By the nature of his work, the seafarer is
obliged to travel from country to country and is exposed to great variations of cli
mate and also to any disease that may be prevalent in the port of call. He may there
fore become a carrier of disease, so that the protection of his health is of importance
not only to himself and the other members of the crew but also to the populations of
other countries he visits. Yet, on account ofthe nature ofhis employment, it is diffi
cult to provide the seafarer with the same standard of health care that is gene rally
available to other sections of the population.
At the time of the opening session of the Joint Committee, the following factors
were of most importance to the seafarer's health: medical examinations, medieine
chests on board, accomodation and food supplies on board, hospital treatment, re
habilitation and social welfare. The Committee made recommendations aimed at
finding solutions to problems in these areas. Also, proposals were made regarding
the control of tuberculosis and venereal diseases among seamen.
In 1954, the Joint ILO/WHO Committee met for the second time and suggested
the minimal list of medicaments which should be contained in a ship's medicine
chest. It also discussed the model scheme of diagnosis, treatment and other control
procedures in venereal infections, reviewed the diagnostic and therapeutic mea
sures for these infections in a number of large ports throughout the world and dis
cussed the medical examinations of seamen to detect tuberculosis.
Ouring the third meeting of the Committee, in 1961, it was realized that it had
been difficult to present adefinite picture of seafarers' health problems as very little
accurate or reliable data had been available. Not all countries were able to give pre
eise employment statistics regarding seafarers. Even fewer countries were able to
provide an age group structure of their merchant navy personnel. Without such in
formation, no morbidity study was possible. Also, there was considerable variation
in the problems encountered between various countries owing to different geogra
phical and soeial conditions.
A further step in expanding the international cooperation on the health of sea
farers was the WHO International Medical Guidefor Ships. published in 1967.
Following the resolution ofthe World Health Assembly, WHO Pilot Health Cen-
X Foreword
tres for Seafarers were designated in Gdynia, Poland and Auckland; New Zealand
in order to collect international data on morbidity and aceidents among seafarers,
to conduct research related to their health, to provide medical and dental services
for seamen and fishermen and to conduct postgraduate training in maritime medi
eine. In 1975, the Department ofNautical Medieine, Hamburg, was also designated
byWHO.
The fifth (1973) and sixth (1981) sessions ofthe Joint Committee in Geneva.dealt
with medical and first-aid training for ship personnel, preventive care ofteeth and
mouth and emergency dental faeilities for seamen in ports, medical examination of
crew members of tankers carrying bulk chemicals, existing medical centres for sea
men, immersion hypothermia, recording of medical examinations and treatment of
seafarers and the updating of the International Medical Guide for Ships. In 1982, in
collaboration with the Centre in Gdynia, this Guide was updated and the new edi
tion will be published by WHO in 1984.
With developments in the world shipping industry during recent years - the in
troduction of new types of ships and new technologies - the pattern of the health
problems of seafarers has changed. Infectious diseases have become less important
(in fact, smallpox was completely eradicated from the world in 1976). One of the
new problems has been their exposure to the dangers connected with carrying
chemical cargoes in bulk. This new challenge has been met by experts and by inter
national organizations. In 1973, the Medical First Aid Guidefor Use in Accidents In
volving Dangerous Goods was published by IMCO. Other problems inc1ude the ef
fect of environmental stress on the seafarer's health the psychosoeial aspects of
work on-board ship, the need always to maintain high standards of health on mod
ern, highly automated ships, on which the number of crew has decreased compared
with standards existing in the 1960s and 1970s, and also the need to introduce the
telemetric system of exchanging health information from ship to shore-based hospi
tals.
All these and many other problems still need to be studied and answers found
through the combined efforts of shipowners, seafarers, seientists and experts in
maritime medieine.
For all of them, the Handbook of Nautical Medicine will be an excellent source of
up-to-date information on all relevant subjects. It will also provide a source of in
spiration for further research and efforts to improve the environmental conditions
on board ships which influence the health of seamen and to improve the health ser
vices provided for them, both at sea and on shore.
The Handbook is an important contribution to international cooperation on the
health of seamen. Experts, invited by the editors and representing a number of well
known research centres on maritime medicine from eleven countries, have present
ed here a wide range of subjects c1early and coneisely, indicating appropriate direc
tions for further research.
Dr. M. A. EI Batawi
Chief Medical Officer
Office of Occupational Health
WHO,Geneva
Preface
Over recent decades the shape ofthe shipping industry has changed considerably in
response to the pressures exerted by changing international patterns oftrade togeth
er with the swings of fortune in national economies. Many of the traditional mari
time countries have suffered a decline in their fleets while over the same period
there has been a corresponding increment in those of emerging countries. The
competition for available cargoes in depressed world markets has been intense.
However, the international trade in exports from and imports to countries through
out the world is stilliargely dependent upon transport by sea. This has been respon
sible for the continued growth of the shipping industry as a whole, despite the loss
of passengers to air and land travel, which has resulted in the severe decline in the
number of passenger liners. Indeed, it is estimated that there is a total world
strength in excess of 70000 ships registered within the fleets of over 70 maritime
countries.
A direct consequence of heightened competition in international sea trade has
been the impetus given to continuing advances in ship design, technology and cargo
handling. This has led to the development of larger, faster ships manned by fewer
crew and spending much less time in port. In many countries the average cargo ship
carries only 20 crew members and this complement has been reduced still further by
some shipping companies. The advent of container ships and other highly specia
lised types, such as carriers of bulk chemicals, liquified gas, oil and ore, has brought
additional attendant problems for both seafarers and the occupational doctors con
cerned with health and welfare.
The unfortunate impact of these commercial changes has been that nowadays,
with the exception of certain eastern European countries, few doctors are carried by
merchant ships and, regrettably, just as few are employed in full-time practice in
maritime organisations and shipping company offices ashore. This is a matter for
continuing concern because, although living standards on ships have improved, it
has yet to be shown that these have produced a commensurate improvement in the
health of crew members. It is quite possible to argue that the reduction of hard
physical work in conjunction with plentiful rich food and cheap tobacco and alco
hol has had a deleterious effect. Furthermore, the alm ost universal trend towards
single cabins for all crewmembers is not always psychologically beneficial.
It is true that a carefully selected smaller crew should result in a higher average
standard of health on board irrespective of a possible healthier environment. The
drawback is unfortunately that given a smaller crew, there is less reserve to cushion
the effect of interim illness among crew members. Therefore, the pre-employment
medical examination should be made even more stringent to exclude anyone who
has a condition, or pre-condition, which might develop into unfitness for work at
any time in the future. It is alm ost universally agreed that medical examinations of