The First Fleet: The Convict Ships in need of Telehealth

The medical story behind the First Fleet is a triumph of public health and a reminder to us all that a healthy, clean environment and good diet can go long way.

As we prepare to commemorate another Australia Day, it’s a timely reminder of how far medicine has come since the epic voyage of the First Fleet.

 

The Industrial Revolution in the 18th century displaced large numbers of former workers who flooded into cities in search of work. Cities became overcrowded and people often turned to crime to survive. In Britain, the prisons filled and the authorities began housing prisoners (convicts) in rotten prison ships called hulks. But as the prison population continued to climb, Britain looked beyond its shores.

 

Britain first used colonial North America as a penal colony. Merchants would transport the convicts and then auction them off to plantation owners. Up to 50,000 British convicts were sent to America by this route, but after the American War of Independence ended in 1783, the newly formed USA refused to accept any more of Britain’s convicts. In December 1785, Orders in Council were issued in London for the establishment of a penal colony in New South Wales (Australia).

 

On 13 May 1787, the First Fleet left English shores on one of the world’s greatest sea voyages. The Fleet comprised 11 ships carrying up to 1500 people and their required stores. They travelled for more than 15,000 miles over 252 days without losing a ship. Their route went southwest to Rio de Janeiro, east to Cape Town, then via the Great Southern Ocean to Botany Bay with its mission to set up Australia’s first penal colony. 16 convicts were lost to fever before the ships set sail but only forty-eight people were recorded to have died on this epic journey, a death rate of just over three per cent.

 

It is from the diaries of surgeons such as Arthur Bowes Smyth that we have learned of the harsh conditions and medical illnesses endured on this journey. Bowes Smyth had primary responsibility for the 100 female convicts on board the Lady Penrhyn, and to his credit all except one survived the eight-month voyage. This is particularly remarkable when one recalls that his stock of medical equipment was very limited, and that there were no medical provisions at all for children, or for the babies born on the voyage.

 

While Bowes Smyth made no secret of his dislike for the convict women, the new penal colony in New South Wales would need a healthy workforce. Therefore he was greatly concerned for their health and well-being, and one can detect, in some entries of his journal, a certain sense of pride in a job well done. Captain Philip himself was enlightened about hygiene and diet on the ship’s fleet, and was probably correct in his claim that the convicts were in better health by the time they left Rio de Janeiro than when they had left Portsmouth five months before.

 

Conditions had not been kind for the convicts on the journey to Rio. Tropical rainstorms stopped convicts from exercising or drying their wet clothing., and the heat and moisture below decks provided a perfect medium for vermin, ticks and other parasites to flourish. Dysentery, typhoid, smallpox and cholera plagued convicts and sailors alike. The ship’s bilges became foul-smelling and Captain Phillip gave orders that the bilge-water was to be pumped and cleaned out daily. On these ships where these orders were ignored, a number of convicts fell sick and died.

 

The fleet reached Rio on 5 August and stayed for a month to prepare for the next onerous stage of the trip.  In Rio they cleaned and repaired the ships and took on board large quantities of food and water for the Pacific Ocean crossing ahead. Bowes Smyth records that the female convicts’ clothing had become infested with lice and were promptly burnt. With no clothes immediately available they were then issued with clothes made from rice sacks. The convicts largely remained below the deck during this month while the officers explored Rio and were entertained by its inhabitants.

 

The first fleet finally left Rio de Janeiro on 4 September to run before the westerlies to the Cape of Good Hope in Southern Africa, where the boats again replenished their stores and stocked up on plants, seeds and livestock for their arrival in Australia.

 

Assisted by the gales in the “Roaring Forties” the heavily-laden ships surged through the violent seas. In the last two months of the voyage, the Fleet faced challenging conditions, spending some days becalmed and on others covering significant distances. As they reached Van Diemen’s land a freak storm damaged some of the sails and masts of the ships.

 

What is most impressive about the voyage of the First Fleet is that its death rate was relatively low compared to late 18th century standards. It was recorded at7/month per 1000 convicts. By comparison, the death rate on the Second Fleet was seven times higher, and its convicts were in a much weaker condition on arrival in New South Wales, with a further 16% dying shortly afterwards. The Reverend Johnson documented that the Second Fleet survivors who landed were “ wretched, naked, filthy, lousy and many of them utterly unable to stand, to creep or even to stir hand at foot”.  It was decided that inadequate provisions and crowded conditions on board were the causes. Government regulations subsequently stipulated that a naval surgeon should superintend every transport vessel. When this rule was relaxed, a further rise in the death rate ensued. From 1800 onwards, surgeons were reinstated and, after 1805, placed on the same ranking as army medical officers, with authority over all disciplinary and medical matters.  By 1815 this included also the ventilation and cleaning of the vessel. Such measures meant the death rates fell significantly to 2.4/1000/month. To demonstrate the effectiveness of these measures the equivalent death rate on emigrant ships crossing the Atlantic to America was nearly double – for a journey that was half as long.

 

The medical story behind the First Fleet and its journey across stormy oceans is a triumph of public health and a reminder to us all that healthy, clean environment and good diet can go long way.

 

References

http://www.femaleconvicts.org.au/docs/seminars/Voyages_HamishMaxwellStewart.pdf

http://www2.sl.nsw.gov.au/archive/discover_collections/history_nation/terra_australis/journals/bowes_smyth/index.html

https://www.britishmuseum.org/research/publications/online_research_catalogues/paper_money/paper_money_of_england__wales/the_industrial_revolution.aspx

http://sydneylivingmuseums.com.au/stories/why-were-convicts-transported-australia

How to avoid sun damage and heat stress

We all love hot summer days at the beach or on a family picnic, but we all know too well how quickly skin damage, eye damage and heat stress can happen when we are having a load of fun in the sun!

Some exposure to sun is healthy whist too much causes disease, so it is wise to take note of how to avoid the negative side effects of too much sun.

6 quick points to note and remember about the sun and our reaction to it:

1. A little sunshine has health benefits but too much causes disease.
2. Sunshine dehydrates the body, damages skin and causes skin cancer, photo-aging, cataracts and eye tumours (benign and malignant).
3. Sunshine replenishes vitamin D stores, reduces myopia (shortsightedness) and reduces depression.
4. If blood vitamin D levels are truly low, dietary supplementation (fish) plus vitamin D supplements are probably safer than increasing sun exposure.
5. Don’t be fooled by cloud cover! The sun’s rays can pass through thin and hazy clouds.
6. Remember to slip, slop, slap, seek shade and slide on a pair of “sunnies”.

 

The ancient Greeks believed that Apollo the Sun God harnessed his chariot to take the sun across the sky. He was seen as a healer and the God of Medicine but also the God of Plague who spread diseases and pestilence.

Just as Apollo encompassed both cure and disease, so does the sun. Sunlight is made up different ultraviolet (UV) frequencies. UVB is the frequency responsible for sunburn, skin cancer, hyperpigmentation, and photo-aging: in fact UV radiation is responsible for 80% of our skin’s fine lines, wrinkles and sagging.

However sunlight has other effects too.

 

Sun and the skin

Certain skin types are more vulnerable to the effects of the sun (white skin with blue eyes more than dark brown to black skin). But everyone regardless of skin type is at risk. Photoprotection is crucial for ALL skin types. This includes sun avoidance at peak hours, sunprotective clothing and sunscreens

 

1.     Sun Avoidance

A score >3 on the World Health Organisation UV Index is when sun protection measures are required. Australia is consistently above 3 all year round except in the winter months in certain regions. In January the UV index is extreme.

Don’t be fooled by cloud cover! The sun’s rays can pass through thin and hazy clouds.

 

2. Sun Protective Clothing

Hats, long sleeves shirts, collars are all recommended particularly on hot summer days when prolonged sun exposure may occur. Some clothes have been given a ultraviolet protection factor (UPF rating). A UPF 50 allows only one 50th of UV radiation to filter through to your skin.

 

3. Sunscreen: Which to use?

Broad spectrum sunscreens with high sun protection factor (SPF 30+), particularly those with ingredients that protect against UVA1 (e.g. Zinc oxide, titanium dioxide and avobenzone) are preferred for those going out in the Australian sun. Cosmetics that use broad spectrum protection with an SPF 15- 30 are preferred to those only containing UVB filters.

 

Sunscreen in children:

Parents should avoid direct exposure to baby’s skin in the first year if possible. But this can be difficult, so The Australian College of Dermatologists recommend sunscreens be used at any age when exposed to the sun if clothing/shade is not available. Since infants have an immature skin barrier, oil-based emulsions such as titanium dioxide or zinc oxide are preferred as they have broad spectrum protection and minimal irritation.

 

How much to put on and when?

Sunscreen must be applied liberally and frequently.  If you don’t put enough on, it wont work. The teaspoon rule is a good guide in children: 1 teaspoon to face and neck, 2 to back and front torso, 1 teaspoon to each arm, 2 to each leg.

It should be applied 15- 30 minutes prior to sun exposure to allow a protective film to form. Reapply every 2 hours, even for those that are water resistant.

 

SUNBURN: top tips

●     Moisturiser cream may help soothe the skin.

●     If pain is associated, try non steroidal ant-inflammatory analgaesics like ibuprofen (e.g. Nurofen)

●     Do not de-roof blisters, as this may lead to infection. Cover the blisters with gauze.

●     Ensure you drink plenty! Sunburned skin loses moisture faster.

●     Do not go out into the direct sunlight until your sunburn has resolved

 

SUN and the EYES

Eye Sunburn: Photokeratitis and photoconjunctivitis

Just like sunburn to the skin, eyes that are exposed to excessive UV radiation become red, sore and sensitive. Prolonged exposure can also cause eye tumours (benign and malignant) and cataracts. Hence, wear sunglasses (preferably with large / wraparound lenses) that block 99-100% UVA and B radiation. Don’t be fooled by a dark tint alone. A dark tint does not necessarily mean that the sunglasses fit this criteria. Your kids need them too.

 

SUN : The benefits

Vitamin D

Sunlight (especially ultraviolet B, UVB) is essential for the synthesis of vitamin D which helps us absorb calcium and phosphate from our food. When levels of vitamin D are low, there is a risk of bone disease. In children this is called Rickets (suffered by Tiny Tim from A Christmas Carol, along with TB) and is rarely seen in Australia. In grownups, especially the elderly, inadequate vitamin D causes Osteomalacia and can cause fractures when elderly people fall.

It is also suggested (but not definitively proven) that vitamin D has a role in preventing heart disease, cancer and asthma.

The amount of sun exposure required to get the benefits of Vitamin D depends on skin type, geography and UV index. Given the risks of sun exposure,  dietary supplementation (fish) plus vitamin D supplements would seem safer if blood vitamin D levels are truly low.

 

Depression: Seasonal Affective Disorder

We all feel uplifted with the big bright blue skies of an Aussie summer. Consequently it is not surprising to note that some patients describe increased depressive symptoms in late autumn and winter which improve once summer arrives. Such cyclical symptoms are part of Seasonal Affective Disorder. In addition those with bipolar disease may describe increased symptoms of mania or hypomania in the summer but less so in the winter. It is postulated that sunlight may have a direct effect on serotonin levels and thereby account for these changes in mood.

 

Myopia (Shortsightedness)

Studies suggest that if children spend less time in the great outdoors, then short sightedness /myopia can ensue. The prevalence of myopia has doubled in the USA and Europe over the last 50 years and links with the amount of sun exposure/light have been suggested.

 

In conclusion

Just like anything else, enjoy the sun sensibly and take in moderation! In particular, wear good quality sunscreen and sunglasses and remember to ‘slip, slop, slap, seek and slide’.

 

References

http://wiki.cancer.org.au/policy/Position_statement_-_Risks_and_benefits_of_sun_exposure

http://www.bom.gov.au/jsp/ncc/climate_averages/uv-index

http://www.nature.com/news/the-myopia-boom-1.17120

http://www.webmd.com/eye-health/features/how-to-pick-good-sunglasses#1

Sunscreens: an overview and update. J Am Acad Dermatol 2011: 64:748

Clothing reduces the sun protection factor of sunscreens. Br J of Dermatolof 20102: 162:415

Sun Protection and Skin Examination practices in a setting of High Ambient Solar Radiation: A population based Cohort Study. JAMA Dermatol 2015: 152:982

Sunscreen Use: Controversies, challenges and regulatory aspects. Br J Dermatolo 2011: 165: 255

The Future is Here

The future of healthcare has launched in the form of an app that puts you directly in touch with an emergency specialist doctor. Save time by avoiding the hospital trip and long wait.

Meet My Emergency Dr; the smartphone app that connects you with emergency specialists and provides help when you need it. If you or a family member are sick, the team of Emergency Specialist Doctors at My Emergency Dr can remotely assess you, make a diagnosis, provide expert medical advice and in many cases arrange the treatment you need.

CEO Dr. Justin Bowra, a senior emergency physician and founder of ConnectedMed understands the importance of quick access to doctors qualified in emergency medicine, and wants to make emergency healthcare more accessible to Australians.

“Our vision at My Emergency Dr is to give every Australian urgent video access via your smartphone to an Emergency Specialist, wherever they live and whenever they call. All of our doctors are qualified specialists in Emergency Medicine. Simply download the app and connect to an Emergency Specialist who will be able to assist you wherever you are.”

My Emergency Dr provides urgent assessment and diagnosis. The service does not replace 000, but will provide a convenient way of getting urgent diagnosis and medical advice from a qualified emergency specialist without having to wait at a hospital.

Dr. Bowra intends the service to work with the patient’s GP, and providing references to pathologists, imaging services and pharmacists. “Registered clients have 24 hour-a-day immediate phone and video access to a team of Emergency Specialists who can remotely assess, diagnose and arrange treatment.

My Emergency Dr will email you a copy of the consultation record to take to your GP. If medications need to be organised, we can email you an electronic prescription. Similarly, we can also email you referrals for x-rays or blood tests.”

You can download My Emergency Dr from the App Store or Google Play
Open it and follow the instructions provided.