User:Mark Harnitchek/sandbox

Seasickness - History of Causes & Cures
Other names	Mal de Mar, feeding Mother Carey's chickens, chunder, technicolor yawn, liquid laugh, having a little spit
Seasick passengers from an 1841 illustration
Specialty	Neurology
Symptoms	The "Big Four:" Pallor, Cold Sweats, Nausea, Vomiting
Causes	Real or perceived motion
Diagnostic method	Onset of symptoms
Prevention	Avoidance of triggers or stay ashore
Treatment	Behavioral measures, medications
Medication	Scopolamine, dimenhydrinate, dexamphetamine
Prognosis	Generally resolve within a day, onset of calm seas, or getting one's "sea legs"
Frequency	Nearly all people in sufficiently rough seas; one-third highly susceptible

Seasickness – A Brief History of Causes and Cures

“I am never, never sick at sea.”

“What, never?"

“No, never.”

“What, never?”

“Well, almost never.” Gilbert and Sullivan, HMS Pinafore, 1878

For as long as seafarers have been “going down to the sea in ships,” they have been getting seasick and then figuring out how not to get seasick. I spent some, but thankfully not much, of my Navy career with the dreaded symptoms of mal de mar – the cold sweats, headaches, nausea and hurling of being seasick.I found that what worked on some cruises didn’t work on others and what worked on one ship didn’t work on the next. Most of the time -- with all tribute to Neptunus Rex, Ruler of the Raging Main; Davey Jones, his Majesty’s Scribe; and all the Mermaids, Sea Serpents and other Living Things of the Sea -- I did not get sick at all. As Gilbert and Sullivan claimed, however, “almost no one never gets seasick.” This essay will provide a brief history of the sickness and its cures.

“So that you will not be sick on a ship: Grind fleabane and wormwood together in olive oil and vinegar and rub on the nostrils frequently.” Apuleius Platonicus, Herbarius, 2 AD

Greek and Roman texts from 800 BC – 800 AD mention causes and remedies for seasickness. Two thousand years ago, Hippocrates, the father of modern medicine, figured out that “sailing on the sea proves that motion disorders the body.” The Greek word for seasickness was “nautia” from “naus” meaning ship. The subsequent English derivation from the Greek was “nausea.” The Greeks and the Romans attributed the symptoms and cures for seasickness in the context of the humoral theory of the four bodily fluids: yellow bile, phlegm, black bile and blood. Seasickness was caused when these fluids and their associated organs – stomach, liver, lungs, et al -- were out-of-balance. The Chinese pathology, on the other hand, followed their classical medical theory of the life force “Qi” being disturbed by external pathogens. For seasickness, climatic factors like the wind were thought to be pathogens that entered a weakened body and caused illness.

“It is an old adage that there is nothing worse than the sea to confound a man, be he ever so strong.” Homer, 800 AD

Both the Greeks and the Romans recognized that rough seas and unpleasant smells made the symptoms worse, and that seasoned sailors were far less affected than landsmen. Preventative measures, surprisingly similar to more “scientific” 19th and 20th century methods, included fasting one day before the voyage, eating light meals of dry bread and boiled lentils during the voyage, and looking to the horizon and not the rough seas near the ship. Once ill, treatment included inhaling the fragrance of aromatic plants and herbs and drinking tea made from dry wine, wormwood shrub or white hellebore. Chinese cures like swallowing white sand syrup, drinking water drops from a bamboo stick or placing earth from a kitchen hearth beneath the hair seem a bit unusual by today’s standards. In the following paragraphs, however, they will appear no odder than the advice given by medical doctors in the 19th and early 20th centuries. Ultimately, the Chinese offered the best advice of the ancients when it came to avoiding seasickness: “If you can get there by land, do not go by water.”

'“Marcus Cato said he had never repented but three times in his whole life, once when he paid a ship’s fare to a place instead of walking.” Plutarch 110 AD

Remarkably, in the second century, AD, Roman and Chinese scholars established a connection between seasickness and the eyes and brain – a diagnoses in the same medical neighborhood of Williams James in 1882 almost two millennia later. James, a Harvard psychologist and philosopher, discovered that deaf-mutes – those with damaged vestibular systems (the inner ear that provides balance) -- did not get seasick no matter how much the ship pitched and rolled. James’ work eventually led to the current and correct theory of “vestibular overstimulation which held that when there is too much motion, the signals from your balance sensors (in the ear) overloaded the brain.”

“Take a fish that has been found in the stomach of another fish, cook it, season it with pepper, and eat it as you go onboard”Dr. G. H. Niewenglowski 1909

For the sufferers of the maritime malady, the “blood and guts” causes and cures of modern medicine offered no relief to seafarers of the 19th and early 20th centuries. While some of these remedies were couched in heaps of impressive anatomical and medicinal jargon, others were completely ridiculous as the “two fish” cure noted above, but proposed by a doctor nonetheless. Remedies ran from the slightly out-of-the-ordinary (champagne, cognac, Worcestershire sauce, sea water, aspirin) to the oddly surprising (codfish bullion with potatoes, red herring, smoked tongue, baked apples). Unfortunately, none of these modern therapies were any more effective than the concoctions of the ancient Greeks, Romans, and Chinese. The mal de mare continued as the scourge of the sea causing “sufferers to become helpless, without will, without shame, without decency … wishing that the vessel would sink and end the agony.”< Western medicos, however, were persistent in their search for relief as evidenced 1200 articles on seasickness appearing in American, French and British medical and scientific journals between 1840 and 1950. They were so abundant that the British Medical Journal commented: “Everything that can be swallowed has been claimed to cure motion sickness.” Among this profusion of remedies, cures, diagnoses, and causes, I offer the following selection of the truly silly:

• Hitting below the belt: In 1847, a French doctor declared that seasickness could not be prevented with medicine as its causes were purely mechanical. As the vessel pitched up and down in heavy seas, the force of the intestines against the diaphragm pushed bile from the stomach out of the mouth. All that was required to prevent seasickness was to press the intestines against the pelvis to keep them from moving about. This was accomplished with a belt that was “forcibly applied … during a long and painful voyage.” The reader wonders what caused the pain – the seasickness, the belt, or both.

• Vinegar, walnuts and filter paper: In 1858, Scientific American’s “New Inventions” section declared this new concoction was “a boon more highly prized than a princely diadem.” This preventative was “patented in England by a Frenchman living in Italy” was prepared as follows: Soak, in one and three quarters pints of vinegar, for twelve hours: rue, ½ oz., turmeric, ½ oz., green husks of walnuts, ½ oz., annatto, ½ oz., potash ½ oz., and a poppy head. Boil this odd soup for about half an hour and strain through fine linen. Soak five pieces of filter paper measuring ten by seven inches in this solution. When dry, sew the paper into a pouch of light fabric and tape it to “the pit of the stomach.” (The modern reader is left wondering what is remotely scientific about this remedy.)

• Breathe in, breathe out, have a drink: In 1879, Scientific American again touted “the perfect” non-medicinal cure which “would rob the ocean travel of half its terrors.” Like the previous article, the “scientists” of the magazine contended that this odious malady was caused by “undue pressure upon the stomach and liver which deranged the action of these organs …(and) caused extra bile to be thrown into circulation.” To prevent this derangement, the seafarer simply needed to regulate their breathing according to the “pitching of the vessel, drawing breath in as she rises and breathing out as she falls into the trough of the waves.” This rhythmic breathing, the magazine assures the reader, becomes involuntary after a little practice. If this does not work, “cool effervescing drinks” like champagne will reduce nausea, dizziness, and “return tone to the system.” (There is nothing like a few stiff belts of booze when you are already dizzy and puking.)

• Don’t worry, be happy: By 1883, Scientific American found “a cure for seasickness at last.” In this “new and peculiar method,” the Reverend Mr. Thwing “approaches the suffering passenger unawares from behind, places his hand upon the patient’s head, and speaks in an assuring tone of voice.” The Reverend, also a hypnotist, puts the passenger into a trance which ends the sickness resulting in supreme happiness. The passenger is restored from the trance completely cured with the words “all right” and is ready to “enjoy full meals of victuals without let or hindrance.” The magazine comments that if they were steamship line owners, their first order of business would be to hire this sneaky, hypnotic man of the cloth – “one thousand dollars a trip would be nothing for the services of such a man.”

• I feel magical: On a transatlantic voyage in 1885, a Russian doctor used a mixture of cocaine and “rectified spirits of wine” every two to three hours upon embarkation and throughout the voyage. One eighteen-year-old young woman reported feeling “truly magical.” (I’ll be bet she did.) A year later, an American doctor used a similar cocaine concoction and reported no positive results. The doctor did, however, comment that people will likely to continue to use the cocaine remedy anyway. (Hmm, I wonder why.)</ref>

• Breath in, breath out, part II: In 1889, Scientific American reported on yet another “infallible” breathing cure for seasickness. In this installment, a Moscow doctor reported that seasickness was caused by “inadequate aeration of the patient’s blood, which consequently becomes poisonous to his brain and gives rise to sympathetic sickness.” In this remedy, the doctor instructed seafarers on how take a breath every three seconds, with their eyes closed. Once the doctors had “thoroughly educated their patients on the modus operandi of the cure” (breathing with your eyes closed), the remedy was permanent for the remainder of their voyage. (I much prefer the breathing cure that includes the champagne).

• Don’t forget the mustard and linseed: Not to be outdone by the “scientists,” The Ladies Home Journal joined the war against the mal de mare in 1889 with a female-specific cure. Here, the company surgeon of the Peninsular and Oriental Steam Navigation Company ordered a drink of tepid water to soothe the stomach, a two-part linseed and one part mustard poultice applied to “the epigastric region” and then a draught, every quarter hour, of choral hydrate, simple syrup and more tepid water. The doctor then adds that “anyone who has seen much of this malady can hardly doubt that its origin is mental, and in a large majority of cases the imagination is the source of trouble. (Hmm, if seasickness is all your head, why not apply the poultice to your noggin instead of your epigastric region?)

• It really is all in your head: Finally in 1889, an English doctor cracked the code on the relationship between motion, the eyes, and the inner ear. Leveraging the work begun by Harvard psychologist William James, Dr. Edgar Darnell argued that overstimulation of the senses associated with equilibrium – the eyes, the ears and the brain – were causing the nausea, vertigo and vomiting. The good doctor concluded that “attention should therefore be given to the nervous condition of excitability rather than to the stomach.” (Three cheers for Dr. Darnell!)

• “A League of Their Own” By the beginning of the 20th century, the seasickness mavens decided to team-up to fight “that most humiliating and not least painful of human afflictions” – the dreaded mal de mar. In 1901, a French physician began formation of a League Against Seasickness. Headquartered in Paris, the League issued a Journal du Mal de Mer that featured the latest and greatest on stomach remedies (he obviously did not read Dr. Darnell’s JAMA essay), “suspension and other apparatus to lessen the effects of movement of the vessel,” apparatus for the immobilization of the viscera (stomach belts and wraps), cabin ventilation, oxygenation of the patient (more breathing exercises), and deodorization of places.” Sponsored by the King of the Belgians, the league planned their first Congress in Ostend, and even planned an experimental sea voyage to the Congress with six hundred physicians from Antwerp, Hamburg and French ports.

• Stay horizontal: Dr. Viko’s remedy eschewed medicines, poultices, stomach belts, and breathing exercises. Instead, the good doctor relied on the tried-and-true relief used by sick sailors – the hammock. On a recent trip across the North Sea in the winter (argh), Dr. Viko rigged a blanket hammock in his stateroom and stayed in it until the seas calmed. The doctor reported that no matter how much the ship rolled, the hammock stood still and kept the horizontal position.

• Bad vibes: In 1901, JAMA reported, somewhat skeptically, that naval architects had figured out what was causing seasickness. Disregarding two thousand years of people barfing on sailing ships, the ship designers decided it was vibration caused by the engines, not the pitching and rolling, that was making people sick. Sailing ships were not the culprit, big steamers were. According to the ship designers, “when the engines of the ship strike the proper note … a quasi-musical phenomenon … created a pathological discord of the nervous and digestive systems.” This was made worse when lying down because the engine vibrations were transmitted to the passenger by the vibrating springs of the mattress! The JAMA didn’t buy the naval architects quasi-musical double-speak and stuck with Hippocrates – it was the motion of the ocean that made people seasick.

• Electric hats, motorized chairs and spinning gyroscopes: The early 20th century saw an increasing number of electro-mechanical devices to combat seasickness. When one physician recommended hot compresses around the head, a company designed a leather cap with a thick felt lining that could be kept continually hot. The wet felt “was kept hot by wires, which may be connected to the electric lighting system of the ship.” The hot compress increased the blood flow to the brain and “removed cerebral anemia which is the cause of seasickness.” The appliance, I am sure, was quite safe given the negligible danger when wearing a wet electric hat on your head. The motorized chair, a rather uncomfortable looking device, would counteract the motion of the ship by moving the seated passenger in the direction opposite of the ship’s movement, “thus counteracting the causes producing the seasickness.” Finally, the gyroscope “was a very clever device” designed by the Institution of Naval Architects (the vibration guys). The 12-foot diameter, 10-ton spinning disk was situated amidships, “rendering the ship insensible to the effect of the wave motion, the rolling motions virtually eliminated.” Unfortunately, there was no way to counteract the fore and aft pitching motion of the ship. There is no record of the gyroscope being installed on a ship. Bulleted list item

• Look into my "eye:" In 1906, the Women’s Magazine pronounced that seasickness was due to a nervous condition associated with the eyes. This condition could be easily cured with “a few drops of tincture of atropine in each eye” or by simply “putting a bandage over one eye” for the voyage.

• Precious bodily fluids and flannel: A Dr. Talbot, harkening back to ancient Greek and Roman theories about the importance of bodily fluids, recommended testing the urine three weeks before embarkation. “Cleaning out the system thoroughly with saline waters and antacid treatments” was imperative. Once the bodily fluids were in balance, the passenger was to “take a strip of soft flannel about six inches wide and three yards long (and) wrap it around the abdomen and stomach tightly. This will prevent movement of the internal organs which affect the nervous system.” Eating little and drinking hot water was recommended. (This sounds like a fun cruise – a flannel bodysuit and nothing to eat with a hot water chaser, but good bodily fluids – where do I buy a ticket?)

• My digestive juices are scared: Dr. Boldyreff, a physiologist, from Michigan recommends seagoers throw their seasickness remedies overboard. “The power of suggestion is more potent than drugs to combat unpleasant eventualities when one sallies forth on the briny deep” says the good doctor. Boldyreff believed that fear was the culprit of seasickness and this “psychic reaction of fright inhibits the secretion of digestive juices.” The doctor’s curative suggestion was pre-voyage lectures for potential passengers on ‘the causes and prevention of seasickness.” Likewise, he recommended training for the crew “so that tactless comments to passengers suggesting seasickness are reduced to a minimum.” (What would a doctor from Michigan know about seasickness and the ocean anyway?)

• A blindfold and a bath: When all other remedies fail, Dr. R.A. Bennett recommends a blindfolded salt water bath between 90 and 95 degrees, its specific gravity 1.020. The curative effect happens because “the bath moves as the ship does, but the water has not the time to respond to the motion, so it and the patient immersed in it remain fairly motionless.” (Don’t forget to pack your hydrometer and thermometer so you can measure the specific gravity and temperature of the water.)

• What about the Eskimos?: Another endeavor undertaken by medicos and scholars of the disease was to categorize who was immune and who was susceptible to getting seasick. Dr. A Saha of the British Steam Navigation Company commented that women were “poor sailors” and “infants in arms” and deaf-mutes appeared to be quite immune. Dr. A. Seitz, another ship’s doctor of many years, commented that “women suffer oftener than men and little girls of ten to twelve year more than anyone else.” The doctor continued that “among the white men, Germanic peoples are more resistant.” (Seitz is German of course.) Hindus and Chinese, due to their life philosophy Seitz suggests, “take a certain satisfaction in their suffering (and) bear their affliction with stony faced stoicism.” Captain Seidelhuber contended that “thinkers, brain-workers and the sick, nervous and fearful were susceptible … while babies, the insane, and persons of high courage and in good physical condition such as acrobats, athletes, rope-walkers and dancers were immune, or less affected. Americans of both sexes, who are far more nervous than the English suffer more than the English do.”

• Nuts to you: The Ladies Home Journal stepped back into the fray in 1946 with a little blurb from an old cookbook. It counseled that when “crossing the ocean not to be misled into taking great quantities of remedies and medicines.” Ginger bread, nuts and sugar comfits (a nut covered in sugar) would ensure a happy trip across the pond.

• Ask a sailor: When all other seasick remedies fail, ask the sailors who go to sea for a living what they do. Here’s what the stewards from Cunard and White Star Line did to prevent seasickness:

1. White Star Line Eat plain, nutritious food 24 hours before embarking. When feeling ill, “the passenger should go below at once to his berth and keep perfectly quiet. Complete rest is the safest and surest remedy. Take in plenty of fresh air, exercise and be abstemious in diet. A little champagne, well-iced, may be taken.”
2. Cunard Keep a clean stomach prior to embarkation. If feeling ill “let alone the greasy things, the sweet things, and the highly-seasoned things. If very ill, “keep horizontal with the head low; put an icebag to the back of the neck … and eat nothing till there is an appetite for food. (Good advice from two veteran sailors with sturdy sea-legs.)

Operation Seasickness – Johns Hopkin’s MDs find the cure: Two thousand years after Hippocrates observed the connection between the motion of the ocean and seasickness, two Johns Hopkins doctors – Leslie Gay and Paul Carliner – discovered the remedy in 1947 -- by accident. While testing an experimental drug for hay fever and hives, the doctors administered the drug to a patient with hives who also suffered from carsickness. After taking the drug several times, the patient never got sick on the streetcar going home. The doctors were intrigued and planned a test on a troop ship, the General Ballou, bound for Bremerhaven with 1366 soldiers in December 1948. After a stormy North Atlantic crossing, the doctors found the drug was 90 percent effective for relieving seasickness during the voyage. For those soldiers treated prior to embarkation, only 2 percent of the soldiers got seasick while 25 percent of the soldiers given the placebo became ill. The generic name of this anti-histamine is dimenhydrinate, better known today as Dramamine. Both Dramamine and Scopolamine (worn as a patch) have since become highly popular and very effective seasickness remedies.