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 :

(1) The lack in the food of an essential factor or vitamin, which leads to a condition of the body with diminished resistance to deleterious influences.
(2) The addition to the system during this devitalized state of a poison.

Prevention aims, therefore, at the provision of food containing the active vitamin in sufficient quantity and in taking steps to eliminate as far as possible poisons from the system.

With regard to supplying the vitamin, naturally much of the provisions carried must be in the form of preserved foods. Unfortunately, most canning and preserving processes have a detrimental effect upon the vitamin, and it is under conditions where men are compelled to live on them for long periods, with no access to fresh foods, that the danger of scurvy arises.

For many years lime-juice was regarded as a sure preventive and a certain cure, but this has proved fallacious.

There are, however, certain canned and dried foods which contain active anti-scorbutic vitamin, though not in such great amount as fresh vegetables. One should endeavour to rely, therefore, not on any one product, but on the regular provision of all foods which are of value in this way.

With regard to the dietary, there are two sets of conditions to be prepared for: Life on the ship or at a well-stocked base, permitting of a full and varied diet for which more or less bulky foods can be used; and sledging conditions, including abnormal circumstances arising from accident, which require a close ration.

In making my arrangements I placed reliance on the following foods: For the first set of conditions, lemon-juice concentrated by the method advocated by Surgeon Rear-Admiral Sir P. W. Bassett-Smith; dried milk made by the “roller” process, condensed milk prepared by evaporation in vacuo; canned tomatoes; peas, beans and lentils for being made to germinate, and on prolonging the use of potatoes, carrots and onions as far as conditions should permit.

Under sledging conditions the party is placed on a definite limited allowance. A sledging ration is composed somewhat as follows: Pemmican, nut food, biscuit, tea, sugar and dried or condensed milk, amounting to a total weight of about 2½ lbs. per man per day, and having a food value of about 5,000 calories. Of these, only the milk can be said to contain active vitamin, and not in sufficient quantity to prevent scurvy.

Shackleton added to his Endurance sledging ration capsules of lime-juice prepared without heat. This was in 1913 when the vitamin theory was scarcely evolved, and is an example of his remarkable ability to organize in detail.

For this expedition I added lemon-juice prepared as for use aboard ship, but made into tablets and packed in air-tight containers, and dried milk packed in small air-tight packages, each package containing only one day’s ration, thus avoiding undue exposure to air.

Three different vitamins are described by investigators:

  1. The anti-rachitic fat-soluble A vitamin,
  2. The anti-neuritic[24] water-soluble B vitamin, and
  3. he anti-scorbutic water-soluble C vitamin.

I have spoken only of the last; the first hardly needs consideration here. The anti-neuritic vitamin is more easily preserved and supplied than the anti-scorbutic, and for the prevention of beri-beri the following foods were added to the ship’s dietary: Rice (containing the germ), wholemeal flour, oatmeal, dried eggs, 355 dried peas, beans and lentils, and marmite, a yeast product, for adding occasionally to soups and stews. For sledging conditions: Marmite, ½ oz. per man per day (to be placed in the “hoosh”).

In preparing the supplies we carried a large variety of foods, for it is of importance to prevent monotony in meals. This Shackleton always realized. The following from the “The Worst Journey in the World” is interesting: “Meanwhile Shackleton’s hut was very pleasant at this time of year … and the food. Truly Shackleton’s men must have fed like turkey cocks for all the delicacies here….” The addition of a few delicacies adds little to the cost of an expedition, but means a great deal to those engaged in it. I think it would surprise most people to know what can be done in the way of supplying wholesome and attractive foods in a preserved state by modern plants. There should be one standard of quality only: the best, and goods should be obtained only from firms of the highest repute.

The elimination of poisons from the system is aimed at firstly, by thorough preliminary examination, as already indicated, to avoid sources of poisons in the body itself, e.g., the mouth, teeth, throat, and nasal passages with their accessory sinuses, and, secondly, by ensuring that no bad or “high” food shall be eaten.

Constipation in any of the personnel is a factor which must be avoided, and it is necessary that all hands be impressed with the importance of a regular daily movement of the bowels and a complete evacuation at each act. Defæcation is apt to be hurried or neglected in bad weather at sea and in cold and snowy weather ashore. Polar travel does not admit of comfortable latrines, and this often means exposure to wind and drift, for the daily functions are carried out in the ordinary way. This exposure of the body, though exceedingly uncomfortable, leads to no lasting harm, for, as will be shown, it is in the comparatively bloodless extremities that frost-bite usually occurs. Constipation is followed by absorption of poison from the bowel, and so must be especially avoided if the risk of scurvy is imminent. Its correction in bad weather must be carefully carried out, for the cruelty of drastic purgation under these conditions can be imagined.

In future those responsible must make themselves au fait with the steps necessary to prevent the onset of deficiency diseases. Scurvy caused the failure of Lord Anson’s expedition; in Captain Cook’s brilliant voyages it was absent. Compare the bad conditions in the Alert and Discovery in 1875 with the earlier voyages of Sir Robert McClure in the Investigator. Always success and failure have depended upon its presence or absence. In more recent times, take the case of Captain Scott and the gallant companions who met their fate so bravely. Mr. Cherry Garrard attributes their failure to return from the Pole to several conditions, one of them a deficiency in the calorific value of their ration. “It is a fact that the polar party failed to make their distance because they became weak, although they were eating their full ration or more than their full ration of food, save for a few days when they were short on the way down the Beardmore Glacier….” He goes on to say: “The Summit (S) ration consisted of biscuits 16, pemmican 12, butter 2, cocoa 0.57, sugar 3, and tea 0.86 oz.; total, 34.43 oz. daily per man.”

I do not know the composition of the pemmican, but this ration should yield nearly 5,000 calories. I should consider it to be devoid of anti-scorbutic and anti-neuritic vitamin, and, indeed, the whole medical history of that return journey shows that these men were fighting an unknown enemy greater than all the forces of the Antarctic. In a footnote Mr. Cherry Garrard mentions the possibility of vitamin deficiency, and it is noteworthy that Dr. Atkinson added fresh onions (brought by the ship) to the next year’s ration. I think there can be no doubt that there was vitamin deficiency, and it all goes to emphasize my point of the absolute necessity for careful medical organization to prevent these preventable conditions, for it is my firm belief that the cause of Scott’s death lay not in the Antarctic, but in his preparations in England prior to setting out. The knowledge of the subject necessary to enable him to prepare a sledging ration containing active vitamin was not then available.

As there are two definite causes of fully developed scurvy, viz. the lack of “vitamin” and the addition of a poison, so the symptoms and signs divide themselves into two stages:

(1) A stage of general lassitude with loss of vigour and a diminished resistance to outside influences.
(2) A stage of toxæmia which once started progresses rapidly and produces the symptoms and signs usually associated with scurvy.

One must be constantly on the watch for the first stage, for unless carefully looked for it will probably not be recognized, as the man affected can give little clue to what is wrong with him. I saw many hundreds of such cases during the war in North Russia when scurvy was common, none of them showing any local signs at all. When the better-known signs appear, such as spongy gums, blotches in the skin and lumps in the legs, the disease is in an advanced stage.

My own arrangements for prevention were published in full prior to our start in the Lancet, August 13th, 1921. I believe this is the only Antarctic expedition that on setting out has not taken chances with scurvy, though the absence of any signs of the disease from any of Sir Ernest Shackleton’s own parties is remarkable. The reason is that the necessary knowledge had not till that time been available.

Space forbids a full description here, but there are two important points to which I must refer: Dried cereals by themselves do not contain active anti-scorbutic vitamin, but if made to germinate the green shoots which sprout from them are rich in it. This is a point of immense practical value, the application of which is obvious. With regard to fresh meat, it has been shown by Stefansson in the North, and by members of the Endurance expedition in the South, that health can be maintained on a purely meat diet, and that fresh meat, if taken in sufficient quantity, is effective to cure scurvy. Stefansson, in the Friendly Arctic, says that it must be eaten raw or very much underdone, but our experience in the South showed that this is not necessary. In fact, a certain degree of cooking is advisable. He states also that putrefactive meat is an effective cure for scurvy. This I think is dangerous teaching; in any stage of scurvy anything putrefactive should be avoided if possible unless there is nothing else.

Those general readers who desire to learn more of this most interesting disease are referred to the bibliography at the end of the report.

On this expedition there was no scurvy, and no risk of it, for we were never long enough away from sources of fresh food. Yet I would emphasize the necessity of strong anti-“deficiency disease” measures in polar work, whatever the programme may be, for in the pack ice accidents may at any time occur leading to altogether unforeseen conditions as regards food supply.

Frost-bite is a condition well known to all polar explorers. If neglected it may lead to most crippling results, and, like scurvy, requires careful preventive measures.

The parts of the body most commonly affected are the exposed parts of the face, especially where the skin is drawn tight over underlying bone, e.g. the sides of the nose, the cheekbones and the chin; the ears, the fingers and the toes. In parts other than the fingers and toes the condition is usually not serious, for frost-bite of the face and ears, if neglected, may cause disfigurement, but no real crippling. It is a good practice for men in company to scrutinize each others’ faces, and a valuable piece of equipment is a small mirror in which a man without companions can examine his own face. Frost-bite of the fingers, though more serious, is usually quickly recognized and promptly treated.

Frost-bite of the toes and feet is an extremely dangerous condition and may have far-reaching results. The danger lies in the fact that its incidence is often unknown to the man attacked, and, though he may suspect its onset, he may neglect to examine his feet, for polar footgear is elaborate and cumbersome, examination of toes on the march means a halt, and a certain amount of time is consumed in unfastening and securing the foot-coverings.

Prevention is aimed at generally by maintaining health and a vigorous circulation. Anything which depresses the health and lowers vitality predisposes to frost-bite. In polar work the most important are exhaustion, hunger and vitamin deficiency. During a sledge journey vitamin deficiency, the consequent lack of resistance, and the more easily induced frost-bite create a condition of the gravest danger to the man or the party so affected.

Locally, prevention lies in providing suitable clothing. In whatever form it takes the principle aimed at is the same, viz. to provide a non-conducting air space round the skin. The head and ears are protected by woollen and windproof helmets. The face cannot be covered, for masks get so heavily iced up as to make things worse. A cowl can be fitted to the helmet which, when thrown forward, to some extent shields the face from winds. The hands are enclosed in mitts, not gloves, in which the fingers are all together. The finger portion should be large enough to allow inclusion of the thumb when the hand is not in use. Sometimes two or three pairs are worn, the outer pair being of windproof material.

To provide adequate foot protection which shall not at the same time be cumbersome is not an easy matter, for things which are loose about the feet are unwieldy. Woollen socks which enmesh the air in their stitches provide a good insulating air space. In low temperatures two, three or four pairs may be necessary. To prevent constriction of the feet it is of importance that each outer pair of socks should be a size larger than the one inside, and so they should be supplied in series. The cramming of a foot with too many pairs of socks into a boot too small for them is bad, for the circulation of blood to the toes is restricted and the air space is lost. Cold feet have often been cured by telling the wearer to remove a pair of socks.

All possible steps must be taken to see that the air space is not replaced by moisture, i.e. the feet and coverings must be kept dry. This is a difficult problem; coverings which allow of ventilation allow access of damp from the outside, and waterproof coverings retain perspiration. It is usually impossible to ensure absolute dryness, and therefore socks should always be changed before turning in to sleep. This should be made an inviolable rule, yet it is one which is often broken. Damp socks should not be placed in a freezing atmosphere, for the moisture in them will freeze and render difficult the putting of them on in the morning. They should be kept in the sleeping-bag or placed under the jersey. By this means they dry rapidly. Sennegrass may be used for taking up perspiration; it has the property of rapidly giving up its moisture. Some people prefer to use pieces of flannel instead of socks; the pieces are wrapped about the feet, and have the advantage that when taken off they can be spread out and thus dry more rapidly.

All tight fittings and all constrictions which serve to impede the circulation should be avoided. Success in preventing frost-bite is attained only by continued and careful attention to detail.

Precautions which are carried out by men in good condition are liable to be ignored by those who are exhausted or weak from any cause, and under these conditions frost-bite occurs frequently. A frost-bitten part becomes waxy white in appearance. If treated at once no harm results, if neglected death of the part ensues. Treatment on the spot consists not in rubbing the part with snow (men have been killed for less), but in applying dry, gentle warmth. Very light massage may be used, but violent rubbing, especially of the face, is liable to remove the cuticle and leave a weeping sore. Fingers can be thrust inside the affected man’s own clothing next to the warm skin. A frozen toe can be similarly nursed back by a “Good Samaritan” placing the toe against his skin and enfolding the ankle—a most unpleasant job, but most excellent treatment. A hand taken from a warm mitt can be placed on the face, nose or ears. Recovery is accompanied by an intense feeling of “pins and needles.” A part that does not immediately come back to normal must be kept warm and dry, and the application of a little methylated spirit or turpentine is good.

It is essential to avoid grease and wet. I have, in the Antarctic, the Italian Alps, and in Russia, made extensive tests of oils, fats and grease, and have come to the conclusion that the application of vaseline or ointment is the worst treatment possible, especially if the part is liable to be again exposed to cold. Too great heat is bad. The circulation must be coaxed back gently. Too sudden a return leads to exudation and choked capillaries, just as theatre passages are choked at the cry of “Fire!”

Non-recovery leads ultimately to gangrene. If superficial, the part may separate of itself, leaving a good new skin underneath which is at first very tender; if deeper, judicious amputation may be required. The gangrene may be dry or moist. In the former case the part shrinks and becomes black and scaly, the condition having little effect upon the general health. It is dry and inoffensive. In the case of moist gangrene the part becomes septic, is very offensive, and absorption of poisons leads to impaired health. The amount of the limb that requires amputation depends upon the severity and extent of the frost-bite. It must be emphasized that in examining a part for frost-bite the waxy appearance may not be present. It does not follow that the part has not been frost-bitten or is not seriously affected. There is a more slowly produced condition, due to the action of prolonged cold, in which blood returning into the capillaries which have been damaged by the continued constriction due to the cold sets up inflammation and exudation, which may lead to death of the part. Signs of mottling, at first pinky white, later blue-grey, should be looked for, and if they appear the parts must be treated with the greatest care. If circumstances permit, the limb should be raised, rested, and dry, warm (not hot) dressings applied. For unbroken parts I use cotton wool which has been thoroughly dried, bandaged lightly; for cases when the skin is broken, lint which has been warmed and the surface scorched to render it sterile, covered with warm, dry wool, and again lightly bandaged. This simple treatment can be applied under any conditions in which it is possible to produce a flame. Cases take a long time to recover fully. Ointments, hot wet dressings, and poultices should be avoided. A milder though similarly produced effect leads to an irritable condition resembling chilblains. It affects commonly the tips of the ears. The momentary exposure of bare skin does not lead to immediate frost-bite, but the length of time that it can be exposed depends upon the temperature, the amount of moisture present, and the strength of wind. It is often necessary in carrying out a piece of work to expose the hands, which may require periodical warming up. Much depends upon the circulation, for if a job is attempted after the body has been for some time at rest frost-bite sets in quickly. If, on the other hand, the individual has been working hard, walking or running, and the blood is pulsating actively, the hands and other parts can be exposed for comparatively long periods without harm.

As a result of unrecognized and untreated frost-bite strong men have been crippled for life. Constant watchfulness is required; its danger cannot be over-estimated, nor too much emphasis placed upon measures for its prevention.

Notes on Oils and Grease

It is commonly believed that fats, oils and grease are good non-conductors of heat and if placed on the clothes or on the skin help to keep one warm. There was never a greater fallacy, for it is common experience of polar explorers that the reverse is the case. Circumstances do not permit of regular laundrying or even of regular hot baths, and situations are not rare at this work in which men have spent several months without a wash or a change of clothes. After the loss of the Endurance the party had neither for a year. The clothes inevitably became greasy, especially about the elbows and thighs. The cold could be felt “striking through” the greasy parts.

It was often necessary to kill and cut up seals. In the process the left hand grasped the blubber and became very greasy, whilst the right hand, which wielded the knife, very largely escaped. Usually it was possible only to wipe with snow, which had little effect to remove the grease, before replacing the hands in mitts. Subsequently the left hand felt colder and was more liable to frost-bite. Socks which have been worn for some time and become slightly greasy are less warm than clean, dry socks. There are socks of a type manufactured by certain firms which have been deliberately imbued with grease to make them warmer. The wearing of them produced the opposite effect. During the war I made experiments upon myself and with troops, in which two stretcher-bearers massaged the feet of each man, the left foot with whale oil and the right by rubbing only. Both were done at the same time and for the same length of time. The results were greatly in favour of the dry rubbing. I collected also a number of socks which had been worn (and were therefore greasy) and dried them thoroughly. I acquired some absolutely new socks, and issued one dry, greasy sock and one new sock to each man. Evidence in this case was not unanimous, but was numerically in favour of the clean sock.

The conclusion is that oils and grease are of small value for protection against cold and should as far as possible be avoided.

It may be thought that by not washing or having a change of clothes for a long period the skin gets into a bad state. Fortunately, in the Antarctic there are no human parasites, and one does not perspire so freely as in warmer climates. Nevertheless, when working hard in very low temperatures perspiration may be very free, and consequently well-ventilated clothing is necessary. Modern Antarctic equipment consists of warm woollen underclothes and very light windproof overalls made of closely woven material. Furs are not used, though they are favoured still by some Arctic explorers. The theory is often put forward that the best procedure to adopt in the Arctic is to copy as nearly as possible the clothing of the Esquimaux, for, that being their home, naturally they know what is best. This view is strongly urged by Canadians who trade along the Arctic coast. Certainly it has the advantage of cheapness, but I wonder if they went to Central Africa whether they would adopt the loin cloth—also cheap? As a matter of fact, experience has shown that the skin improves in condition and takes on a white, silky softness that some women might envy. It is advisable under the conditions to seize any chance of still air and bright sunshine to remove the clothes, dust from them the flakes of skin which are constantly being shed, and give the body an air bath.

Snow-blindness is a condition of acute and sudden congestion of the eyes, affecting chiefly the conjunctivæ (the delicate membranes which cover the greater part of the front of the eye). The little blood-vessels become dilated, producing a prickly sensation of grit in the eyes, which become painful in strong light. The condition may become worse, leading to a marked congestion with heavy discharge and total blindness. Snow-blindness is produced less frequently by sun-glare on the snow than by a diffuse dull light which casts no shadows and requires continuous strain to pick out hummocks and unevenness of the ice. It is said that people with less pigment, i.e. “blue-eyed” people, suffer more than those with darker, more heavily pigmented eyes, but this is not always the case.

The condition can be prevented by wearing goggles with tinted lenses; e.g. the ordinary dark Crookes lenses are quite effective. The frame is of importance, for it must allow of free ventilation without side glare. The Rowley snow goggle, as used by Amundsen and Shackleton, is a thoroughly effective design. The contour of the face and the depth of the eye sockets differ so much in different individuals that each man should be fitted for goggles prior to starting.

If treated early the condition gives little trouble. Even bad cases are easily treated on board ship, or at a base, by protecting the eye from strong light, and frequent bathing with warm water, boracic lotion, or, better still, very dilute zinc sulphate. If on the march, treatment is more difficult, for lotions will probably not be available. Small, portable and very effective tabloid outfits are obtainable, containing eye drugs in small lamellæ, which, when placed in the eye, are dissolved in the tears and so form lotions. It must be remembered, when selecting the small outfits, that one which may be easily manipulated in the warm showrooms of Messrs. Burroughs and Wellcome may not be so easily handled with fingers benumbed and made clumsy with cold.

For the non-medical man the best treatment is first to place in the eye a cocaine lamella to relieve pain, and follow it in a few minutes by another of zinc sulphate. Pituitary and adrenal extracts have a very rapid effect, but must be used with great care. Untreated snow-blindness in bad cases may lead to permanent results. The condition is preventable and easily treated in its early stage, hence once more the great importance of careful preparation.

Bacterial affections are rare. “Colds in the head” hardly ever occur, and if they do are probably due to germs brought by the party themselves. Wounds, however, readily become septic. Even clean cuts take a long time to heal, and unite with more scarring than usually happens in more temperate regions. This is due to the comparatively bloodless condition of the skin. Steps should always be taken to keep the injured part as warm as possible. When possible it is an economy to rest and carefully look after open wounds however slight, for the reluctance to heal often causes long-continued annoyance.

Every polar surgeon must be prepared to do his own nursing. There is no one else to do it. Conditions for a sick or injured man, even under the best circumstances, are far from being ideal, yet much can be done by improvising and keeping an adaptable mind. Comfort, even for an invalid, is a relative term. The great thing is to keep the patient cheery, and in the ship, at a base hut, in a tent, or even under an upturned boat, one can be continually doing little things to make him feel that he is being well looked after.

The surgeon’s advice is often sought with regard to local food supplies. There is very little in the way of animal flesh that one cannot eat if put to it, and a few precautions in cooking can make almost anything palatable. The meat of whales, seals, sea-elephants, sea-leopards and penguins is all very similar, being composed of a dark red coloured flesh of coarse texture. They have a somewhat strong oily taste, which one learns not to dislike in cold regions. The organs, such as the brains, hearts, livers and kidneys, are edible and are said to be rich in anti-neuritic vitamin. One has to beware of parasites. Fish form the diet of most of these animals, and are a prolific source of tape worm, round worm and small thread worms. Often, also, the liver contains small trematodes. Weddell seals and sea-leopards especially seem to be infested with these parasites; on being cut open they have often an unpleasant toxic smell, the intestines swarm with worms, the heart may have small cysts on its surface, small animalculæ may be detected in the bile which flows from the cut liver, and the spleen and lymph glands are often enlarged, showing that the animal is suffering from a general poisoning. Unless the party is starving, such an animal should naturally be rejected in toto, although the meat may appear to be sound.

The crab-eater seals, which live largely on small crustaceæ, are much more healthy animals. Penguins also require careful examination. Seabirds have a rather strong taste of oil and fishiness, which can largely be removed by soaking them in dilute vinegar for twenty-four hours. Young albatross and paddy birds require no special treatment and are delicious. Fish swarm in Antarctic and sub-Antarctic regions wherever there is shoal water and kelp, as also round the South Atlantic islands, where crayfish also can be obtained. Every effort should be made to vary a diet of preserved provisions by seizing the chance whenever possible of obtaining any of the above.

There is much of interest in the medical side of exploration that space forbids me to touch on, but there is one point which is likely to concern the surgeon of a polar expedition, whose department is an all-embracing one: the health and physical fitness of sledge dogs.[25] Many explorers have found dogs unsatisfactory as a means of transport. This is especially the case with British explorers. Scott found them a failure on his first expedition and put little trust in them on his last. Shackleton, in his own first expedition, as a result of his experience with Scott, used ponies in preference. Careful organization has been put into providing and preparing for various forms of mechanical transport before the expeditions concerned left England, yet Shackleton in getting ready for the Endurance expedition is, so far as I know, the only British explorer who seriously organized and thoroughly prepared for an efficient service of dog transport prior to his start. Sledges, harness, traces and, last, not least, food and sledging rations were worked out in detail. Commander Wild, who associated with him in this work, is a strong advocate of their utility. During the expedition the dogs were rigidly disciplined and carefully “vetted,” and the results were splendid. We were unable to attempt the cross-country journey, yet the work of the dogs day by day was marvellous. There was no ice too rough for them, they crossed broad leads of water at high speed over nothing but rubble, wherever men could take a sledge they could take it faster, and sometimes go where men could not. They required no tents or sleeping-bags—only a minimum of one pound of good food per day.

Dogs are living organisms, like men, and require treatment as such. Their characters must be studied and their health looked after. To begin with, like men, they must be physically fit, they must be kept fit, their coats brushed and combed, their skin and paws kept in good order, they must be freed from parasites, and their fighting wounds made to heal. Like men, they must be well disciplined and trained, and then they are fit to send out on a sledge journey.

The sledging ration must be as carefully worked out as that of the men with a view to calorific value and vitamin sufficiency. Dogs are possessed of a high degree of intelligence, are hardy, and can look after themselves. As I have said, they can take a sledge anywhere that men can, therefore they are worth looking after. Yet one of the most pitiable things in the history of polar exploration is the way in which dogs have been neglected, left in miserable condition when probably all that was required was a dose of castor oil and a good vermifuge, made to work to the last ounce on a totally inadequate ration, and finally driven to death.

Amongst the names of non-British explorers which stand out are those of Sverdrup, Amundsen and Peary. They looked after the health of their dogs, and were amply repaid for the care expended.

During the voyage of the Quest there was little sickness. A number of casualties occurred, most of them trivial and easily dealt with, none producing serious results.

There was one death: Sir Ernest Shackleton. The cause was atheroma of the coronary arteries. The condition was a long-standing one and in my opinion was due to overstrain during a period of debility. In his history there are many occasions when it may have been produced. The scurvy which he developed during the southern journey of the Discovery expedition may have produced lasting results. It has been stated that his collapse caused the failure of that journey. I must make it plain that the development of scurvy in an individual during a sledge journey is not in any way the fault of the individual, but results from faulty organization. Sir Ernest Shackleton has never had a single case of scurvy, or any condition allied to it, in any party under his charge. His condition may have been produced during his own great pioneer journey towards the South Pole.

What is remarkable is that in such an advanced condition he was able to carry on as he did. It shows, psychologically, a wonderful will power and an unyielding determination to overcome difficulties. In this respect may be noted one of the last things which he wrote (in a final letter to Mr. Rowett):

“Never for me the lowered banner,

Never the lost endeavour.”

In other psychological respects he was remarkable, as is seen in the combination of a happy and apparently carefree temperament with an ability for accurate and detailed organization. As a leader he was always “boss.” He was condemnatory of shortcoming and exacting in the service rendered by subordinates, yet he drew from all who worked for him a deep liking and an unfailing loyalty. His physical qualities are well known. As a living organism he was wonderful.

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