The Therapeutic Value of Ocean Voyages (1899)
With the oncoming of cold nights and foggy mornings the thoughts of very many invalids in this country are turned towards the best means of getting through the winter. To those who may contemplate a long sea voyage in a warmer climate than ours, we would commend a careful study of two eminently sensible and practical papers recently published in the Zeitschrift fur didtetische und physicalische Therapie, by Sir Hermann Weber, and in the Berliner klinische Wochenschrift, No. 41, by Dr. Edmund Friedrich, of Dresden.
In both will be found many points of importance, which have not often been put forward in so convincing a manner. That a sea voyage may prove a valuable tonic after exhaustion from any cause, and may even seem to have a curative effect upon certain morbid conditions, was well known to the ancients. A voyage on the waters of the Mediterranean was as highly appreciated by them as the Australian voyage by their descendants, but, regarded as a therapeutic agent, a long sea voyage will succeed or fail according to the discretion with which it is used.
The theoretical advantages which it offers of abundant fresh air and light, invigorating winds, equable temperature, absence of exertion and complete mental rest, are all apt to be discounted by prolonged spells of bad weather. The patient who is obliged to remain between decks in a steamship, in company with uncongenial and possibly sea-sick fellow travelers, the inlets of fresh air almost entirely closed, the meals served under difficulties, and the unceasing vibration of the engines preventing real rest, is often led to change his views as to the merits of sea voyaging in search of health during the winter months.
On a sailing ship there are some advantages which a steam vessel cannot offer, and amongst these the greater degree of quiet and the greater purity of air stand prominently forward. But even on a sailing ship there are periods of calm when the air on deck is hardly to be called pure, and when storms necessitate the closure of all external openings, the condition of the atmosphere between decks is often decidedly foul.
While the best as well as the worst appointed vessels are subject to vicissitudes of climate, a great difference exists between the means provided on different ships for minimizing the drawbacks to the enjoyment of an ocean voyage. Sir Hermann Weber gives the very sound advice that one should no more think of taking a berth on a vessel for a long voyage without personal inspection and careful inquiry than one would think of hiring or purchasing a house on the auctioneer's warranty alone. Assuming, then, that a satisfactory ship has been selected, the question next arises whether its destination is likely to be suitable to the particular conditions of the patient.
While extolling the value of short voyages such as the Atlantic passage to North American ports, or to Madeira or the Mediterranean, for simple recuperation after overwork or illness, both Sir H. Weber and Dr. Friedrich recognize the advantage of prolonged sojourn on the sea in cases of actual or threatened tuberculous disease. The latter points out that the cure, if cure it is to be, must be more complete under conditions which preclude the possibility of a premature return to the ordinary round of life.
The long voyage has its disadvantages mainly in the unavoidable monotony of the life, and especially of the diet; but in the shorter voyages, interrupted by many excursions on shore, there are other dangers, arising from personal imprudence, to which there is no temptation on board ship. Looking to the records of actual experience of ocean voyages, it would appear [that for the early cases of tuberculosis in male patients the percentage of benefit is high, but that in the case of female patients the amount of benefit obtained in the long run is relatively small. It is an important fact—recorded by Sir Hermann Weber—that many of his lady patients have given expression to the view that the ocean voyage is not suitable for women.
The invalid on board ship, whether suffering from consumption or any other disease, is under ordinary conditions free to consult the ship's doctor or not as he pleases.
The doctor has no disciplinary power over him. The need for such power is nowhere more clearly evident than on a well-appointed private yacht, where everything that science can suggest or wealth provide is at hand, to enable the patient to live an ideally hygienic life, but where all these provisions and precautions may be rendered of no avail, owing simply to the want of an authoritative word in season.
The necessity for discipline in dealing with consumption is now fully recognized on shore, where sanatorium treatment is becoming every day more popular, but hitherto it has not been properly recognized at sea. Why should not ocean-going sanatoria be as successful as those on shore?
Rochard expressed the somewhat caustic opinion that if the right sort of ship could be sent to the right place in the right kind of weather, and laden with the right sort of patients, a great deal of good might result. At the present day it is not quite so impossible to realize these conditions as at the time when he wrote his well-known paper on the effects of a voyage to warm climates in cases of phthisis.
Many of the large steamship companies have found it profitable to send out their ships on pleasure excursions to various parts of the world, and a little further enterprise alone is needed to fit out and dispatch floating sanatoria properly equipped and placed under absolute medical control, as far as the patients are concerned, to any part of the world that may be thought best at each season of the year.
But until such ideal arrangements can be made, the intending voyager in search of health will do well to take to heart the advice given in the two papers to which we have referred.
"GroupThe Therapeutic Value Of Ocean Voyages," British Medical Journal, Vol. 2, No. 2027, Saturday, 4 November 1899: pp. 1301-1302