Surgical Sociology: The Surgeon at Sea 1913
In considering fields of medical endeavor, insufficient attention has been given to the work of the ship's surgeon. As a general rule, the young physician recently graduated from his medical course, feeling desirous of an ocean voyage or some remunerative recreation, seeks to secure benefits by taking a position as a ship's doctor. In return for his technical training and service, he is able to secure a trip either without compensation or with a very small emolument.
With the evolution of transatlantic liner to huge proportions that are capable of accommodating entire villages, as far as population goes, it is but reasonable that ample provision should be made for medical attendance. The accident rate among employees of sea-going vessels is sufficiently high to warrant the employment of a surgeon by the company in order to give adequate attention to the crew. In addition to the men below decks, the large voyaging population requires some systematic plan for caring for its health during the period of transportation.
At the present time, many of the larger steamship lines give a salary of fifty dollars a month to the ship's doctor, in addition to the opportunity of charging small fees to the passengers of the first and second class. On the larger vessels where the work required of the ship's surgeon is more onerous, the salaries vary from sixty to eighty-five dollars a month with many applicants seeking to fill the positions.
The entire question of ship sanitation should come within the purview of the chief medical officer of the large vessels. He should be a medical health officer as well as the ship's surgeon. If employed by the company, his services should be devoted to the interests of his employers in safe-guarding the health of the crew and attending to their various ailments. As a supplementary vocation, he should be enabled to practice as occasion demands a month the passengers of the first and second class, who may perchance require his professional service in either a medical or surgical capacity.
One frequently reads of the sudden operation which must be performed for the relief of a strangulated hernia or the removal of a diseased appendix, when the imagination of the reporter pictures the emergency operating room with the victim receiving an anesthetic at the hands of some volunteer passenger, probably a physician and possibly a layman. The assistants at the operations are performed under stress and excitement and the fullest opportunity for recovery is afforded the patient insofar as a meager equipment and untrained operators can offer. This, to be sure, does not characterize the condition of all vessels, but it should not exist on any ship carrying the floating population which today is housed on our great trans-oceanic passenger vessels.
In the United States, there is, on the average, one physician for every 568 persons, while in some of the smaller towns there may be two or three physicians to 300 inhabitants. This is somewhat suggestive of the ratio that exists in normal distributions of population. It is obvious that the nature of the traveling population is not as cosmopolitan nor as representative of all social strata as is a similar large group peacefully attending to normal occupations. It is patent, however, that to charge one physician on board a ship with a responsibility of caring for the physical health of 3,00 human beings, or even 5,000 is to supply inadequate medical service.
In order to establish the grade of ship's doctor as one worthy in dignity, honor and distinction, it is necessary to establish rigid requirements for this position. Only medical men who have secured a good technical training, followed by practical experience in a hospital, should be permitted to serve in this capacity. The position should not be designed to give recreation, even to the most deserving physician. It must be raised to the standards of service in the navy in order that it may become a worthy branch of professional life. The tendency of the time is to make the ship's surgeon a man of power and a valuable adjunct to the successful maintenance of health and comfort during the voyage. The story of the ship's surgeon has not been written. It is fraught with difficulties, but laden with opportunities. It requires judgement, discrimination and skill. It is a noble work, if it be well done.
Wile, Irs S. M.D., Department Editor, "Surgical Sociology: The Surgeon at Sea", American Journal of Surgery, New York, Vol XXVII, No. 10, October 1913, Page 395.