Self-reported vitality and health status are higher in Dutch submariners than in the general population.

Introduction: Living aboard submarines has a potential negative effect on health. Although studies have evaluated specific health hazards and short-term outcomes, long-term health effects have not been investigated in this population. Methods: Veteran submariners were contacted through the veterans' society and administered a World Health Organisation validated questionnaire (SF-36) assessing their physical, emotional, and social functioning. Scores were compared with those of the general (reference) population and scores in veteran submariners were differentiated by rank, time at sea and time in service. Statistical analyses were performed using the Wilcoxon signed rank and Kruskal-Wallis tests. Results: Of the 1,025 submariners approached in December 2019, 742 (72.4%) completed and returned the questionnaire before July 2020. All 742 were men, of median age 68 (interquartile range [IQR] 59-76) years (range 34-99 years). Of these subjects, 10.3% were current smokers, 64.4% were former smokers and 23.7% had never smoked. Submariners scored significantly better (P < 0.001) than the general population on all eight domains of the SF-36. Except for 'pain' and 'change in health status over the last year', scores for all domains decreased with age. Scores were not significantly affected by smoking status, rank, service, and time at sea. Conclusions: Dutch veteran submariners have better self-reported vitality and health status than the general Dutch population. Rank, service, and time at sea did not significantly affect scores of Dutch submariners.

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Is physiotherapy a luxury? What can the perplexing absence of the physical therapies tell us about the profession's future?

Physiotherapists interested in the profession's future have turned in recent years to historical evidence to understand how the physical therapies were practiced before the advent of modern healthcare. However, studies to date suggest that their practice was largely confined to social elites, and those from working-class or poor populations rarely, if ever, experienced them. To test this theory further, this study focuses on British sailors during the Napoleonic wars (1803-1815). Utilizing historical and semi-fictional accounts, this study shows that healthcare on board naval fighting ships concentrated almost entirely on the prevention of disease, and the medical and surgical management of acute trauma. Even though sailors experienced shocking levels of traumatic injury, none appear to have experienced any form of physical therapy. This study supports the argument that prior to the 20th century, the physical therapies were luxuries available primarily to those with surplus time and money, and that widespread access to physiotherapy has relied on state-sponsored universal health coverage. It follows, then, that the decline of universalized healthcare may have profound implications for many marginal groups in society, as well as the physiotherapy profession itself.

COVID-19 outbreaks among crew on commercial ships at the Port of Rotterdam, the Netherlands, 2020 to 2021.

BackgroundDuring the COVID-19 pandemic, international shipping activity was disrupted as movement of people and goods was restricted. The Port of Rotterdam, the largest port in Europe, remained operational throughout.AimWe describe the burden of COVID-19 among crew on sea-going vessels at the port and recommend improvements in future infectious disease event notification and response at commercial ports.MethodsSuspected COVID-19 cases on sea-going vessels were notified to port authorities and public health (PH) authorities pre-arrival via the Maritime Declaration of Health. We linked data from port and PH information systems between 1 January 2020 and 31 July 2021, derived a notification rate (NR) of COVID-19 events per arrival, and an attack rate (AR) per vessel (confirmed cases). We compared AR by vessel type (workship/tanker/cargo/passenger), during wildtype-, alpha- and delta-dominant calendar periods.ResultsEighty-four COVID-19 events were notified on ships, involving 622 cases. The NR among 45,030 new arrivals was 173 per 100,000 impacting 1% of vessels. Events per week peaked in April 2021 and again in July 2021, when the AR was also highest. Half of all cases were notified on workships, events occurring earlier and more frequently than on other vessels.ConclusionNotification of COVID-19 events on ships occurred infrequently, although case under-ascertainment was likely. Pre-agreed protocols for data-sharing between stakeholders locally and across Europe would facilitate more efficient pandemic response. Public health access to specimens for sequencing and environmental sampling would give greater insight into viral spread on ships.

Asociación entre el bajo nivel de vitamina B12 y deterioro cognitivo en adultos mayores del centro médico naval del Perú

Introducción: Los adultos mayores son suscepctibles a la malnutrición y el déficit de vitaminas. Objetivo: Determinar la asociación entre el bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores del centro médico naval, ubicado en Lima-Perú, en el periodo 2010-2015. Métodos : Se realizó un estudio transversal analítico, a partir de un análisis secundario de la base de datos Texas-Cemena UTMB 2010-2015 del centro de investigación del envejecimiento (CIEN) de la Universidad De San Martín De Porres. Para la cuantificación de la variable de deterioro cognitivo se utilizó el MiniMental test. Para analizar la asociación, se realizó la prueba de chi cuadrado y la regresión de Poisson. Resultados : El 57,6% de los pacientes fueron de sexo masculino y la edad promedio fue de 78 ± 8,4. El 41,2% presentó deterioro cognitivo y el 9,5% de los pacientes presentó déficit de vitamina b12. Los factores independientemente asociados al deterioro cognitivo fueron el antecedente de enfermedad cerebro vascular (RP= 1,38 IC 95% [1,24-1,53]), depresión (RP = 1,88 IC 95% [1,80-1,97]),) y déficit de vitamina B12 (RP = 1,10 ic 95% [1,01-1,20]),). Conclusiones : En el presente estudio se encontró asociación entre un bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores.

Introduction: Older adults are susceptible to malnutrition and vitamin deficiency. Objective: To determine the association between the low level of vitamin B12 and cognitive deterioration in older adults from the Naval Medical Center, located in Lima-Peru, in the period 2010-2015. Methods: An analytical cross-sectional study was carried out, based on a secondary analysis of the Texas-Cemena UTMB 2010-2015 database of the center for research on aging (cien) of The University Of San Martín De Porres. To quantify the cognitive impairment variable, the mini mental test was used. To analyze the association, the chi-square test and poisson regression were performed. Results: 57.6% of the patients were male and the mean age was 78 ± 8.4. 41.2% presented cognitive deterioration and 9.5% of the patients presented vitamin B12 deficiency. The factors independently associated with cognitive impairment were a history of cerebrovascular disease (pr= 1.38 95% ci [1.24-1.53]), depression (pr= 1.88 95% ci [1.80-1 .97]) and vitamin B12 deficiency (pr = 1.10 95% ci [1.01-1.20]). Conclusions: In the present study, an association was found between a low level of vitamin B12 and cognitive deterioration in older adults.

Unique challenges in naval military dentistry.

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.

Bed bugs on ship: a French review.

BACKGROUND: Linked to the increase in international travel and development of insecticide resistance, a resurgence of bed bug infestation has been observed since the 2000's and become now a worldwide public health problem. Passenger ships as part of the tourism industry are traditionally infested by bed bugs, but the whole maritime world is now concerned. MATERIALS AND METHODS: We conducted a short questionnaire-survey among the 22 doctors of the French seafarers' health services to assess the level of this phenomenon in the occupational maritime environment. RESULTS: Twenty seven per cent of the doctors reported that a patient shared to them a bed bug infestation on board. In that case, all declared that the infestation impacted the patient's life on board. Eighteen per cent responded that a shipowner had already sought their support in face of a bed bug infestation. Lastly, 27% considered that bed bug infestation is an increasing problem. CONCLUSIONS: Bed bugs infestation on board has a major impact on the seafarers and passengers, and significant economic consequences. Preventive measures need to be implemented to limit the risks of dissemination. It is essential to inform and educate seafarers on best practice.

Musculoskeletal diseases among French military high-speed boat pilots.

In 2016, the French Navy acquired a new high-speed boat, called ECUME. It exposes crewmembers to significant Whole Body Vibrations. This work explores the musculoskeletal diseases among this population. We conducted a retrospective declarative epidemiologic study using anonymous questionnaires. Eighty-four sailors were included. Fifty-six (66.7%) report acute traumas during a nautical raid during the 12 months study period. Sixty (71.4%) report chronic pains, which they associate with their nautical activity. Among them, only 16 (26.7%) have consulted a doctor, but 32 (53.3%) report consuming medication, including 18 through selfmedication. More than half rely to alternatives medicine, especially osteopathy. The traumatic risk of ECUME riding is obvious. Many crewmembers minimize their symptoms, and consult rarely a physician. They give preference to selfmedication and alternative medicines.

Acute occupational phosphine intoxications in the maritime shipping sector: a scoping review.

The aim is to assess the prevalence and knowledge on acute occupational exposure to phosphine in the shipping industry. We followed PRISMA guidelines for scoping review. We searched in 4 databases without language and date restrictions for scientific articles in peer-reviewed and gray literature. We found 13 peer-reviewed articles and 63 articles in gray literature. These covered 56 incidents from 1963 to 2019 for a total of 254 victims and 22 fatalities. There is an increase in the number of reported cases over the last 20 years. Neurologic and gastrointestinal symptoms are predominant, and hospitalization is needed in 80% of cases. Our review underlined the principal risk as gas exposure through leaks between holds and the ventilation system. Further studies on the knowledge and the prevention in order to improve good practices onboard, prevent the risk of fire explosion, and a global reporting system of new cases are recommended.

Raising Boys for the Navy: Health, Welfare, and the British Sea Services, 1870-1905.

Efforts to improve the quality and quantity of seafarers in the Royal Navy and merchant service became a particular concern amidst the degeneration debates of late-Victorian Britain. Maritime reformers not only promoted fitness in adult sailors, but also particularly sought to improve health and physique of boy recruits in order to rear a new generation of healthy sailors. This article shows how both services experimented with tighter admission criteria and dietary and exercise reforms, and became early advocates of using metrical standards to exclude all but the fittest, healthiest boys from training opportunities. While the physical monitoring of boy recruits undoubtedly showed the value of early lifestyle interventions in fostering healthy development, the rising physical standards of British seafarers in this period was just as much the result of restrictive medical examinations as a commitment to welfare initiatives.

Telemedical Maritime Assistance Service at the University Center of Maritime and Tropical Medicine in Gdynia. The analysis of 6 years of activity.

BACKGROUND: In the 1960s, the International Labour Organization passed a convention under which all countries with national shipping were obliged to create a 24-h telemedicine center for ships. In accordance with the convention, Telemedical Assistance Service centers were to provide permanent access to medical advice given by qualified doctors and to create an international platform for the exchange of information and experience. In Poland, the Telemedical Maritime Assistance Service (TMAS) was established in 2012, and its duties in a 24-h system are carried out by doctors from the University Center of Maritime and Tropical Medicine (UCMTM) in Gdynia. The aim of this work was to determine the reasons for medical officers reporting for help from the TMAS doctor on duty and to create a database of the most common diagnoses and actions undertaken, and in particular evacuation. MATERIAL AND METHODS: In the presented work, the authors analyzed TMAS telephony and e-mail advice provided by doctors of the UCMTM in Gdynia, in the period from October 2012 to the end of 2018. RESULTS: In the 6-year period, UCMTM doctors provided TMAS advice 225 times, recommending evacuation in over 20% of these cases. Infectious diseases were the most common cause of contact in the entire period under analysis - 61 cases were recorded, accounting for as many as 27% of all applications. Injuries were the second most frequent reason for seeking help from TMAS, and 20% of TMAS applications (44 cases) were related to trauma. CONCLUSIONS: The obtained data show that TMAS doctors face various medical problems; therefore, providing proper medical assistance to patients requires a close multidisciplinary cooperation between medical officers, TMAS doctors and emergency services. Med Pr. 2020;71(2):121-5.

Mental health of Chinese naval officers and soldiers: 2009-2019 / 第二军医大学学报

In recent years, mental health of naval officers and soldiers has attracted wide attention. The present research reviewed literatures on the mental health of naval officers and soldiers from 2009 to 2019, and summarized the characteristics, influencing factors and mental health intervention. The common psychological problems of naval officers and soldiers were depression, anxiety and sleeping problems; the comparative research of mental health level between naval personnel and other military services was still controversial; the branch of the navy, long-term and long-distance navigation as well as personal factors (personality, coping style and life events) influenced their mental health; and only few researches focused on mental health intervention of naval officers and soldiers. The present problems in mental health researches of naval personnel included small scale, inconsistent results, single research method and lack of experimental research. Future studies are needed to expand the sample size and diversity of naval branches, explore the promotion effect of psychological intervention on the mental health, and emphasize to the impact of various military stress factors on the mental health of naval officers and soldiers.

Epidemiology of physician interventions in maritime environment by the Marseille Fire Brigade (BMPM) from 2005 to 2017.

BACKGROUND: Marseille is the second largest city in France. The Marseille Fire Brigade (BMPM) is the largestunity of the French Navy. This organization is in charge of rescue operations and medical intervention in theMarseille area. The aim of the study was to describe the epidemiology of interventions that required a physicianto be present that were performed by the BMPM between the years of 2005 to 2017. MATERIALS AND METHODS: The statistical office database of the BMPM and the medical interventions forms (FIM)acquired from the BMPM medical ambulances (SMUR) archives were analysed from the years 2005 to 2017. RESULTS: The BMPM performed a total of 2,375 interventions in the maritime environment between 2005and 2017. A physician was necessary for intervention a total of 186 times. The extraction and analysisreports of 107 medical intervention forms found the BMPM archives revealed a significant number ofinterventions (67%) in the southern bay of Marseille and Frioul, specifically from the If and Planier islands.The majority of interventions (77%) took place within the 300m band. The most common cause of medicalintervention was due to an accidental fall into the water, followed by boating (sailing and motor), and swimming.Drowning was the most common cause of mortality, consisting of 34% of all interventions. Divingaccidents represented 14% of interventions. Trauma affected 22% of the study population and 83% oftrauma patients were transported to the hospital under the supervision of a physician. CONCLUSIONS: Potential areas for improvement in the management of drowning victims are the use ofSzpilman's classification, sonography, and non-invasive ventilation. A recertification course for medicaleducation training of BMPM doctors on the management of diving accidents could help to optimize theinformation recorded on FIM. Accident prevention training should be continued and reinforced when itcomes to maritime activities.

Survey of on-spot first-aid training status of primary naval healthcare personnels / 第二军医大学学报

[Abstract] Objective To known about the status of first-aid techniques among naval primary healthcare personnels, providing reference for improving the related first-aid training. Methods A self-made questionnaire was created based on the naval training activities of mass war wound rescue and the requirements of new guidelines and assessment standards. The questionnaire was used to investigate 172 primary naval healthcare personnels. The first aid techniques were divided in well-mastered, mastered, unskilled and un-mastered. And our analysis focused on the first-aid training of war wound and the mastery of first-aid techniques. Results The naval primary healthcare personnel well mastered the six traditional first-aid techniques, including hemostasis, ventilation, bandaging, fixation, handling, and cardiopulmonary resuscitation. Techniques such as infusion via bone, advanced airway management were not well-mastered, or even hard to master. Conclusion To improve war wound rescue capability of primary naval healthcare personnels, we should continue the training activities of mass war wound rescue, improve the related theory, strengthen the related training, and establish a practical war wound rescue training and evaluation system.

Conception and design of a global naval medical geographic information database / 第二军医大学学报

Medical geographic information plays an important role in prevention, treatment, rescue and delivery of the wounded, prevention and control of diseases, and supplement and use of medicines and equipment. We collected and collated the natural geography, social geography, medical geography and military geographic information of 181 coastal countries and regions in the world, and constructed a global naval medical geographic information database. This database can provide fast and efficient information support and decision support, and contribute to implementing naval medical support timely and effectively and promoting the comprehensive development of China’s naval health services.

Insomnia of soldiers in Chinese navy escort fleets in Aden Gulf: Status and influencing factor analysis / 第二军医大学学报

Objective To explore the insomnia status and the influencing factors of navy soldiers during escort in Aden Gulf. Methods Totally 476 soldiers were collected by random cluster sampling method. The mental health status of the soldiers was assessed by Eysenck personality questionnaire-revised, short scale for Chinese (EPQ-RSC) and symptom check list-90 (SCL-90) at 1 week before the escort. At 2 months after the long voyage, the insomnia status and general situation were assessed using the insomnia severity index (ISI) scale and the general situation questionnaire, respectively. The multivariate linear regression analysis was conducted to analyze the influencing factors of insomnia. Results A total of 474 valid questionnaires were collected. During the escort, 44.1% (209/474) of the soldiers suffered from insomnia of different extents, with 28.1% (136/474) subthreshold insomnia, 13.5% (64/474) moderate insomnia and 1.9% (9/474) severe insomnia. The multivariate linear regression analysis showed that the times of escort, night duties and the frequency of oral ulcer were the influencing factors of insomnia (R2=0.68; standardized regression coefficients were -0.101, 0.111 and 0.172, respectively; all P<0.05). Meantime, emotional stability also influenced insomnia to a small extent (R2=0.03, standardized regression coefficient=0.173, P<0.05). Conclusion The sleep quality of the soldiers during long-time escort is severely influenced, with high prevalence of insomnia. The main influencing factors include the times of escort, night duties and the frequency of oral ulcer, and emotional stability may also be an influencing factor.

Naval military medical geographic information system based on ArcGIS / 第二军医大学学报

Focusing on the diversified training environment of the Chinese navy and the peculiar injuries of the soldiers, we created a navy military medical geography information system based on ArcGIS two-dimensional development platform by using the large sample survey data of a certain naval medical support unit. This established system can link the naval injury data, civilian and military health resources and spatial geographic data, contributing to the monitoring and early warning of the navy injury, information management of medical resources, and decision-making in medical support.

'Cleanse or Die': British Naval Hygiene in the Age of Steam, 1840-1900.

This article focuses on the consolidation of naval hygiene practices during the Victorian era, a period of profound medical change that coincided with the fleet's transition from sail to steam. The ironclads of the mid- to late- nineteenth century offered ample opportunities to improve preventive medicine at sea, and surgeons capitalised on new steam technologies to provide cleaner, dryer, and airier surroundings below decks. Such efforts reflected the sanitarian idealism of naval medicine in this period, inherited from the eighteenth-century pioneers of the discipline. Yet, despite the scientific thrust of Victorian naval medicine, with its emphasis on collecting measurements and collating statistics, consensus about the causes of disease eluded practitioners. It proved almost impossible to eradicate sickness at sea, and the enclosed nature of naval vessels showed the limitations - rather than the promise - of attempting to enforce absolute environmental controls. Nonetheless, sanitarian ideology prevailed throughout the steam age, and the hygienic reforms enacted throughout the fleet showed some of the same successes that attended the public health movement on land. It was thus despite shifting ideas about disease and new methods of investigation that naval medicine remained wedded to its sanitarian roots until the close of the nineteenth century.