APPENDIX V
MEDICAL
By A. H. Macklin, M.D.
The following is intended to give briefly an idea of the special conditions met with in Antarctic regions and the steps taken for the prevention of disease.
The chief work of the surgeon of a polar expedition is done before the ship leaves England, and if it has been properly carried out there should be little to do during the actual journey. In this respect casualties are excepted, for naturally they cannot be foreseen. They are prepared for by providing a good general surgical outfit, the exact composition of which will depend upon the amount of money available for its purchase and on the space at disposal for its storage. Also, as the practice of medicine and surgery is more of an art than an exact science, it will depend largely upon the individual surgeon. Many things can be omitted; for example, splints, which can be improvised as required. There are, however, definite lines upon which the prevention of sickness may be carried out, and the following are important points:—
Ordinary sickness can be largely ruled out by careful examination of personnel and insistence on absolute physical fitness. In making the general examination the following points should be specially looked for: bad teeth, pyorrhœa, septic tonsils, and any chronic disease about the mouth, nasal passages or the accessory sinuses. They are often the cause of latent trouble unsuspected by the applicant, and their importance will be seen later in dealing with scurvy. The ears should be tested for hearing and for any signs of middle ear disease. One should examine for varicose conditions, hæmorrhoids and anal fissure or fistula, rupture, flat feet, and other deformities of the feet and toes, however slight, old-standing corns, bunions, etc. A history of dislocations should be inquired for, especially of the cartilages of the knee. My opinion is that any of these conditions should absolutely rule out all new applicants, for the presence of any one of them will inevitably lead to trouble. Their occurrence in men of previous polar experience must be carefully considered. Venereal disease should be an absolute bar. The wearing of spectacles does not necessarily rule out an applicant, but the necessity for them is a great handicap in cold regions.
There are three main conditions which must be specially considered and prepared against: Scurvy (and allied conditions), frost-bite and snow-blindness. Sea-sickness is a fourth condition which may cause disability, but as in the prevention and treatment of any disease the main principle is to remove the cause, this cannot be arranged for except by peace offerings to Æolus. The individual must “go through it.” If he gets over it—good; if he shows no signs of ever adapting himself, and much of the work of the expedition is to be done at sea, he must be sent away at the first opportunity, for chronic sea-sickness is a very wearing condition and renders the subject of it useless for work. The Quest was a particularly lively ship, and we lost in this way two otherwise very useful members of the company.
With regard to sea-sickness remedies which depend mainly upon drugs having a depressing influence on the brain, I think they are useful for short journeys of a few hours. For long journeys with continued bad weather I consider them not only useless, but harmful.
Scurvy (and allied conditions).—The history of scurvy in war and famine, in the early days of long voyages, and in Arctic and Antarctic exploration shows the important part which this disease has played. Fully developed scurvy is a horrible condition which renders the individual an offence to himself and to those about him. A famous Austrian physician, Kramer, described it as “The most loathsome disease in nature,” so that the demoralizing effect of an outbreak in a small and crowded ship or land base can easily be imagined.
Although a disease which has been recognized for centuries, it is only in recent years that medical science has been brought to bear upon it and the causation fully investigated. The result is that much new knowledge has been brought to light.
For practical purposes it may be regarded as due to two main causes :