10 
LAND &f WATER 
January 31, 19^^ 
The Health of the Fleet 
By Lewis R. Freeman, R.N.V.R. 
IT was a great dav for the Principal Medical Officer. In 
spite of the fact tliat there were nearer 1,200 than r,io<i 
men on his ship, the returns of " Sick " and " Hospital " 
cases had been recorded bv successive " pairs of spec- 
tacles " for several da vs. Exen a single twenty-four hours 
like that for a battleship on active service was worthy oj 
remark, and tiiree or four da\s of it undoubtedly constituted 
a record for the British or any other Navy. That the clean 
'ilieet would be spread over "a whole week was almost too 
much to hope for, even after the sixth day of the double 
(luck's eggs had gone b\'. But now the moniing of the seventh 
day had come, the last of a week in which there had been no 
rase of sickness on a ship which carried one of tiie largest, if 
not the largest, complement of men in the British Navy. It 
was no wonder that the P.M.C.'s eves were beaming and that 
he shook hands all round with his Staff Assistants, for it was 
;in achievement which might well stand as a record for man\- 
a voar. , , • , 
"" Since you do not appear likely to be troubled with any- 
thing worse than a rush of congratulations to-day, sir," 1 
said after extending my ov\Ti felicitations, "perhaps yoivll 
have time to tell me how you've done it. I've heard fine 
tributes paid the R.N. M.S. by French, American and Italian 
doctors who know something'of it, but I was hardly prepared 
to find you starting a sort of Ponce de Leon ' Fountain of 
Perpetual Youth,' in the British Fleet. " 
The P.M.O. laughed. 
" Making a health resort of a battleship, with your dressmg 
stations under casemates and your sick bay all but under a 
turret, does seem a bit Uke reversing the saying about ' in 
♦he midst of life we are in death,' " he replied. "But the fact 
remains that this ship, the whole of the Grand Fleet indeed, 
is one of the most remarkable " health resorts ' the world has 
ever known. Not since the dawn of history has there been a 
large body of men with so small a percentage of bodily ills 
and ailments as that which mans the ships of the Grand Fleet 
Jit this moment. This is due to the absolutely unique con- 
ditions which prevail here, and our success in maintaining and 
improving the standard of health is principally due to making 
the most of those conditions. 
" The health of any community — of any body or collection 
of human beings — depends primarily upon the natural 
salubrity of the region in which it is located and the extent 
to which it is isolated from those living under less favourable 
conditions. A city may be very healthy naturally, but if its 
inhabitants are subject to a constant influx of more or less 
infected transients from less healthy places its own standard 
must inevitably be lowered. Under normal conditions, a 
modern warship — either in port or at sea — is one of the 
healthiest places in the world, and such sickness as prevails 
there is almost always contracted ashore and carried — and 
•* often spread — abroad. 
" With a Fleet that has its base near a large city, so that 
the men are in more or le.ss constant contact with those 
ashore, the health of the former will \-ery largely depend 
upon the extent to which that contact can be controlled. 
Between dock-hands, etc., coming aboard and the sailors 
going ashore, it is difficult under such circumstances to keep 
the men afloat much healthier than those on the land. It is 
only when there is comparatively complete isolation from 
large cities that it is possible to take full advantage of the 
ideal conditions for maintaining physical healthfulness at sea, 
and such conditions exist to a degree never before equalled in 
Naval history. Our success here is merely the consequence 
of making the most of those unique conditions. 
" On the score of bodily healthfulness, life as lived in the 
Grand Fleet has more favouring conditions, and fewer un- 
favouring ones, than that possible at any other point at which 
a considerable fleet has ever had its base. Indeed, I could go 
farther than that, and say that never has a large number of 
men, either afloat or. ashore, had such an opportunity to 
maintain so high a standard of physical health. In thefirst 
place, wet, cold and stormy though it is for much of the year, 
the climate is a salubrious and invigorating one for the 
]>hysically sound man that the sailor must be before he finds 
his way into the Navy at all. Even ashore the population is 
notably robust. 
" In the next place, the anchorage is isolated, but not too 
isolated. It strikes almost the ideal mean on this score. In 
the ordinary routine, there is practically no contact whatever 
between those afloat and the people ashore. If the men land 
at all it will he for a game of football, a cross-country- run, road 
work or something of the sort; in the course of which nothing 
whate\-er is seen of the resident population. It is not prac- 
ticable to give the men a long enough shore leave to allow 
them to visit a neighbourig town, where one sees rather less 
navy blue as a rule than in many an inland town in England. 
The steward doing his marketing is about the only regular 
human link between a ship and the shore, and his contact 
with those on shore is not of a character likely to be dangerous. 
This leaves the fresh drafts and the men returning from leave 
as almost the only possible carriers of new infection. How 
those are looked after 1 will explain presently. 
" Much more complete isolation than this is, of course, 
effected when a cruiser or a fleet of cruisers goes on an ex- 
tended voyage or patrol, but in such a case the freedom from 
contact with shore life is offset by the more arduous conditions 
of life, especially in the matter of diet. The great thing 
about the situation is that its unique position makes it 
possible to eliminate most of the rigors of seaUfe without being 
exposed to the health dangers of harbour life. A ship here 
can be just as well victualled as at Portsmouth, so far as the 
men are concerned, while letters and newspapers six times a 
week are ample service on that score. As 1 have said, tlu^ 
conditions for keeping mind and body at their best are ideal, 
and give us a unique opportunity for establishing new health 
records for the Navy. 
Sources of Infection 
" Of the two main channels by which disease could come 
to us from the outside — returning leave men and new drafts — 
the latter is the more dangerous, and therefore the one the 
more closely watched. Generally speaking, the men get 
leave about every nine months, this more or less roughly 
coinciding with the period in which the ship is in dock for 
repairs. If during a man's leave there is a case of any in- 
fectious or contagious disease in the house where he has 
stayed, or if he has reason to believe that he may have been 
exposed to infection or contagion elsewhere, he is ordered to 
report that fact immediately upon his return to the ship, 
when we take such precautions as the circumstances seem 
to warrant to prevent trouble. His clothes are disinfected, 
and he is ordered to report for examination over a period of 
days varying with the disease to which there was risk of his 
having been exposed. This enables us to isolate him (should 
it be necessary) before he is in a condition in which he could 
pass on the disease to others. A useful check which we have 
upon a man who might neglect to report his possible exposure 
to disease during his leave is the law which requires medical 
officers in all parts of Great Britain to ascertain if any soldier 
or sailor on leave is Uving in any house where^ there is a ca.se of 
infectious disease, and to report this fact to the proper 
authorities. In this way it may be that we learn a man has 
been exposed even before he returns to the ship. 
" New drafts are watched equally closely. Some time before 
a man's arrival a health sheet is sent to me on which is indi- 
cated any disease which he maj^ have had during his period 
of service, together with information as to whether or not he 
may have been exposed to anything infectious in the interval 
inmiediately before he is sent to us. Any treatment for minor 
chronic ailments which may be in progress is continued on 
ship. A general disinfection of kit and a daily reporting for 
twenty-one days for examination makes it practically im- 
]iossible for a new rating to bring disease to the ship. 
" The greatest obstacle to the preservation of perfect health 
in the men on a warship is the unavoidable necessity of having 
them sleep close together in comparatively confined spaces 
This ship, from the fact that she was originally designed for a 
foreign Power, is worse off than most modern battleships on 
that score, and, everything else equal, would be more difficult 
to keep the men in health on than in any of the others. rhi> 
is one of the reasons why I am so gratified by our showing 
ol the past week. Sleeping in hammocks in itself is not 
unhealthy — quite the contraiy, in -fact — but the danger lies 
in the chance an infectious disease has to spread among so main- 
men lying almost side by side and head to feet. Thorou.s^Jjt 
vi-ntilation is the best preventive of disease under the ciixnnn- 
stances ; this has been provided by fans. 
" The one thing dreaded above all others on a warship is 
cerebro-spinal meningitis, both on account of its unavoidably 
liigh rate of mortality and the difficulty of preventing its 
spread under the limiting conditions. Luckily, we have had 
practically none of it up here. In the event of the appear- 
ance of a case of any infectious disease, the man is isolated, 
the men of his mess are put under observation and all of their 
clothes are disinfected. As soon as possible the case is re- 
moved to one of the hospital ships which are always here. 
The restricted sleeping quarters occasionally are responsible 
for the quick spread of a bad cold . but the fresh, ft^e from germs 
