75 PORT OF LONDON SANITARY COMMITTEE. ANUAL REPORT of the MEDICAL OFFICER OF HEALTH To 31st December, 1919. Presented 16th December, 1920. PLON 22 REPORT, For the Year ended 31st December, 1919, OF THE MEDICAL OFFICER OF HEALTH FOR THe POET OF LONDON. BY WILLOUGHBY MASON WILLOUGHBY, B.A., M.D., B.C., Cantab., D.F. H. Carab., Medical Officer of Health, Port of London. LONDON: Printed by Charles Skipper & East, 49, Great Tower Street, e.o. 3. ROLL, Mayor. A Common Council holden in the Chamber of the Guildhall of the City of London, on Thursday, the 16th day of December, 1020. THE Port of London Sanitary Committee did this day deliver into this Court a Report in writing under their hands, of their proceedings, and submitting the Annual Report of the Medical Officer of Health of the Port to the 31st December, 1919 ; which was read. Ordered, That the Report be printed, and a copy sent to every Member of this Court. BELL. To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London, in Common Council assembled. We, whose names are hereunto subscribed, of your Port of London Sanitary Committee, to whom it has been referred to carry into execution the powers assigned to the Corporation, as the Port Sanitary Authority of the Port of London, beg to submit for the information of your Honourable Court the Annual Report of Dr. Willoughby Mason Willoughby, the Medical Officer of Health of the Port of London, for the year ended the 31st December, 1919, which Report contains a full and detailed account of the work done in the Port during that period by the Medical Officers and Inspectors. The work of your Medical Officers has been effectively carried out. The number of cases of dangerous infectious diseases entering the Port was again small, but of serious character. Plague was dealt with on three vessels, two of which were technically "Infected" and one was "suspected." The detection of Plague by members of the medical staff and prompt dealing with the ships infected is highly praiseworthy. In neither of the three ships was Plague suspected until on entry into the Port. The opportunity afforded of comparing the conditions on the seven Plague ships dealt with in 1917, 1918 and 1919 has shown a definite course of the malady on shipboard when rat infection is the cause of human cases. 2 The Rat Order of the Ministry of Food, now replaced by the Rats and Mice Destruction Act, was amended to include Port Sanitary Authorities as Local Authorities," and proved useful in the control of rat-infested ships. Small-pox was a serious menace, as is shown in the tables and comments thereon. An outbreak of Para-Enteric Fever occurred on one of the Training Ships in the Port, the cases being treated by arrangement in Denton Hospital. The contribution of the Corporation to the Venereal Diseases Treatment Centre in the County Borough of West Ham was increased at the beginning of the year to £400 per annum. The Public Health (Pneumonia, Malaria, Dysentery, &c.) Regulations, 1919, came into force on the 1st March, extending the list of infectious diseases which are compulsorily notifiable and imposing new duties upon the Port Sanitary Authority and its Officers. The place of mooring for "infected ships" entering the Port has now been fixed by arrangement with H.M. Customs at "Gravesend Reach from the Lobster Roads to Shornmead Beacon." The examination of rats for the detection of Plague was continued, one infected rat only being found in January, and your Committee approved the issue by your Medical Officer of Health of a special questionaire to Port Medical Officers of the United Kingdom, with a view to inducing some uniformity of practice in rat disinfestations, &c. The inspection of Food and of Nuisances throughout the Port was carried out in a satisfactory manner. Members of a Special Committee appointed by the Secretary of State for India and delegates to the Polish and Norwegian Legations respectively were received and informed by your Medical Officer of Health on various points relating to Port Sanitary Administration. The Launch "Lady Truscott" proved unreliable owing to defects which developed in the water-tube boiler. Re-tubing of the boiler was necessary, and with this repair it was decided to improve the steaming qualities by substitution of oil fuel for coal. The work was put in hand at an estimated cost of £2,000. An Account of Receipts and Expenditure in connection with the Port of London Sanitary Authority for the year ended the 31st March, 1920, is appended, in accordance with the Order of your Honourable Court, for the information of the Court. All which we submit to the judgment of this Honourable Court. Dated this fourteenth day of December, 1920. W. Fortescue. Wm. Gibson. GeoRge Briggs. Hugh Shirreff. W. W. Green. Robt. Peachey. B. T. Swinstead. J. G. Howell. Thos. Pimm. OFFICES OF THE Pott of London Samtary Authority and Medical Officer of Health at 51, KING WILLIAM STREET, GREENWICH S.E. lO. Telegraphic Address - "MEDOFF, GREEN, LONDON." Telephone No. GREENWICH 360. BOARDING STATIONS. RI VER THAMES Hulk "Hygeia," Gravesenp, RIVER MEDWAY - - Garrison Point, Sheerness. Telephone No. (Hulic "Hygeia") GRAVESEND 325. HOSPITAL FOR INFECTIOUS DISEASES at DENTON, near GRAVESEND. Telephone No. (Hospital) GRAVESEND 957. Ditto (Medical Officer of Health) „ 86. Ditto (Deputy Ditto) „ 373. LIMITS OF THE PORT OF LONDON. The limits of the Port of London as at present defined commence at High Water Mark in the River Thames at Teddington Lock, in the County of Surrey, and extend down both sides of the River Thames to an imaginary straight line drawn from the Pilot Mark at the entrance of Havengore Creek, in the County of Essex, to the lands end at Warden Point, in the Isle of Sheppey, in the County of Kent, such point, being the North-Western limit of the Port of Faversham, and shall extend up and include both sides of the River Medway to an imaginary straight line drawn from the South-East point of land westward of Coalmouth Creek, thence across the said River Medway to the Westernmost point of the piece of land which forms the Eastern side of the Stangate Creek, or, in other words, the North-West. point of Fleet Marsh, and from thence in a Southerly direction to Iwade Church, in the said County of Kent, and thence in a North-Easterly direction to Elmley Chapel, in the said Isle of Sheppey, a supposed direct line from Elmley Chapel to Iwade Church, being the Western limit of the Port of Faversham, and the said Port oi London shall include the Islands of Havengore Creek aforesaid, called Potton and Rushey Islands, and so much of the said Creek and watercourse as extends from it to the town of Rochford, and shall also include all other islands, rivers, streams, creeks, waters, watercourses, channels, harbours, docks and places within the before-mentioned limits contained. 4 INDEX. PAGE PAGE Acajou Nuts 51 Medical Inspection 6,36 Actinomycosis 49 Mumps 29 Australian Beef 49 Mutton and Lamb 49 Beef 49 Notification of Infectious Disease 7, 35 Beri-Beri 33 Nuisances 55-56 Canal Boats Acts 59 Nuts 51 Canned Meats 50 Offal 50 Cerebro-spinal Meningitis 24 Offensive Cargoes 57 Chicken-pox 23 Onchocerca (see Australian Beef) 49 Cholera 16 Plague 8 Diphtheria 22 Pneumonia (see Influenza) Enteric Fever 20 Pork 49 Establishment, &c. 5 Port, Limits of, &c. 3 Fish 50 Prepared Foods 52 Food Inspection 48 Preserves, Jam, &c. 51 Foreign Meat Regulations 48 Rabbits 50 Fruit 50 Rats 39-45 Fumigating Apparatus 58 Sanitary Conveniences, &c. 57 German Measles 23 Sanitary Inspection 54,58 Grain 52 Scarlet Fever 23 Hospital 45,58 Small-pox 16 Infectious Disease 7,45 Smoked and Salted Meats 50 Influenza 28 Staff 5,59 Introductory 6 Sundry Foodstuffs 52 Launches, Hulks, &c. 58 Tinned Meats 50 Malaria 25 Tuberculosis (Pulmonary, &c). 26 Meal and Flour 46 Unsound Food 46 Measles 23 Veal 49 Meats, Canned 50 Vegetables 51 ,, Smoked, Salted and Sundry 50 Venereal Disease 31-33 INDEX TO TABLES. TABLE. PAGE TABLE, PAGE I. Medical Inspection - 6 XXV. Vessels and Premises Disin- II. Infectious Disease—Summary 7 fected - - - 34 III. Compulsory Notification of XXVI. Number of Disinfections of Infectious Disease, with Effects - - - 35 number of Deaths - 7 XXVII. Rats Destroyed - - 38 IV. Plague - - - 8 XXVIII. Rats found Dead, Analy- V. Cholera - - - 16 sis, &c. - - - 39 YI. Small-pox - - - 16 XXIX. Rats—Examination of - 41 VII. Enteric Fever - - 20 XXX. Hospital Cases, &c. - - 45 VIII. Diphtheria- - - 22 XXXI. Unsound Food—Seized, &c. 46 IX. Scarlet Fever - - 23 XXXII. Unsound Meat—Destroyed, X. Measles - - - 23 Weights, &c. - - 47 XI. German Measles - - 23 XXXIII. Foreign Meat—Notice to XII. Chicken-pox - - 23 Export - - - 48 XIII. Cerebro-spinal Meningitis - 24 XXXIV. Sanitary Inspection—Sum- XIV. Malaria - - 25 mary - - - 54 XV. Tuberculosis—Pulmonary - 26 XXXV. Sanitary Inspection—Nuis- XVI. Miners' Phthisis - 27 ances on Vessels - 55 XVII. Influenza and Pneumonia - 28 XXXVI. Sanitary Inspection—Nuis- XVIII. Mumps - - - 29 ances in Shore Premises - 56 XIX. Dysentery - - - 30 XXXVII. Sanitary Inspection—New XX. Gastro-Enteritis - - 30 Works - - - 57 XXI. Erysipelas - - - 30 XXXVIII. Sanitary Inspection—Offen- XXII. Venereal Disease - 31 sive Cargoes - - 57 XXIII. Beri-Beri - - 33 XXXIX. Fumigation of Vessels - 58 XXIV. Miscellaneous Diseases - 34 XL. Canal Boats - - 63 5 STAFF. List of Officers forming the Staff of the Port of London Sanitary Authority, 31st December, 1919. Office. Name of Officer. Date of Appointment to Present Position. MEDICAL OFFICER OF HEALTH W. M. Willoughby, B.A., M.D., B.C., D.P.H.Camb. February, 1916. DEPUTY Lieut.-Col. J. S. Warrack, R.A.M.C., T.D., M.A., M.D.. C.M.Aberdeen, D.P.H.Camb., Barrifter-at-Law. February, 1916. ASSISTANT MEDICAL OFFICERS— Gravrsend W.D.Betenson,M.R.C.S,L.R.C.P., Lond., D.P.H. Lond. (Acting Deputy M.O.H. and M.O., Denton Hospital). July, 1907. A. Kidd, M.R.C.S., L.R.C.P., Lond, D.P.H. 1909. Sheerness E. V. Legge, M.A., M.D., B.C., B.A.O., L.M.Dublin. 1909. GREENWICH OFFICES— Clerk W. J. Albrow March, 1890. 1st Assistant E. A. Sorrell October, 1894. 2nd ditto W. C. Barbara June, 1903. Junior ditto Vacant Ditto J. A. Gillis April, 1914. Caretaker F. Hudgell November, 1906. FOOD INSPECTORS *W. Anderson, Cert.R.San.Inst. July, 1898. *T. W. Bailer, Cert.R.San.Inst. July, 1901. *A. Garland, Cert.R.San.Inst. December, 1917. SANITARY INSPECTORS *W. G. Wetjen, Cert.R.San.Inst. August, 1898. *W. W. Burr, Cert.R.San.Inst. August, 1898. *H. R. Hopkins, Cert.R.San.Inst. February, 1899. *P. R. Larabe. Cert.R.San.Inst. January, 1900. *J. H. Rolfe, Cert.R.San.Inst. September, 1901. *W. Elward, Cert.R.San.Inst. March, 1909. *F. J. Massie, Cert.R.San.Inst. March, 1909. C. A. Shepherd, Cert.R.San.Inst. January, 1909. *W.J.Berry, Cert.R. San.Ins. February,1994 DENTON HOSPITAL— Medical Officer Lieut.-Col. J. S. Warrack, R.A.M.C, T.D, M.A., M.D, C.M. Aberdeen, D.P.H.Camb, Barrister-at-Law. 1916. Matron - J. Jackson - February, 1918. Assistant Nurse (Temporary) - M. Woodward - - - - November, 1919. Ditto ( Do. ) - A. Foggo --- - - November, 1919. Ditto ( Do. ) - R. Reddington - October, 1919. Maidservant ( Do. ) - F. Elcombe - August, 1919. Ditto ( Do. ) M. F. Tuffield - - - . August, 1919. Wardmaid ( Do. ) - N. Hewlett - October, 1»19. Porter, &c. ( Do. ) - J. H. Robinson - August, 1917. STEAM LAUNCHES— '' Lady Troscott "— Master - - - - W. Jarvis - April, 1911. Engineer - J. A. Ilardman - December, 1911. M ate - - A. "F. Rough - - - - November, 1914. Stoker - A. E. Howard - - - - February, 191 ii. " David Burnett — Master ------ C. H. Price - October, 1913. Engineer - J. Steen (see " George Briggs ") - September, 1914. Deckhand - Vacant - fetokei Do. - •• ueorge biiiqgs —Motor Launch Master ------ C. Strange - October, 1913. Engineer - J. Steen - GREENWICH MOORINGS- FUMIGATING BARGE "THOMAS"— Stoker, &c. - Vacant - BARGE "ELLA VICARS"— Watchmen ----- ( H. A. Clarkson - May, 1912. I E. Ditch - - - - - December. 1914. GRAVESEND— HULK "HYGEIA"— Sliipkeoper - A. Salter - July, 1898. These Inspectors possess the Special Certificate of the Royal Sanitary Institute for Inspectors of Food. 6 PORT OF LONDON SANITARY OFFICES, 51, KING WILLIAM STREET, GREENWICH, S.E. 10. TO THE WORSHIPFUL THE PORT OF LONDON SANITARY COMMITTEE. Gentlemen, I have the honour of presenting my Annual Report for the year 1919, with details of the work done by your Officers and Inspectors. It will be seen that major infectious diseases called again as in recent years for great watchfulness and effort, amid the difficulties and dislocations which were the inevitable outcome of the movement of large masses of men and foodstuffs to and from every part of the world. Two ships were found by your Medical Officers to be Plague infected and one to have been Plague infected. The discovery in each of the three cases was a demonstration of the value of the system in operation under your Worshipful Committee and constitutes a creditable piece of detective work. 63,624 rats were reported to have been destroyed on ships and in the docks. 3,2S7 rats were examined for Plague; in January one rat was found to be infected. There was no unaccountable mortality among rats discovered in any dock throughout the year An epidemic of Para-Enteric Fever occurred on one of the Training Ships in the Port, 28 cases being removed to Denton Hospital. Small-pox entered the Port from the Continent. The disease was prevalent in various parts of the globe in epidemic proportions and received close attention throughout the year. The Tables show the menace of this disease to have been very large Cholera caused no anxiety; one ship which was declared to have had a Cholera infection on board was found to have been Plague infected and was dealt with accordingly. A change in system of disinfestation, from the mechanical production of Sulphur Dioxide to the method of simple burning of sulphur has almost led to disuse of the barge "Thomas" with its apparatus. This change is chiefly due to the dislocation of normal duties brought about by the withdrawal of launch crews for towage and for the long operation of fumigation, and in anticipation of much greater dislocation which would take place under the amended Orders of the Ministry of Food and the Rats and Mice (Destruction) Act. The Orders and the Act have greatly extended the powers and duties of the Authority. The launch "Lady Truscott" proved unreliable when again put, in commission. The boiler tubes needed renewal, while coaling and steaming difficulties determined a change to an oil fuel system. The work was put in hand at an estimated cost of £2,000. The usual Tables and Reports on Food Examination and Canal Boats are annended. TABLE I.—MEDICAL INSPECTION—GRAYESEND. From 1st January to 31st December, 1919. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number medically inspected 39 39 40 76 137 126 108 70 94 112 95 76 1,012 Number of passengers 2,158 2,528 848 1,531 193 374 81 745 222 206 982 1,067 10,935 Number of crew 3,056 3,510 4,750 4,918 4,296 3,615 4,110 3,907 5 2,715 2,971 7,817 8,252 53,917 Number of foreign arrivals 594 635 717 764 855 737 736 705 679 733 675 627 8,457 7 TABLE II.—INFECTIOUS DISEASE. Disease. 1910. 1911. 1912. 1913. 1911. 1915. 1916. 1917. 1918. Mean annual number for 10 years ending 31st December, 1919. 1919. (a) Cases reported: Cholera (including suspected cases) 5 9 2 19 ... 2 5 2 ... 5.3 9 Yellow Fever (ditto) ... ... ... 4 . . . ... ... ... ... 0.4 ... Plague (ditto) 6 ... 9 4 4 4 • • • 18 12 7.7 20 Small-pox 8 13 34 19 9 47 15 2 16 20.6 43 Scarlet Fever 21 11 10 40 30 18 5 ... 8 14.7 4 Diphtheria ... 11 18 37 16 10 18 7 9 23 17.4 25 EntericFever 39 70 61 65 67 64 61 43 26 57.3 77 Measles 23 175 61 64 228 337 836 168 256 220.0 52 German Measles . . . ... 3 4 ... 10 8 33 4 6.9 7 Erysipelas ... 5 11 3 3 3 9 1 . . . ... 3.8 3 Typhus Fever ... ... 1 ... ... ... . . . 1 ... 0.2 ... Continued Fever 1 5 9 13 2 7 5 2 2 4.6 ... Relapsing Fever ... ... ... ... ... ... ... . . . 19 1.9 ... Tuberculosis:— Pulmonary ... ... 71 151 127 96 53 45 38 63.2 51 Other kinds (including Miners' Phthisis). ... ... ... 7 45 6 19 26 20 15.8 35 Other diseases (including Chickenpox). 25 38 42 38 50 48 44 166 2,552 489.0 1,887 Total 144 350 343 447 575 666 1,059 515 2 ,976 928.8 2,213 (6) Treated in Port Sanitary Hospital: Cholera (including suspected cases) 2 ... ... ... ... ... ... ... ... 0.3 1 Yellow Fever (ditto) ... ... ... ... ... ... ... ... ... ... ... Plague (ditto) 2 ... 1 2 1 ... ... 9 12 3.7 10 Small-pox 2 6 2 9 2 10 2 ... 1 4.7 13 Scarlet Fever • • • 6 • • • 3 8 10 2 ... 5 3.5 1 Diphtheria 4 3 ... 7 1 3 I 1 ... 2.1 1 Enteric Fever 17 22 35 29 30 17 34 15 7 24.8 42 Measles 2 7 27 18 9 ... 4 3 2 10.5 • •• Erysipelas ... ... 1 ... ... 1 ... 1 ... 0.3 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 4 7 9 1 5 4 8 6 4.5 ... Other diseases (including Chickenpox). 7 8 7 14 9 11 6 24 24 13.2 22 Total 37 56 80 91 61 90 53 61 57 67.6 90 TABLE III. Return of the number of cases of Infectious Disease notified to the Ministry of Health during the year 1919, and of Deaths from the diseases notified. This Table includes all cases actually introduced or occurring within the Port, but does not include cases reported as having occurred on vessels during the voyage, but which had either recovered or been removed from the vessel before arrival at Gravesend. ] Notified. Deaths. Plague (including suspected) 8 3 Small-pox 12 ... Scarlet Fever 3 ... Diphtheria (including Membranous Croup) 27 ... Enteric (Typhoid) Fever 55 ... Puerperal Fever ... ... Typhus Fever ... ... Cholera 1 ... Relapsing Fever ... ... Continued Fever . . . ... Cerebro spinal Fever 2 ... Acute Poliomyelitis ... ... Erysipelas 2 ... Ophthalmia Neonatorum ... ... Tuberculosis : Pulmonary 40 ... Other kinds 32 ... Chicken-pox 15 ... Whooping Cough . . . ... Measles 6 ... German Measles 1 ... Other Diseases 184 ... 8 NUMBER OF NOTIFICATIONS (SURVEILLANCE) DURING 1919. Passengers 110 Crew 40 Stevedores, &c. ... Number of Notifications received from Practitioners 116 TABLE IV.—Plague (including suspected cases). Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Jan. 29 s.s. "Japan," of Bombay 4 Landed at Suez. May 19 s.s. "Malta," of Greenock, 102,398. Ditto 1 Bombay. J une 3 s.s. "City of Exeter," of •Glasgow, 136,927. Sydney 1 Ditto. Aug. 18 s.s. "Clan Lamont," of Glasgow, 111,280. Buenos Ayres 1 Removed to Port Sanitary Hospital. Oct. 23 s.s. "Nagoya," of Greenock, 135,323.' Yokohama 10 1 case died on board. 9 cases removed to Port Dec. 22 s.s. "Kaisar-I-Hind," of Greenock, 128,653. Bombay 3 Sanitary Hospital. Lauded at Tort Said. Total 20 PLAGUE. The s.s. "Japan" arrived from Bombay on the 28th January, 1919, with a crew of 154, 52 passengers and a passenger crew of 193 natives. The ship left Bombay on 2nd January, and on 6th January four natives were taken ill; two of these with enlarged femoral glands were landed at Suez on the 12th, two died on board after a few hours' illness from "Malignant Malaria"; one of these had "Parotitis." On the 13th January a native fireman, who was stated to have been ill for four days with diarrhoea and vomiting, died. On the 14th another native coal trimmer died. The latter had not been reported sick, but was stated to have had three loose motions before death. Four more natives had similar symptoms, and were landed at Port Said, being regarded as suspected Cholera. The cases of "Parotitis" and Malignant Malaria, in conjunction with the cases of illness presenting "femoral" buboes, appeared to be significant of Pestis outbreak about 6th January. Your Boarding Medical Officer, Dr. Kidd, considered the history to be one of Plague, not Cholera. Your Medical Officer immediately inspected the ship and concurred in this diagnosis, finding no evidence of Cholera in the detailed histories of the cases, but much that made Plague a practical certainty. One native who was ill on arrival was removed to Denton Hospital on the 28th January for observation, but his illness proved uneventful. The vessel was treated as if rat infected with Plague; cargo was discharged while in the quarantine ground at Gravesend. The water tanks were also emptied and cleansed. During the course of enquiry it was ascertained that the ship's cat had been observed to be sick about the 18th January, having a swelling under the neck which broke down into pus, after which the cat recovered. (A similar cat history was obtained on s.s. "Somali" in a Plague infection on that ship.) On enquiry amongst the natives it was ascertained that at Port Said, in shifting food stores, ten dead rats were found in the native food storeroom, and dead rats were also found under the steam pipes forward. The food store was situated under and communicated with the starboard forecastle quarters. The four cases on which the ship was suspected of Plague were berthed on this side of the forecastle. The rats were thrown overboard without any report being made to responsible officers. During discharge of cargo at Gravesend, sixteen dead rats and several dead mice were found. All were much decomposed or dried up. No case of Plague was found in the few rats caught and examined. Fumigation of the whole of the ship was carried out at Gravesend on the 12th and 13th February. The total number of rats found after fumigation was 31. 9 The s.s. "Malta," of Greenock, arrived from Wellington on the 17th May, 1919. On the 25th March a native fireman was taken ill. Symptoms—backache, pains in legs, Fever. He was sent to hospital at Bombay on the 27th March; subsequently diagnosed as Bubonic Plague. All the native crew were discharged at Bombay on the 26th March. The European crew were removed to another ship, cargo was discharged, and whole vessel disinfected with sulphur dioxide (Clayton apparatus) and kept closed up for three days. A new crew was shipped 16th April. On the third examination of dead rats found at Bombay the B, Pestis was obtained. The patient was still alive when the vessel sailed from Bombay. The interest of this infection lies in the possibility that the rat infection on the ship started at Bombay, and was carried to and from Wellington on the ship, though the disease only broke out amongst the ship's complement on arrival of the ship again in Bombay. Your Medical Officer has observed that the Pestis infection sometimes remains thus dormant on ships, preceding disturbance of the cargo or other interference with infected holds. The s.s, "City of Exeter" arrived at Gravesend from Sydney on the 3rd June, 1919. The vessel arrived at Bombay on the 25th April, 1919. On the 30th a man was reported sick with Femoral Bubo. He was taken ashore and died on 2nd May. No sick or dead rats were found, and no other cases occurred. The vessel was moored in the stream at Bombay, and did not go alongside a wharf. The vessel had been fumigated with the Clayton gas generator in Bombay, but apparently only the between decks were dealt with and not the holds containing cargo. The vessel had also been fumigated in Sydney. Some dead rats had been found uninfected after the Bombay fumigation. The s.s. "Clan Lamont," from Calcutta via Colombo, Durban, Cape Town, Buenos Ayres and Monte Video, arrived at Gravesend 22nd July, and in London on 29th July, having loaded at Buenos Ayres. She left Buenos Ayres on the 20th June after a five weeks' stay in that port. On the 16th August, Ameer Currim, aged 19, a saloon steward, was taken ill suddenly with high fever, headache, and right femoral bubo. He was taken to Denton Hospital on the 18th August. The ship was fumigated for purposes of rat disinfestation and the living quarters rendered flea free, the ship being moved out from Tilbury Dry Dock into the river for this purpose. The ship's personnel was kept under surveillance. By bacterial experiment it was eventually proved that the case was definitely one of Bubonic Plague The history of rats on the ship shows that the vessel was fumigated in Buenos Ayres, with the Calcutta cargo in situ, before discharge at that port. The fumigation was on the 13th and 14th May, and a general cargo for London was loaded subsequently. Dead rats were found on the boat deck in proximity to a ventilator from No. 4 hold towards the end of June, two also in a ship's lifeboat close to another ventilator from No. 4 hold and in proximity to the patient's quarters, during overhaul of the ship's boats in Surrey Commercial Dock. About 30 rats were killed in the Buenos Ayres fumigation, and 36 were killed on board in Surrey Dock by trap and poison. The ship was in the Surrey Dock from the 29th July to 15th August, thence proceeding to Tilbury Dry Dock, where the case occurred, and was promptly notified by the doctor in attendance on the ship. Six contacts were landed for disinfection, and the disinfestation and disinfection of the ship was carried out on the 19th August—19 rats were killed in the fumigation. The incidence and course of Ship Plague infections which has from time to time been brought before your Worshipful Committee is reflected in this case, in that:— (1) The ship underwent a probably incomplete fumigation in Buenos Ayres. (2) The fumigation of the living quarters in Buenos Ayres rendered the crew temporarily immune and greatly prolonged the time of human development of the disease, by temporarily freeing the living quarters from rats and fleas. 10 (3) The man attacked was in the steward's department; the connection between him and rat flea is through the community of interest of patient and rat in the food available. (4) The rat infection probably began in Calcutta, and was disturbed and driven up on deck at Buenos Ayres and in London. (5) The clinical aspect of the whole case formed the guide to action, and the bacteriological certainty obtained was, of necessity from its difficulties, behind the time for the prompt action required by the case and taken by your Deputy Medical Officer. The circumstances were fully notified to the Ministry of Health. The s.s. "Nauoya" arrived in London on Saturday, 25th October, 1919, midday, from Yokohama via Kobe, Shanghai, Hongkong, Singapore, Penang, Colombo, Port Said, Marseilles, Gibraltar and Plymouth. The ship left Yokohama on the 30th August, and Marseilles on October 17th. On visiting the ship on her arrival, your Boarding Medical Offcer, Dr. Kidd, found that a death and cases of Influenza which were reported were in fact Plague. The passengers on board numbered 165. In addition 53 passengers had landed at Plymouth. The lists of addresses were scrutinised and the passengers disembarked. Conditions and history: — Cases.—(1) Fakeer Massajee Kasab was taken ill on the 21st October and died on the 23rd He presented only Fever without glandular enlargement. He was buried at sea. (2) Kassim Mesial, Lascar assistant to Case 1, aged 15, was taken ill on the 22nd a.m. His history and condition showed Fever, malaise, a slight gland (bubo) in the left femoral region, excessive vomiting and delirium He was moribund on the ship, and died on landing into Denton Plospital. Your Medical Officer examined the bubo forthwith and found in stained films abundant microscopic evidence of Plague. The diagnosis was confirmed bv the Ministry of Health. (3) Fakeer Nala, 38, Lascar 111 on the 22nd October, presented Fever and malaise, with a large right femoral bubo. This man died suddenly on the 14th November. (4) Abdul Ismail, 18, Lascar, was ill on the 23rd October. He now presented a deep left inguinal tenderness. On suppuration the Plague bacillus was demonstrated. (5) Alle Omer, 56, fireman, was ill on the 25th with Fever and malaise. This man appeared cachectic. It is possible he has not suffered from Plague. (6) Ismail Abram, Lascar, had a temperature of 103 on the 22nd October, and was normal on the 24th, his symptoms being those of simple Fever and malaise. Cases 2, 3, 4, 5 and 6 were removed to hospital on October 25th. (7) On Sunday, 26th, I saw Hassim Eloy, 30, Lascar, on the ship. He had been taken ill that morning. He presented a collapse temperature of 96 deg., and an extreme tenderness in the right femoral region with slight swelling This man was removed to hospital forthwith and died on Tuesday the 27th. The diagnosis was confirmed microscopically. (8) Hassim Kassim, Lascar, an eighth case, was taken to Hospital on the 27th, and proved a mild case. Where the diagnosis of Plague is not evident (Cases 5 and 6), the fact that these cases, 1 to 6, were grouped originally as an Influenza epidemic warranted the supposition that all had suffered from the same disease. Case No. 5 can possibly be put in another category, in that he was berthed entirely apart from the Lascars who form the remainder of the cases, and on his appearance of chronic weakness. As in every Infectious Disease, however, in Plague quite mild cases occur. History of Eats and Rat Mortality.—Enquiry elicited the following facts:— On the outward voyage from London, on the 23rd June, before Aden was reached, cabin floors in the 'tween deck accommodation were being moved in order to find the source of effluvia. Dead rats were found. The upper 'tween decks in the holds are converted throughout into passenger accommodation. The deck is planked on battening deep enough to harbour rats between the temporary wooden and iron decks. 11 The ship was known to be very ratty. Constant trapping was accounting for numbers of rats. At Shanghai (August 1st) the ship was "disinfested" by means of Flue Gas (Carbon Monoxide, Carbon Dioxide mixture), after which there was much ripping up of cabin floors because of dead rats under the planking in the 'tween deck passenger accommodation. At Yokohama the ship was quarantined for Cholera. Here the fore peak was disinfected for "flies" by means of Sulphur Dioxide Gas. The peak has not been disinfected at Shanghai because the crew's quarters were situated over this. The ship was fumigated at Marseilles by Clayton Apparatus on October 15th. From the fact that passengers were back in their 'tween deck accommodation very shortly after the fumigation of the holds, this fumigation could not have been so much a measure of extermination of rats as a cause of their flight from amongst the cargo exposed to the gas. The tally of rats taken during the round voyage is :—- Caught by traps or found dead 683 194homeward. Killed by fumigation at Shanghai and tallied 292 Total 975 The rat figures were daily entered in a note-book by the Chief Officer. For a few days after the fumigation at Shanghai no rats were caught; then the daily average gradually rose. The diagnosis of Rat Plague was made by the Pathologist to the Ministry of Health from a rat found dead in the tween deck on the 29th October. On the 30th October another dead rat from the same situation examined by me showed a typical macroscopic Plague condition in the liver. Both these rats had come out from cover, and had been picked up within a few hours of death. During discharge the number of dead rats found was 36. Their location was as follows:— Forward store room 4 Hold No. 1 21 ,, No. 2 1 ,, No. 5 2 Died tween deck 2 Trapped on deck 3 Found dead on boat deck 3 36 After the final fumigation, and on sweeping up the deck, 188 rats were found dead. Among the illnesses on the outward voyage is one of a refrigerating mechanic, who was taken ill on the 3rd August, suffered from "Influenza" and died of "Cardiac Failure" in hospital at Yokohama on August 14th. This case was seen by successive doctors on the 5th, 9th and 12th August; but in the light of subsequent events may possibly have been one of Septicæmic Plague. Focus op Infection.— Seven out of the eight cases of Human Plague were from the Lascar quarters in the port main deck forecastle. The eighth case (Case 5) in a fireman was from a 'tween deck lower forecastle accommodation. The first two cases (both died) were in the Kasab, who issues the native stores, and the boy who bunked by his side and was his assistant. The native food store, which is situated in the peak in front of the collision bulkhead, and therefore separated from all communication with the hold except over deck through the Lascar quarters, opens into these quarters by means of a trap in the deck within a few feet of where Cases 1, 2, 3 and 4 were bunked. Practically beneath the bunks of Cases 1 and 4 two goose-neck ventilators opened from the peak food store into the Lascar quarters. On the 28th October five putrid or dead rats were found in the peak (one decumanus and four rattus). I saw fly pupæ and larvae on these rats. The peak was not fumigated at Marseilles It is said amongst the Lascars that the patients knew their illness to be due to Plague. Cargo.—This consists largely of silk in all states, and all holds contain rice, tapioca, and peas 12 Measures Taken.— The cases were landed to Hospital. The forecastles, with their contents, were immediately subjected to a sulphur fumigation on the 25th October. This preliminary fumigation was repeated on the 27th, and again once in the case of the Lascars' forecastle and peak. The Goanese crew were removed under observation out of the ship, and the crew reduced to a skeleton on the 29th. All addresses of those leaving were notified for purposes of surveillance. Passengers, including Plymouth landings, were notified to their several destinations on the 27th. Before any of the crew paid off, their clothing was put through the WashingtonLyons apparatus for purposes of flea disinfestation. The native crew remaining was similarly completely disinfested at Denton, though the preliminary sulphur fumigations on board were, I believe, to be relied on to render the clothing of this crew flea free. The whole crew remaining on the ship received a½ c.c. (1,500 million) dose of Plague vaccine, and the Lascars a subsequent 1 c.c. does (3,000 million). The cargo was discharged in barges which were worked in daylight hours only. No craft were allowed alongside after dark. The ship workers were clad in overalls tied in at the waist and ankles against the attacks of fleas, and left the ship each evening only. The ship workers were notified for "surveillance." The majority of the workers had had practical experience in dealing with previous Plague ships. The cargo was barged to Tilbury Dock, and stored for a period of a fortnight from the discharge of the last parcel of goods into the dock receiving shed. A concrete floored shed was selected for storage and a watch kept on the rat conditions of the vicinity. The ship was empty of cargo on the 12th November, and final disinfestation was made on that date The Clayton Apparatus was used for the holds—375.000 c.f., and other spaces—272,000 c.f., were disinfested by 396 1-lb. candles. Total space 647.000 c.f. The total notifications made were:— Passengers 217 Crew 45 Ship workers 93 Comments.—The history of this ship shows:— (1) That she was already infected on the outward voyage before the 23rd June (2) That the rat infection produced no human infection until after the Marseilles fumigation on the voyage home, October 15th. (3) That the CO2CO fumigation at Shanghai was not nearly a complete disinfestation. (4) That the Yokohama SO2 fumigation of the peak for "flies" may be held to imply the presence of dead rats in the native food stores at that time. (5) That the dead rats found in the peak at Gravesend being fly-blown and with fly pupas on them must have been lying dead in the fore peak many days before the preliminary safety fumigation at Gravesend. (6) That this fore peak was not fumigated at Marseilles. In common with many Plague ships brought to the notice of your Worshipful Committee, in this case the food store forms the focus of infection for human beings, and the issuer of rations and his assistants are the first victims. In common with s.s. "Moora" and s.s. "Nankin," this ship was found to be infected on the outward voyage. Your Medical Officer has already brought to your notice the theory that:— (1) Infection of human beings may be and is long delayed, or even entirely avoided, by chance circumstances in the presence of a Eat Plague epizooic on a ship, the fleas of the dgad rat being the intermediaries. (2) If Human Plagues be by chance avoided on one voyage, the rat epizooic may remain undiscovered, or if discovered undeclared, to infect the ship on the next outward voyage, and a stray Plague rat may be discovered near a berth during or after the stay of a ship in port, the ship, not the port, t then becoming suspect. (3) Disturbance of a ship's cargo without the simultaneous preventive of rat invasion of deck quarters, especially by any partial (and it can only be partial) fumigation of a ship's cargo in situ, in the presence of Plague or where Plague is suspected, is a procedure dangerous to human life 13 The history of the previous voyage of the s.s. "Nagoya" becomes therefore of interest Previous Voyage s.s. "Nagoya."—The ship left London February 27th, and arrived at Bombay March 27th, left Bombay April 19th, and arrived. in London May 6th. Cargo was discharged at Marseilles and in London, nowhere else. No fumigation took place. The homeward cargo consisted of cassia, ginger, albumen, wax, lard, tapioca, vanilla, egg powder, skins, cocoa, silk waste with cocoons, rape seed. No mortality was noticed amongst rats during the voyage or in port. The returns of sick persons on board during the voyage show nothing suspicious. The significant facts are that the ship came from Bombay on that voyage and carried a cargo not unattractive to rats. The present infected voyage shows that the ship was ratty. The previous stav in London throws fresh light on the history of s.s. "Nanki" and s.s. "Moora," and lately s.s "Kashmir" detained at Colombo, each with Plague on the outward voyage. The "Nagoya" Was berthed at No. 13 Shed, Royal Albert Dock, from the 19th to 29th May. She was succeeded in this berth by the s.s. "Nankin," 2nd to 11th June. These two ships shifted to and lay at No. 19 Shed, 30th May to 5th June, 13th June to 25th June, respectively. The s.s. "Kashmir" lay at No. 17, the between shed (the numbers are odd on the North side and even on the South) from July 18th to 13th August. The previous voyage of the s.s. "Kashmir" was between Southampton and Havre, trooping, and was followed by a stay of some months in Glasgow, so that it is not likely that Plague rats were on board on her arrival in the Royal Albert Dock. The facts of the berthing and overlap of these vessels in dock suggest either s.s. "Nankin" or s.s. "Nagoya" as the original source of infection of s.s. "Kashmir," and the one of the other. s.s. " Moora." a ship commandeered by the Commonwealth of Australia, was also moored close by at this time and had Plague on board on the outward voyage. In view of the group of cases of ship infections found in June, July and August, and of the recent "Nagoya" outbreak which comes into the same group, though with long-delayed human outbreak, it must be assumed that there was cross infection in the North Quay about Nos. 13, 15, 17 and 19 Sheds between the ships, or that all received Plague infected rats from this neighbourhood. It is, of course, possible that both s.s. "Nagoya" and s.s. "Nankin" were subjects of independent infections. Such a condition would be paralleled in the histories of s.s "Himalaya" and s.s. "Oceania" in the past, but the juxtaposition in berthing of the four ships recently infected is highly significant in view of the long duration of overlap in port. No rat mortality had, however, been observed either at this point in the dock or on either of the infected ships during their stay in London. The history and conditions found in s.s. "Nagoya" suggested again the necessity of routine fumigation of ships from the East, and of a close supervision of the rat conditions on board at the time of discharge of their cargoes, and the rat conditions in the neighbourhood of the receiving sheds. No development in the case of the s.s. "Nagoya" took place, or was expected. Your Medical Officer was on board this ship during the process of fumigation and observed :—- (1) The thoroughness of the methods used. (2) The danger to life which would of necessity be present in the use of any lethal gas which did not announce its presence readily, under the usual circumstances of ship fumigation. s.s. "Kaisar-I-Hind" arrived from Bombay on the 22nd December, 1919. On the 24th November, a Canteen sergeant reported sick whilst in the Suez Canal, with femoral bubo. He had been ill three days. On the 25th November, two privates were ill with buboes, inguinal and axillary. All three cases, with five contacts, were landed at Port Said. All passengers, troops and most of the crew were landed at Alexandria, where clothes and bedding were disinfected, and the ship Claytonised, 26th November-l0th December. Before disinfection, no dead or diseased rats were found. After disinfection 219 dead rats were picked up. 14 The greater part of the cargo was landed prior to disinfection and replaced after this was complete. No member of the crew or passengers was attacked. It is possible that the soldiers were infected in Bombay. The cargo consisted of manganese ore, myrobalams, hides and skins, linseed, cashew nuts, casein. Plague on Outward Bound Ships.—The following letter was addressed to the Clerk of the Port of London Sanitary Authority, and was answered by direction of your Chairman, Mr. W. W. Green, with the enclosure of a Report which had already been prepared for your Worshipful Committee:— Ministry of Health, Whitehall, S.W. 22nd July, 1919. Sir, I am directed by the Minister of Health to inform the London Port Sanitary Authority of the occurrence of cases of Plague on the s.s. "Nankin" at Port Said, and on the s.s "Moora" at Malta. Both vessels are outward bound from London, and arrived in these ports on the 12th instant. Up to the 15th instant there were 17 cases with 7 deaths on the former and 4 cases with one death on the latter. Dr. Addison would be glad to be informed whether the circumstances associated with these vessels whilst in dock in the Port of London were such as to suggest that Plague existed on them, either among the crews or among the rats on board, or whether possible Plague infected rats could have gained access to the ships whilst they were in dock. I am, Sir, Your obedient Servant, (Signed) H. 0. STUTCIIBEEBY. The Clerk to the London Port Sanitary Authority. Port of London Sanitary Authority, 51, King William Street, Greenwich, S.E. 10. 21st July, 1919. To the Worshipful the Port of London Sanitary Committee. Gentlemen, 1 have to report the following occurrences in sequence since they seem to have a bearing on a point of cardinal importance to the Port Sanitary Authority on which action has already been taken by your Medical Officer. As already reported early in the year, the s.s. "Chakrata" from Bombay came to London, after discharging freight, and part loading outward cargo at Middlesboro'. The ship lay alongside 21 and 23 Sheds, Royal Albert Dock, and during her stay four dead Plague rats were discovered in close proximity to her berth. The occurrence was not followed by spread of the rodent infection, nor was rat mortality noticed previously in the dock. Your Medical Officer suspected this ship as the source of the Plague rats. s.s. "Malta," on the voyage from Wellington to Bombay, was reported on arrival in the Thames, 4th May, 1919, to have had Human Plague on board between Colombo and Bombay, and was disinfested of rats at Bombay. The source of Plague was undiscovered. s.s. "City of Exeter," on voyage from Sydney to Bombay, was reported on arrival in London on 3rd June, 1919, to have had Plague on board five days after arrival in Bombay. The source was again unknown; disinfestation took place in Bombay. s.s. "Moora" was reported to me by the Admiralty on the 17th July, 1919, to have had Plague on board between Gibraltar and Malta on the outward voyage from London. She lay at No. 17 Shed, Boyal Victoria Docli, to load cargo, having come from Bombay to Middlesboro' for discharge of cargo. This history may be compared with that of s.s. "Chakrata." s.s. "Nankin" was reported to me on the same day as having had Plague on board on the outward voyage between Malta and Port Said. She lay at No. 13 Shed, Boyal Albert Dock, and left London on 30th June, 1919. There is no rat mortality in any part of the Port Sanitary district to account for the outbreaks on these last two ships. But in the light of the histories of s.s. "Himalaya," 15 "Oceana," and "Persia," in the past and, more recently, of the ships "Sardinia," "Matiana," "Somali," and "Hector," it appears possible that the human incidence following on Rat Plague can be delayed over long periods on a ship. Infection of certain rat communities on board, or the driving of infected rats into the living quarters on a ship would be likely to take place on disturbance of the cargo; such was the theory with regard to s.s. "Sardinia" and s.s. "Matiana." These ships, with the s.s. "Somali" and "Hector," had long voyages. The post-war quick voyage might in some cases not allow of the development suggested, prior to arrival; but only on some disturbance in the hold such as cargo discharge occasions, would the hold rats seeks temporary refuge in the crew's quarters or in food store rooms, thus carrying the infection of human beings on board. The unloading at the port at which the voyage ends is not the end of any rat infection on board, and may well be the beginning of the human infection. This theory, which your Medical Officer considers tenable both from the point of view of etiology of the disease and from his observations on infected ships and rats in the port, suggests : I. That rat mortality should be a matter for declaration by those in authority on the ship, under penalties. I am certain that rat mortality on ships has been cloaked in the past, and that questioning is not sufficient. The officer questioned may not know, or may even consider it his duty not to know, of a mortality at the time of questioning on the subject. II. That at present a routine disinfestation of ships from the East, and particularly Bombay, is a necessity. Your Medical Officer has requested this disinfestation of both the Peninsular and Oriental and British India Companies whenever their ships on the Eastern run have not been disinfested within six months, and it will be specially urged if Bombay be a port of loading or of call. Other companies will need to conform to this procedure. There is a Rat Destruction Bill at the present time before Parliament. The Bill embodies the powers conveyed to Port Sanitary Authorities in the Rat Order, 1918, and Amending Order, 1919, of the Ministry of Food, and would make these permanent if it became law. The matter of rats in ports and on ships is definitely one of health over and above food destruction. Your Medical Officer has therefore, after consultation with the Chairman of your Worshipful Committee, communicated the matter of this Report to the Ministry of Health. I have the hononr to be, Gentlemen, Your obedient Servant, W. M. WILLOUGHBY, Medical Officer of Health, Port of London. The further light thrown on these cases by the arrival of the s.s. "Nagoya" later in the year is shown in the full report on this vessel. Routine disinfestation of ships was subsequently found to be difficult. Unless definite signs of rattiness be found on board a ship the reasonableness of such disinfestation is not sufficiently apparent. In connection with the disinfection of Plague ships at Gravesend, a question arose through the Sanitary Committee of the Gravesend Corporation in communication with the Local Government Board, as to the location of ships on the "Quarantine" grounds during the process of discharge and fumigation. A conference was arranged b.etween the Local Government Board Inspector and a deputation of the Sanitary Committee of the Gravesend Corporation, on the afternoon of the 19th March, 1919. Your Medical Officer was invited by the Local Government Board Inspector to be present at the proceedings. The Gravesend Authority was reassured by the statement of the Local Government Board Inspector, on this question of risk of infection during the discharge of cargo and rat disinfestation, that proximity of the ship to the town, rather than mooring the ship far down the river was more satisfactory, both in the technical matter of discharge of cargo and in the sanitary supervision which the Port Sanitary Authority exercises over these ships. On request, your Medical Officer added to the assurance which had been already expressed by the Local Government Board Inspector, that everything was being done to safeguard the health, not only of Gravesend, but the country at large, and that the minutest precautionary detail was carefully thought out and arranged to that end. The deputation to the Sanitary Committee of the Gravesend Corporation expressed its full satisfaction with the explanation afforded. 16 TABLE v.—Cholera. Date. 1919. Name of Vessel, Port of Reg1stry. and Off1c1al No. Where from. No. of Cases. How dealt w1th. Jan. 29 s.s. "Japan," of 98,349. Bombay 7 1 case removed to Port San1tary Hosp1tal. 6 cases landed at Port Sa1d. Apr1l 4 s.s. "Chupra," of Glasgow, 121,321. Calcutta 1 None. D1ed. Bur1ed at sea. Sept. 13 s.s. "Eden Hall," of L1verpool, 87,841. Novoross1sk 1 Landed at Novoross1sk. Total 9 The cases or supposed Cholera ou s.s. "Japan are noted under the head1ng" Plague. CHOLEBA. s.s. "Chupra" arr1ved from Calcutta on the 4th Apr1l, 1919. On the 2nd March a sold1er was taken 1ll w1th D1arrhoea of sudden onset, and d1ed the same day. No further 1nformat1on was obta1nable. Pat1ent had compla1ned of symptoms suggest1ng "ptoma1ne" po1son1ng at Calcutta prev1ously to leav1ng that port. The pat1ent was put 1nto the sh1p's hosp1tal, and later the body was bur1ed at sea. All 1nfected effects were dumped. Troop decks and hosp1tal were d1s1nfected. s.s. "Eden Hall" arr1ved from Novoross1sk on the 10th September. Dur1ng the last week 1n July two A.B. 's were taken 1ll w1th D1arrhoea, and taken to hosp1tal at Novoross1sk as poss1ble cases of Cholera. The men were left 1n hosp1tal, but the 1llness appears to have been of a m1ld nature and both were convalescent when sh1p left. TABLE V1.—Small-pox. Date. 1919. Name of Vessel, Port of Reg1stry and Off1c1al No. Where from. No. of Cases. How dealt w1th. Feb. 17 s.s. "Manora," of Glasgow, 133,129. Bombay 1 Landed at Aden. „ 17 s.s. "C1ty of L1ncoln," of L1verpool, 131,377. D1tto l Landed at Colombo. March 1 s.s. "Manora," of Glasgow, 133129. D1tto 1 Aden. „ 18 s.s. "Sard1n1a," of Glasgow, 115,696. Sydney 2 Marse1lles 1. 1 d1ed and body bur1ed at sea. Apr1l 4 s.s. "Chupra," of Glasgow, 121,321. Calcutta 1 Aden. 9 s.s. "Clan Ke1th," of Glasgow, 136,654. Ch1ttagoug l Galle. 17 s.s. "Herefordsh1re," of L1verpool, 120,903. Rangoon 1 Bombay. „ 17 s.s. "H1ghland Ladd1e," of London, 129,080. — 1 R1o de Janeiro. 24 s.s. "Culna," of Glasgow, 124,164. Bombay 6 Port San1tary. May 2 s.s. "Ormonde," of Glasgow, 141,866. D1tto 1 Plymouth. 8 s.s. "Manaar," of L1verpool, 140,530. Calcutta 1 Suez. 8 s.s. "Stork," of London, 118,473. Naples 1 Hammersm1th. 12 s.s. "Cantabr1a " (Spa1n) Oporto 1 Seamen's, Greenw1ch. „ 14 s.s. "Suev1c," of L1verpool, 113,456. Auckland Suspected - 6 5 Suez 2, G1braltar 3, Southampton 2, Port San1tary 2. „ 16 s.s. "Burma," of Glasgow, 136,333. Lyttelton 1 Aden. 27 s.s. "Gablonz," of Tr1este Bombay 1 Port Sa1d. June 1 s.s. "Karroo," of South Sh1elds, 133,310. Calcutta 1 Colombo. Carr1ed forward 33 17 Small-pox—continued. Date. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. It119. Brought forward 33 J une 7 s.s. "City of Karachi," of' Liverpool, 120,846. Calcutta 1 None. Isolated on board. 8 s.s."Katoomba," of Melbourne Bombay 4 Port Sanitary 1, Gibraltar 2, Malta 1. „ 18 s.s. "Clan MacBride," of Glaso-ow " 1.13 087 Chittagong 1 Madras. July 31 s.s. "Karon," of Glasgow, 137,791. Sydney 1 Landed at Suez. Sept. 6 s.s. "Clan Matheson," of Chittagong 1 Landed at Colombo. Dec. 24 s.s. "Devanha," of Greenock, 1J 7,400. Bombay 2 Removed to Port Sanitary Hospital. Total 43 SMALL-POX. In May, two vessels, s.s. "Stork" and s.s. "Cantabria," arriving from Naples and Oporto respectively, landed cases of Small-pox in London, although both vessels had passed, under examination at Gravesend, as "All well." At the onset of the case from each ship, the diagnosis was made with sufficient promptness, and the precautions taken were such as to prevent any spread. But the fact that vessels arrive from foreign ports within a period of time equal to or less than that of incubation of a disease, constitutes a danger which cannot be completely met by any system of examination on entry of the vessel. The above instances are cases in point. The s.s. "Culna" left Bombay 26th March, and arrived at Gravesend April 23rd. After leaving Plymouth on the 22nd April, three natives reported sick, and were . found to have rashes of probable Small-pox. On full examination of the crew, another case of suspicious rash was discovered. At Gravesend, on 23rd April, the four cases, together with a contact who had Fever and another case found to have a commencing rash were removed to Denton Hospital. Cases 1, 2, 3 and 6 proved to be Small-pox—three severe. Case 4 was found to be Chicken-pox—a matter of close diagnosis in the face of concomitant Small-pox cases. Case 5 developed no rash and all symptoms subsided. There were 356 natives on the ship—87 of the "Culna" crew and 269 of passenger crews. These were all vaccinated at Gravesend and taken ashore for disinfection, and all the native quarters were fumigated and washed down. The ship proceeded to dock on the same night. A further case of Small-pox occurred on the 28th April, and was removed to Denton Hospital The crew were under observation. Of the European crew of 22 persons, ten were not revaccinated, these having undergone the operation within the previous twelve months. One white passenger was vaccinated, and was under surveillance by notification. The source of infection was possibly Port Said, at which place Arabs were on board during twelve hours of bunkering on the 7th April (fourteen days before the date of commencing rash). At Plymouth 569 troops were landed. The troops came on board at Bombay. The Local Government Board, the Port Medical Officer, Plymouth, and the War Office, received immediate notification of the conditions found on the ship on arrival at Gravesend. At this time there was Epidemic Chicken-pox in Bombay; cases of this disease had recently occurred amongst crews arriving in the Port of London with some frequency. Small-pox and Chicken-pox have before occurred together on one ship during the voyage, but the cases had been landed before arrival in the Port of London. 18 The following correspondence arose in connection with an outbreak of Small-pox in the town of Gravesend:— Town Clerk's Office, Gravesend. 15th July, 1919. INFECTIOUS DISEASE. Dear Sir, I am directed by the Health Committee of the Gravesend Town Council to write to you with reference to the recent outbreak of Small-pox. The Committee are of opinion that there is strong prima facie evidence that the outbreak is due to the proximity of the Denton Hospital to the town. Out of the 18 cases that have occurred all except one came from a district which is near the Hospital. The Committee are of opinion that the Hospital is too near a large population, and that the treatment of infectious disease, especially a disease like Small-pox, should be discontinued. They suggest that arrangements might be made by which infectious disease should be dealt with in the hospital in Long Reach, and that the Denton Hospital could be used for non-infectious cases. The Committee are also of opinion that some arrangements ought to be made by which the Borough could be relieved of the expenses of dealing with Small-pox cases which arise largely from ships coming to the Port. They think it unfair that a small town should have to bear the whole of this cost, and suggest that the Port Authority ought at least to make a contribution. I am, Yours truly, (Signed) H. H. BROWN, Town Clerk. The Clerk, Port Sanitary Authority. Guildhall, London, E.C. 2. 1st October, 1919. Dear Sir, The Committee of the Port of London Sanitary Authority, having considered your letter of the 15th July last, have directed me to reply to you as follows : The 18 cases which have occurred in the district situated near Denton Hospital do not constitute any evidence that the Hospital is a menace to the town. It is clearly shown by the dates of onset in the various cases that a group of four cases between the 23rd and 26th were infected from a source undiscovered, and the remainder were all contact cases with these four. Of the late cases, in two no contact with the previous cases of Small-pox was traced, but the date of onset in one of these coincides with that of a number of other cases in the later group, and the occupation of the other was that of a teacher at a school in the infected district; these are to be included amongst the contact cases. We have, therefore, to deal with a group of four early cases infected from a common source, not with 18 cases constituting "strong prima facie evidence" as having occurred in a district near the Hospital. These first four cases, as indicated by their dates of onset, are referable to one unknown source, and, as in almost all Small-pox epidemics, to one case which apparently, up to the present, has not been traced. This common source was at large early in May. Cases were admitted to Denton Hospital on the 23rd April, and one case on the 2nd May, so that the period of infection coincides with the presence of cases in Denton Hospital, but this fact constitutes the only link in the way of evidence that there is any possible connection between the outbreak and the Hospital. The Port of London Sanitary Committee would point out for your information that there were at that time many possible avenues of infection : the Croydon outbreak, for instance, was traced to its one source—a soldier. It must also be remembered that the Gravesend Military Barracks are situated as close to the four early cases at Gravesend as is Denton Hospital—one of the cases, indeed, practically in the same street with the Barrack gates—and the possibility of outbreak arising from military dispersal on demobilisation was at that time a matter of anxiety to every Sanitary Authority. Secondly, about that time there was a serious menace to all South and East Coast Ports by reason of the large infected areas both on the Continent and in Asia. Sailors from every port in the Kingdom come to Gravesend in search of, or taking up. employment, and form a possible source of just such a mild case as is a common precursor of a,n epidemic. Further, many boats enter the river or lie at Gravesend which have come from infected ports, their voyage having occupied less time than the incubation period of the disease. A case arising after the arrival of such a vessel, and after the crew has been paid off, is a third possible source of infection. The known and guarded cases are not the usual sources of epidemics, but unknown mild ambulatory cases. 19 Gravesend has had the protection of the Port of London Sanitary Committee for many unbroken years, and though the town derives much of its prosperity from the river, it has not contributed, nor been asked to contribute, to the expense of this protection. It is naturally expected that the town, in conformity with every other, must be prepared to meet the time when, as must inevitably occur, cases of Small-pox arise, whatever may be the source. The Committee are of opinion that, had Denton Hospital been considered the source of the outbreak, it should not have been left to the late date of 15th July—the end of the outbreak— for communication between the Authorities on a matter of such vital importance to the public health. Small-pox, above many epidemic diseases, necessitates that the closest co-operation be established at the earliest possible moment. The record of the Hospital has been clean in the past, and the Port of London Sanitary Committee do not consider that the prima facie evidence mentioned by the Corporation of Gravesend will bear close inspection. Yours faithfully, (Signed) JAMES BELL. s.s. "Suevic" arrived from Auckland on the 14th May. Two cases of Small-pox and two possible contacts for observation were removed to Denton Hospital. It was reported that two cases of this disease had been landed at Suez, three suspects at Gibraltar, and two cases at Southampton, between 28th April and 12th May. The passengers were landed at Southampton. The crew remained on board, and its members were kept under daily observation in London. Disinfection of the vessel and contacts was carried out at Gravesend. The names and addresses of crew leaving the vessel were notified to the various Medical Officers of Health In connection with Small-pox on the s.s. "Suevic," the following is a copy of a letter received from the Tilbury Urban District Council, together with reply sent by your Medical Officer:— Tilbury. May 21st, 1919. Dr. Willoughby, Port of London Sanitary Authority. Dear Sir, I am directed by my Council to call your attention to the fact that the s.s. "Suevic," which is reported to have had a case of Small-pox on board, is at present being fumigated in the Tilbury Docks. My Council are of the opinion that all necessary fumigation should have been carried out prior to the ship being allowed to enter the dock, and as they are given to understand that a number of men have refused to work on this vessel because of this, I am instructed to ask you for an explanation as to the circumstances. I shall therefore be glad to hear from you, that I may report to my Council at their next meeting. Yours faithfully, A. W. BUCKNER. May 22nd, 1919. The Clerk, Tilbury Urban District Council, Council Offices, Tilbury. Dear Sir, I am in receipt of your letter of May 21st, with regard to the fumigation of s.s. "Suevic," which is taking place in Tilbury Dock. All necessary fumigation with regard to the many Small-pox cases which have occurred on the ship "Suevic" was carried out prior to that vessel's entry into the dock. I presume your letter has reference to the Small-pox only, and not to the many fumigations which take place for all sorts of conditions other than those of scheduled infectious diseases, such as the fumigation to which you allude as having been carried out on this ship in the dock. This latter fumigation was not carried out on account of Small-pox nor under the direction of this Authority. Yours faithfully, W. M. WILLOUGHBY, Medical Officer of Health, Port of London. 20 The s.s. "Manoha" arrived at Gravesend on 17th February—a case of Small-pox had been landed from the ship at Aden on the voyage home While on ship was in dock three cases of Small-pox were notified to your Medical Officer on March 4th and removed to Denton Hospital from among the native crew Another case of Small-pox has been recently notified from among the officers of the ship. Your Medical Officer did not agree the diagnosis as to the three natives of India received into Denton Hospital. These were cases of Chicken-pox. The officer notified as Small-pox had been in association with a cadet who, seen by your Medical Officer, was found to be suffering from Chicken-pox. In the light of these four cases of Chicken-pox, it is certain that the history of the outbreak on the ship, probably including the case landed at Aden, is one of six cases of Chicken-pox. s.s. "Katoomba" arrived from Bombay on the 8th June. On the 15th May, a soldier on board was reported sick with symptoms suspicious of Small-pox. He was considered to have had Small-pox when he came on board on the 15th May. Another soldier was taken on board at Port Said on the 27th May—he had headache and fever—rash out 29th. He was landed at Gibraltar on the 3rd June. One of the crew (a butcher) was taken ill on the 1st June—rash out 3rd June; landed at Gibraltar. On arrival of the vessel at Gravesend, a fireman was removed to Denton Hospital with Small-pox. This patient was in the ship's hospital for venereal bubo up to the 6th June. From the 27th to 30th May he was in the next bunk, in the hospital, to one • of the cases of Small-pox landed at Gibraltar. On the 2nd June he was vaccinated. On the 8th he was seen and was apparently well, though he had vomited once on the 7th, he himself attributing this to food. On the 9th the rash appeared. Constitutional symptoms—none. General vaccination had been performed in the case of passengers, crew and troops on board, with few refusals. Infected quarters were fumigated and effects dumped Passengers and crew were inspected at Gravesend, and their names and addresses of destination were notified to the various Medical Officers of Health. s.s. "Devanha" arrived from Bombay on the 24th December, when a Goanese servant was removed to Denton Hospital suffering from Small-pox. The crew were vaccinated. Names and addresses of passengers and crew were notified to the various Medical Officers of Health. Disinfection of the vessel was undertaken by .the ship's surgeon and master. TABLE VII.—Enteric Fever. Date. 1919. Name of Vessel. Port of Registry and Official No. Where from. No. of Cases. How dealt with. Feb. 3 s.s. "Nosted I.," of London, 67,334. Dieppe 1 Landed at Barry. ,, 28 s.s. "Field Marshall," of London, 142,385. Dares Salam 1 Treated on board. March 1 s.s. "Australrange Albany 1 Cape Town. ,, 8 s.s. "Moncaster Castle Java - 1 Colombo. ,, 16 s.s. "Carventum," of Glasgow, 120,176. Mauritius 2 Malta. April 1 s.s. "Sardinia," of Glasgow, 115,696. Sydney 1 None. Proceeded home. May 11 s.s. "Navasota," of Southampton, 135,702. Buenos Ayres 1 Port Sanitary. ,, 27 s.s. "Gablonzof Trieste Bombay 1 Aden. June 8 s.s. "Katoomba," of Melbourne, Ditto 2 Port Sanitary. ,, 12 s.s. "Berrima," of Greenock, 135,332. Sydney 1 None. Treated on board. July 18 s.s. "Lake Grama," of Chicago. Montreal 2 Removed to Gravesend Hospital. „ 22 s.s. "Glengyle," of London; 137.487." Yokohama - 1 Landed at Port Said. ,, 28 s.s. "Ida " Palermo 1 Removed to Port Sanitary Hospital. Carried forward 16 21 Enteric Fever—continued. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Brought forward 16 Aug. 2 s.s. "Millpool," of West Hartlepool. Mauritius 5 Landed at Aden and Port Said. ,, 7 s.s. "Warwickshire," of Liverpool, 112,458. Fremantle - 1 Removed to Port Sanitary Hospital. ,, 13 s.s. "Glenapp," of Glasgow, 141,887. Singapore - 1 Landed at Suez. ,, 17 to Nov. 11 Training Ship "Cornwall" - 28 Removed to Port Sanitary Hospital. ,, 23 s.s. "Manchurian Prince" New Orleans- 1 Ditto. Sept. 6 s.s. "Manora" Rangoon 1 Remained on board. ,, 6 s.s. "Sardinia," of Glasgow Sydney 2 Removed to hospital at Islington. ,, 8 s.s. "Kashgar," of Greenock, 128,254. Bombay 1 Landed at Aden. ,, 8 s.s. "Siretul" (Roumanian) Alexandria - 1 Admitted to Seamen's Hospital, Greenwich. ,, 9 s.s "Manora," of Glasgow, 133,129. Bombay 1 Removed to Port Sanitary Hospital. ,, 23 Canal boat "Sandford." reg. Brentford, No. 352. Hammersmith 1 Removed to hospital at Hammersmith. Oct. 5 s.s. "Somali," of Greenock, 114,056. Melbourne - 1 Landed at Port Said. ,, 10 s.s. "Clan McKinlay," of Glasgow, 141,890. Calcutta 1 Landed at Suez. ,, 18 s.s. "Roila" Cuba - 1 Landed at Las Palmas. ,, 23 s.s. "Roda," of London, 143,087. Melbourne - 1 Removed to Port Sanitary Hospital. ,, 25 s.s. "Rvvarden" Norway 1 Admitted to Seamen's Hospital, Greenwich. ,, 25 s.s. "Minia," of London, 56,762. N. Atlantic - 3 Removed to Port Sanitary Hospital. ,, 29 s.s. "Rvvarden" Norway 1 Admitted to Seamen's Hospital, Greenwich. Nov. 4 s.s. "Minia," of London, 56,762. N. Atlantic - 2 Ditto. ,, 22 s.s. "Boonah," of London, 139,007. Sydney 1 Isolated on board. ,, 30 s.s. "Highland Laddie," of London, 129,082. Buenos Ayres 1 Removed to Port Sanitary Hospital. Dec. 17 s.s. "Highland Glen," of London, 129,139. Ditto 2 Ditto. ,, 23 s.s. "Manora," of Glasgow, 133,129. Bombay 1 Died on board. ,, 23 s.s. "Australia." of London, 136,740. Ditto - 1 Landed at Colombo. ,, 8 s.s. "Prinz Ludwig " 1 Removed to Port Sanitary Hospital. Total 77 ENTERIC FEVER. An outbreak of Enteric Fever occurred on the Training Ship "Cornwall," beginning in August. Cases were admitted to Denton Hospital, on the 17th August seven, 20th August two, 2nd September two, 6th September six, 15th-24th September five, 25th October one, 27th November five; all except one of the 28 cases admitted were found to be Enteric Fever. Mixed vaccine was given to most of the ship's complement in September. Of the later cases two had been inoculated within ten days of their admission, three some weeks before the attack, one proved not to be a case of Enteric Fever, and two were amongst the uninoculated. Serum reactions, taken before inoculation was begun, showed four of the cases to be of the nature of Paratyphoid A. 22 In three cases occurring several weeks after inoculation the Typhoid, but not any Paratyphoid, reaction was obtained. The epidemic was one of mild Paratyphoid Fever; two deaths occurred. As a result of inspection in August the following general recommendations were made and acted on :— Thames water not to be used for washing out galleys. Cook boys to be inspected for cleanliness when coming on duty and wear clean caps and overalls. Food stuffs to be protected from flies. An ablution basin to be kept in the galley, with clean towels; the towels of the boys not to be brought in. Closet seats to be washed with disinfectant solution daily. It was recommended that another urinal be fitted in the bows of the ship, and fouling of the deck there be the subject of disciplinary action. Carriers were sought amongst the cook boys, but none found. The mildness of some of the attacks, in onset, led to delay in segregation of cases; and there was a tendency to lodge the boys in a sick bay on board pending full diagnosis. Many of the cases were ambulatory in the early stages. These were the probable factors leading to the prolongation of the epidemic. The source of the epidemic was not traced. TABLE VIII.—Diphtheria. Date. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. 1919. Feb. 18 Training Ship " Exmouth," at Grays 6 Removed to Eastern Hospital (M.A.B.). „ 28 Ditto ditto 2 Ditto. Mar. 12 s.s. " Australmead," of Melbourne, 131,436. Melbourne 1 Removed to South Eastern Hospital (M.A.B.). „ 13 Training Ship "Exmouth." at Grays 1 Ditto. „ 18 Ditto ditto 1 Ditto. „ 24 Training Ship " Arethusa," at Greenhithe 1 Dartford. „ 31 s.s. " Boonah," of London, 139,007. Adelaide 1 Southampton. April 17 Training Ship " Exmouth," at G rays 1 Removed to Eastern Hospital (M.A.B.). May 19 s.s. " Nagoya," of Greenock, 135,532. Bombay 1 None. Left vessel convalescent. July 28 s.s. " Navaroa " - 1 Lauded at Aden. Sept. 8 Training Ship " Arethusa," at Greenhithe 1 Removed to Hospital on shore. „ 26 s.s. " Balder," of Gothenburg - Gothenburg 1 Removed to Port Sanitary Hospital. Oct. 10 Training Ship " Exmouth," at Grays 1 Removed to South Western Hospital (M.A.B.). „ 23 Training Ship " Arethusa," at Greenhithe 1 Removed to Hospital on shore. „ 29 s.s. "West Cherow" (U.S.A.) Philadelphia 1 Isolated on board. Nov. 17 Training Ship " Arethusa," at Greenhithe 2 Removed to Hospital at Dartford. „ 29 Training Ship " Exmouth," at Grays 1 Removed to Joyce Green Hospital. Dec. 2 Barge " Noclaf," of Rochester, 98,807. Upnor 1 Removed to Brook Hospital. Total 25 23 TABLE IX.—Scarlet Fever. Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. 1919. June 7 s.s. " Trafford Hall," of Liverpool, 120,906. Calcutta I Removed to Port Sanitary Hospital. July 14 s.s. " Balmoral Castle," of London, 129,074. Sydney I Landed at Plymouth. Dec. 2 s.s. " Neuralia," of Glasgow, 133.081. Bombay I Taken ill at home. „ 13 s.s. " Demosthenes," of Aberdeen, 129,362. Brisbane I Treated on board. Total 4 TABLE X.—Measles. Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. 1919. Feb. 17 s.s. " Manora," of Glasgow, 133,129. Bombay 1 Landed at Plymouth. 26 s.s. " Chanda," of Glasgow, 121,308. Outward Bound Treated on board. March 1 s.s. " Manora," of Glasgow, 133,129. Bombay 1 Landed at Plymouth. 10 s.s. " Chanda," of Glasgow7, 121,308. Ditto Treated on board. May 2 s.s. "Ormonde," of Glasgow, 141,866. Ditto 1 Highbury Nursing Home. 20 s.s. " Loyalty," of Bombav, 98,887. Ditto 1 Marseilles. June 7 s.s. " Indarra," of Fre mantle. Ditto 1 Proceeded home. 7 s.s. " Margha," of Glasgow, 141,876. Ditto 1 Plymouth. 18 Training Ship " Worcester " Greenhithe 1 Ship's. On shore. Aug. 3 7 s.s. " Eduard Woermann " s.s. " Sicilia," of Glasgow, 113,933. Cape Town Bombay 30 1 Landed at Rotterdam. Isolated on board. Oct. 21 s.s. " Highland Rover," of London, 129,067. Buenos Ayres 2 Ditto. 31 s.s. " Egypt," of Greenock, 105,58i. Singapore 1 Removed to M.A.B. Hospital. Nov. 4 s.s. " Orsovo," of Glasgow, 128,278. Brisbane 1 Landed at Toulon. 22 s.s. " Saxonia," of Liverpool, 110,648. New York 3 Landed at Havre. 28 Ditto Ditto 3 Proceeded home. Dec. 9 s.s. " Prinz Ludwig," of London, 143,122. Sydney 1 Landed at Plymouth 13 s.s. " Demosthenes," of Aberdeen, 129,362. Brisbane 1 Isolated on board. Total 52 TABLE XL—German Measles. Date. 1919. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. May 16 s.s. " Dufferin " Bombay 1 Isolated on board. Nov. 22 s.s. " Boonah," of London, 139,007. Sydney 2 Ditto. Dec. 9 s.s. " Prinz Ludwig," of London, 143,122. Ditto 4 Landed at Plymouth Total 7 24 TABLE XII.—Chickenpox. Date. 1919. Name of Vessel. Port of Registry aud Official No. Where from. No. of Cases. How dealt with. Jan. 29 s.s. " St. Albans," of London, 129,108. Bombay 3 2 cases landed at Aden and 1 at Suez. March 1 s.s. " Manora," of Glasgow, 133,129. Ditto 4 Port Sanitary Hospital. 11 21 Training Ship " Exmouth " s.s. " Markara," of Glasgow, 136,332. Grays Bombay 1 2 South Eastern Hospital (M.A.B.). 1 Gibraltar, 1 Port Sanitary Hospital. 22 s.s. " Historian," of Liverpool, 105,364. Calcutta 1 None. Isolated on board. April 4 s.s. "War Panther," of London, 142,418. Mauritius 1 Port Sanitary Hospital. 4 s.s. " Chupra," of Glasgow, 121,321. Calcutta 2 Aden. 24 s.s. " Culna," of Glasgow, 124,164. Bombay 1 Port Sanitary Hospital. May 3 4 Ditto s.s. " Novara," of Greenock, 131,860. Ditto Shanghai 2 3 Ditto. None. Isolated on board. 14 16 s.s. " Teesta," of Glasgow, 115,777. s.s. " Dufferin " Bombay Ditto 1 1 Marseilles. Isolated on board. 20 Ditto ... Ditto 1 Dartford Hospital (M.A.B.). 24 s.s. " Manora " Ditto 3 None. Isolated on board. June 18 s.s. " Export " Rotterdam 1 Port Sanitary Hospital. April 3 s.s. " Devanha " 1 Ditto. July 17 s.s. " Steersman," of London, 129,046. Oporto 1 Landed at Lisbon. Aug. 20 s.s. " Scotian," of Glasgow, 129,547. Montreal 1 Proceeded home. Sept. 1 Training Ship " Exmouth " 1 Removed to hospital at Tottenham. 22' s.s. " Cluny Castle," of London, 118,323. Sydney 1 Treated on board. Oct. 2 s.s. " Lucie Woermann," of London, 143,075. Walfish Bay 5 Landed at Rotterdam. Nov. 3 s.s. " Carisbrook Castle," of London, 108,351. Cape Town 1 Proceeded home. 5 s.s. " Warrior," of Liverpool, 120,873. - 1 Treated on board. 13 s.s. " Delta," of Belfast, 120,709. Newcastle 1 Proceeded home. 15 s.s. " Port Albany," of London, 136,676. Sydney 5 Ditto. 17 Training Ship " Exmouth " - 1 Removed to Eastern Hospital (M.A.B.). 29 s.s. " Indarra," of Fre mantle, 131,639. Sydney 2 Proceeded home. Dec. 23 s.s. " Delta," of Belfast, 120,709. Bombay 2 Treated on board. Total 50 TABLE XIII.—Cerebrospinal Meningitis. Date. 1919. Name of Vessel, Port of Registry, arid Official No. Where from. No. of Capes. How dealt with. March 10 s.s. " Sir Redvers Buller " Calais 1 South Western Hospital (M.A.B.). Dec. 29 s.s. " Tioga," of London, 132,668. Barrow 1 Removed to Hospital at Stant'ordleHope. Total 2 25 TABLE XIV.—Malaria. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. Feb. 10 s.s. " Thurland Castle," of Liverpool, 136,197. Bathurst 7 Treated on board. March 15 s.s. " Moorish Prince," of Newcastle, 133,556. Ditto 3 Admitted to Seamen's Hospital', Greenwich. 21 s.s. " War Hound " Java 2 Landed at Gibraltar. 24 s.s. " War Hamlet " — 4 Seamen's Hospital, Greenwich. April 4 s.s. " War Panther," of London, 142,418. Mauritius 1 Gibraltar. 22 s.s. " Cycle," of Melbourne, 108,706. — 10 Treated on board. 24 s.s. " Skegness," of Swansea, 104,679. Bathurst 1 Sierra Leone. May 19 s.s. " Benavon," of Leith, 123,011. Ditto 4 Bathurst. 20 s.s. " Clan MacWilliam " Mauritius 2 None. Treated on board. June 4 s.s. " Kabinga," of London, 125,599. Colombo 1 Royal Albert Dock. 11 s.s. " Delta," of Belfast, 120,709. Bombay 1 Port Said. 17 s.s. " Gambia," of Liverpool, 137,484. Freetown 3 Port Sanitary Hospital. July 8 s.s. " Neuralia," of Glasgow, 138,081. Shanghai 1 Removed to Port Sanitary Hospital. 10 s.s. " Twilight," of Leith, 119,885. Bathurst 1 Ditto. 14 s.s. " Balmoral Castle," of London, 129,074. Sydney 1 Landed at Plymouth. ic s.s. " Gaboon," of Liverpool, 137,434. Lagos - 14 Treated on board. 18 s.s. " Atlanten " - Africa - 1 Removed to Port Sanitary Hospital. Aug. 6 s.s. " Warwickshire " - — 1 Ditto. Sept. 6 s.s. " Minora - Rangoon 1 Treated on board. 14 s.s. " Cranmore," of Liverpool, 120,894. Alexandria - 1 Ditto. Oct. 16 s.s. " Bremen - Bombay 23 Ditto. 16 s.s. " Wisley," of London, 118,121. Java 5 Ditto. 1 died. 20 s.s. " City of Calcutta," of Glasgow, 115,759. Calcutta 1 Ditto. 20 s.s. " Gloucestershire," of Liverpool, 131,296. Rangoon 2 Ditto. Nov. 4 s.s. " Maashaven " (Dutch) - - 1 Admitted to Seamen's Hospital, Greenwich. 11 s.s. " Wisley," of London, 181,121. ' Saniarang 1 Died at sea. 13 s.s. " Bremen " - Sydney 3 Treated on board. 17 s.s. " Greleden " Bombay 11 Ditto. 17 s.s. " Koningin Luise Sydney 16 Ditto. 18 s.s. " Neuralia," of Glasgow, 133,081. Bombay 6 Ditto. 29 s.s. " Gaboon," of Liverpool, 137,434. Opobo - 7 Ditto. 29 s.s. " Sicilia," of Glasgow, 113,933. Bombay 9 Ditto. Dec. 5 s.s. " Derbyshire," of Liverpool. 106,876. Rangoon 1 Ditto. 10 s.s. " Arzila," of Liverpool, 124,097. Demerara 1 Ditto. 12 s.s. " Warri," of Liverpool, 113,482. Teneriffe 4 Ditto. 13 s.s. " Macharda," of Liverpool, 140,593. Calcutta 2 Landed at Tilbury. 15 s.s. " Gaika," of Southampton, 106,908. Mombassa 3 Removed to Port Sanitary Hospital. 19 s.s. " Mentor," of Liverpool, 137,408. Yokohama - 3 Treated on board. Total 159 26 TABLE XV.—Pulmonary TuberculosIS. Date. 1919. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases. How dealt with. Jan. 3 s.s. " Ionic," of Liverpool, 115,337. Wellington 2 Proceeded home. Feb. 10 s.s. " Merchant Prince," of Newcastle, 114,419. Hull 1 Admitted to Seamen's Hospital, Greenwich. March 13 s.s. " Genzan Maru," of Toldo. - 1 Ditto. April 1 s.s. " Dmvuma," of London, 136,725. Natal 1 None. Proceeded home. 17 s.s. " Stephan," of Liverpool, 120,903. Bussia 1 Chatham. 17 s.s. " Palma." of Belfast, 116.009. Sydney 1 None. Proceeded home. 24 s.s. " Tahiti," of London, 117,715. Wellington 1 None. Died on board. May 7 H.M.A.T. " Ebain " Cape Town Southampton. 8 s.s. " Lord Sefton," cf London,124,938. Java 1 Gibraltar. 8 s.s. " Miltiades," of Aberdeen, 118,179. Sydney 1 None. Proceeded home. 9 s.s. " Kinsale," of Glasgow, 105,850. Gothenburg 1 Ditto. 16 s.s. " Burma," of Glasgow, 136,333. Lyttleton 1 Colombo. 19 s.s. " Port Hacking," of London, 112,681. Wellington 1 None. Proceeded home. •20 s.s. " Osakee " — 1 Seamen's Hospital, Greenwich. June 2 s.s. " Defender," of Liverpool. Calcutta 1 None. Proceeded home. 5 s.s. " Onega," of New York New Orleans 1 None. Bemained on board. 13 s.s. " Atsuta Maru," of Tokio Yokohama 1 Ditto. 14 s.s. " Ingoma," of Liverpool, 135,475. Durban 1 Died. Body buried at sea. 18 s.s. " Highland Piper," of London, 132,559. Buenos Ayres 1 None. Proceeded home. 18 s.s. " Athenic," of Liverpool, 115,329. Wellington 1 Ditto. 26 s.s. " Burma," of Glasgow, 136,333. Lyttleton 1 Admitted to Seamen's Hospital, Greenwich. July 13 s.s. " Carmarthenshire," of Shanghai 1 Died, and body buried at Belfast, 136,347. sea. 21 s.s. " Bona venture " (Bus sian). Archangel 1 Admitted to Seamen's Hospital, Greenwich. 28 s.s. " Willis," of Botterdam Botterdam 1 Died on board. Aug. 27 s.s. " KaisarlHind," of Greenock, 128,653. Sydney 1 Remained on board. Sept. 6 s.s. " Kyber," of Liverpool, 135,564. Bombay 1 Died on board. 8 s.s. " Devanha," of Greenock, 117,400. Sydney 1 iemained on board. 26 s.s. " Mishima Maru " Kobe 1 Admitted to Seamen's Hospital, Greenwich. 26 s.s. '' Brodmead," of London, 105,262. Hankow 1 1 Landed at Havre. Oct. 3 s.s. " Chyebassa," of Glasgow, 124,171. Calcutta 1 Proceeded home. 8 s.s. " Ormonde," of Glasgow, 141,866. Brisbane 2 Died at sea. „ 20 s.s. " Clan Mace wen," of Glasgow, 135,053. Tamatave 1 sanded at Aden. 20 s.s. " Gloucestershire," of Liverpool, 131,296. Bangoon 1 Remained on board. „ 21 s.s. " Port Darwin," of London, 140,446. Melbourne 1 Ditto. Carried forward 37 27 Pulmonary Tuberculosis—continued. Date. 1919. Name of Vessel, Port of Registry, and Official No. Where from. No. of Cases How dealt with. Brought forward - 37 Oct. 24 s.s. " Kashgar," of Greenock, 128,654. — 1 Admitted to Seamen's Hos pitai, Greenwich. 27 s.s. " War Plum," of London, 142,771. Sapela - 1 Ditto. 28 s.s. "Kashgar," of Greenock, 128,654. — 1 Ditto. Nov. 6 s.s. " Carpati," of Braila Alexandria - 1 Ditto. ,, 6 s.s. " General Manoury " — 1 Ditto. 15 s.s. " Lancashire," of Liverpool, 140,529. Rangoon 1 Proceeded home. 17 s.s. " Irishman," of Liverpool. Sydney 1 Ditto. 17 s.s " Prinz Hubertus " Ditto 1 Ditto. 19 s.s. " Swakopmund," of London, 143,182. Ditto 2 Landed at Southampton. Dec. 24 s.s. " Neuralia," of Glasgow, 133,081. Bombay 1 Admitted to Seamen's Hos pitai, Greenwich. „ 24 s.s. " Warwickshire," of Liverpool, 115,258. Bangoon 1 Proceeded home. 24 s.s. " Durham Castle," of London, 118,387. Cape Town - 1 Ditto. 28 s.s. " Carnarvonshire," of Belfast. 132.049. Dalny - 1 Landed at Colombo. Total 51 TABLE XVI.—Miners' Phthisis. Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. 1919. March 11 s.s. " Durham Castle," of London, 118,387. Durban 4 None. Proceeded home. May 27 s.s. " Dunvegan Castle," of London, 105,854. Cape Town 1 Ditto. June 13 s.s. " Walmer Castle," of London, 114,839. Ditto 4 Ditto. „ 16 s.s. " Saxonia," of Liverpool, 110,648. New York 1 Tilbury. July 18 s.s. " Kildonan Castle," of London, 112,615. Sydney 10 Proceeded home. „ 28 s.s. " Gaika," of Southampton, 106,908. Durban 9 Ditto. Aug. 13 s.s. " Glenapp," of Glasgow, 141,887. Singapore 1 Landed at Port Said. Oct. 14 s.s. " Balmoral Castle," of London, 129,074. Cape Town 2 Proceeded home. Nov. 19 s.s. " Bremen " Sydney 1 Ditto. Dec. 3 s.s. " Grantully Castle," of London, 129,058. Cape Town 1 Ditto. „ 22 s.s. "Durham Castle," of London, 118,387. Ditto 1 Ditto. Total 35 28 TABLE XVII.—Influenza. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. o Cases How dealt with. Jan. 31 H.M.O.T. " Warrenee " — 6 Military cases. „ 14 s.s. " City of Shanghai," of Liverpool, 140,533. Calcutta 3 Landed at Port Said. „ 15 s.s. " Ambassador," of Newcastle, 106,618. Tyne 4 Military cases. „ 20 s.s. " Royal Scott," of Leith, 129,399. Boulogne 24 Ditto. Feb. 22 s.s. " P. Claris," of Barcelona. — 2 Rotherhithe Infirmary. „ 25 s.s. " Hillingdon," of London, 135,130. Tyne 1 Gravesend (Military). „ 28 s.s. " Nankin," of Greenock, 131,857. Bombay 1 None. Treated on board. March 5 s.s. " Magna," of London, 139,157. Cape Town - 70 Seamen's Hospital, Greenwich . Some cases isolated on board. „ 5 s.s. " Australrange " - Albany 1 Royal Albert Dock. „ 11 s.s. " Shropshire," of London, 132,607. — 1 0 Seamen's Hospital, Greenwich. „ 15 s.s. " Glendene," of Newcastle, 131,839. San Nicholas 1 Ditto. „ 17 s.s. " Intaba," of Aberdeen, 129,345. Cape Town 1 Ditto. „ 24 s.s. " Australrange," of Sydney. - 1 Seamen's Hospital. Greenwich. „ 24 H.M.S. " Wahine " - - 1 Ditto. „ 24 s.s. " Barima " - Malaga- 1 None. Isolated on board. April 2 s.s. " Borda," of Greenock, 135,340. Sydney 7 None. Died on board. „ 3 s.s. " Italian Prince," of Newcastle, 101,836. Dunkirk 1 None. Proceeded home. „ 17 s.s. " Frienfels " Basra 50 Some isolated on board. Some Seamen's Hospital, Greenwich. „ 24 s.s. " Newby Hall," of Liverpool, 120,848. Middlesbrough 1 Seamen's Hospital, Greenwich. „ 24 s.s. " Laurel Branch "- Hull 1 Ditto. „ 28 s.s. " Newby Hall," of Liverpool, 120,848. Middlesbrough 1 Seamen's Hospital, Greenwich. „ 28 s.s. " Laurel Branch," of Sunderland, 114,654. Hull 1 Ditto. May 6 s.s. " Saxonia," of Liverpool, 110,648. New York 6 5 convalescent on arrival. 1 Tilbury Cottage Hospital. „ 16 s.s. " Santa Theresa," of Liverpool, 135,578. Forcados 10 Las Palmas 6. 4 isolated on board. „ 19 s.s. " Malta," of Greenock, 102,398. Bombay 1 Died on board. „ 23 s.s. " Tyr " Gefle 3 None. Isolated on board. „ 30 s.s. " Chindwara," of London, 128,930. Middlesbrough 3 Seamen's Hospital, Greenwich. June 10 s.s. " Canberra," of Melbourne. Bombay 1 None. Died on board. „ 11 s.s. " Delta," of Belfast, 120,709. Ditto 1 Ditto. „ 14 s.s. " Ingoma," of Liverpool, 135,475. Durban 260 Rotterdam (10 deaths). „ 16 s.s. " Field-Marshall," of London, 142,385. Ditto 140 Landed at Rotterdam. 6 deaths. „ 18 s.s. " Clematis," of North Shields, 109,887. River Plate 1 Seamen's Hospital, Greenwich. Carried forward 606 29 Influenza.—continued. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. Case How dealt with. Carried forward 606 July 7 s.s. " Neuralia " — 1 Removed to Port Sanitary Hospital. 17 s.s. " Ionic," of Liverpool, 115,337. Wellington - 1 Treated on board. 18 s.s. " Kildonan Castle," of London, 112,615. Sydney 1 Ditto. 25 s.s. " Plassy," of Greenock, 109/259.' Ditto 1 Ditto. 27 s.s. " Delta," of Belfast, 120,709. Ditto 1 Admitted to Seamen's Hospital, Greenwich. 28 s.s. " Navaroa " Bombay 2 Died at sea. Aug. 22 s.s. " Malwa," of Greenock, 127,543. Ditto 603 Landed at Plymouth. 27 > f -J| Training Ship " Exmouth " - — . 1 Removed to Grays Infirmary. Sept. 6 s.s. " Sicilia," of Glasgow, 113,933. — 1 Died on board. 23 s.s. " Soudan," of Greenock, 114,052. Bombay 1 Treated on board. Oct. 5 s.s. " Chindwara," of Glasgow, 128,930. Ditto 1 Admitted to Seamen's Hospital, Greenwich. 5 s.s. " Ormonde," of Glasgow, 141,866. Brisbane 400 Treated on board. 10 s.s. " Clan McKinlay," of Glasgow, 141,890. Calcutta 1 Landed at Pt. de Galle. 20 s.s. " Clan Mace wen," of Glasgow, 133,053. Tamatave 1 Died on board. 20 s.s. " Western Ally," of Los Angeles. - 1 Admitted to Seamen's Hospital, Greenwich. 24 s.s. " Pengreep," of Falmouth, 133,349. - 1 Ditto. 28 Ditto - 1 Ditto. 28 s.s. " Black Prince," of Newcastle, 114,437. - 1 Ditto. 31 s.s. " Boonsborougli (U.S.A.). New Orleans 1 Ditto. Nov. 3 s.s. " Tenno Maru " (Japan) Havre 1 Ditto. 14 s.s. " British Marquis," of London, 125,685. - 1 Ditto. Dec. 5 s.s. " Derbyshire," of Liverpool, 106,876. Rangoon 15 Treated on board. 13 s.s. " Machrada," of Liverpool. 140,593. Calcutta 1 Ditto. 22 Training Ship " Exmouth " - 1 Removed to hospital on shore. Total 1,646 TABLE XVIII.-MUMPS. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from No. of Cases. ! How dealt with. April 4 s.s." Barima," of Southampton, 135,632. Malaga 1 Seamen's Hospital, Greenwich. „ 14 H.M.S. " Angora" - - —— 1 Removed to South Eastern Hospital (M.A.P.). May 6 P. & 0. Shore Quarters, Royal Albert Dock. - 1 Isolated in Shore Quarters. July 2 s.s. " Thongwa," of Glasgow, * 115,7tS8. Calcutta 1 Isolated on board. „ 11 s.s. "Chaya" Bombay 1 Ditto. ,, 25 s.s. " Plassy," of Greenock, 109,259. Sydney 1 Ditto. Carried forward 6 30 M umps—continued. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No of How dealt with Cases Brought forwaad - 6 Aug. 23 s.s. '' Royalty " - 1 Removed to South Eastern Hospital (M.A.B.). „ 28 s.s. " Plassy," of Greenock, 109,2">9. - 1 Transferred to s.s. " Khiba." Sept. 23 s.s. " Soudau," of Greenock, 114,053. Bombay 1 Treated on board. Oct. 14 s.s. " Bremen " Ditto 1 Ditto. „ 20 s.s. " Mandala," of Glasgow, 137,806. Calcutta 2 Ditto. Nov. 13 s.s. " Bremen " - 6 Ditto. Total 18 TABLE XIX.—Dysentery. Date. 1919. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with. March 20 s.s. " Sardinia." of Glasgow, 115,696. Bombay 1 Seamen's Hospital, Royal Albert Dock. April 4 s.s. " War Panther," of London, 142,418. Mauritius 1 Aden. Sept. 6 s.s. " Sargasso," of London. 125,734. Demerara 1 Landed at St. Michaels. Oct. 20 s.s. " Agapenor," of Liverpool, 135,553. Shanghai 1 Admitted to Seamen's Hospital, Royal Albert Dock. Dec. 19 s.s. " Mentor." of Liverpool, 137,408. Yokohama 1 Landed at Colombo. Total 5 TABLE XX.—Gastro-Enteritis. Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with.p 1919. April 2 s.s. Gracchus," of Glasgow, 101,745. Sydney 1 None. Died on board. TABLE XXL—Erysipelas. Date. 1919. Name of Vessel, Port of Registry and, Official No. Where from. No. of Cases. How dealt with. Jan. 28 West India Dock, I^awn House. - 1 Isolated at home. „ 19 H.M.S. " Haupiri" - 1 Admitted to Seamen's Hospital, Greenwich. June 17 s.s. " Burriana," of Glasgow, 134,141. S'fax 1 Gibraltar. Total 3 31 TABLE XXII.—Venereal Disease (cases on vessels arriving at Gravesend). Date. 1919. Case. No. of Cases. Rating. Advice given. Jan. 1 Syphilis 1 Fireman To attend Greenwich Hospital. 1 Ditto 1 Crew A.B. - Treated by ship's Surgeon. 15 Ditto 1 Fireman To attend Gravesend Hospital. 15 Ditto 1 Sailor - Ditto. Feb. 4 Soft Sore, &c. 1 Fireman Arrangements made to send case to London Br. Hospital, Dean Street. 17 Gonorrhoea (Convalescent) 1 A.B. - Seamen's Hospital, Greenwich. 17 Gonorrhoea 1 Steward Ditto. 20 Gonorrhoea and Bubo 2 A.B.'s Recommended to London Hospital. 20 Gonorrhoea only 23 Syphilis, Chancre and Bubo - 1 2nd Cook - To Greenwich Hospital. 24 2 Gonorrhoea and Buboes 2 Naval ratings passengers. Landed at Plymouth. 25 Gonorrhoeal Rheumatism 1 Steward To attend Greenwich Hospital. March 1 Gonorrhoea 1 Seaman Ditto. 1 Soft Chancre 1 Carpenter - Ditto. 1 Syphilis 1 Seaman Ditto. 1 Gonorrhoea 1 Ditto Ditto. 3 Syphilis 1 Ditto Ditto. „ . 15 Gonorrhoea and Bubo 1 Steward Ditto. 16 Syphilis 1 Seaman Ditto. 19 Soft Sore 1 Ditto Ditto. '21 Gonorrhoea - 2 Ditto To attend Gravesend Hospital. 21 Bubo 2 Ditto Ditto. 22 Soft Chancre 1 Native Treated on board. 24 Syphilis 1 A.B. - To attend Greenwich Hospital. 28 Gonorrhoea and Bubo 1 Crew (Portuguese) To obtain Medical advice. April 9 Gonorrhoea 3 Crew - To attend Greenwich Hospital. 10 Syphilis 1 Ditto Ditto. 10 Gonorrhoea 2 Ditto Ditto. 11 Gonorrhoea 1 Seaman Ditto. 13 Gonorrhoea - 1 Steward Ditto. 15 Syphilis 1 Fireman Ditto. 18 Gonorrhoea - 7 Seamen Ditto. 18 Ditto 1 Gunner To attend Naval Hospital. 19 Syphilis 1 Seaman To attend Greenwich Hospital. 19 Gonorrhoea and Bubo 1 Ditto Ditto. 22 Gonorrhoea 1 Ditto To see Doctor at Tilbury Docks. 23 Bubo 1 Ditto To attend Greenwich Hospital. 23 Gonorrhoea 1 5th Engineer To Connaught Road. 23 Syphilis 1 A.B. - To Connaught Road. (Leaflets issued.) 23 Ditto 1 Chinese Convalescent. 23 Soft Sore 1 Fireman Convalescent. 24 Syphilis 1 Ditto To attend Royal Albert Dock Hospital. 24 Gonorrhoea 4 Seamen Convalescent. 30 Gonorrhoea 1 Sailor Convalescent. (Leaflets issued.) 30 May 4 Syphilis 1 Ditto To Connaught Road. (Leaflets issued.) Ditto 1 Gunner (Naval) To Naval Authorities. Carried forward 61 32 Venebeal Disease—continued. Date. 1919. Case. No. of Cases. Hating. Advice given. Brought forward 61 May 4 Syphilis 1 Sailor To Connaught Boad. 4 Ditto 2 Firemen To Seamen's Hospital. 4 Gonorrliceal Bubo - 1 Native Treated by ship's Surgeon. 11 Gonorrhoea - 2 Seamen To Boyal Albert Dock Hospital. 11 Chancre 1 A.B. Ditto. 12 Gonorrhoea - 2 Firemen To Gravesend Hospital. 12 Syphilis 1 Fireman Ditto. 12 Syphilis, Tertiary 1 Native Steward. To Connaught Road. 12 Gonorrhoea 4 Sailors Ditto. 12 Soft Sore 1 Sailor Treated by ship's Surgeon. (Leaflets issued.) 12 Syphilis 1 Ditto Ditto. 12 Gonorrhoea 3 Firemen To Connaught Boad. 12 Syphilis 1 Sailor Ditto. 18 Ditto 1 Crew To Seamen's Hospital. June 3 Chancre 1 Fireman Ditto. 5 Bubo 1 Seaman Ditto. 5 Gonorrhoea 1 Ditto Ditto. 7 Secondary Syphilis 1 Fireman To nearest hospital to dock. 8 Gonorrhoea 1 Seaman To Seamen's Hospital. 8 Syphilis 1 Boatswain Ditto. 12 Ditto 3 Seamen Ditto. 12 Gonorrhoea 3 Ditto Ditto. 12 Chancre 1 Seaman Ditto. 18 Ditto 1 Ditto To nearest hospital. 19 Syphilis 2 Chinese To Seamen's Hospital. 19 Gonorrhoea 1 Fireman Ditto. 23 Syphilis 1 Ditto To London Hospital. 23 Gonorrhoea 2 Firemen To Greenwich Hospital. (Leaflets issued.) 24 Gonorrhoea 1 Seaman To attend Connaught Boad Hospital. 26 Soft Chancre 8 Seamen Ditto. July 3 Syphilis 1. Seaman Ditto. 8 Gonorrhoea 1 Ditto Ditto. 8 Chancre and Bubo 1 Ditto Ditto. 12 Syphilis 2 Seamen Ditto. 16 Gonorrhoea 4 Ditto To attend Guy's Hospital. 23 Syphilis 2 Ditto To attend Seamen's Hospital. 26 Soft Chancre 1 Seaman Ditto. Aug. 2 Syphilis, Secondary Bash 1 Ditto Ditto. 3 Gonorrhoea 3 Seamen Ditto. 4 Ditto 1 Seaman Ditto. 4 Chancre 1 Fireman Ditto. 7 Gonorrhoea 2 Engineers Ditto. 9 Bubo 1 Fireman Ditto. 9 Syphilis 1 Lascar Ditto. 9 Ditto, Secondary 1 Seaman Ditto. 9 Chancre 1 Coal trimmer Ditto. 9 Soft Sore 1 Ditto Ditto. 17 Gonorrhoea 1 Fireman Ditto. 20 Syphilis 1 Ditto Ditto. 25 Gonorrhoea 1 Seaman Ditto. 28 Soft Chancre 1 Ditto Ditto. Oct. 3 Primary Syphilis 2 Seamen Ditto. 3 Gonorrhoea 2 Ditto Ditto. 3 Syphilis 1 Seaman Ditto. 13 Ditto 1 Ditto Ditto. 14 Soft Sores 6 Seamen To attend hospital at Liverpool. 14 Gonorrhoea 2 Ditto Ditto. Carried forward 155 33 Venereal Disease—continued. Date. 1919. Case. No. of Cases. Rating. Advice Given. Oct. 17 Brought forward Gonorrhoea and Rheumatism 155 Engineer To attend Seamen's Hos pitai. 26 Ditto 1 Cook Ditto. 28 Chancre 3 Seamen Ditto. 28 Gonorrhoea 1 Seaman Ditto. 28 Chancre and Bubo 1 Ditto Ditto. Nov. 2 Gonorrhoea 1 Seaman To Royal Infirmary, Edin burgh. 3 Ditto 3 Seamen To Seamen's Hospital. 7 Syphilis 1 Seaman Ditto. 11 Gonorrhoeal Orchitis 1 Ditto Ditto. 12 Soft Chancre 3 Seamen Treated on board. 17 Ditto 2 Ditto To Seamen's Hospital. 18 Venereal Bubo 1 Native Treated on board. 20 Syphilis 1 Fireman To attend a hospital. 29 Gonorrhoea 2 Firemen Ditto. 29 Syphilis 1 Seaman Ditto. 29 Gonorrhoea 1 Ditto Ditto. 30 Ditto 1 Ditto Ditto. Dec. 4 Syphilis 1 Ditto To Grav.esend Hospital. 5 Gonorrhoea 1 Fireman To Seamen's Hospital. 8 Venereal Bubo 1 Crew - Ditto. 8 Gonorrhoea 1 Ditto Ditto. 8 Syphilis 2 Ditto Ditto. 10 Venereal Bubo 1 Fireman To attend a hospital. 10 Soft Sore and Bubo 1 Ditto Ditto. 11 Gonorrhoea 1 Ditto- Ditto. 11 Chancre 1 Ditto Ditto. 15 Gonorrhoea 1 Seaman Ditto. 23 Syphilis 1 Ditto Ditto. 23 Venereal Bubo 1 Native Ditto. 23 Gonorrhoea - 2 Ditto Ditto. 29 Venereal Bubo 1 Ditto To Seamen's Hospital. 30 Syphilis 3 Crew - To Greenwich Hospital. 30 Gonorrhoea - 1 Ditto Ditto. Total 200 VENEREAL DISEASES. In January, your Medical Officer recommended that the contribution of the Port Sanitary Authority to the Venereal Diseases Clinic at the Royal Albert Dock Hospital be continued and increased to 400l, i.e., one-third of the estimated cost of the Centre, an increase bringing the net annual expenditure of the Port Sanitary Authority from 751, to 100?. TABLE XXIIL—BERI-BERI Date. 1919. Name of Vessel. Port of Registry and Official No. Where fiom. No. of Cases. How dealt with. Aug. 20 s.s. " Chakrata," of Glasgow, 133,109. Calcutta 1 Admitted to Seamen's Hospital, Greenwich. „ 23 s.s. " Knight Templar," of Liverpool, 120,900. Dalny 1 Ditto. Sept. 6 s.s. " Hellas " (Norwegian) Bangkok 1 Died on board. Nov. 22 s.s. " Altai Maru" (Japan) Kobe 1 Treated on board. Dec. 11 s.s. ' Ajax," of Liverpool, 113,395. Shanghai 1 Ditto. „ 28 s.s. " Clan Robertson," of Calcutta 1 Ditto. Glasgow, 108,684. Total 6 34 TABLE XXIV.—Miscellaneous Diseases, &c., 1919. Disease. No. of Cases. Disease. No. of Cases. Appendicitis 1 Brought forward 31 Abdominal trouble 2 Bright's disease 1 Mastitis 1 Bronchitis 2 Malarial cachexia 1 Cancer 1 Nephritis 1 Cirrhosis of liver 1 Ptomaine poisoning 1 Chill 1 Pleurisy Congestion of lungs 2 Pleural effusion 1 Diarrhoea 1 Poisoning 1 Dog bite 1 Peritonitis 1 Debility 1 Bheumatism 1 Gastric ulcer 1 Sprue 1 Fever 2 Sea sickness 1 Heart disease 4 Sciatica 1 Heat stroke 5 Senile decay 1 Internal injury 1 Suicide 1 Intestinal catarrh 2 Tonsillitis 2 Jaundice 2 Carried forward 31 Total 49 TABLE XXV. Vessels and Premises Disinfected, from 1st January to 31st December, 1919. Month. Reason for Disinfection. Total number of Disinfections. Cerebro-spinal Meningitis. Chicken-pox. Cholera. Continued Fever. Diphtheria. Enteric Fever. Erysipelas. Malaria. Measles. Influenza. Plague. Remittent Fever. Scarlet Fever, Small-pox. Pulmonary Tuberculosis, &c. Precautionary Measure. Vessels Fumigated and Sprayed. January ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 3 February ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... ... 1 5 March 1 ... ... ... 2 ... ... ... 1 1 ... ... ... 1 ... ... 1 7 April ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... 4 May ... 4 ... ... ... 1 ... ... 1 ... ... ... ... 2 3 ... 3 14 June ... ... ... ... ... 1 ... 1 ... 9 ... ... 1 2 3 ... 8 18 July 1 ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... 3 6 August ... 1 ... ... ... 3 ... ... ... ... 1 ... ... ... ... ... 7 12 September ... 1 ... ... 2 4 ... ... ... ... ... ... ... ... 2 ... 7 16 October ... 1 ... ... ... 2 ... ... 2 2 1 ... ... ... 3 ... 8 19 November ... 2 ... ... ... 2 ... ... 2 ... ... ... ... ... 3 ... 4 13 December 1 ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 ... 1 6 Totals 3 10 1 ... 0 19 ... 1 6 8 0 ... 1 6 16 ... 44 123 TABLE XXVI. Number of Disinfections of Effects, Bedding, &c., from 1st January to 31st December, 1919. Month. Reason for Disinfection. Hospital Bedding, kc. Total Effects. Number of times S<eam Disinfector was userl. Disinfected by Fumigation. Cholera. Chickenpox. Cerebrospinal Meningitis. Continued Fever. Diphtheria. Enteric Fever. Malaria. Measles. Pulmonary Tuberculosis, &c. Plague. | Influenza. Scarlet Fever. Smallpox Precautionary ' Measure. January 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 3 2 ... February ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... March ... ... ... ... 2 ... ... 1 ... ... ... ... 1 ... ... 4 3 1 April ... 1 ... ... ... 1 ... ... ... . . . ... ... 2 ... 1 5 2 1 May ... 1 ... ... ... 1 ... 1 1 ... ... ... 3 ... 2 9 3 3 June ... ... ... ... ... 1 ... ... ... ... ... 1 2 ... 2 7 6 ... July ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 5 1 1 August ... ... ... ... ... 3 ... ... ... 1 ... ... ... ... ... 4 2 ... September ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 4 7 ... October ... 1 ... ... ... 3 ... 1 ... 1 ... ... ... ... 1 7 5 1 November ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 8 ... December ... ... 1 ... 1 2 ... ... ... ... ... ... 1 ... ... 5 5 ... Totals 1 3 1 ... 4 15 3 ... 1 3 ... 1 9 11 55 44 7 35 Annexed is a resume of the Local Government Board Begulations showing the New Duties and Powers of the Port Sanitary Authorities to whom, amongst various Local Authorities, the General Order is addressed :— I.—The Regulations are dated 7th January, 1919, and come into force on 1st March. II. (3).—The provisions apply to every ship, vessel, or boat as nearly as may be as if it were a building, have effect throughout England and Wales, and shall be enforced and executed by every Local Authority. II. (1) (a).—A Port Sanitary Authority is a Local Authority by definition. IV.—Notice of duties imposed on them is to be given to all Medical Practitioners resident or practising within the district of the Port Sanitary Authority. The Public Health (Pneumonia, Malaria, Dysentery, &c.) Regulations, 1919, came into force on the 1st March, and the following letter was sent to shipowners known to trade with London:— Gentlemen, NOTIFICATION OF INFECTIOUS DISEASE. MALARIA, DYSENTEBY, TBENCH FEVER, ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. These diseases have been made notifiable by the Public Health Regulations, 1919, in addition to the diseases already scheduled as list attached. May I ask your cooperation with the Port of London Sanitary Authority in the matter as follows:— Wherever a Medical Practitioner generally acts on your behalf on shipboard within the jurisdiction of the Port Sanitary Authority, or is engaged as Medical Officer on your vessels, I would ask that his duty under the above Regulations of notifying the diseases mentioned to this office, be brought specifically to his notice by you. Your obedient Servant, W. M. WILLOUGHBY, Medical Officer of Health, Port of London. List of scheduled diseases for attachment Smallpox. Relapsing Fever. Diphtheria. Continued Fever. Membranous Croup. Measles and German Measles. Scarlatina or Scarlet Fever. Cerebrospinal Fever. Typhus Fever. Acute Poliomyelitis. Typhoid Fever. Ophthalmia Neonatorum. Enteric Fever. Tuberculosis. 36 V.—Cases of Malaria, Dysentery (Amoebic and Bacillary), Pneumonia (Primary and Influenzal), and Trench Fever are to be notified to the Medical Officer of Health by the Medical Practitioners in due form. VI.—Misdirected notifications received by the Medical Officer of Health are to be forwarded to the Medical Officer of Health to whom they are proper. VII.—On receipt of notification, or on becoming aware of a case, the Medical Officer of Health shall investigate the source of infection and take steps for preventing spread and for removing conditions favourable to infection, and if a Medical Practitioner is not in attendance the Medical Officer of Health shall investigate the nature of the case. VIII.—Trench Fever cases. Malaria (Indigenous cases) and Dysentery outbreak are to be immediately notified, with names and addresses of patient, to the Local Government Board and to the County Medical Officer of Health. IX.—Treatment of these diseases is to be secured by the Medical Officer of Health in a suitable hospital, unless treatment elsewhere is satisfactorily preventive of spread. X.—Malaria.—If the Medical Officer of Health considers such action necessary he shall take all practicable steps to ensure that every (1) case is supplied with mosquito netting, (2) treatment with quinine, (3) receives instructions as to prevention of relapse and spread. XI.—Two or more cases occurring in and contracted within a district may necessitate the appointment of a medical man for the purpose of (1) a systematic search for cases in suspected houses, (2) suitable treatment and handling of the cases and destruction of mosquitos. These measures implying collection of material for miscroscopic examination. XII. XV.—Dysentery and Enteric Fever.—A Medical Officer of Health may by written notice require that a patient or a " carrier " of these diseases discontinue any occupation connected with the preparation or handling of foods, and may specify measures which shall be taken as to cleansing, disinfection, disposal of excreta, destruction of flies, and prevention of food contamination. XII.—He may* by written notice require clinical examination of a suspected " carrier " ; if such examination prove positive he may require that the '' carrier '' shall no longer be employed in preparation or handling of foods. XIV.—Trench Fever.—In cases of Trench Fever a Medical Officer of Health may by notice require destruction of lice throughout any building, and temporary segregation of inmates or contacts for a period until their persons and clothing have been freed from lice. XVI.—The same regulation applies to Typhus and Relapsing Fevers. VII.—In these diseases the Medical Officer of Health shall notify the Local Government Board and County Medical Officer of Health of the names and addresses of persons affected. XVII.—Expenses incurred by the Medical Officer of Health shall be defrayed by the Local Authority. XVIII.—Institutions are exempt from these regulations except by consent of the Managers. XIX.—Persons suffering from Malaria or Dysentery or Trench Fever who are on board ship may, on certification by the Medical Officer of Health, be removed to hospital in the absence of effective isolation against spread of the disease. The Local Authority may provide medical assistance or hospital accommodation in these diseases. Where a suitable hospital or place of reception is provided within the District of a Local Authority, cases may be removed to such hospital or place on certificate of the Medical Officer of Health, and with consent of the superintending body of such hospital or place, at the cost of the Local Authority. The scope for effective work of the Port Sanitary Authority is considerably enlarged by the above regulations. Your Medical Officer anticipates that the hospital at Denton will be more continuously in use, and that this will be a factor tending to stability in that institution. Work throughout the staff of the Authority will be increased to some extent in every department, but more especially among the Medical Officers. The staff at present authorised will, as far as can be foreseen, suffice. In the presence of an epidemic of Influenzal Pneumonia, however, the accommodation at Denton Hospital will obviously not suffice for the Port Sanitary District. Some details of hospital equipment for microscopical diagnosis and for treatment will be necessitated. During the War the treatment of severe cases of Malaria has already been undertaken in Denton Hospital It is advisable that the third launch should be brought into commission as soon as possible for this purpose; a deck hand and engineer are required to fill the places of men who have fallen in the War Your Medical Officer recommends that these hands be obtained. INSPECTION OF VESSELS AT SOUTHEND. As a matter of convenience to shipping, several vessels awaiting clearance at Southend, owing to no berths being available either in the docks or in the river, were visited by your Medical Officers there. This breach of the routine is deprecated as being inconvenient and unsafe; arising out of a merely temporary phase in shipping movements, it was not expected that the procedure would be necessary either in many cases or over a long period. 37 Under the Cholera, Yellow Fever and Plague Regulations it is for His Majesty's Customs to appoint a place of examination for ships from infected coastlines, and for the Port Sanitary Authority in conjunction with His Majesty's Customs, a place where ships found, on Medical examination, to be infected may be dealt with. It is of importance in administration that these should coincide, and should be at the point which the evolution of the details of examination in past years has indicated as suitable, having regard to the convenience of all parties concerned in quarantine measures. The point has now been fixed as the " Gravesend Reach, from the Lobster Roads to Shorne Mead Beacon." '22nd December, 1919. The Inspector-General of Waterguard, H.M. Customs, Custom House, Lower Thames Street, E.G. 3. Dear Sir, In accordance with our telephonic conversation of this morning, I enclose a list of the coast lines of which the ports are " infected " for the purposes of the Cholera, Yellow Fever and Plague Regulations, 1907, as regards the work of the Port Sanitary Authority. I should like to take this opportunity of fixing, in agreement with you, a place of mooring in conformity with Part III. Art. VI. of the Regulations, and also to suggest, if I may, that the reach from the Lobster Roads to the Shorne Mead Beacon Light being agreed upon under Art. VI. might also be a place selected by you under Art. II. 2, Part II., as being convenient to this Authority for rapid examination and administration efficiency. Since in the current year no less than three ships have been found by the Port Sanitary Authority to be in fact " infected " -(two) or " suspected " (one) of Plague, I view with considerable anxiety the practice which—originating during the War is continuing and growing under post-war conditions—of the landing of uninspected passengers or crews from ships out of infected ports at Southend. Thanking you for your kind communication on the subject, I am, Dear Sir, Your obedient Servant, (Signed) W. M. WILLOUGHBY, Medical Officer of Health, Port of London. Custom House, London, E.C. 24th December, 1919. Dear Sir, I beg to acknowledge the receipt of your letter of the 2'2nd instant, addressed to the Inspector-General of the Waterguard, enclosing a list of the coast lines of which the ports are infected " for the purposes of the Cholera, Yellow Fever and Plague Regulations, 1907, and I shall be glad if you will advise me of any further corrections. I agree that the place of mooring in conformity with Part III. Art. VI. of the Regulations shall be Gravesend Reach from the Lobster Roads to Shorne Mead Beacon Light, and also that the same place shall be selected by the Customs Officers under Art. II. 2, Part II.,as being convenient to all parties for rapid examination and administrative efficiency. I am sending a copy of this correspondence to the Chief Preventive Officer at Gravesend for his information and guidance. Yours faithfully, (Signed) J. A. HAWKINS, Waterguard Superintendent. The Medical Officer, Port of London Sanitary Authority. 38 TABLE XXVII.—Return of Rats caught and destroyed during 1919. The entire cost of destroying these rats has been borne by the Shipowners and Port of London Authority. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. Millwall Dock— Warehouses 130 170 145 289 564 363 290 276 263 298 356 214 3,358 Vessels during voyage — 60 — 159 119 — 12 — — 30 — — 380 „ while in dock 205 168 20 92 206 99 123 101 88 202 199 257 1,760 Surrey Commercial Dk. Warehouses 102 125 86 115 335 121 102 100 95 93 336 108 1,718 Vessels during voyage ,, while in dock 70 98 105 11 107 — 68 — — — 13 — 472 Regent's Canal Dock— Warehouses - - - - - - - - - - - - - Vessels during voyage - - - - - - - - - - - - - „ while in dock - - - - - - - - - - - - - St. Katlierine's Dock— Warehouses 31 76 86 69 129 88 91 120 110 115 114 78 1,107 Vessels during voyage - - - - - - - - - - - - - ,, while in dock - - - - - - 9 - - - - - 2 London Dock— Warehouses 147 275 254 279 252 207 270 229 245 278 302 172 2,910 Vessels during voyage - — — — - — - o J o „ while in dock - — — — 596 68 181 28 67 20 115 40 1,115 Albert and VictoriaDks.— Warehouses 304 386 337 352 674 511 528 600 587 507 725 430 5,941 Vessels during voyage 27 251 94 — — 212 — 17 245 375 1.483 42 2,746 ,, while in dock - 639 445 631 995 1,159 778 1,544 2,974 2,635 2,287 4,525 2,036 20,651 West India Dock- Warehouses 94 198 254 163 179 143 140 231 196 206 334 182 2,320 Vessels during voyage - 29 — 24 72 80 75 30 145 25 70 332 882 „ while in dock - 265 303 395 357 485 417 1,324 347 302 510 480 358 5,543 East India Dock— 1 W arehouses 40 29 27 3 37 18 16 23 29 65 67 51 405 Vessels during voyage „ while in dock - 93 54 52 16 100 107 357 148 89 99 264 164 1,543 Tilbury Dock— W arehouses 187 212 325 325 451 402 369 414 328 334 571 347 4.265 Vessels during voyage — - 197 — — 527 — — — — 68 1,014 1,806 „ while in dock - 276 264 376 76 658 513 477 422 117 413 480 628 4,700 River— During voyage - - - - - - - - - - - - — While in river - - - - - - - - - - - - - Totals - 2,610 3,143 3,387 3,325 6,123 4,654 5,969 6,060 5,541 5,857 10,502 6,453 63,624 Total from February, 1901, to 31st December, 1918 1,012,605 Total from 1st January to 31st December, 1919:— In Dock Warehouses 22,024 On Vessels during voyage 5,814 On Vessels while in Dock and River 35,786 Total 1,076,229 39 TABLE XXVIII. Return of Rats Foxjnd Dead or Trapped. Dock. Total. Found dead. Trapped. Royal Victoria Dock 1,067 2 1,065 Royal Albert Dock 1,577 6 1,571 St. Katherine's Dock — — — London Docks — — — Millwall Dock 287 2 285 East India Dock 22 - 22 West India Dock 34 — 34 Surrey Commercial Dock 3 — 3 Tilbury Dock 266 — 266 Unknown (Dock) 31 1 30 3,287 11 3,276 Found dead 11 Trapped 8,276 Total 3,287 Analysis of Non-Infected Rats. Dock. Found dead. Trapped. Classification of Species.* M.D. M.R. M.A. M.M. Royal Victoria Dock 2 1,064 824 218 - Royal Albert Dock 6 1,574 1,426 117 32 2 St. Katherine's Dock — — — — — — London Dock. — — — — — — Millwall Dock 2 285 234 37 16 — East India Dock — 22 17 5 — — West India Dock — 34 22 8 4 — Surrey Commercial Dock — 3 3 — — — Tilbury Dock — 266 136 80 36 14 Unknown (Dock) 1 30 28 — 3 — 11 3,275 2,690 465 115 16 Analysis of Infected Rats. Dock. Found dead. Trapped. Classification of Species. * M.D. M.R. M.A. M.m. Royal Victoria Dock — 1 1 - - - Royal Albert Dock - - - - - - St. Katherine's Dock - - - - - - London Dock - - - - - - Millwall Dock - - - - - - East India Dock - - - - - - West India Dock - - - - - - Surrey Commercial Dock - - - - - - Tilbury Dock - - - - - - Unknown (Dock) - - - - - - — 1 1 - - - Return of Rats Examined, 1919. Dock. No, Classification of Species.* M.D. M.R. M.A. m.m. Royal Victoria Dock 1,067 825 218 24 - Royal Albert Dock 1,577 1,426 117 32 2 St. Katherine's Dock - - - - - London Dock - - - - - Millwall Dock 287 234 37 16 — East India Dock 22 17 5 — West India Dock 34 22 8 4 Surrey Commercial Dock 3 3 — — Tilbury Dock 266 136 80 36 14 Unknown (Dock) 31 28 — 3 — 3,287 2,691 465 115 16 * Table of Classification. M.D. Mus decumanus (norvegicus) 2,691 M.R. Mus rattus 465 M.A. Mus alexandrinus 115 M.M. Mus musculus 16 Total 3,287 Analysis of Rats Found Dead. Dock. Found dead. Classification of Species. m.d. m.k. m.a. m.m. Royal Victoria Dock 2 1 1 - - Royal Albert Dock 6 4 1 1 - St. Katherine's Dock - - - - - London Dock - - - - - Millwall Dock 2 2 - - - East India Dock - - - - - West India Dock — — - - - Surrey Commercial Dock - - - - - Tilbury Dock — — - - - Unknown (Dock) 1 1 - - - 11 8 2 1 M.D. 8 M.R. 2 M.A. 1 M.M. — Total 11 Analysis of Rats Trapped. Dock. Trapped. Classification of Species. m.d. m.r. m.a. m.m. Royal Victoria Dock 1,065 824 217 24 - Royal Albert Dock 1,571 1,422 116 31 2 St. Katherine's Dock - - - - - London Dock - - - - - Millwall Dock 285 232 37 16 — East India Dock 22 17 5 — — West India Dock 34 22 8 4 — Surrey Commercial Dock 3 3 — — — Tilbury Dock 266 136 80 36 14 Unknown (Dock) 30 27 — 3 — 3,276 2,683 463 114 16 M.D 2,683 M.B 463 M.A. 114 M.M. 16 Total 3,276 40 (Signed) H. B. NEWHAM. TABLE XXIX; ANALYSIS OF ACCOMPANYING TABLES. RETURN OF 11ATS EXAMINED DURING YEAR ENDED 31ST DECEMBER, 1919. DOCK. Number fiom each Dock. Found Dead. Trapped. Found Dead. Trapped. In fee led. NonInfected. Infected. Non-Infected. Infected. Non-Inf ected M.D M.R. M.A M.M. M.D. M.R. M.A. M.M. M.D. M.K. M.A. M.M. M.D, M.R. M.A. M.M. Found Dead. Trapped. Found Dead. T rapped. Royal Vicloria Dock 1,067 2 1,065 1 1 ... 824 217 24 ... 1 1,066 1 ... ... ... 824 218 24 ... ... l 2 1,064 Royal Albert Dock 1,577 6 1,571 4 1 1 1.422 116 31 2 ... 1,577 ... ... ... ... 1,426 117 32 2 ... ... 6 1,571 St. Katherine's Dock ... ... ... ... ... ... ... ... ... ... • ... ... ... ... ... ... ... ... ... ... ... ... ... London Dock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... • • • ... ... ... ... ... Millwall Dock 287 2 285 2 ... ... 232 37 16 ... ... 287 ... ... ... ... 234 37 16 ... ... ... 2 285 East India Dock 22 ... 22 ... ... ... 17 5 ... ... ... 22 ... ... ... ... 17 5 ... ... ... ... ... 22 West India Dock 34 ... 34 ... ... ... 22 8 4 ... ... 34 ... ... ... ... 22 8 4 ... ... ... ... 34 Surrey Commercial Dock 3 ... 3 ... ... ... 3 ... ... ... ... 3 ... ... ... ... 3 ... ... ... ... ... 3 Tilbury Dock 266 ... 266 ... ... 136 80 36 14 ... 266 ... ... ... ... 136 80 36 14 ... ... ... 266 Unknown (dock) 31 1 30 1 ... ... 27 ... 3 ... ... 31 ... ... ... ... 28 ... 3 ... ... 1 30 3,287 11 3,276 8 2 1 2,683 463 114 16 1 3,286 1 ... ... ... 2,690 465 115 16 ... l 11 3,275 3,287 3,287 3,287 3,287 3,287 42 MINISTRY OF FOOD RAT ORDER, 1918. In accordance with a request made by your Worshipful Committee to the Ministry of Food, an Order amending the Rats Order, 1918, and dated 26th March, 1919, was made by the Food Controller under the Defence of the Realm Regulations. By this amendment the expression " Local Authority " was altered to include Port Sanitary Authorities, as follows :— For the purpose of this Order, the expression " Local Authority " shall mean :— (a) As regards England and Wales, the County Council, the Mayor, Aldermen and Commons of the City of London in Common Council assembled, the Council of a County Borough, or the Port Sanitary Authority of a Port Sanitary District. (b) As regards Scotland, a County Council, Town Council, or the Port Local Authority of a Port Local Authority District, The expressions " Port Sanitary District " and " Port Local Authority District " shall mean any port or part of a port for which a Port Sanitary Authority or a Port Local Authority has been constituted under the Public Health Acts including the Public Health (London) Act, 1891, and any such Port Sanitary District or Port Local AuthorityDistrict shall form no part of any Administrative County, County Borough or Burgh. The City of London shall form no part of any Administrative County. The provisions of this Order shall apply to every vessel lying in any water within any Port Sanitary District or Port Local Authority District in like manner, as nearly as may be, as if it were a building. Formerly the expression " Local Authority " meant as regards England and Wales, a County Council or the Council of a County Borough; and, as regards Scotland, a County Council or a Town Council, and mention was not made of Port Sanitary Authorities or ships. The matter of the Rat Orders was brought forward by your Medical Officer at a meeting of the Associated Port Sanitary Authorities on the 28th June. The following letter and enquiry were sent to all Port Medical Officers in England :—• 2nd July, 1919. Dear Sir, DEFENCE OF THE BEALM. MINISTRY OF FOOD RAT ORDER, 1918. Order Amending the Rat Order, 1918, Dated 26th March, 1919. At a meeting of the Association of Port Sanitary Authorities held on Friday, 28th June, 1919, the subject of utilisation on shipboard of the Amended Rat Order (March, 1919) of the Ministry of Food, by Port Sanitary Authorities as Local Authorities under the Order, was discussed. Under the Order the disinfestation of rat-ridden ships is the duty of the owners and masters and is carried out at their expense. The powers of the Port Sanitary Authorities are those of examination as to rattiness, ordering of disinfestation, supervision of disinfestation and, in contingency, execution of the work, the expense in this being recoverable. It seemed good to a committee constituted by the Port Medical Officers of Health then present, that the views of Port Medical Officers should be obtained on several points in order that action might have that uniformity which is desirable in the interests of Sanitary Authorities, Port Authorities and Shipping. Deputed by this committee I beg to lay before you the enclosed enquiry for your kind consideration and answers. Yours faithfully, (Signed) W. M. WILLOUGHBY, Medical Officer of Health, Port of London. ENQUIRY. Principles I.—Does the Order convey useful powers over and above those of any other Order hitherto issued for the purpose of ship disinfestation? II.—Should the powers and facilities of this Ministry of Food Order be rendered permanent in some form as a Public Health measure of sanitation rather than of food preservation? Practice :— III.—Are trapping and poisoning satisfactory methods of disinfestation of ships? Can these be considered as more than palliative measures? IV.—Is fumigation of a ship when empty of cargo the most satisfactory method of disinfestation? 43 V.—Is Sulphur Dioxide the most suitable gas to use in fumigation? VI.—Is 1 lb. of sulphur burned in each 1,000 cubic feet sufficient for disinfestation? VII.—Is a four-hour closure of spaces under S02, as a minimum, sufficient for disinfestation? VIII.—Given an atmosphere of S02 from 1.5 to 3 per cent, in a hold, has the method of production, whether by machine or burning-pot, or candle, or from condensing bottle, any special significance with regard to rat destruction? Inspection :— IX.—What methods of inspection and what indications should guide in the conclusion that a ship needs disinfestation? X.—Is it desirable that, with a view to securing to the shipowner the most convenient moment for disinfestation, information as to the necessity for disinfestation be a matter of intercommunication between Medical Officers of Health? The following report was made to the Association :— 9th October, 1919. RAT ENQUIRY. I have pleasure in reporting on the Enquiry made at the request of Medical Officers of the Association, as follows :— Sixty-three lists of questions were sent out. Answers were received from 23 Medical Officers including those of all the larger ports in England. The questions were mostly leading questions and could be directly answered in few words, but the comments kindly made are of large interest. I have to regret that the Scottish ports were not circularised. (1) There is agreement that the powers conferred under the Food Orders are useful in dealing with rats on ships. (2) And that permanency should be given in some way to such Orders as a measure of Public Health. (3) There is also complete agreement that trapping and poisoning of rats is only auxiliary to fumigation as the proper method of disinfestation of ships. A proper supervision of the fumigation is emphasised in some of the answers. (4) Those who from experience could answer Question 4, were unanimous that the most satisfactory time for disinfestation was immediately on complete discharge of cargo. (5) Sulphur dioxide gas is in evident favour as a fumigant in all the ports; in the words of the Medical Officer of Health for Liverpool: " It is economical, free from risk to human life and efficient when used in proper quantity." I myself have always felt unable to accept the heavy responsibility for danger to life accruing in the use of any very lethal gas or one which does not announce its presence to the unwary; in practice, many people are about during the fumigation of a ship. (6) Opinion was divided on the question of the efficacy of 1 lb. of sulphur burned in 1,000 cubic feet. The more general practice is the burning of 2 lbs. to 3 lbs. of sulphur per 1,000 cubic feet. Some Medical Officers are satisfied with the 1 lb. (7) As with the amount of sulphur burned, so with the time of action to be allowed, opinion was divided and the general practice is a longer exposure—six, eight or more hours. Some answers, though agreeing, emphasised the minimal nature of the four hours suggested in the question. i'8) Answers as to the methods of production of the sulphur dioxide atmosphere show that however produced the 1.5 to 3 per cent, atmosphere of sulphur dioxide is efficient, and that the method of production is immaterial. Some suggestive remarks made in the answers to Question 8 are the following (0) " The question is one of rapid development; the quicker a space is filled with gas the more efficiently the work is done." This would imply for sulphur pots and candles and for condensing bottles as wide a distribution of fumigating units over the space to be fumigated as is possible. (b) . . the disinfestation must be immediately commenced after the cargo has been got out on account of the rats transferring their quarters . . ." This implies that food stores, pantries, living quarters, chain lockers and peaks should be under fumigation simultaneously with the holds, and urges the necessity of immediate disinfestation. I would add a suggestion of the proven utility of a deck search—boats, steampipecasings, winch barrels, &c.—while the ship is under fumigation. (c) " Burning pot or candle quite satisfactory." (d) " Condensing bottle found quite effective." (e) Up to the 3 per cent, concentration we employ, the method of production is immaterial." (/) " Condensing bottle best." (g) " The methods used are burning candles, 21 lbs. to 1,000 feet, and Boake. Boberts & Co.'s " Sulphume " cylinders, which are simple, reliable and efficacious." One ounce of liquid is evaporated in 50 cubic feet. This is stated to produce 1.55 per cent. gas. (h) The machine is most efficient." (1) The burning pot is quite satisfactory, and can be left alone to do the work." 44 In London both the Clayton apparatus and sulphur candles are used. The Clayton apparatus cannot be in six places at once; and has of late been '' snowed under in the utilisation of the new powers. 1 lb. in 1,000 cubic feet as a minimum burned in candle form is found effective; the custom is to burn more. Two replies mention that sulphur in larger quantities burns incompletely and only slowly. I would suggest that, with a diffuse distribution of the candles or pots over the decks of a large hold, any atmosphere which prevents rapid burning is lethal to rats; and on the other hand, that if the candles or pots be massed, an atmosphere approaching that of a flame extinguishing gas (11 per cent.) can be locally produced in low-lying regions, owing to the sinking en masse of the concentrated S02 before diffusion takes place. Massing of candles, especially in the deeper parts of the ship, is therefore to be avoided as delaying rapid diffusion and tending to delay complete and rapid burning. The following data are useful:— 1 lb. sulphur gives 11.8 cubic feet of gas. 1 lb. sulphur gives 1.18 per cent, atmosphere of sulphur dioxide in 1,000 cubic feet. per cent, atmosphere kills a rat with great rapidity. Water absorbs 50 volumes of SO2 Considerable condensation and absorption takes place on and into all surfaces. On fumigation, bilges should be dry. I have ventured to interpolate a few remarks because in many cases our colleagues have avowed a want of practical experience, or have asked for a definite lead in the matters which are before us. The practical hints given by the larger ports in answer to question suggested to me the expansion of these hints accordingly. The following indications for disinfestation or methods of inspection are mentioned :— Rats found dead on open hatches. Evidence of rat depredations in food stores. Observations of the crew and the amount of " droppings " left about. That the vessel has come from an infected port. That no recent disinfestation has been done. The presence of rats as decided by enquiries. Enquiries from Master. Inspection of rat excrement. All grain ships. All ships from infected ports. Evidence of Master and crew. Store rooms, galleys and baker's shops should guide the inspection. Enquiries of crew. Inspection of bilges, limbers and ceilings of holds, fore and aft peaks, store rooms, lazarettes, &c. Presence of rats, especially dead rats, injury to foodstuffs, and lastly the following complete Plague programme:— (a) The fact that a vessel trades with a Plague infected port and is rat infested. (b) The history of the vessel, Plague rats discovered at sea, an examination of the ship's records. (c) Examination by Medical Officer when boarding, statements by Master might reveal indications of Plague infested rats or unusual sickness. (d) Presence of rat Plague or unusual mortality. 9. Methods of inspection :— Specially trained rat searchers and catchers duly appointed for the purpose will examine for indications of rats. The course pursued in London at present is that (1) Every ship found on inspection or enquiry to be ratty, (2) Every ship trading to the East which has not within six months been satisfactorily disinfested by fumigations. is fumigated immediately on discharge of cargo and in every part simultaneously. Qualified inspectors decide as to rattiness and rat mortalities and enquiries are made of the personnel. 10. There is entire agreement on the desirability of intercommunication between Medical Officers. The case has been succinctly put as follows:—The most convenient time (for fumiga" tion) .will be when the holds are empty, and therefore vessels carrying part cargo may require " reference from one Port Medical Officer to another. It would be a great advantage if definite " arrangements were made on these matters between Port Medical Officers; already this is " undertaken voluntarily to a large extent." I have endeavoured to make the extraction of the answers sent as complete as possible; a matter of ease since the unanimity of expression has been very large. W. M. WILLOUGHBY. It has been found difficult to insist that every ship trading with the East, which has not within six months been satisfactorily disinfested by fumigation, shall be fumigated on discharge of cargo in the Port, It has been, however,"found advisable that closer enquiry and inspection should be made by your Sanitary Inspectors, and action taken according to the state of the ship as regards rattiness. 45 The following letter was received from the Tilbury Urban District Council:— 20th November, 1919. Dead Sir, It has been reported to my Council that considerable damage is being caused by rats in the Town, and especially in the Docks, and a report has been presented, a copy of which I enclose, upon the various methods employed for exterminating these pests. My Council resolved that the scheme on the lines of the Liverpool scheme should be adopted in the Tilbury Urban District, and, having regard to the large numbers of rats in the Docks, the great damage caused by them, and the necessity if the scheme is to be a success, for all the Authorities to combine, I was directed to write asking if your Authority would co-operate with my Council by establishing in those portions of the Docks within your jurisdiction a permanent scheme on the lines proposed. Yours faithfully, (Signed) A. W. BUCKNER, Clerk. The Port of London Sanitary Authority, 44, King William Street, Greenwich, S.E. 10. to which your Medical Officer replied as follows :—• 2.4th November, 1919. The Clerk, Tilbury Urban District Council, Council Offices, Tilbury. Dear Sir, I have received your letter reports, and will lay it before the Port Sanitary Committee at the next meeting. Meanwhile may I point to the permanent scheme for many years past in force in the Tilbury and all other Docks under the jurisdiction of this Authority—a scheme summed up in the provisions for :—■ (1) Rat destruction on shipboard. (2) Rat destruction in the Dock, and, lastly, the most important and only permanent measure—- (3) Rat proofing of food stores and prompt removal of edible rubbish. This scheme will continue in the future in any circumstances; but very gladly in co-operation with the similar work lately undertaken by the Tilbury Urban District Council. Your obedient Servant, W. M. WILLOUGHBY, Medical Officer of Health, Port of London. TABLE XXX.—Hospital. Remaining in Hospital on 31st December, 1919 6 Total number of days treatment during the year 2,398 Average number of days treatment for each case 25.78 Average daily number of patients in Hospital 3.92 Average daily cost of maintenance per patient 1s. 10.05d Average total cost of maintenance per patient 21. 7 s. 4½d. Number of Casks Admitted, Cost of Maintenance, &c. Patients remaining' in Hospital on 31st December, 1918 Admitted. Discharged, Died. Remaining under treatment. Cholera 0 0 0 0 Cholera (suspected) 1 1 0 0 Plague 7 4 3 0 Plague (suspected) 3 3 0 0 Small-pox 13 11 0 2 Scarlet Fever 1 3 0 0 Enteric Fever 42 36 2 4 Continued Fever 0 0 0 0 Diphtheria 1 1 0 0 Measles 0 0 0 0 Erysipelas 0 0 0 0 Chicken-pox 11 11 0 0 Cerebro-spinal Fever 0 0 0 0 Other Diseases 11 12 0 0 Totals 90 82 5 6 46 TABLE XXXI. Quantity and Description of Unsound Food Seized and Destoyed foe the Year knding 31st December, 1919. Original packages. Sundry quantities by weight. Loose Articles. Approximate Total weight of Goods destroyed. MEAT— No. Description. Tons. cwts. qrs. lbs. No. Description. Tons. cwts. qrs. lbs. Fresh and Frozen— Beef 179 1 quarters 2 5 3 1 923 f pieces } 52 14 2 2 t & crops ) & bags J Mutton and Lamb 818 carcases 0 11 0 12 543 pieoee 28 4 2 15 Veal, Pork and Offal 1,832 various 0 2 0 14 244 pieces,&c. 54 5 3 0 Sausages 5,084 cases . . . ... ... 216 2 2 9 Preserved— Tinned 1,798 cases ... . # _ 1,773 tins 27 18 1 13 Smoked and Salted 9 boxes "o 0 2 0 ... ... 2 14 1 26 Sundry 156 bags, &c. ... ... ... ... ... 293 12 1 26 RABBITS— Frozen 3,097 crates ... 77 1 1 10 Tinned 100 cases ... ... ... 118 tins 3 12 2 0 POULTRY and GAME— Frozen 6 packages ... ... ... ... ... ... 0 4 3 25 FfSH— Preserved, Dried . . . 0 0 2 15 ... ... 0 0 2 15 ,, Tinned and Bottled Shell 230 eases ... ... ... ... 313 tins K O 1 2 15 Wet " 7 casks ... ... ... ... 0 10 2 "o FRUIT— Fresh 729 crates,&c. ] 15 1 8 76 pkgs.,&c. 35 12 9 12 Preserved, Dried 11,050 boxes, <Sc. 3 9 0 18 191 bskts.,&c. 172 13 I 14 „ Tinned and Bottled 4,397 tins & cases ... . . . . . . . . . ... 19 17 2 15 ,, Jam and Marmalade ... ... ... ... ... 167 tins 0 5 2 9 VEGETABLES— Fresh 147 bags . . . •.. ... 7 10 0 0 Preserved, Dried 24 bags ... ... ... ... ... . . . 2 1 0 12 „ Pickled 552 barrels ... ... ... ... ... 100 0 0 0 NUTS— Whole ... ... ... ... ... ... ... ... "A "o ... Desiccated and Shelled ... ... 0 2 3 0 ... ... 0 2 o 0 PROVISIONS— Tea ... ... ... . . . . . . ... ... ... ... ... Coffee ... ... ... ... ... . . . ... ... ... Cocoa ... .. • ... ... ... . . . ... ... ... ... Butter, Cheese, Lard, Margarine 11 tubs ... ... ... . . . 0 3 3 12 Condensed Milk 2,068 cases, &c. ... ... 138 tins 49 2 3 20 Prepared Foods ... 439 9 1 8 . . . 439 9 1 8 Biscuits and Confectionery ... ... • . . . . . ... ... Sugar ... ... ... ... ... » • . ... GRAIN— Wheat, Maize, Barley, Rice, &c. ... 1217 19 3 15 ... 1,217 19 3 15 MEAL and FLOUR ... ... ... . . . ... ... CONDIMENTS and SPICES " 1 case • . • . . . . . . 0 0 3 12 EGGS • . • ... ... ... . . . ... ... ... ... ... EGG YOLK ... ... ... ... ... ... ... ... SUNDRIES 234 bags ... ... ... 22 10 3 14 Total 32,529 various 1665 13 2 7 4,516 various 2,829 15 0 19 Approximate Total weight of Goods destroyed during the year 1910 2,483 6 2 13 19U 1,408 4 3 1 1912 3,758 7 1 2 1913 2,458 0 2 21 1914 1,184 11 1 1 1915 3,118 5 3 19 ?J ?? 1916 5,664 9 2 5 1917 4,847 8 1 5 1918 1,200 7 0 11 1919 2,829 15 0 19 Average for 9 years, 1910 to 1918 :—2,902 tons 11 cwts. 1 qr. i bs. 47 TABLE XXXIT. Description of Meat Destroyed. Year. Beef. Mutton. Veal, Pork, Offal. Tinned. Smoked and Salted, &c. Total. Tons ciots qrs. lbs. Tons cwts. qrs. lbs. Ton s cwts qrs lbs. Ton s act. qrs lbs. Ton s cwt •. qrs. lbs. Ions wts qrs. z bs. 1910 1,100 0 0 27 50 8 1 „! Pork 3 ind. Vea 5 il— 0 13 !■ 2 2 2 32 13 1 1 6 1,234 1 3 24 Offal- 44 12 1 19 1911 341 6 3 18 25 9 1 6! Pork 4 Offal- ind Vea 8 i— 1 19 I- 8 2 5 3 18 2 0 462 11 0 0 80 19 1 8 1912 58 3 0 3 14 3 2 3i Pork 7 and Vec 14 il— 2 13 c 5 17 3 17 3 2 2 16 108 11 3 6 Offal- 19 10 0 10 1913 31 13 0 18 134 5 o i4l Pork 0 and Ve 16 il— 1 2 V 1 14 3 22 11 14 3 6 252 8 1 20 Offal- 69 3 1 14 1914 82 9 3 26 161 11 1 221 Pork 11 and Vej 6 il— 1 27 V 3 8 0 13 1 19 0 3 316 13 0 24 Offal- 55 18 0 17 1915 294 18 2 20 64 2 1 uj Pork 13 and Ve 7 jl — 0 27 ( 6 3 0 15 17 2 0 2 453 14 2 26 Offal- 58 1 1 3 Ilil6 162 7 2 4 10 12 1 ,°{ Pork 21 and Ve 9 *1— 2 4 I 6 15 1 26 693 6 2 9 918 17 0 0 Offal- 24 5 2 3 1917 227 11 1 18 44 10 2 "I Pork 0 and Ve 9 al — 2 15 V 1 10 0 18 78 17 3 16 361 13 0 1 Offal 8 13 0 27 1918 274 15 0 2 5 5 1 201 Pork 0 ande 16 il— 3 1 | 30 14 0 12 0 10 2 6 331 1 0 15 Offal 18 19 1 2 1919 52 14 2 2 28 4 2 15.] Pork 13 and Ve 0 il— 1 6 | 27 18 1 13 272 14 1 26 435 17 3 0 Offal41 5 1 22 To'a! for ten years ... 2/S26 0 1 26 538 13 3 25 498 2 2 0 93 13 1 3 1,118 19 3 6 4,875 10 0 4 48 TABLE XXXIII. PUBLIC HEALTH (FOREIGN MEAT) REGULATIONS, 1908. During the year Notices were served under Articles HE. (5). IV. (1) of the above-mentioned Regulations, for the exportation of the following meat : — Date of Arrival. Name of Vessel. Where from. Where lying. Description and quantity in respect of which Notices were served. 1919. Jan. 3 s.s, Baronesa " Buenos Ay res Royal Albert Dock *378 pig sides. „ 3 s.s. " Benalla " Do. Do. *1,102 pig sides. „ 24 s.s. " Marquesa " Do. Do. *12 pig sides. „ 24 s.s. " Whakatane " Rio de Janeiro BuenosAyres Royal Victoria Dock 117 bags pork. May 13 s.s. " Marquesa '' Royal Albert Duck 6 cases pork loins, 1 case pork kidneys. 61 headless pig carcases. Jun. 30 s.s. "Highland Glen " Do. Do. Sept. 29 s.s. " Waimana" New Zealand Do. 42 headless pig carcases. 1 bag of beef pieces. *The above-mentioned pig sides came within the definition of " Foreign Meat of Class I.," the importation of which is prohibited. The matter was brought to the notice of the Importers, who stated that:—• " In October last, we received several consignments of heavy pigs which showed " signs of Bone taint, resulting from the difficulty of freeing such heavy carcases " from natural heat before freezing. To obviate a recurrence, thereby wasting " valuable food and refrigerating space on steamers, the method of ' siding ' " was adopted." The sides were admitted after as thorough an examination as possible, on the understanding that in future shipments the regulations would be adhered to. FOOD INSPECTION. The Regulations issued by the Local Government Board (now the Ministry of Health) under the Public Health (Regulations as to Food) Act, 1907, were carried out in the Port of London, and resulted in 2,829 tons 15 cwts. 0 qrs. 19 lbs. of Unsound Food being destroyed or disposed of in such a manner as to prevent its being used for human consumption. Exceptions are shown in the disposal of some of the goods for the manufacture of confectionery and distillation. The goods used for the manufacture of confectionery were condensed milk which had either undergone a yeast fermentation or had been returned to this country owing to caramelisation and discolouration. The deleterious qualities were removed in the process of re-manufacture, and thus the use of a considerable quantity of valuable food material was retained. The goods used for distillation consisted of dried apricots and raisins. The goods were disposed or as follows, only those which could not be used for some useful purpose being actually destroyed :— Tons. Cwts. Qrs. Lbs. Boiled down (recovery of fat, &c.) 665 9 1 23 Cattle and Poultry Food 1,707 12 3 4 Manufacture of Confectionery 35 7 2 14 Distillation - 4 3 18 Destroyed— Buried 254 9 2 18 Burned 166 10 2 26 Total 2,829 15 0 19 The total shows an increase of 136 per cent. compared with the year 1918. A summary of Unsound Food disposed of is shown in Table XXXI. In no instance was it necessary to apply for a Magistrate's Order for the condemnation and destruction of Unsound Food seized by your Officers. A list of Notices served under Articles III. (5), IV. (1) and VI. of the Public Health (Foreign Meat) Regulations, 1908, requiring the exportation of foreign meat imported contrary to the Regulations, is shown in Table XXXIII. 49 Beef —The total quantity of beef seized and disposed of as unfit for human consumption was 175 quarters, 4 crops, 825 pieces, 98 bags and a quantity of trimmings weighing 52 tons 14 cwts. 2 qrs. 2 lbs., against 274 tons 15 cwts. 0 qrs. 2 lbs. in 1918." The largest quantity seized on any vessel was 15 tons 15 cwts. 2 qrs. 7 lbs. Mutton.—The mutton and lamb seized and disposed of totalled 818 carcases, 508 pieces, 35 bags and a quantity of trimmings, weighing in all 28 tons 4 cwts. 2 qrs, 15 lbs., against 5 tons 5 cwts. 1 qr. 20 lbs. in 1918. The largest seizure on any vessel was 7 tons 7 cwts. 2 qrs. 7 lbs. Australian Beep Affected with "Worm" (Onchocerca).—No beef affected with " Worm " (Onchocerca) came under the notice of your Officers during the year. Actinomycosis in Ox-Tongues.—Most of the ox-tongues which arrived in the Port of London were, at the request of the consignees, removed from the district of the Port Sanitary Authority (without inspection) to cold stores within the City of London and the Metropolitan Borough of Finsbury, to be examined there under the supervision of the Medical Officers of Health of those districts. The following shows the results of the examination of some ot the consignments carried out in the Port of London by your Inspectors :— 252 tongues examined. 1 found diseased. 240 „ „ Nil „ „ 252 „ „ 1 „ „ 252 „ „ Nil „ „ 250 „ „ Nil „ „ 252 „ „ Nil „ „ 252 „ „ Nil „ „ 250 „ „ Nil „ „ 250 „ „ Nil „ „ 252 „ „ 1 „ „ 250 „ „ 3 „ „ 250 „ „ Nil „ „ 250 „ „ 7 „ „ 250 „ „ Nil „ „ 250 „ „ Nil „ „ 250 „ „ Nil „ „ 251 „ „ 3 „ „ 226 „ „ Nil „ „ 252 „ „ Nil „ „ 252 „ „ 3 „ „ 60 „ „ Nil „ „ 252 „ „ 1 „ „ 252 „ „ 2 „ „ 252 „ „ 6 „ „ 252 „ „ 3 „ „ 252 „ „ 1 „ „ 250 „ „ Nil „ „ 252 „ „ Nil „ „ Pork.—During the year detailed examination was made of 18,610 carcases and 536 sides, with the result that 165 carcases and 15 sides were found to be affected with Tuberculosis. The pork seized and destroyed during the year was as follows: Tuberculous. Unsound. From. Carcases. Sides. Heads. Carcases. Sides. Pieces. Heads. Argentine - 144 15 — — — — — China 6 — — — — — — South Africa 15 — — — — — — Ship's Stores — — — 13 18 8 2 Totals 165 15 — 13 18 8 2 Veal.—The veal seized as unfit for human consumption consisted of 2 carcases and 2 sides, weighing 8 cwts. 2 qrs. 27 lbs. 50 Offal.—The offal seized as unfit for human consumption was 41 tons 5 cwts. 1 qr. 22 lbs., and comprised:— Tons. Cwts. Qrs. Lbs. Livers, Ox—3 cases, 56 bags, 69 loose 2 10 1 4 „ Sheep—37 bags, 7 loose 0 19 1 4 „ Pig—28 cases, 1 bag loose 0 14 2 9 Sweetbreads—1 case 0 0 1 22 Kidneys—82 cases, 464 boxes, 65 bags, 65 lbs. loose 4 2 1 11 Hearts—551 bags, 4 part bags, 173 lbs. loose 17 13 1 6 Tongues—1 case, 77 bags, 53 loose 3 17 3 25 Cheeks—82 bags 3 3 2 27 Tripe—5 bags 0 3 3 4 Tails—2 cases, 42 bags 1 17 3 18 Skirts—-1 case, 58 bags 1 12 3 26 Sundries—115 cases, 124 bags 4 8 3 6 Total weight 41 5 1 22 Sundry Meat.—Meat coming under the heading "Seized," consisted of mutton, lard, butter and various stores, weighing 293 tons 12 cwts. 1 qr. 26 lbs., contained in 1 case, 2 boxes, 153 bags and various weights in bulk, from ships mined and on fire. Sausages and Sausage Meat.—Sausages and sausage meat seized as unfit for human consumption consisted of 5,084 cases, weighing 216 tons 2 cwts. 2 qrs. 9 lbs. Meats—Canned.—The tinned meats seized and disposed of comprised :—1,789 cases, 1,773 tins, weighing 27 tons 18 cwts. 1 qr. 13 lbs. Meat—Smoked and Salted.—Bacon, 9 boxes 56 lbs.; trimmings, 2 tons 14 cwts. 1 qr. 26 lbs Rabbits—Frozen.—3,097 crates of rabbits weighing 77 tons 1 cwt. 1 qr. 10 lbs. were seized during the year. Rabbits (Tinned), Poultry and Game.—100 cases 118 tins of rabbits weighing 3 tons 12 cwts 2 qrs. 0 lbs , and 6 bags of poultry weighing 4 cwts. 3 qrs. 25 lbs. were seized during the year. Fish.—Goods of this description destroyed included :— Tons. Cwts. Qrs. Lbs. Wet—7 casks 0 10 2 0 Dried—-Stores 0 0 2 15 Tinned—Salmon, 230 cases, 343 tins 5 1 2 15 Total weight 5 12 3 2 Fruit (Green).—A substantial increase is shown in with the 6 tons destroyed last year :—- goods of this class compared Tons. Cwts. Qrs. Lbs. Apples—19 barrels, 2 boxes 1 13 0 20 Bananas—255 crates 5 6 1 12 Oranges—113 boxes, 57 barrels, 26 packages 8 19 2 0 Pears—4 barrels, 117 boxes, 50 half-cases 3 17 1 8 Grape Fruit—2 barrels 0 2 0 0 Lemons—65 boxes 13 5 0 0 Tomatoes—88 crates 2 5 0 0 Pineapples—6 cases 0 2 3 0 Sundries—1 cask 0 1 2 0 Total weight 35 12 2 12 51 Fruit (Dried).—172 tons 13 cwts. 1 qr. 14 lbs. of goods of this class were destroyed, as compared with 11 tons 1 cwt. 2 qrs. 15 lbs. in the preceding year :— Tons. cwts. Qrs Lbs. Dates—4,544 boxes 7 2 0 0 Apricots—2 cases 0 0 3 16 Figs—9 boxes, 1 bag, 185 baskets 3 14 0 27 Plums—5 bags, 16 boxes 0 8 2 25 Eaisins—9 cases, 404 boxes 10 4 0 2 Prunes-—19 cases 0 2 0 0 Currants—12 qr.-cases 0 1 2 0 Sundries—39 cases, 6,003 boxes (fruit salad) 151 0 0 0 Total weight 172 13 1 14 Fruit (Tinned and Bottled).—A substantial increase is shown by the 19 tons 17 cwts. 2 qrs. 15 lbs of goods of this class destroyed, as compared with the 17 cwts. 2 qrs. 16 lbs. destroyed last year :— Tons Cwts. Qrs. Lbs. Fruit Pulp—250 tins, 1 case 1 2 3 8 Tomato Puree—31 cases, 128 tins. I 11 1 20 Tomatoes—140 cases, 333 tins 3 15 0 11 Peaches—168 tins 0 2 1 4 Pineapples—26 cases 0 6 3 24 Pears—293 cases, 22 tins 9 10 0 1 Various—3,194 tons, 24 cases 3 9 0 4 Total weight 19 17 2 15 Jam and Marmalade.—167 tins, weighing 5 cwts. 2 qrs. 9 lbs., were seized and destroyed. Vegetables: Fresh— Tons . Cwts. qrs. Lbs. Carrots and Beets—54 bags 2 7 0 0 Onions—loose 0 10 0 0 Shallots—93 bags 4 13 0 0 Dried— Beans—4 bags 0 5 1 25 Peas—20 bags 1 15 2 15 Preserved— Cucumbers (pickled)—552 barrels 100 0 0 0 Total weight 109 11 0 12 Nuts.—The only goods of this class consisted of Cashew Nuts, siftings, &c., weighing 2 cwts. 3 qrs. 0 lbs. Provisions :— Tons. Cwts. Qrs. Lbs. Tea 0 0 0 0 Coffee 0 0 0 0 Cocoa 0 0 0 0 Cheese 0 0 0 0 Margarine 0 0 0 0 Butter—11 tubs 0 3 3 12 Sugar 0 0 0 0 Condensed Milk—110 barrels, 1,958 cases, 138 tins 49 2 3 20 Total weight 49 6 3 4 52 Prepared Foods.—Quaker Oats, 439 tons 9 cwts. 1 qr. 8 lbs. Grain:— Tons. Cwts. Qrs. Lbs. Wheat 1,199 19 3 5 Oats 6 2 2 20 Maize 7 5 0 6 Barley 4 12 1 12 Total weight 1,217 19 3 15 Condiments and Spices.—Mustard, 1 case, weighing 3 qrs. 12 lbs. Sundries.—Starch flour, 234 bags, weighing 22 tons 10 cwts. 3 qrs. 14 lbs. On the 11th April. 6,003 cases of dried fruit salad and 404 cases of raisins, which had been damaged by fire and water, were seized by one of your Inspectors. Efforts were made to sort the goods and to dispose of them for animal food, but without success. Therefore it became necessary to destroy the whole parcel, weighing about 160 tons, by burning. On the 17th April a vessel arrived from the Persian Gulf with about 138,000 boxes of dates. The dates were found to be in a bad condition, and were seized by one of your Food Inspectors The owners wished to be allowed to dispose of the goods, on the understanding that any found by the buyers to be unsound were to be returned and allowed for or replaced. Your Medical Officer could not agree to that proposal, as doubtless it would have resulted in many unsound dates being sold to the public, and he recommended that the goods should be distributed amongst various districts and sorted under the supervision of the Medical Officers of those districts before they were offered for sale. The owners, however, did not see their way to adopt the suggestion, and the whole of the goods were eventually sorted in the dock under the supervision of your Inspectors, who were engaged upon the work for about six months, with the result that:— 53,365 boxes were passed as fit for human consumption. 81,871 „ „ rejected as unfit for human consumption. Arrangements were made for those rejected as unfit for human consumption to be disposed of for the purposes of distillation and cattle food, subject to the actual users giving to your Medical Officer a written guarantee that none of the dates would be used for human food and specifying :— 1. The purpose for which they would be used. 2. The address at which they would be used. In all cases where dates were released under such guarantees, the Medical Officers of Health of the districts to which the dates were removed were informed of the facts. The unsound dates were distributed about the country in small quantities, and at the end of the year 1,332 tons had been released under guarantees. On the 4th June 9,772 boxes and 15 tons of loose dates, which arrived during May, were also seized by one of your Inspectors. These were dealt with in the same way as those referred to above. The distribution of the dates necessitated the writing of several thousands of letters, and at the end of the year large quantities of the dates remained at the docks to be disposed of. In May 5,286 cases of sausages from Australia were discharged from a vessel and placed in the Victoria Dock Cold Store, where they were found by one of your Food Inspectors to be in a mouldy condition. On your Medical Officer's suggestion they were sorted. The sorting was completed on the 17th June, and resulted in :— 1,888 cases being passed as fit for human consumption. 3,398 „ „ rejected as unfit for human consumption. 53 On the 18th September it was found that delivery had not been taken of the 1,888 cases which had been passed as fit for human consumption, and that in the interval they also had become unfit, therefore it became necessary to destroy the whole consignment as unfit for human consumption. The net weight of the goods was 124 tons 4 cwts. 2 qrs. 0 lbs. The s.s. "Suevic," from Auckland and Bombay, arrived on the 14th May. There were on board 9,740 crates of rabbits. On the 26th May men refused to work in No. 2 hold owing to a bad smell coming therefrom, which it was later ascertained arose from crates of rabbits, 3,053 of which were found to be in very bad condition. Much difficulty was experienced in disposing of the bad rabbits, which were eventually buried at the mud shoot at Dagenliam. On the 18th September a vessel from Buenos Ayres arrived with 225 bags of pork hams and 280 bags of pork shoulders. This meat came within the definition of Foreign Meat, Class 1, the importation of which is prohibited by the Foreign Meat Regulations. The importers stated that it was purely owing to a misunderstanding between their Buenos Ayres house and their London office that the goods were sent, their London office being under the impression that the goods were mild salt cured hams and shoulders. The goods were eventually admitted to this country on the understanding that they would be cured before removal from store in London, and, further, that no similar consignment will be admitted in the future. The matter was brought to the notice of the Ministry of Health. During the year applications were received from Importers to be allowed to remove various foodstuffs from the district of the Port of London without examination by your Officers, on the understanding that the goods would be examined and dealt with under the supervision of the Medical Officer of Health of the district to which the goods were removed. The permission asked for was given in respect of the following foodstuffs : For removal to the City of London :— 6,800 cases of tinned apricot pulp. 235 casks and 318 cases of orange pulp. 46 cases of peach pulp. 24,787 bags of ox-tongues. For removal to thfe Borough of Bermondsey :— 2,108 boxes of Quaker oats. 5,166 crates of cheese. 1,468 cases of condensed milk. 40 pig carcases. 225 bags of pork hams. 280 bags of pork shoulders. 444 tons 1 cwt. 3 qrs. 4 lbs. damaged wheat. For removal to the Borough of Finsbury :— 25 cases of bacon. 32,499 bags of ox-tongues. For removal to the Borough of Lambeth :— 2,825 boxes of Quaker oats. For removal to the Borough of Stepney :—• 2,000 cases of tinned apricot pulp. For removal to the Borough of Poplar :— 2,000 cases of tinned apricot pulp. For removal to the Borough of West Ham :— 17,922 cases of tinned orange pulp. For removal to the Borough of Hove :— 1,130 boxes of dates. For removal to the district of the Southall-Norwood Urban District Council:— 1,000 cases of tinned apricot pulp. 54 TABLE XXXIV.—General Summary, and Analysis, of the Sanitary Inspections of Vessels, &c., in the Port of London, for the year ended 31st December, 1919. Foreign. Coastwise. Inland Navigation. Shore Premises. Sick Seamen referred to Hospital. Water Barges Steam. Sail. Steam. Sail. Steam. Sail. Lighters (uninhabited). Canal Boats. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. ■ Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. No. in District in good condition. 31st December, 1918. New Barges Condemned. | Use Discontinued. No. in District  9940 57 888 1090 12 54 1345 10 117 583 8 17 690 -43 7475 27 403 2920 5 151 153 28 5 5222 29 655 2 - - - - - - Total Inspections to 31st December, 1918-1,223,415 Docks and River. No. Total Inspections from 1st January to St. Katherine's - 1,041 Foreign - 11,030 London 2,038 Regent's Canal 952 Coastwise - 1,928 Millwall 1,678 Inland Navigation 11,238 West India 1,833 Premises on shore 5,222 29,418 Poplar 250 Total 1,2 52,833 East India 1,442 Cleansing of Crew's Quarters, &c. :— Victoria 2,349 Royal Albert 1,549 Total to 31st December, 1918 - 79,883 Commercial 2,073 Total No. of Vessels from 1st January to 31st December, 1919 1,678 Tilbury 1,015 Total 81,561 Gravesend District — Number of vessels inspected : — River—*Upper District - 3,880 *Middle „ 1,094 In the Launohes— *Lower „ 3,002 " Lady Truscott " 3,002 Total vessels 24,196 "David Burnett" "George Briggs " 4,974 Shore premises 5,222 Total 7,976 Total 29,418 In the Docks, &c. 16,220 *Upper District extends from Greenwich to Teddington. Total 24,196 "Middle „ „ „ Greenwich to Erith. *Lower „ ,, „ Erith to outer limits of the Port of London. COMPARATIVE TABLE. Total number of Inspections of vessels from— 1910. 1911. 1912. 1913 . 1914. 1915. 1916. 1917. 1918. 1919. Yearly average for the 10 J8&rs ending 31st December, 1919 "Foreign" " Coastwise," " Inland Navigation," and other Inspections 13,710 14,0151 5,177 14,42 5 13,539 12,472 10,244 8,365 8,362 11,030 12,133.9 24,857 24,009 28,035 24,501 24,475 22,237 19,634 20,881 20,390 18,388 22,740.7 Total 38,567 38,0244 3,212 38,92 6 38,014 34,709 29,878 29,246 28,752 29,418 34,874.6 6 55 TABLE XXXV. NUMBER OF NUISANCES ON VESSELS REPORTED AND DEALT WITH during the year ended 31st December, 1919. Description of Nuisances. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Smoke Nuisances :— Number of complaints received ... ... ... ... ... 1 ... ... ... ... ... ... 1 Number of recurrences reported ... ... ... ... ... ... ... ... ... ... ... ... ... Offensive Cargoes (Bye-laws):— Number of Infringements reported 1 2 ... 1 4 ... ... 1 2 ... ... 4 15 Structural and other Defects:— Ventilation 2 6 8 ... 7 1 1 1 5 1 3 4 39 Lighting 2 1 ... ... 1 1 1 ... 3 1 2 2 14 Heating 1 3 2 1 1 ... ... 1 ... 1 2 3 15 Bare iron in crew's quarters ... 1 1 1 ... ... ... ... ... ... 3 ... 6 Leaky decks, hawse-pipes, cable casings, &c. 4 7 5 2 3 1 ... 2 2 4 1 9 40 Defective bulkheads and floors 2 ... 3 ... 2 1 1 1 2 2 ... 1 15 Sanitary conveniences 1 1 1 1 7 3 4 ... 2 2 2 1 25 Ship's gear or stores stowed in crew's quarters 1 1 ... ... 1 ... ... ... ... ... 2 ... 5 Foul bilges and peaks 1 ... 2 ... ... 2 2 ... ... ... ... ... 7 Storage of drinking water (dirty or defective tanks) ... ... 1 1 ... ... ... ... 2 ... ... ... 4 Dirty quarters 118 137 138 147 123 111 138 121 149 139 152 205 1,678 Accumulation of offensive matter ... ... ... ... ... 3 1 ... ... ... ... ... 4 Miscellaneous Nuisances 3 4 5 1 1 7 3 2 4 2 3 2 37 Totals 136 163 166 155 150 131 151 129 171 152 170 231 1,905 Total number of vessels on which structural alterations were ordered 6 10 16 5 13 7 4 3 t 8 7 10 8 97 Total number of vessels on which structural alterations were reported as carried out 2 1 4 6 8 4 2 4 1 6 12 3 53 NUMBER OF NUISANCES IN THE RIVER REPORTED AND DEALT WITH during the year ended 31st December, 1919. From discharge of foul liquid, sewage, &c., into the River Oftensive condition of River water ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... ... ... ... ... ... 1 ... ... ... ... ... 1 56 TABLE XXXYT. NUMBER OF NUISANCES ON SHORE PREMISES REPORTED AND DEALT WITH during the year ended 31st December. 1919. Description of Nuisances. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Smoke Nuisances:— Number of complaints received ... ... ... ... ... ... ... ... ... ... ... ... ... Number of recurrences reported ... ... ... ... ... ... ... ... ... ... . . . ... ... Structural and other Defects :— Ventilation ... ... ... ... ... ... ... ... ... ... ... ... ... Lighting ... ... ... ... ... ... ... ... ... ... ... ... ... Heating ... ... ... ... ... ... ... ... ... ... ... ... Dilapidations ... ... ... ... ... 1 ... ... ... ... ... ... 1 Sanitary conveniences ... 1 ... ... 1 4 5 ... ... 3 1 ... 15 Water supply ... ... ... ... ... ... ... ... ... ... ... ... ... Dirty premises 36 44 59 47 60 55 45 56 38 62 74 79 655 Accumulation of offensive matter ... ... 1 ... 1 ... 1 ... 1 2 2 1 9 Drainage 2 ... ... ... 2 1 1 ... ... ... ... ... 6 Foul cesspits, latrines, &c ... ... ... ... 1 ... 3 ... ... . . . ... ... 4 Miscellaneous nuisances ... 1 ... ... 1 3 4 1 4 2 2 4 22 Totals 38 46 60 47 66 64 59 57 43 69 79 84 712 Number of shore premises on which structural alterations were ordered 2 1 ... ... 4 4 5 1 2 3 2 3 27 Number of shore premises on which structural alterations were reported as carried out 4 1 ... ... ... 4 ... 1 ... 2 ... 2 14 SUMMARY. Smoke. Structural. Offensive Cargoes. Drainage, Sewage, &c. Miscellaneous. Totals. Number of Nuisances reported— (a) On vessels 1 163 15 ... 1,726 1,905 (b) On shore ... 16 ... ... 690 712 (c) On the River ... ... ... 1 ... 1 Totals 1 179 15 7 2,416 2,618 Number of written Intimations— (a) On vessels 1 84 15 ... 35 135 (6) On shore ... 12 ... 3 14 29 (c) On the River ... ... ... ... ... ... Totals 1 96 15 3 49 164 Number of Statutory Notices— (a) On vessels ... ... ... ... ... ... (6) On shore ... ... . . . ... ... ... (c) On the River ... ... ... ... ... ... Totals ... ... ... ... ... ... 57 TABLE XXXVII.—SANITARY WORKS. Part I. Date completed. Works. 1919. Jan. Royal Albert Dock. Construction of drainage, &c., in connection with Canteen. Feb. Royal Albert Dock. Erection of latrines in connection with Dry Dock Equipment.* June 30 East India Dock. Erection of latrine at East Quay. July 30 South West India Dock. Drainage at Pearson's Canteen. * Passed as a temporary measure only. Part II. Sanitary works and alterations, not yet reported as completed Date Plan submitted. Works. 1919. Feb. 25 Royal Victoria Dock. Proposed drainage, &c., in connection with Millennium Mills. June 4 Royal Albert Dock. Proposed drainage at Carpenters' Shop, Central Works, P.&O. Yard. Ditto—Proposed new latrine at Eastern and Western Dry Docks. July 8 Ditto—Proposed new latrines at Platers' Shop, Western Works. 23 Ditto—Proposed new manhole at Dry Docks. 28 Regent's Canal Dock. Proposed alterations to drainage at Messrs. Cohen's premises. Oefc. 3 Surrey Commercial Dock. Proposed new sanitary conveniences. 4 Royal Albert Dock. Proposed sewer connection at Messrs. Lester and Perkins' Yard. 11 Ditto—Proposed drainage at Messrs. Lester and Perkins' Premises. Dec. 13 East India Dock. Proposed new water-closet at Messrs. Pearson's Canteen near Orchard House Gate. 30 Royal Albert Dock. Proposed sewer, North side. TABLE XXXVIII.—BYE-LAWS—OFFENSIVE CARGOES. Fifteen cases of infringement of the above-mentioned Bye-laws were reported during the year. In each case written notice was sent to the owners of the barges concerned :— Date. 1919. Name of Vessel. Infringement. Jan. 3 Lighter " Buttercup" Laden with an offensive cargo, house refuse not properly and securely covered so as to prevent any nuisance arising therefrom, and also loaded above the coamings. Fob. 15-17 Lighter " Gerald " Ditto. Ditto. Also remaining within the district for a longer period than forty eight hours. April 27 Lighter " Gamecock " Loaded with fish in a bad condition not properly and securely covered so as to prevent any nuisance arising therefrom. May 9 Lighters " Gloxinia " and " Begonia " Loaded with house refuse matter not properly and securely covered so as to prevent any nuisance arising therefrom, and the cargo was also loaded above the coamings. 30 Lighter " I.X.I.A." Loaded with a cargo of house refuse not properly and securely covered so as to prevent any nuisance arising therefrom, and also loaded above the coamings. 30 Lighter " Myrtle " Ditto Ditto. Aug. 7 Open barge " Faith " Removing and carrying condemned fish otherwise than in a suitable tank or receptacle properly constructed and furnished with a sufficient covering so as to prevent the escape of any such material therefrom. Sept. 5 Lighter " Gamecock " Failing to have the lighter thoroughly cleansed within six hours of the discharge of an offensive cargo (fish refuse) therefrom. ,, 5 Lighter " Thaw " Ditto Ditto. Dec. 19 Dumb barge " Freesia " Loaded with a cargo of house refuse not properly and securely covered so as to prevent any nuisance arising therefrom, and loaded above the coamings. 23 Lighter " Hawthorn " Ditto Ditto. 30 Lighters " Bluebell " and " Gorse " Loaded with house refuse and manure not properly and securely covered so as to prevent any nuisance arising therefrom. 58 TABLE XXXIX.—FUMIGATING APPARATUS, BARGE "THOMAS." The fumigating plant was used on four occasions during the year. Date. No. of Vessels. Capacity in Cubic Feet of Space Fumigated. 1919. Jan. 18 1 381,800 Feb. 12-13 1 555,800 Mar. 20-21 1 100,100 Nov. 12 - 1 375,210 SANITARY ORGANISATION AT PORTS. Your Medical Officer received the following letter, which refers to an interview with the Committee mentioned :— East India United Services Club, London. 28th October, 1919. The Chairman, Port of London Sanitary Authority. Sir, I have the honour, on behalf of the members of the Committee appointed by the Right Honourable the Secretary of State for India to enquire into the system of sanitary organisation at Ports in the United Kingdom, to thank you for the kindness and assistance extended to them by your Health Officer and his staff on the occasion of their visit to your Port. I am, Sir, Your obedient Servant, (Signed) B. S. CADELL, Chairman. During the year, Doctors Adamski and Hanasz, accredited to the Polish Legation, were shown the work of the Port, and received information in the methods pursued. Dr. H Engelsen, accredited to the Norwegian Legation, has been the recipient of similar courtesy. LAUNCHES. "Lady Truscott."—A new funnel and ventilator were fitted during January. Repairs were also made to baffle plates, casing doors, &c. During May a boiler tube gave out. On an inspection by your Consulting Engineers, several tubes were found to require renewal. Repairs to the boiler and the provision of an oil fuel apparatus for this launch was considered and sanctioned by the Authority at a cost of about £2,000. HOSPITAL. The following items in repairs were carried out at Denton :— A new incinerator chimney. Lengthening of the flue to the office firegrate by means of a long chimney-pot. Repairs to the feed pump of the steam boiler used for disinfections, retubing of this boiler and provision of new funnel. Replacement of the notice board at the head of the causeway and repairs to the causeway itself. Repairs in gale damage to roof of C Block (Enteric Fever Wards). On assuming residence in Gravesend during April, Dr. J. S. Warrack was placed in telephonic communication with the Local Exchange, and was provided with a bicycle for use in official journeys to and from the Hospital. UNIFORMS. Owing to the excessive price of leather sea boots, gum boots were provided for the use of launch crews. &c 59 STAFF. Medical Officers.—-Dr. E. V. Legg'e was off duty sick for a few days during January. Office.—T. J. S Cotterell, Junior Clerk, resigned his position in November. Hospital.—Miss Jackson, Matron, was taken ill in December with appendicitis, and underwent an immediate operation in the Gravesend Hospital. She made a quick and satisfactory recovery. Several changes took place in the Nursing and Domestic Staff during the year. " Hygeia."—J. H. Salter was appointed Shipkeeper in the place of I. Rogers, deceased; at 28s. per week with bonus. Lady Truscott "—A. E. Howard, Stoker, met with an accident to his kneecap. He was able to remain on duty. Ella Vicars."—H. A. Clarkson, Watchman, also met with an accident, injuring his ribs. He was off duty for 11 days. Several members of the Staff were off duty for varying periods, suffering from Influenza. The members of the Staff on active service with H.M. Forces, with the exception of two killed in action, resumed their respective duties on demobilisation. CANAL BOATS ACTS. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to present herewith the Annual Report on the working of the Canal Boats Acts and Regulations within the district of the Port of London Sanitary Authority during the year ended 31st. December, 1919. The Acts and Regulations apply within the whole of the district under the jurisdiction of the Port of London Sanitary Authority, including the River and Docks— as a "canal," for the purposes of the Act, " includes any river, inland navigation, lake, or water being within the body of a county, whether it is or is not within the ebb or flow of the tide." The navigation, in addition to the enclosed Docks, includes the following navigable tributary waters and creeks of the River Thames :— On the right bank— On the left bank— From Teddington downwards :— From Teddington downwards Wandsworth Creek (River Wandle). The entrance to the River Brent. Hay's Dock. Chelsea Dock. Si. Saviour's Dock. Grosvenor Dock. Part of the Grand Surrey Canal within the Limekiln Creek. Surrey Commercial Docks. Bow Creek (Bivei' Lea). Deadman's Dock. Barking Creek (River Roding). Deptford Creek (River Ravensbourne). Bainham Creek (River Ingrebourne). Dartford Creek (Rivers Cray and Darenth). Mucking Creek. The entrance to the Gravesend Canal. Thames Haven. Clifte Creek. Hole Haven. iantley and Coalmouth Creeks. Potten and Rushley Creeks. Part of the River Medway, and of the River Roach as far as Rochford. Swale. The whole of this area is divided into three districts known as the Upper, Middle and Lower, each district being in charge of an Inspector, as follows:— RIVER. Upper District.—Teddington to Greenwich - - Inspector Lambe, 240/. per annum. Inspector Shepherd, 156l per annum. Middle District.—Greenwich to Erith - - Inspector Lambe, 240l per annum. Inspector Shepherd, 156l. per annum. Lower District.—Erith to seaward limits of the Port Inspector Berry, 175l. 10s. per annum, of London (including part of the River Medway). 60 The Docks are divided into four districts known as the Central, Eastern, Western and the Gravesend District. Central District.—West India Dock South West India Dock Inspector Rolfe, 2501, per annum. Poplar Dock Millwall Dock Eastern District.—Royal Victoria Dock Inspector Burr, 250?. per annum. Inspector Wetjen, 250?. per annum. East India Dock Royal Albert Dock Western District.—London Dock - St. Katherine's Dock Inspector Hopkins, 250?. per annum. Inspector Elward, 220?. per annum. Regent's Dock Surrey Commercial Dock Gravesend Di.stpict .—Tilbury Dock Left Shore, from Purfleet Inspector Massie, 208?. per annum. down. Right Shore, from Erith down (2) the total number of inspections tor the year was loo, representing a net number of 92 boats. The remainder, 61, represents repeated visits by Inspectors of this Authority. The number of boats not conforming to the Acts and Regulations was 33 (inspected on 55 occasions, or 21.56 per cent. of the total inspections, the percentage for the previous five years being 17.11 per cent.) In addition to the above, seven boats were at the time of visit found with the cabin doors locked, there being no persons on board. Inspection was therefore impossible, and these visits are not included in the number of boats inspected. (3) With reference to the various infringements of the Act:— Unregistered Boats. April 11 A.C. 1,031 Government Craft. 11 A.C. 1,032 Ditto. Aug. 15 " Rosaline" Registered Port of London. Oct. 27 "Mabel" - - Boat not met with since. No information as to registration. „ 27 " Ellen" Ditto. Notification of Change of Master. Nil. Certificates. Absence of Certificate of Registration was found in the following cases, a complaint being sent to the owners. In the case of those boats marked * information was received that the Certificates were subsequently placed on board :— Feb. 14 *" Sandford " Registered Brentford, No. 352. March 14 " Aldershot " ,, Uxbridge, No. 459. April 7 " Togo " ,, Berkhamsted, No. 385. June 17 " Walsall Queen " ,, Brentford, No. 387. ,, 17 " Queen of the Ocean " ,, Birmingham, No. 1,317. July 30 " Iiuroki " ,, Port of London, No. 428. Sept. 4 " Cicero " ,, Uxbridge, No. 480. ,, 26 *" Sandford " ,, Brentford, No. 352. Nov. 7 " Milner " ,, Berkhamsted, No. 354. 18 " Alkali " ,, Port of London, No. 266. ,, 22 " Colne " ,, Berkhamsted, No. 333. Certificate not identifying Owner with Boat. March 12 " Queen of the Ocean " . Registered Birmingham, No. 1,317. Marking, &c. March 12 " Queen of the Ocean " Registered Birmingham, No. 1,317. April 16 " Richard " ,, Reading, No. 49. June 17 " Queen of the Ocean " ,, Birmingham, No. 1,317. 61 Overcrowding. Jan. 11 *" rose " Registered Brentford, No. 367. The canal boat "Rose," registered Brentford No. 367, was inspected on the 11 th January, 1919— Registered for— Occupied by- Males 1 Aft. Males 1 Aft. Females - 1 Females 1 Children - 4 Children 5 Males 2 Fore. Children 2 Fore. The fore cabin was in a dirty condition and unfit for habitation. Written notice as to the overcrowding was sent to the owner (Mr. Emanuel Smith, of Brentford) on the 15th January. The boat was again inspected on the 10th June, and the complaints found to have been remedied. Separation of the Sexes. Nil. Cleanliness. Jan. 11 *" Rose" Registered Brentford, No. 367. March 14 " Aldershot" ,, Uxbridge, No. 459. May 6 "Scot" ,, Port of London, No. 416. Aug. 12 *"Bee" ,, Port of London, No. 235. Nov. 22 "Colne" ,, Berkhamsted, No. 333. Dec. 16 "Isis" „Port of London, No. 468. Painting. April 16 *"Alice" Registered Port of London, No. 5. May 6 "Scot" „ Port of London, No. 416. Aug. 12 *"Bee" ,, Port of London, No. 235. Sept. 26 "Sandford" „Brentford, No. 352. Nov. 18 *"Alkali" „Port of London, No. 266. Ventilation. Nil. Dilapidation. Jan. 9 "Trent" Registered Uxbridge, No. 392. Feb. 10 *"Harry" „ No. 321. ,, 14 *" Sandford " „ Brentford, No. 352. March 14 "Aldershot" „Uxbridge, No. 459. April 16 *"Alice" „ Port of London, No. 5. May 6 " Scot " „ Port of London, No. 416. „ 12 "Prudence" „ Ware, No. 38. „ 23 "Prudence" „ Ditto. July 5 "Lizzie" „ Brentford. No. 216. „ 30 "Kuroki" „ Port of London, No. 428. Aug. 12 *" Bee" „Port of London, No. 235. Sept. 4 "Cicero" „ Uxbridge, No. 480. Oct. 27 "Mabel" Unregistered. Nov. 18 *"Alkali" Registered Port of London, No. 266. „21 "Coronation" „Uxbridge, No. 366. „ 22 "Colne " „ Berkhamsted, No. 333. „ 28 " Sarah Ann " „ Port of London, No. 480. Dec. 16 " Isis " „ Port of London, No. 468. 30 " Mole " „ Berkhamsted, No. 334. Removal of Bilge Water. Nov. 4 *" Muriel " Registered Port of London, No. 397. Provision of Water Cask. Oct. 27 " Mabel " - Registered. 27 " Ellen" „ Notification of Infectious Disease. Sept. 26 "Sandford" Registered Brentford, No. 352. On the 22nd September. 1919, information was received from the Medical Officer of Health for Hammersmith, that a boy named P. W. Penny, aged nine, of the barge " Sandford." was removed to the Kensington Infirmary on the 19th September, 62 suffering from Enteric Fever. The canal boat "Sandford," registered Brentford No. 352, was visited by an Inspector of the Port of London Sanitary Authority on the 23rd September at Bellamy's Wharf. It was ascertained that the boy had a habit when washing in river water of swallowing a mouthful of the water. The cabin was disinfected at Hammersmith, and again at Bellamy's Wharf. ADMITTANCE OF INSPECTOR. No difficulty has been experienced in regard to the visits of the Inspectors of this Authority. LEGAL PROCEEDINGS. Proceedings have not been taken in any case of infringement of the Acts and Regulations during the year Such were contemplated in the case of the " Colne," registered Berkhamsted No. 333, which boat will be found noted for infringements on the same date with respect to absence of certificate—want of cleanliness and dilapidation. This boat was seen on the 22nd November, in the Millwall Dock, with a man in charge, who denied that he slept on board. He had no copy of the certificate, and the cabin was in a dirty, neglected and dilapidated condition. The owner states that the craft is not used as a dwelling, and that the man employed lived ashore, and that he had retained the certificate in his office. Satisfactory evidence of occupation was not forthcoming, and in these circumstances it was considered probable that proceedings under any section of the Acts or of the Regulations would be unsuccessful. The facts were, however, brought to the notice of the Inspector of Canal Boats at Berkhamsted, with a view to the cancellation of the registration. (5) The total number of infringements found was 55 on 33 boats, inspected on 55 occasions. Formal notice of each infringement was at once given to the owners, and in many cases they were remedied without further complaint. The number of written notices was 31, and the number which has been certified as attended to was 34 ; this number includes orders made in previous years and reported remedied during 1919. DOUBLE BULKHEADS. (6) There were no infringements with regard to the provision of these. (7) No boats have been detained for cleansing. (8) On December 31st, 1919, there were 271 boats on the Register :— Propelled by Tug and Oars - 253 „ Steam 15 „Motors 3 271 (9) One boat was registered in 1919. TABLE Of CANAL BOATS CARRYING CHILDREN ON BOARD. Year No. of boats. No. of boats with children. No. of children. c Average) No. of chiidren per boat. Average No. of boats with children. 1908 1,168 206 459 2.18 17.63 1909 1,432 219 495 2.26 15.29 1910 908 172 354 2.05 18.94 1911 926 173 400 2.31 18.03 1912 841 197 409 2.07 23.42 1913 451 61 196 3.21 13.52 1914 237 82 214 2.60 34.62 1915 197 56 256 4.57 21.52 1916 156 36 101 2.80 23.07 1917 118 41 134 3.26 34.74 1918 109 22 74 3.36 20.18 1919 92 16 69 4.31 17.39 I have the honour to be, Gentlemen, Your obedient Servant, W. M. WILLOUGHBY, Port of London, 63 TABLE XL, SUMMARY OF CANAL BOATS FOR THE YEAR ENDED 31st DECEMBER, 1919. January. February. March. April. May. June. July. August. September. October. November. December. TOTAL 1914. total for the year 1918. 1915. 1916. 1917. New boats registered ... ... ... ... ... ... ... ... 1 ... ... ... 1 3 7 4 2 1 Registration owing to structural alterations ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... Registration for other purposes ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 2 ... ... No. of Visits of Inspection 15 15 18 15 13 13 15 4 12 10 14 9 153 571 413 280 280 188 Conforming to Acts and Regulations 13 13 15 11 10 11 12 2 10 8 8 7 120 473 328 228 225 149 Infringements in respect to :— Registration ... ... ... 2 ... ... ... 1 ... 2 ... ... 5 20 23 9 8 6 Notification of change of master ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Absence of certificate ... 1 1 1 ... 2 1 ... 2 ... 3 ... 11 18 19 10 19 12 Certificate not identifying owner with boat ... ... 1 ... ... ... ... ... ... ... ... ... 1 4 1 2 1 2 Marking, &c. ... ... 1 1 ... 1 ... ... ... ... ... ... 3 14 6 9 6 4 Overcrowding 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 Partition separating sexes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Males over age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Females over age ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Cleanliness 1 ... ... ... 1 ... ... 1 ... ... 1 ... 6 14 10 4 ... 1 Painting ... ... ... 1 1 ... ... 1 1 ... 1 ... 5 23 12 14 2 Ventilation ... ... ... ... ... ... ... ... ... ... ... ... 6 7 3 2 1 Dilapidation 1 2 ... 1 3 ... 2 ... 1 1 4 ... 19 52 37 22 25 19 Removal of bilge water ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 2 ... ... Without pump ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Refusal to admit Inspector ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No proper water vessel ... ... ... ... ... ... ... ... ... 2 ... ... 2 7 8 ... 2 2 Without double bulkhead ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Notification of infectious disease ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... Detained for cleansing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Proceedings taken ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... Cautions given 2 2 ... 4 3 2 3 ... 2 2 5 2 31 79 69 39 31 36 „ attended to 5 ... ... 4 3 5 ... ... 6 2 8 1 34 81 54 38 21 9 Total registered by Port Sanitary Authority since 1887 487 • Cancelled 216 Carrying males 213. Actual number on the Register, 31st Dec«mber, 1919 271 females 55. children 69. 64 ADMINISTRATION OF THE PORT OF LONDON PUBLIC HEALTH (LONDON) ACT, 1391. Dr. REVENUE ACCOUNT for the Year ended 31st March, 1920. Cr. £ s. d. £ s. d. £ s. d. £ s. d. To Salaries of Medical Officers and Clerk 3,947 17 3 By Proceeds of Sale of Unsound Food (for amounts paid to „ Payment to Locum Tenens 88 4 0 Consignees see contra) 1,564 8 10 „Wages 7,973 9 9 „ Sundry Fees 529 19 4 „ Contribution to Officers' Pension Funds 331 6 2 „Refund of proportion of Medical Officer's Salary, &c., by „ Ditto Pensions 82 7 8 Rochester Port Sanitary Authority 100 0 0 „ Pensions 476 13 4 2,19 1 8 2 „ Fidelity Guarantees 1 16 0 ,, Balance carried to City's Cash General Revenue Account ... 16.78 1 2 4 „ Employers Liability under Workmen's Compensation Acts 33 7 11 ,, National Health Insurance 10 11 3 „ Officers' Uniforms 289 12 4 „ Expenses of Steam Launches and Hulk 1,686 5 10 „ Expenses of Offices at Greenwich, including Rent, Rates, Taxes, Lighting, Heating and Repairs 176 14 3 „ Expenses of Medical Officer, including Office Expenses, Postage and Petty Cash Charges 435 15 2 1 5,534 0 11 „ Hospital at Denton, viz. :— Expenses of Nursing Staff 246 3 11 Rent, Rates, Taxes and Insurance 110 12 6 Maintenance and Repairs 76 15 4 Maintenance of Patients, &c. 270 19 9 Miscellaneous Expenses, including Gas, Coal, Stores, and Telephone 360 8 9 1,064 19 6 „ Printing and Stationery 204 1 0 „ Disinfectants 190 4 4 „ Expenses re Epidemic precautions, Examination of Rats, and Analysis of Food Samples 334 13 3 „ Proceeds of Unsound Food paid to Consignees (for amounts received see contra) and Expenses 1,390 16 0 „ Expenses of Inspection of the River 75 0 0 ,, Committee Allowance 75 0 0 „ Expenses of Delegates to Congress of Royal Sanitary Institutes 63 0 0 „ Miscellaneous Expenses 44 15 6 £18,976 10 6 £18,976 10 6 Chamber of London, 16th September, 1920. Charles Skipper and East. Printers, 49, Great Tower Street, b.o.b.