Levy, Samuel

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30 Augustus 1969 S.A. TYDSKRIF VIR GE EESKU'DE 1079A SURVEY OF SEA DISEASES 0 SOUTH AFRICAN SHIPS*SAMUEL LEVY, M.B., CH.B., Cape TownSea diseases first made their appearance on a large scalewhen the voyages of discovery lengthened during the 16thcentury. Over the succeeding two centuries these diseasesflourished during the long trading adventures to the East.They were finally overcome towards the close of the 19thcentury.'In 1781 it was reported by Sir Gilbert Blane' that Iin 7 eamen died at sea; of this number less than lO~odied of battle wounds. James Lind: in 1774, listed themajor causes of illness in seamen, in order of frequency,as fevers (typhoid, typhus, plague, malaria and yellowfever), scurvy, venereal disease, consumption, rheumatismsand fluxes (diarrhoea).The tremendous improvement in the health of seamenin recent years i due mainly to improved living condi-tions on board ships, and also to a gradual advance intheir medical care.This report is a survey of illnesses and accidents occur-ring among seamen serving in 18 cargo-liners of a SouthAfrican shipping company during 1967.MATERIALThe crews investigated consisted of White adult maleofficers of South African or European extraction. Thepetty officers and ratings were Coloured males living inCape Town and its surrounding areas. The crew membersserve at sea for an average period of 9 months, afterwhich leave is usually taken.Voyages are undertaken from South African ports toports in Central and North America, Japan and the FarEast, and the United Kingdom and Western Europe. Theduration of stay in one port varies from less than I day toIS days. The voyage between ports may vary from lessthan I day to 22 days.At sea a designated officer attends to any medical com-plaints. This officer has at his disposal first-aid training, a'Date received: 14 January 1969.standard medical guide for ships' officers' and a drugsuppiy as stipulated by the South African Mini try ofTransport." In an emergency radio advice may be re-que ted from the nearest port. At all ports qualifiedmedical attention is available.This urvey is based on accident and illness reports re-turned to head office in Cape Town by the attendingdoctors at the various ports of call.RESULTSTable I shows the number of officers and ratingsper ship. Also tabulated is the number of visits to doctorfor accidents or illness. One accident or illness may re-quire one or more visits in the same or subsequent ports.From Table 1 it may be seen that there are 5 times thenumber of visits for illnesses as compared with accident.The visits for accidents and illnesses were proportionately30~o and 100% higher for ratings than for officers.Table II indicates the frequency of visits for accidentsand illnesses in different categories. The further break-down of these figure will be di cussed later.TABLE 11. ANALYSIS OF MEDICAL VISITSI/mber of visilS% of lowlCondilion Officers Crew To/(/I visilSAccit:ents 101 251 352 16·1Dental 96 318 414 18-4Skin diseases 73 205 278 12·3Venere.al diseases 33 228 261 11·6Musculoskeletal 30 191 221 9·8Gastro-intestinal 51 154 205 9·0Respiratory 54 J 15 169 7·5Ears 41 72 113 5·0Eyes 17 61 78 3-4Other 30 127 157 6·9Totals 526 1,722 2,248 100·0TABLE I. NUMBER OF CONSULTATIO SManning Accidents IllnessS:,ipTowl Officers Ratings Totalnl/mber Officers Rarings Officers RaTingsI 18 27 3 17 20 19 82 1012 18 30 2 17 19 27 67 943 20 30 6 9 15 22 79 1014 18 27 1 13 14 19 65 845 18 30 8 10 18 18 65 836 18 30 8 10 18 27 56 837 18 32 2 14 16 26 88 1148 18 32 4 18 22 20 64 849 20 46 16 24 40 25 159 18410 20 43 1 8 9 18 92 11011 18 32 2 6 I) 13 47 6012 18 32 4 24 28 27 96 12313 18 30 8 23 31 42 107 14914 19 27 5 13 18 20 83 10315 20 36 8 19 27 16 85 10116 20 36 8 10 18 34 60 9417 20 36 7 14 21 23 79 10218 19 27 8 2 10 29 97 126Totals 338 583 101 251 352 425 1,471 1.8961080 S.A. MEDICAL JOURNAL 30 Augu t 1969Out of a total number of 2,248 consultations for medi-cal advice, 108 visit necessitated crew members being putoff duty for a period of more than 5 days (Table HI). Thisconstituted 4'8°0, which was proportionately the same forofficers and crew.TABLE Ill. ILLNESSES REQUIRING OFF-DUTY PERIODS OF MORETHAN 5 DAYSConditioll Officers CrewAccident on board hip 13 22Accidents ashore I 6Musculoskeletal 0 5Epilepsy 0 3P ychiatric 4 2Migraine ..... 0 2Duodenal ulcer I 7Gastric ulcer . 0 IGastritis ...... 0 2Haematemesis of unknown aetiology 2 0Haemorrhoids I IInguinal hernias 0 3Appendicitis I 12Enteritis 0 1Syphilis 0 3Gonorrhoea 0 2Pyelitis 0 2Dermatiti 2 5Asthma I 0Tuberculosis 0 IBronchitis I 1Totals 27 81Four diversions were made for medical attention. Thesewere for: (a) an officer with an acute depressive psycho-sis; (b) a rating with uncontrollable epilepsy; (c) a ratingwith .;ompound fractures of both tibiae after a fall fromthe ma t; and (d) a rating with severe gastro-enteritis andhaema temesis.During the year under urvey 4 Coloured rating diedwhile erving on the ships: one died of asthma, one ofcoronary thrombo i . and there were 2 eparate incidentsof drowning. There were no deaths among the officers.A more detailed analysis of the illness categories li tedin Table 11 now follows:AccidentsAccidents accounted for 16.1°(, of medical consulta-tions and 59°(, of accidents occurred on deck or in theliving quarters. A large percentage of these were due tofalls on deck, in alleyways or on stairs. Engine-room mis-haps accounted for 27°~ of consultations, and 14% ofcon ultations were for accidents oc:urring while workingwith the cargo. As can be expected. the majority ofaccident involved the hand. Accident caused the greatest10 s of working hour.DentalThe largest number of consultations was for dentalcomplaints. This constituted 18-4% of the total. Dentalcaries is known to be prevalent among the CapeColoured community. from whom the petty officer andratings of these ships are drawn.Skin DiseasesSkin diseases accounted for 12·3 °0 of medical VISItS.Allergic dermatitis wa the 010 t common complaint. Thiswa found to be prevalent among engine-room andcatering staff, where oil and detergents respectively canbe blamed as the most likely allergens. Fungal skin infec-tions accounted for a large percentage of consultations.Pyogenic skin infections were not frequ~nt complaints,but were the most serious as regards crew members beingput off duty. A syphilitic skin rash was diagnosed on oneoccasion.Venereal DiseaseVenereal disease accounted for 11'6°~ of consultations.The greatest problem was urethritis, its comp:ications andtreatment. UnfortunatelY, vessels stay in port for anaverage period of less than 48 hours, which does not givesufficient time for conclusive diagnosis and treatment.Crew members often report for medical attention in portafter port for a continuing urethral dis:harge and aremostly given a different antibiotic on each occasion. Theproblem is whether the antibiotics us_d, mainly penicillinand tetracycline, are as effective as they used to be,or whether they are given in insufficient dosages.There were a few cases of penile sores. Chancroid oc-curred more commonly than syphilitic chancres.MusculoskeletalMusculoskeletal disorders accounted for 9~~ of visits.These were largely due to sprained mU3cles, 'fibrositis',minor bruises and abrasions. Accidents, which mainlyinvolved the musculoskeletal system, can be coupled withthis category and together they account for 25 ° of con-sultations.Castro-intestinal TractGastro-intestinal disorders accounted for 9% of VISItS,and 45°0 of these consultations were for dyspepsia dueto either gastritis or peptic ulceration. Crew memberswere proportionately more often affected than officers.ext in frequency were haemorrhoidal complaints. Diar-rhoeas accounted for 14°0 of visits in this category. Therewere many complaints of pain in the right iliac fossa. Herethe eaman's fear of developing acute appendicitis in mid-ocean is apparent, and this often involved visits to doc-tors in successive ports until an appendicectomy was per-formed. More seamen were hospitalized with disorders ofthe gastro-intestinal tract, especially peptic u!ceration andso-called appendicitis, than with iliness of any othersystem.Respiratory TractInfections were the cause of most respiratory tract dis-eases. Most common were viral upper respiratory tractinfection. FolJicular tonsillitis occurred fairly frequently.One case of pulmonary tub;rculosis was diagnosed ina rating who had had his annual chest X-ray 9 monthspreviously.Asthma is a dangerous disease at sea. One officer washospitalized for an acu.te attack of bronchial asthma, butrejoined his ship 3 weeks later. Six months after this episodehe had another acute attack of asthma and died in hospital.One Coloured rating died of asthma at sea before he couldreceive qualified medical attention.EarsThe most frequent ear disease was otitis externa.30 Augustus 1969 S.A. TYDSKRIF VIR GE EESKU DE 101Fig. I. Percentage of crew seeking medical advice for illnes . Figures are derivedfrom the analysis of itinerarie of 13 ships which accounted for 765 calls atvarious ports.• -fflEQUENCY OFVISITS IN RELATION TO LENGTH OF SrAYIN PORTo - FREQUENCY C¥' VISI TS IN RaA TI 0 N TO LE NG TH OF VOY AGEof inflammatory or allergic origin. Wax in the ears wasfound most commonly in engine-room staff. Thesepatients presented with deafness. One wonders whetherthe wax was secreted as a protective mechanism against theengine-room noise, or whether it wa an accidental find-ing in patients with nerve deafness due to constant ex-posure to this noise.EyesEye symptoms accounted for 3-4% of consultations.Eye infections such as conjunctivitis, Meibomian cystsand styes were the most common complaints. Not in-cluded in this category are corneal foreign bodies lodgedin the eyes as a result of chipping off old paint. Theseoccurred as commonly as eye infections, but have beenclassified as accidents.MiscellaneousNeurological disease was rare. Epilepsy occurred in 3patients. Migraine headaches occurred in 3 patients. Fivepatients had psychiatric illnesses. Depressive psychosis wasdiagnosed on 3 occasions and psychoneurotic illnesses on2 occasions.Cardiovascular disease was rare. One rating died of acoronary thrombosis and there were two consultationswhere a diagnosis of hypertension was made.Other diseases which required medical attention werea few cases of varicose veins and varicose ulcers, renalcolic and one case of glandular fever.16-20"-IS10DAYSsimilar period of time at sea.Further reduction of accident and illnes could beachieved by preventive mea ure .Routine dental examination would reduce the numberof consultations for dental treatment.Venereal disea e hould be preventable.The prevention of peptic ulceration, which i one ofthe more erious of ailments at sea, is more difficult as itaetiology is not definitely known. However, emotionalstress, excessive use of alcohol and tobacco, and dietaryfactors are known to be contributory causes. All the efactor are disturbed in life aboard ship.An unchanging environment has been described bySolomon et al.· and Zuckerman et aI.' as causing stresreactions which may present as anxiety or somatic com-plaints. Common to all these disorders i a rapid resolu-tion of symptoms when contact with a normal environ-ment is made. Byrd8 and Bombard" prescribed constantmental and physical activity as the only means of pre-venting these stress reactions. The very real problem ofboredom at sea can be alleviated by entertainment andorganized activity, both mental and physical, during off-duty hours.S M 1ARYThe incidence and nature of illnesses and accidents occurringin seamen serving in South African merchant ships have beenanalysed.The most common complaints are disorders of themusculoskeletal system, whether due to accident or disease.The most serious illnesses are of the gastro-intestinal tract,especially gastritis and peptic ulceration.II6"1.CONCLUSIONSSea disease have been noticeably reduced in number andseverity over the past century. Whereas in the pastnutritional and infectious diseasespredominated, today the emphasisis on trauma and psychosomaticdiseases. This is mainly the resultof improvement in the generalhealth of the population as well asimproved living conditions andmedical care on board ship.All crew members have annualphysical examinations and X-raysof the chest. This procedure hasshown itself to have beneficialeffects by the small numbers of per-sonnel that have to be put off dutyfor a serious iIJness.A fairly large number of com-plaints was of a trivial nature.Often a visit to the doctor for someminor complaint was used as ameans of obtaining shore leave.Fig. I demonstrates that the per-centage of crew seeking medicaladvice for illness is directly pro-portional to the length of stay ofthe ves el in port. Also demon-strated is the fact that, except fora peak at 5 days, the frequencyof medical consultations for illnessis fairly constant irrespective of thelength of a voyage. The percentageof crew seeking medical advice ishigher while in port than for a1082 S.A. MEDICAL JOURNAL 30 August 1969Although the incidence of accident and illness among crewmembers is not high, the number of medical consultations canpossibly be reduced by preventive means, the most importantof these being improved morale.I wish to thank the Managing Director, Mr M. de W. Marsh,and all personnel of the South African Marine Corporr.tion fortheir kind assistance and co-operation in making this surveypossible.REFERE 'CESI. AlIison, R. S. (1943): Sea Diseases. London: John Bale & Stap:es.2. Tunstall, B. (1936): Ana/omy of Neptl/ne. London: Geotge Routledge& Sons.3. Lind. J. (1774): Gp. cit'4. Board of Trade (1967): The Ship Captain's Medical GI/ide. 20th ed.London: Her Majesty's Stationery Office.5. Ministry of Transport (l96O): Government Gazette Extraordinary, No.6390. Pretoria: Government Printer.6. Solomon. P., Leiderman. P. H., Mendelson, J. and Wexler, D.(1957): Amer. J. Psychiat.. 114. 357.7. Zuckerman. M .. Levine. S. and Biase. D. V. (1964): Psychosom. Med.,26. 250.8. Byrd, R. E. (193): Aloue. 'ew York: G. P. PUlnam's Sons.9. Bombard. A. (1953): The Voyage of rhe Heretilll/e. 'ew York: Simon& Schuster.HETEROTOPIC PROSTATIC TISSUE: A REPORT OF AN UNUSUAL CAUSEOF HAEMATURIA IN A BANTU YOUTH*J. X. Louw" M.B., B.CH., F.es. (S.A.), Themba Mission Hospira,', While River, Eastern Transvaal, AND A. T. H.MARSDEN, M.D., F.e. PATH., SA/MR, JO!:Q."znesburgHaematuria is a very common symptom in the EasternTransvaal because bilharzia is an endemic disease amongthe Bantu. It is regarded as almost normal by the patients.When the haematuria is severe enough to bring the patientto hospital it warrants more investigation and should notbe accepted as a bilharzia problem, as this case illustrates.CASE REPORTA 15-year-old Bantu youth was brought to hospital witha illstory of slightly painful haematuria of several months'duration. Tills haematuria was of such severity as to bringthe patient's haemoglobin concentration down to 6 G /100m!. General examination was completely normal apartfrom the anaemia. Special examination showed a mixedurinary tract infection but no evidence of bilharzja in theurine or on rectal snip. Full blood count, X-ray examina-tion of the chest and IVP were normal.Cystoscopy and examination under anaesthesia showedgross haematuria and a mass in the bladder with noextension outside the bladder wall.The patient was transferred and a cystostomy perform-ed. At operation a large tumour was found, measuring10 x 12 x 4 cm., with slight ulceration at the apex. It wasattached to the bladder wall by a 2 - 3-cm. stalk andsituated on the right lateral aspect of the bladder about3 cm. lateral to the ureteric orifice. As we did not havefacilities for a frozen section, and in view of the fact thatthe patient was very young and the possibility of a benignneoplasm existed, a partial cystectomy was performed.Three weeks later the patient was free from haematuriaand was passing urine well.Histology Report on the TumourThe tumour is composed of glandular areas and areasof smooth muscle. The glands are of prostatic type andsurrounded by a loose fibrous tissue containing a varyingnumber of smooth muscle fibres. They are arranged inlobules which are grouped together into nodules ofglandular tissue. There are also areas of smooth musclewithout any glands where the smooth muscle fibres form"Date teceived: 22 October 1968.t Present address: Tokaroa Hospiolal. North Island. New Zealand.bundles running in different planes and not organized inany way. This mixture of glandular and muscular nodulesis somewhat reminiscent of the structure of a benignnodular hyperplasia of the prostate. The tumour is partlycovered by a thin muscle coat and bladder mucosa whichis ulcerated in places and chronically inflamed. A fewglands of prostatic type are scattered here and there in themucosa.'The specimen consists of aberrant prostatic tissue sothat it is a congenital malformation and not a neoplasm.'DISCUSSIONAccording to Hamilton-Boyd and Mossman' the prostateis derived from a series of endodermal buds in the liningof the primitive urethra and the adjacent pelvic portionof the urogenital sinus in the foetus at about the 55-mm.crown-rump length. These buds grow into the dense sur-rounding mesenchyme which differentiates into muscleand connective tissue components of the gland. The budsare said to arise from all sides of the urethra above andbelow the openings of the mesonephric ducts (future duc-tus deferens) and are arranged into 5 groups: anterior,middle, dorsal and two lateral.The standard urology texts do not have much to sayabout congenital abnormalities of the pr06tate. Campbell'sClinical Pediatric Urology' remarks that congenital ab-sence of the prostate is rare, hypoplasia is common andcongenital prostatic cysts are sometimes seen. Willis3 re-ports several cases of aberrant prostatic tissue, namely, inthe urethra, vesical trigone, root of the penis, behind thebladder and round the unobliterated lower part of theurachus.SUMMARYA rare cause of severe haematuria in a Bantu youth ispresented. This was found to be due to ectopic prostatictissue growing from the lateral wall of the bladder.REFEREl\'CESI. Hamilton-Boyd, W. J. and M ..ssman, H. W. (1966): Humau Em·bryology, 3rd od., p. 293. Cambridge: W. Hefer & Son.2. Campbell. M. (1951): Cliuical Pediatric Urology, p. 313. Philadel phia:VI/. B. Saunders.3. \Vi lis. R. A. (196): Brit. Mee. J .. 3, 267.

A survey of sea diseases on South African ships

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A survey of sea diseases on South African ships

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