AC 4369 PLON 55 103 PORT OF LONDON HEALTH COMMITTEE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, To 3Ist December 1947. 103. PORT OF LONDON HEALTH COMMITTEE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH (MONTAGU TRAVERS MORGAN, M.C., M.D., Ch.B., D.P.H.) To 31st DECEMBER, 1947. Port of London Health Authority, 5, Church Passage, Guildhall, E.C.2. Telegraphic Address "PORTELTH LONDON". Telephone Number CLERKEN.VELL 2011. 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 OP HAVENGORE CREEK, IN THE COUNTY OF ESSEX, TO THE LAND'S 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 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 IS 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 PROM ELMLEY CHAPEL TO IWADE CHURCH, BEING THE WESTERN LIMIT OF THE PORT OF FAVERSHAM, AND THE SAID PORT OF LONDON INCLUDES THE ISLANDS OP HAVENGORE CREEK AFORESAID, CALLED POTTON AND RUSHLEY ISLANDS, AND 30 MUCH OF THE SAID CREEK AND WATERCOURSE AS EXTENDS FROM IT TO THE TOWN OF ROCHFORD, AND ALSO INCLUDES ALL OTHER ISLANDS, RIVERS, STREAMS, CREEKS, WATERS, WATERCOURSES, CHANNELS, HARBOURS, DOCKS AND PLACES WITHIN THE BEFORE-MENTIONED LIMITS CONTAINED. STAFF. List of Officers forming the Staff of the Port Health Authority, 31st December, 1947. Office Name of Officer. Date of entering the service. Medical Officer of Health M.T. Morgan,M.C., M. D., Ch.B.,D.P.H. September 1938. Deputy Medical Officer of Health and Medical Officer in Charge,Denton Hospital. H.M.W illoughby,V.D., M.R.G.S. ,L.R.C.P., D.P.H, D.T.M.& H.,R.N.V.R. May 1929. Assistant Port Health Officer. J. A. Jones,M. B.,Ch.B., D.P.H. April 1 935. ditto. ditto, (vacant) J. R. Davies,M. R. C. 3., L.R.C.P.,D.T.M.& H. January 1939. Sheerness Roarding Station. (Tempy; part Time). H.A.Madwar, L.R.C.P., L.R.F.P.3. December 1927. STAFF (Contd) Office Name of Officer. Date of entering the service. CLERICAL- Principal Clerk. W. C. Barham. March 1901. Principal Assistant. J. A. Gillis, March 1914. First Class Assistant. A.W.Moore. January 1920. General Grade Clerical Assistant. W.L. McLorg. February 1927. ditto. R. C.Ratliff. March 1930. ditto. E.V.Smith. October 1 938. ditto. R.H.Lott. May 1 947. INSPECTORIAL- Sanitary Inspector and Inspector of meat and other food. W.Gray. September 1921. R.Clifford. July 1925. P.W.Coombe. December 1924. ditto. E.H.J ohnson. August 1929. ditto. T.G.Edwards. June 1929. ditto. D.E.Madeley. September 1932. ditto. C.E.Wright. July 1931. ditto. J.S.Beattie. May 1931. ditto. L.A.R.Hundy. January 1934. ditto. T.L.Mackie, M.B.E., A. M.I.N. A. November 1934. ditto. G.Dring. February 1937. ditto. J.Aiken. July 1946. ditto. A.Trevethick. August 1946. ditto. L.N.Tope. August 1946. RODENT OFFICERS- C.F.Woodrow. November 1928. C. W. Moody. February 1929. E.C.Watkins. June 1929. S. A. Croft. June 1929. C.Stockton. June 1940. F. D. Cartman. January 1943. RODENT CONTROL SCHEMERodent Officers. D. J. Davies. August 1941. G. Lamont. March 1945. H. A. Baxter. June 1945. J.E.Carrington January 1946. W.G.Stimson. February 1946, A. G. Blagdon. September 1946. DENTON HOSPITAL- Medical Officer in Charge. H.M.Willoughby. May 1929. Superintent Male Nurse. R.White. August 1947. Staff Nurse (Male). H. G. Rye. August 1947. Assistant Nurse (Male). L. M. Stiling. August 1947. ditto. (vacant) ditto. (vacant) Cook. (vacant) Laundress. Mrs. A. R. Robinson. October 1945. Maid. Miss D.V.Bartholomew. September 1946. do. Miss W.A.Bradford. July 1947. do. (Daily Help). Mrs. L.Anderson. October 1945. Gardener and Assistant Handyman. A.F.King. January 1947. Handyman. J.A.Anderson. October 1945. Ambulance Driver and Assistant Handyman. J.H.White. July 1947. The Hospital was opened for full operation on the 18th August, 1947. (2) STAFF (Contd) Office. Name of Officer. Date of entering the service. LAUNCHES AND HULKS- Launches "HOWARD DEIGHTON" "ALFRED ROBERTSON" "FREDERICK WHITTINGHAM" Hulks "HYGEIA" at Gravesend. "UPLEES" at Greenwich. Navigator (Senior) P. J.Wilkins. November 1928. ditto. J. R. Steen. March 1 926. ditto. H. J. Debnam. April 1931. ditto. W.S.Stimson. March 1944. ditto. W. G.A.King. September 1939. Engineer (Senior) S.J.Crutchley. June 1939. ditto. A. Cook. July 1938. ditto. E.G.Smith. January 1946. ditto. J. F. Trice, M.B.E. September 1947. Deckhand. C. R. Simons. August 1938. ditto. A. R.L.Potter. July 1945. ditto. W.Simmons. July 1945. ditto. (Acting). R. A.Mantripp. March 1945. Deckboy. G.A.Simnonds. February 1947. ditto. C.F.Bowen. December 1945. ditto. B. Bowen. June 1947. ditto. C. Sams. January 1946. ditto. A.Nuttall. April 1 9^6. Steward (Part Time). J.F.Smeed. July 1927. Shipkeeper. A.R.Burge. August 1 945. ditto. E.Alewood. January 1947. Watchman. E.W.S.Edmonds. September 1 933. ditto. H.J.Mason. August 1946. January 1948. TO THE WORSHIPFUL THE PORT oF LONDON HEALTH COMMITTEE. Gentlemen, I have the honour to submit my Annual Report as Medical Officer of Health of the Port of London. Circular 1 61/47 of the Ministry of Health dated 5th November, 1947, directs that "the Authority will instruct their Medical Officer of Health to prepare his Annual Report for 1947 on the lines indicated in Memorandum 302/S.A". Memo,302/S.A. reads as follows:- "PORT HEALTH AND RIPARIAN AUTHORITIES. Annual Reports of Medical Officers of Health. 1. Article 17(5) of the Sanitary Officers (Outside London) Regulations,1935, provides that a Medical Officer of Health shall, as soon as practicable after the 31st day of December in each year, make an Annual Report to the Authority up to the end of December on the sanitary circumstances, the sanitary administration and the vital statistics of the District, containing, in addition to any other matters upon which he may consider it desirable to report, such information as may from time to time be required by the Minister. L (3) 2. Article 27(18) of the Regulations provides that the SanitaryInspector shall, as soon as practicable after the 31st day of December in each year, furnish the Medical Officer of Health with a tabular statement containing the following particulars:- (a) The number and nature of inspections made by him during the year; (b) The number of notices served during the year, distinguishing statutory from informal notices; (c) The result of the service of such notices. 3. The records of the Authority should accordingly be kept in such form as to enable the Medical Officer of Health to prepart his Report without delay at the close of each year. The Report should be in the form and sequence indicated herein the lettering of the tables being adhered to. 4. The Medical Officer of Health should include in his Report anyl comments which he may think desirable (1) under the several heads indicated herein, and (2) in regard to the need for any I developments ofc extensions which, in his opinion, are necessarl to render the work of the Authority fully efficient. 5. In the case of those ports which are approved under the Aliens! Order, 1920, for the landing of Aliens, the Medical Officer ofI Health should report generally upon the work of medical inspection of aliens." The above-mentioned directives have been followed, in so I far as the information asked for is available. The tonnage of vessels entering the Port of London duringl 1947 was 19,923,674 tons as compared with 17,314,187 tons during 1946. I Six thousand eight hundred and fifty vessels arrived from foreign portsl and of these 1,303 were boarded by your Medical Officers. One hundred and eighty three cases of communicable diseases (including malaria) were reported as having occurred on 125 vessels during the voyage, of which 96 were landed in the Port. Eighty six cases, of which particulars are given in Appendix 11(b), were admitted to Infectious Diseases Hospitals. Fifty-I one of these cases were admitted to the Port Isolation Hospital at Denton which was opened for full operation on the 18th August, 1947. No case of human plague occurred during the year on any vessel bound for london. Of the 1,009 rats examined bacteriologically 760 were from vessels and 249 from shore premises,, No rat was reported to be I infected with plague. One hundred and fifty four vessels were fumigated for rodent destruction and the issue of International Deratisation Certificates under the supervision of your Inspectors, All were fumigated with hydrogen cyanide (see Table H) accounting for 2,585 ratsH and 390 mice. A total of 8,538 rats were destroyed during the course ofH the year, 4,476 in ships and 14,062 on shore premises in the Port. In I addition 1,584 mice were destroyed, 447 in 8$ips and 1,137 on shore premises. The work under the Parrots (Prohibition of Import) Regulations, 1930, still in operation, is reported on page 31. The number of water barges in use in the Port was 11. The registration of these craft by the Port of London Authority was (made (4) made conditional upon the report of your Officers as to the fitness of the barges for the carriage of drinking water. These arrangements worked smoothly. No action was taken under the existing Houseboat Bye-laws. The new Bye-laws, in draft form, were under consideration during the year as the result of objections raised by the various parties interested. The total amount of foodstuffs seized and condemned for human consumption and either reconditioned or disposed of for animal consumption or for industrial purposes under guarantee or destroyed was 1,094 tons as compared with 630 tons during the previous year. Your Medical Officer would like to take this opportunity of thanking the Officers of His Majesty's Customs, of the Port of London Authority, the Pilots and members of the staffs of the Shipping Companies and Merchants for their collaboration and assistance in every aspect of the work of the Port Health Authority throughout the year. Dr. H.M.Willoughby, your Deputy Medical Officer of Health, resumed his duties on 1st March, 1947 and I have pleasure in reporting that all members of your staff have carried out their duties both willingly and efficiently. I have the honour to be, Gentlemen, Your obedient servant, M.T.MORGAN. 1. AMOUNT OP SHIPPING ENTERING THE PORT DURING THE YEAR.1947. TABLE A. Number Tonnage Number Inspected NUMBER REPORTED TO BE DEFECTIVE NUMBER OF VESSELS ON WHICH DEFECTS WERE REMEDIED NUMBER OF VESSELSON WHICH DEFECTS WERE FOUND AND REPORTED TO THE MINISTRY OF TRANSPORT'S SURVEYORS. NUMBER OF VESSELS REPORTED AS HAVING OR HAVING AND DURING THE VOYAGE INFEC- TIOUS DISEASTE ON BORARD. by the medical officer of health BY THE SANITARY INSPECTOR FOREIGN Steamers 6,850 11,762,839 1,172 6,737 819 169 61 122 Motor 328 Sailing - - 3 4 - - - - Fishing - - - - - - - - Total foreign 6,850 11,762,839 1,503 6,741 819 769 61 122 Coast- wise Stemers 11,580 8,160,835 1 1690 184 142 39 5 Motor — — Sailing - - - — — — — — Fishing — — — — — — - Total coaswise 11,580 8,160,835 1 1,600 184 142 39 3 Total Foreign and Coartwise 18,430 19,923,674 1,504 8,527 1,903 911 100 125 II. CHARACTER AND TRADE OF THE PORT. TABLE B. (No records yet available). (5) MEDICAL INSPECTION OF ALIENS. Annual Return by the Medical Inspector of Aliens for the year ended 31st December,1947. total number inspected by the medical inspector NUMBER SUBJECTAILED TO DETAILED EXAMINAT- ION BY THE MEDICAL INSPECTOR CERITFICATES ISSUED Trans migrants LUNATIC IDDOT OR M.D. UNDESIR- ABLE FOR MEDICAL REASONS PHYSICALLY INCAPAT- ITSTED SUFFERING FROM ACCUTS INFECTIOUS DISEEASE LANDING NECESSARY FOR ADOEQUATE MEDICAL EXAMINATION (a) Totla number of Aliens Landing At the port. 29.495 24,638 3,419 - — - 2 - • (b) Aliens refused permiss- ion to land by immigration officer 231 6 - - - - - - - (c) Trans migrants - - - - — — — —' TOTAL Aliens arriving at the port. 29,726 24,644 3,419 - - - 2 - - Total number of vessels arriving carrying Alien passengers 1,267, Number of vessels dealt with by the Medical Inspector 611. III. - WATER SUPPLY. 1. Source of Water Supply - (a) For the Port - All the docks in the London Area obtain their water supplies from the Metropolitan Water Board. Tilbury Dock obtains its water from the South Essex Water Company. The majority of the wharves are supplied by Public Water Authorities within whose area of distribution they are situated, while several have their own deep wells. A few have no water supplies available for shipping, in which case any water required can be obtained from water boats. (b) For Shipping - Ships usually obtain water from the shore supplies as indicated above but when no water is available at the berth or if the ship is lying at buoys in the river, supplies are obtained from water boats. 2. Hydrants and Hosepipes - Hydrants within the dock area are of the standard type in use by the Metropolitan Water Board. These are situated at intervals along the quayside and consist of an upright stackpipe with a nozzle coupling to which are attached the hoses. The hoses, usually of rubber covered with a metal coil, when not in use are coiled up and hung in specially constructed boxes at convenient points within the docks. When in use particular care is taken that the hoses do not sag into the dock water and in transference from the ship to shore that at no time do they come into contact with the dock water. If this should happen the hoses are thoroughly cleansed and flushed with fresh water before being used. POLLUTION OF WATER SUPPLY - LONDON, St.KATHARINE. REGENT'S CANAL, INDIA AND MILLWALL AND ROYAL DOCKS. On the 19th March your Medical Officer attended a conference held at the Laboratories of the Metropolitan Water Board at which /'representatives (6) representatives of the Ministry of Health, London County Council, Society of Medical Officers of Health and Medical Officers of the Metropolitan Boroughs, were present. The Director of Water Examination to the Metropolitan Water Board gave an account of the occurrences which led up to the present situation, arising from extensive floods. As a result, and to implement the action already being taken by your Officers in the areas affected, your Medical Officer issued the following detailed instructions;- Memorandum to all Inspectors. I have been informed by the Metropolitan Water Board that the River Lea water has gained access to the mains and that, in consequence, the water supply to the above-mentioned docks is contaminated and should not be used for drinking purposes unless boiled or chlorinated. In the case of ships proposing to take on water for drinking, chlorination cannot be adequately carried out on shore and recourse must, therefore, be had to the chlorination of water tin. ship's tanks. For this purpose ships may be divided into four categories: (1) British Foreign-going vessels. (21 Foreign vessels. f3) Coastwise. (U; Water Barges. British Foreign-going vessels are required to carry a supply of stabilised chloride of lime (bleaching powder) in their medical scales and use should be made of this supply to carry out chlorination of water that is being taken on board. The following is the method of using the powder - The purifying powder when mixed with drinking water in a proportion of 1 part of the powder in 250,000 parts of water has the effect of destroying all organisms in the water, and the object, therefore, is to make a solution of this strength in the water in the tanks. Proceed at follows: First estimate the quantity of water which you require to purify and note that if the tank is party full before filling begins, enough powder must be added not only to sterilise the quantity of water that is being poured into the tank, but also any water that is already in the tank. Thus if the tank contains 1,500 gallons of water before filling and 3,000 gallons are taken in from the shore, sufficient powder must be added to purify U,5000 gallons. The measure with which you are provided holds exactly 60 grains or one-eighth of an ounce, and this quantity is sufficient to purify 200 gallons of water. The following table will assist you to estimate the number of gallons of water in terms of cubic feet or tons;- 36 cubic feet of water - 22i+ gallons - i ton. \ ton - 112 gallons - 18 cubic feet. 1,500 gallons -6.7 tons - 2U0 cubic feet. Each tank must be dealt with separately. Having decided upon the quantity of powder yOu require for each tank, take the measure provided for the purpose and measure out the necessary amount of powder, pouring each measureful on to a piece of clean paper. Take the powder and pour it into the tank whilst filling is proceeding. The tank should be about quarter full when this is done. The water in the tanks must not be used for drinking until at least one hour has elapsed. If the water is used too soon, there may be a slight smell and the taste of chlorine in it. You may rest assured that this smell and taste cannot exert any harmful effect whatever on anybody drinking the water. The taste may persist if the /water (7) water taken on board is muddy or cloudy, and if necessary you must warn persons drinking the water that no harm can arise from the taste. As a general rule, however, all taste and smell arising from the powder disappears within an hour or two of purifying, Foreigh ships and Coasting vessels. In the case of these vessels, the latter certainly, and the former probably, do not carry a supply of chloride of lime and it will be necessary, therefore, to supply the bleaching powder or liquid hypochlorite and to carry out the process yourself in conjunction with the Master or Chief Officer, For this purpose the Metropolitan Water Board will deliver to your Office this morning a carboy containing liquid sodium hypochlorite, two or three Winchester flasks in their baskets to enable you to carry the necessary quantity to the ship, and a funnel and measure. The procedure is the same as for the use of bleaching powder but the quantity to be used is as follows: 1 pint for each 12,500 gallons or proportionately. Water Barges taking fresh water from hydrants in the docks or at a wharf should be stopped doing so since it is not possible to supervise chlorination repeatedly. Such barges should be informed that they may only take water from hydrants on the South Side of the .River or from points outside a reach on the North Side stretching from Tower Bridge to Barking. In addition to either supervising or carrying out the chlorination of water in these four categories of vessels and in the manner described above, you should also warn the Officer in charge that it would be as well to boil the water before use for drinking purposes; not only will this be a double measure of safety but it will secure that any excess of chlorine that will remain in the water is boiled off and will avoid any taste in beverages, such as tea, etc. You should also strongly advise that no more water should be taken on board for drinking purposes than is necessary to reach the first appropriate port of call for replenishments. In using either the powder or the liquid chlorine care should be taken to see that if two or more tanks are in parallel, each tank should receive its own appropriate dose of chlorine in order to secure an even distribution and that the total chlorine should not be put into one tank only, which would have the effect of creating unequal concentrations in the various tanks connected in parallel. If there is any possibility of the engine room supply being linked with the drinking and domestic supply - both supplies should be chlorinated. Arrangements have been made through the Port of London Authority whereby the Dock Superintendents concerned are to notify you of all ships that propose to take on water to enable you to carry out the above-mentioned measures. Finally the precautionary measures apply also to water used in the docks for domestic purposes and you should warn all concerned that all such water should be boiled before use for drinking. The chlorination of ships' drinking water should be regarded as a requirement of the highest priority and the contamination will probably be present during the next fortnight or even longer. Please get into touch with this office if you require further supplies of hypochlorite. (Sgd) M.T.MORGAN. 3. Number of water boats and their sanitary condition - There were eleven water boats working in the Port during the year. Water boats are all of steel construction and of the 'single skin' type, i.e., the skin of the boat forms the sides and (8) and bottom of the tanks and the deck forms the top. The manholes are raised from 6 inches to 1 foot above the level of the deck and have steel covers, fitted with locks to prevent unauthorised persons dipping water from the tanks into buckets which may be dirty, while the craft is unattended. It is the usual practice to clean the tanks every three months and to cenent-wash them every six months. All water boats must be registered annually with the Port of London Authority and before a certificate is granted they must be inspected as to their fitness for navigation in the river and docks. Notification is received that a vessel is coming up for re-registration by the Port of London Authority and this opportunity is taken by the Port Health Authority to inspect the vessel as to its fitness for the carriage of drinking water. The Port of London Authority await a communication from the Port Health Authority stating that the vessel is in a fit condition for the carriage of drinking water before issuing the certificate. This arrangement has worked smoothly for a number of years and enables your Officers to get such repairs and improvements as are from time to time necessary, carried out without difficulty. IV. PORT HEALTH REGULATIONS, 1933 and 19k5. (a) Arrangements for dealing with Declarations of Health - Ships bound for London coming up the English Channel take on a Pilot off Dungeness, those coming across the North Sea take on a Pilot at the Sunk Lightship, near Harwich. The Elder Brethren of Trinity House have kindly agreed that Pilots should hand copies of the Declaration of Health to the Masters of the ships they board, and accordingly supplies of the Declaration of Health are sent, from time to time, to Trinity [House. The Elder Brethren have, however, stipulated that pilots should not be held responsible for any failure on the part of the Masters to Icomply with the instructions of the Port Health Authority. Pilots have, [however, co-operated willingly and conscientiously and consequently the [arrangements are working very satisfactorily. The Port Health Amendment Regulations, 19h5, necessitated a ; slight alteration to the Declaration of Health, page k of which [(instructions) now reads as follows:- INSTRUCTIONS (applying only to the Port of London). The Master of a foreign-going vessel approaching a Port in England lor Wales from a Foreign Port must ascertain the state of health of all Ipersons on board, and fill in and sign a Declaration of Health in the prescribed form, which he must hand to the Customs Officer or to the Port Medical Officer, whichever first boards the ship. 1. If the answer to any of the questions on page 1 is "YES", or if the ship, EXCEPT IN THE CASE OF TANKERS, has called during the previous six weeks at any of the following Ports;- i Ports in ASIA, including JAPAN, the EAST INDIES and CEYLON, AFRICA including MADAGASGAR, the CANARY ISLANDS and CAPE VERDE ISLANDS, TURKEY, BLACK SEA, AZORES, SOUTH AMERICA, CENTRAL AMERICA, GULF OF MEXICO, WEST INDIES. the Master must :- (1) Send a wireless message to "PORTELTH LONDON", stating the name of his vessel and the time* she is expected to arrive off Gravesend. This message must be sent off not more than 12 hours and not less than 4 hours before the arrival of the ship. In the case of vessels bound for the Medway, the wireless message must be addressed to "PORTELTH LONDON", but must be as follows;- "(NAME OF VESSEL) (TIME OF ARRIVAL) SHEERNESS." NOTE. - If wireless is not carried, the Port Health Authority must be | notified of the arrival of the ship as soon as possible. (9) (2) By day,when within the Port of London, hoist the flag signal LIM, meaning "Port Medical Officer required"; By night, when approaching Gravesend, flash letter "Q" repeatedly from the morse lamp. (3) Have the crew mustered ready for inspection by the Port Medical Officer as soon as he boards the vessel. Free pratique will not be granted by His Majesty's Customs until the vessel has been visited by the Port Medical Officer. II. If the answers to all the questions on page I are "NO" ana the vessel has not called during the previous six weeks at any of the Ports mentioned above, the Master need not communicate with the Port Health Authority in the manner described above, unless directed to do so by a Customs Officer. NOTE - (a) Where a foreign-going ship comes to a Port in the United Kingdom from a Foreign Port and makes a Declaration of Health, and thereafter within six weeks calls at another Port in England or Wales in completion of her voyage, the Master shall report on arrival to the Customs Officer or Officer of the Port Health Authority, whichever first boards the ship, every case of ilness (being a case which, if he were making a Declaration of Health, he would be required to include in the Declaration) which has occurred on the ship since the making of the Declaration and has not already been reported. (b) Article 16(1) of the Regulations states:- "Where a ship arrives from a Foreign Port no person other than a Pilot, a Customs Officer, an Immigration Officer, or a person acting in the execution of these Regulations shall, without the permission of the Medical Officer or other authorised Officer of a Port Health Authority, board or leave the ship until it is free from control under these Regulations, and the Master shall take all steps necessary to secure compliance with this provision". M.T.MORGAN Medical Officer of Health. Port of London. * Name of ship as one word. Time on 2k hour clock. The present practice at Gravesend is that every vessel from 'foreign' is hailed by His Majesty's Customs. When a ship is boarded by one of your Medical Officers, he collects th° Declaration of Health. She Customs Officers take the forms from the ships which are not medical inspected and the Boarding Medical Officer collects them daily, usually first thing in the morning when he makes up the list of vessels that have arrived during his 2k hour period of duty. The days batch of forms are then posted to the Central Office together with the Medical Officer's other records and reports. At Sheerness the Declarations of Health are collected by the Medical Officer or the Customs and forwarded by the former with his weekly report. Boarding of Vessels on Arrival - The Port Health Authority maintain at Gravesend a hulk, the "HYGEIA" on which the Boarding Medical Officers live during their tour of duty. The Boarding launch "HOWARD DEIGHTON", which has an ambulance room on deck, lies alongside the "Hygeia". There are three Boarding Medical Officers and three crews for the launch, each having 2k hours afloat and i|8 hours ashore. Ships are boarded at any time of the day or night, as soon as they arrive off Gravesend. The "Hygeia" is connected by an underwater cable to the telephone cables ashore and in accordance with the requirements set out in the Declaration of Health, wireless messages sent from an incoming vessel are picked up by the North Foreland Radio Station and transmitted by land cable to the "Hygeia". (10) The Customs also maintain a launch constantly on duty in this Reach of the River, and it is here also that the deep sea pilot hands over to the river pilot. Thus all three services are in close touch with one another. When the boarding launch is undergoing overhaul or is, by any other reason temporarily out of commission, the Medical Officer boards from the Customs launch, by courtesy of His Majesty's Customs. During this period an up-river launch is sent to Gravesend to enable the Sanitary Inspector on the lower river district to carry out his duties and remove any case of infectious sickness to hospital. During the year your Worshipful Committee has had under consideration the purchase of an additional launch for duty on the Gravesend Station, such a launch to be capable of replacing the "Howard Deighton" while out of commission and thus avoiding the necessity of sending an up-river launch to Gravesend. At other times this launch would be available to the Inspector on the lower river and Gravesend districts. Reference is made above to the use of the Customs launch for boarding by the Medical Officer but although the Customs are most generous and courteous in giving every possible facility, their primary duty is to hail and grant pratique to every incoming vessel from 'foreign', consequently they frequently cannot stand by while the Boarding Medical Officer inspects a number of passengers and a large crew or carefully examines cases of sickness which may be of an infectious nature. It is, therefore, obviously desirable that the Medical Officer should always have his own launch so that he can have time to do his work thoroughly without feeling that he is delaying the Customs Officers and making it difficult for them to carry out their own duties. Notifications to the Authority of inward vessels requiring medical attention - Arrangements are in force by which the General Post Office telephone direct to the Medical Officer on duty on the "Hygeia" all messages received by the North Foreland Radio Station from vessels in accordance with the instructions on the Declaration of Health. There is always a Medical Officer on duty, a launch available and,up to the time of re-opening Denton Hospital for the reception of cases, arrangements were made for infectious cases to be admitted to hospital at Grays Thurrock and Colchester. Occasionally a vessel voluntarily sends a full Quarantine Message in code, which is deciphered by the Medical Officer from Volume II (Radio) of the International Code of Signals, but practically all messages are received direct from the ships, but when some serious infectious sickness has occurred on board, advance information is received from the Ministry of Health through the Information Bureau of the International Health Office. Ships requiring medical attention are required to fly the flag signal LIM during the day and to flash "Q" on their morse lamp by night when approaching Gravesend, both signals meaning "Medical Officer required". Mooring Stations designated under Article 10 - Owing to enemy action certain mooring stations designated by the port of London Authority were no longer in existance. During the year, however, and after correspondence with the Port of London Authority and the Waterguard Superintendent of His Majesty's Customs and Excise the following Mooring Stations were adopted:- (11) MOORING STATIONS. Appointed by the Meddical Officer of Health, Port of London under Article 10(1) and (2) of the Port Sanitary Regulations, 1933. * Destination of Ships. Under Article 10 (1) Under Article 10 (2) London and St.Katharine Dock. East India Dock. Regent's Canal Dock. Riverside Wharves and Creeks. The nearest available river moorings by arrangement with the Harbour Authority. Surrey Commercial Dock. Quebec Dock Buoys West India Dock Millwall Dock. Mark Lane Buoys Millwall Dock. Royal Victoria Dock. Mudfield Quay,South Side. Royal Albert Dock. No. 1 Berth, R.A.Dk. Basin. Gravesend Reach. King George V.Dock. No.1 Berth (lay-bye) Tilbury Docks. The most suitable quay berth available. River Buoys, e. g., Charlton Buoys. The buoys at which the vessel is moored. Dry Docks. The dry dock in which the vessel is lying. Thameshaven Holehaven & oilTankers. Canvey. Place of mooring, loading or discharge. As under Article 10(1) -do- other ships. North side of river opposite Jetties. -do- Chapmans Anchorage. Place of mooring, loading or discharge. -do- Southend and Leigh. -do- Gravesend Reach. Sheerness Ridham Oil Chatham Tankers. Rochester etc. -do- As under Article 1 0( 1) -do- other ships. -do- Garrison Point. Particulars of any Standing Exemptions from the provisions of Article 1U. No standing exemptions have been made in regard to ships proceeding above Gravesend but the question of exemption for certain vessels, particularly "oil tankers" proceeding up the River Medway and to Thameshaven, was the subject of correspondence with the Waterguard Superintendent of His Majesty's Customs and Excise, resulting in the following arrangements:-. (12) HEALTH REGULATIONS (Customs Code Vol.U Part 4). PORT OF LONDON Procedure to be followed for SHIPS PROCEEDING UP RIVER TO GRAVESEND AREA OR ABOVE. The list of infected areas (Customs Code Vol.4 Pt.4 para.3) referred to as the "listed areas" below, is given on page 4 of the London Declaration of Health Form. Glassification of ship C.C. Vol.4.Pt. 4. paras. 5& 6. Answere given to questions on the Declaration of Health Form. If vessel has come from a "listed area" within six weeks of her arrival in London. Customs Procedure. (1) All "foreign going" ships other than Tankers. All in the negative. No. Issue Certificate of Pratique. (2) -do- If any are in the affirmative or Yes. (a)lnform the Master that he:- (i)must not allow any unauthorised person to leave the ship without the Medical Officer's permission. (ii)should not proceed beyond Gravesend Reach without the Medical Officer's consent. (iii)by day immediately hoist LIM flag signals or by night flash "Q" signal to Hygeia. (b) Leave full Certificate of Pratique under cover addressed to Medical Officer of Health who will issue it in due course (see footnote (ii) >. (c) In the most expeditious manner possible take any necessary action to ensure that the Medical Officer is cognisant of the vessel's arrival. (3)"Foreign going" ships. Tankers, All in the negative. Can be disregarded. Issue Certificate of Pratique. (4) -do- If any are in the affirmative. Can be disregarded. As in the case of ships at (2) above. (5) Home Trade If a written Declaration of Health is taken and any answered in the affirmative. As in the case of ships at (2) above. Footnote (i) From the heading of Col.3 it will be seen that the fact that a ship has come from a "listed area" before six weeks of her arrival here can also be disregarded. Footnote (ii) If the Medical Officer of Health detains the vessel he . will not issue the Pratique Certificate but return it at once to the Preventive Officer who will then issue to the Master a Modified Certificate of Pratique. Custom House, London, B.C.3. (Sgd) C.R. PURSER Waterguard Superintendent. HEALTH REGULATIONS (Customs Code Vol.4.Part 4.) PORT OF LONDON Procedure to be followed for ships at:THAMESHAVEN. HOLEHAVEN. CANVEY. CHAPMAN3 ANCHORAGE.SOUTHEND and LEIGH. The list of infected areas (Customs Code Vol.4.Pt.4, para 3) referred to as the "listed areas" below, is shown on page 4 of the London Declaration of Health Form. Glassificat ion of ship (C.C. Vol.4.Pt.4. paras.5 & 6. Answers given to questions on Declaration of Health Form. If vessel has come from a "listed area" within six weeks of her arrival in London. Customs Procedure. (1) All "foreigngoing ships other than T ankers. All in the negative. No. Issue Certificate of Pratique. (2) -do- If any are in the affirmative. Yes. (a)Inform the Master that he is not to allow any unauthorised person to leave the ship without the Medical Officer's permission. (b)lssue modified pratique and allow vessel to proceed to her place of mooring, loading or discharge.(see footnote (i). (c)ln the most expeditious manner possible notify the Medical Officer of Health on the Hygeia. Telephone Gravesend 325 (see footnote (ii) (3)"Fore igngoing" ships. Tankers. All in the negative. Can be disregarded. Issue Certificate of Prat ique. (4) -do- If any are in the affirmative. Can be disregarded. As in the case of ships at (2) above. (5) Home Trade Ships. If a written Declaration of Health is taken and any answered in the affirmative. As in the case of ships at (2) above. Footnote:-(i) A full "Qertificate of Pratique" is to be left under cover on board addressed to the Medical Officer of Health who will issue in due course. (ii) Should any difficulty arise in contacting the Hygeia the message is to be passed via Gravesend Custom House, telephone Gravesend 1234. From the heading of Col.3 it will be seen that the fact that a ship has come from a "listed" area before six weeks of her arrival here can also be disregarded. Custom House, London, E.C.3. (Sgd)C.R.PURSER. Waterguard Superintendent. (14) Assistant Superintendent,Gravesend. Chief Preventive Officer, Sheerness. Preventive Officers-Rochester,Chatham Dockyard and Ridham Dock. HEALTH REGULATIONS (Customs Code Vol.4.Pt.4.) PORT OF LONDON SHEERNESS PROCEDURE. 1. The list of infected areas, referred to as the "listed areas" below, (Customs Code,Vol.4.Part 4,para 3) is given on page 4 of the London Declaration of Health Form. 2. The Medical Officer of Health,Port of London Health Authority, requests the application of the following procedure as from the 1st,March,1947. Classification of ship (C.C, Vol.4.Pt.4. paras. 5 & 6. Answers given to questions on Declaration of Health form. If vessel has come from a "listed area" within six weeks of her arrival at Sheerness, Customs Procedure. (1) All foreign going ships other than Tankers. All in the negative. No. Issue Certificate of Pratique. (2) -do- If any are in the affirmative, or Yes. Inform the Master that he is not to allow any unauthorised person to leave the ship without the Medical Officer' permission. Issue Modified Pratique and allow vessel to proceed to her berth. In the most expeditious manner possible notify Dr. Madwar in the case of ships berthing at Sheerness or Dr.'Murray in the case of ships proceeding direct to Rochester. (3) Foreigngoing shipsTankers. Are all in the negative. Can be disregarded. Issue Certificate of Pratique. (4) -do- If any are in the affirmative. Can be disregarded. As in the case of ships at (2) above. (5) Home Trade Ships. If a written Declaration of Health is taken and any answer is in the affirmative. As in the case of ships at (2) above. From the heading of Column 3 it will be seen that the fact that a ship has come from a "listed" area before six weeks of her arrival here can also be disregarded. As regards ships shown at (2), (4) & (5) it will facilitate matters if a full Certificate of Pratique is left under cover on board addressed to the Doctor for him to hand to the Master in due course. Custom House, London,E.C. 3. (Sga) C.R,PURSER. ' Waterguard SupermtendBBt. (15) Experience of working Article 16 - (1) As ships are cleared in the River immediately on arrival, no difficulty has been experienced in preventing the embarkation or disembarkation of unauthorised persons. (2) When a ship arrives which has on board a case of one of the major infectious diseases or on which such a case has died or has been landed abroad within the incubation period of the particular disease, it is the practice to regard every person on board as a contact and accordingly to arrange for his observation or surveillance. Those persons intending to leave the ship must give their names and addresses before leaving and this is done by issuing such persons with a specially prepared double post-card, on one half of which he gives full details of his name and the address to which he is proceeding immediately on disembarkation and the other half he is asked to keep and use only should he change his address during a specified period. This half of the card is on the "Business Reply Card" system so that the person concerned does not have to stamp it. What, if any, arrangements have been made for;- (a) Premises and waiting rooms for medical examinations- Medical examinations are usually carried out on board ship but there are rooms available for the medical inspection of Aliens on the Tilbury Landing Stage. (b) Cleansing and disinfection of 3hips, persons and clothing and other articles. Disinfection of infected quarters is usually carried out by the Sanitary Inspector in whose area the vessel berths. Should,however, the space requiring disinfection be large a private firm is employed who carries out the disinfection under the supervision of the Sanitary Inspector. Although Denton Hospital was closed for a part of the year for the reception of cases, the Disinfecting Station, containing a Washington Lyons Steam Disinfector has been available for the disinfection of clothing, bedding etc. (c) Premises for the temporary accommodation of persons for whom such accommodation is required for the purposes of the Regulations - So far it has not been necessary to make special provision on a large scale, and if the necessity did arise the ship would be detained until temporary accommodation ashore had been found. (d) Hospital accommodation available for Plague, Cholera, Yellow Fever, Smallpox and other infectious diseases - During the closure of Denton Hospital arrangements were made with Medical Officers of Health of the Essex County and Grays Thurrock Rural District Council for the reception of cases of infectious disease. The Isolation Hospital at Denton was re-opened for the reception of cases on the 1 8th August, 1947. (e) Ambulance Transport - The launch "Howard Deighton" used by the Medical Officers as a Boarding launch is fitted with an ambulance room on deck with accommodation for four stretcher cases or eight walking cases. The middle river launch the "Alfred Robertson" has a fairly spacious after cabin in which a patient could be carried but would only be used as such should the "Howard Deighton" be out of commission. (16) Arrangements have gone forward for the building of another launch to work in co-operation with the "Howard Deighton" and it is hoped that the building of this launch will be commenced early in 1948. Since the opening of the Hospital the motor road ambulance has done invaluable service in the speedy removal of cases of infectious diseases, particularly from vessel lying in the London Docks. (f) Supervision of contacts - The method of dealing with contacts who are leaving a ship has been (described on page 1 6. Arrangements for the Bacteriological or Pathological Examination of Rats. The bacteriological examination of rats for plague is carried out in the laboratories of the Seamen's Hospital, Greenwich. Specimens of rats caught in shore premises or killed on board ship by fumigation are collected by the Rodent Officers and conveyed to the Seamen's Hospital in special tin boxes. Each rat has attached to its hind leg a small label on which is written a letter combination indicating the dock where the rat was obtained and a number. In the case of a ship rat, the name of the ship. The daily returns of the Rodent Officers indicate clearly this letter-number combination, with a further note showing exactly where and how each rat was obtained. Should a rat be found to be plague infected the laboratory would at once notify the Medical Officer, quoting the letter and number on the label attached to the rat in question and a reference to the Rodent Officer's report would indicate exactly where plague preventive measures should be instituted. Arrangements made for other Bacteriological and Pathological Examinations. All bacteriological and pathological examinations are carried out at the laboratories of the Seamen's Hospital, Greenwich. Arrangements for the diagnosis and treatment of Venereal Diseases among Sailors, under International arrangements. The Venereal Diseases are not compulsorily notifiable but efforts are made to bring to the notice of all seamen using the Port the facilities for free treatment under the Brussels Agreement. When the Medical Officers board ships on arrival they always snquire whether there are any cases of venereal disease on board and should there be a case the infected person's attention is drawn to the importance of obtaining skilled treatment as soon as possible and to acquaint him with the situation of the Clinic nearest the ship's berth and the time at which cases may attend. Similarly the Sanitary Inspectors have a supply of pamphlets listing the names and addresses of places of treatment together with the days and times such treatment is available and in addition the Port Health Authority has printed this notice in 21 different languages and these notices are pasted up st vantage points throughout the whole dock area. Arrangements for the interment of the dead. When cases of infectious disease die in the Port Health Hospital, arrangements for interment are made with an Undertaker in Gravesend. (17) TABLE C. Cases of Infectious Sickness landed from Vessels. DISEASE. Number of cases during the year. Number of Vessels concerned. Average Number of cases for previous 5 years. Passengers. Crew. Pulmonary Tuberculosis. 4. 20. 24. 10.0 Malaria - 12. 8. 16.0 8. 2. 8. 2.8 Chickenpox - 9. 7. 6.0 Dysentery - 9. 6, 1. 8 Pneumonia 3. 7. 9. 2.0 German Measles 1. 2. 2. 0. 8 Diphtheria - 4. 4. 4.4 Cerebro Spinal Memingitis — 1 . 1. - Poliomyelitis - 1 . 1. 0.4 Mumps 1. - 1. 2.4 Enteric Fever 1. 1 . 2. 0. 8 Scarlet Fever - 10. 1. 3.4 TABLE D. Cases of Infectious Sickness occurring on vessels during the voyage, but disposed of prior to arrival. DISEASE Number of cases during the year. Number of Vessels concerned. Average Number of cases for previous 5 years Passengers. Crew. Pulmonary Tuberculosis 1. 2. 3. 1.4 Measles 16. - 8. 1.6 Dysentery 14. 3. 3. 0.6 Chickenpox 8. 4. 9. 7.8 Mumps 3. - 3. 1.6 Pneumonis 4. 5. 7. 0.4 Smallpox - 2. 2. 1.4 German Measles 2. - 2. 1.4 Malaria 2. 12. 7. 110.4 Enteric Fever - 3. 2. 2.0 Diphtheria - 1. 1 . 0.8 Poliomyelitis 2. - 1 . - Polioencephalitis 1. - 1 . - Cerebro Spinal Memingitis 1 . - 1 . - Erysipelass - 1. 1 . - (18) CHOLERA IN EGYPT, During the latter part of the year a severe Cholera epidemic broke out in Egypt. While it was extremely unlikely that any actual cases of cholera would be introduced into the United Kingdom by ships arriving from Egyptian ports, it was, nevertheless, deemed advisable, as a measure of safety, to require that all ships that had taken on water in Egypt on their voyage home should chlorinate all such water, then to pump out the tanks containing such water and to have the tanks cleansed. Any fresh water taken on in these tanks, no matter what the source, should be chlorinated before use. The bilges were required to be pumped dry. To this end the Pilotage Department of Trinity House was requested to collaborate by distributing to their Pilots the following notice with an instruction that the Pilots should hand a copy of the notice to the Masters of all ships arriving from Egypt To the Master s. s. You are hereby required forthwith to chlorinate all water that has been taken on in any port in Egypt, then to pump out the tanks containing such water and to have the tanks cleansed. Any fresh water taken on in these tanks should be chlorinated before use. The bilges should also be pumped dry. (Sgd) M.T.MORGAN. Medical Officer of Health, Port of London. In addition it was deemed advisable that any fresh fish, shellfish, fruit and vegetables taken on in Egypt should be destroyed in the ship's furnace and an instruction was sent to your Boarding Medical Officers to seize any such material on arrival of a ship off Gravesend and supervise its destruction. The action to be taken on the arrival of vessels in dock was laid down in the following memorandum which was circulated to all your Sanitary Inspectors;- "A supply of liquid Chloros (Sodium Hypochlorite solution) has been obtained from the Metropolitan Water Board for the chlorination of ship's tanks that have taken on water in an Egyptian port. Arrangements have been made for the dispatch of one container (one gallon size) to the East and West India Dock Office, the Surrey Dock Office and the Tilbury Dock Office. These containers should be kept in a cool dark place. The procedure to follow is as described hereunder - (1) Instructions have been given, through the Pilots, to all ships that have called at an Egyptian port and have taken on water there, to chlorinate the tanks concerned as soon as they receive the instructions at the mouth of the Thames, and then to empty the tanks forthwith before they proceed up the Thames; after emptying, the tanks to be flushed out. (2) As soon as the ship arrives in dock and takes on fresh water in these tanks, this water is to be chlorinated with Chloros solution under the supervision of the Sanitary Inspector, who must also see that the tank has been flushed out before refilling. (3) To chlorinate the tanks, proceed as follows - Each individual tank must receive an amount of Chloros solution calculated for the amount of water to be taken on in the tank - 1-oz. of Chloros solution is required for each 1,000 gallons of water. 1,000 gallons = hi tons. (19) . (4) Instructions have also been given that all fresh fruit, vegetables and fresh fish that has been taken on in Egypt, remaining on the ship on arrival, is to be destroyed in the ship's furnace. If this has not been down River, it must be done in the docks and must be strictly carried out. Meat and canned goods need not be touched." By December the incidence of cholera in Egypt had fallen to almost nothing and the instructions for the chlorination of water and the cleansing of water tanks were cancelled.E was, however, decided that the requirement to destroy fresh stores taken on in Egypt should continue until further notice. SUSPECTED CASE OP SMALLPOX - s.s."3TANCLEBVE". On Saturday, February 15th, the above-mentioned vessel arrived off Gravesend at 0840 hours and was boarded by the Boarding Medical Officer on Duty. The Master in his Declaration of Health considered he had a case of chickenpox on board. The vessel's ports of call were as follows Auckland 4.12.46; Lyttleton 16.12.46; Panama Canal 16.1.47; Jamaica 20.1.47; Newport Ne#s 28.1.47; The vessel had been away from the United Kingdom for two years. History of Case. The patient was an assistant steward aged 19. He took ill on 10.2.47 with backache and headache. On 11.2.47 the backache continued and his temperature was 101°. On 12.2.147 a rash commenced on his face, irritable, temperature 1000. 13.2.47 rash generalised, temperature normal. 14.2.47 rash vesicular, temperature 100°, backache gone. Action taken on Arrival. On arrival the patient had a terrperature of 99°. His general condition was good. He had a generalised pustular rash, heaviest on face. There was one lesion in each palm and one on the sole of his right foot. The lesions were neither "shotty" nor superficial but had been scratched by the patient, who also had acne, which complicated the 'picture'. No definite cropping had occurred although lesions were not all at the same stage. The patient had one small vaccination scar on his left arm, stated to be about two years old - the only occasion on which he had been vaccinated. The patient had not been isolated, the ship's hospital being in use to accommodate 5 Distressed British Seamen. He was removed to the Port Isolation Hospital at Denton together with two immediate contacts as a case of suspected smallpox. All the personnel on board (43 crew and 5 D.B.S) were vaccinated, the contents of the infected quarters removed with the patient for disinfection and the cabin was fumigated with formalin. The names and addresses of the crew and other persons on board (pilots) were forwarded to the local Medical Officers of Health concerned, with a brief note of the circumstances. On Monday, 17th February, your Medical Officer visited the case and after making a careful examination came to the conclusion that it was not one of smallpox but of chickenpox, there being evidence of chickenpox rather than smallpox distribution with some cropping. However, in view of the Boarding Medical Officer's diagnosis and the action that had been taken in vaccinating the crew, your Medical Officer called in Dr.Periera, who examined the case and said that, in his opinion, it was undoubtedly chickenpox. (20) A further note was therefore sent to the Medical Officers of Health of the districts to which the crew were proceeding informing them that the case of suspected modified smallpox, the contacts of which were in their area, was now regarded as a case of chickenpox. A specimen of blood from the patient was sent for examination to ascertain whether there were any immune bodies. No further action seemed necessary. SCABIES ORDER. 1941. Circular 180/47 dated 29th December, 1947. from the Ministry of Health directed that the Emergency Laws (Transitional Provisions) Act,1946, and the Emergency Laws (Miscellaneous Provisions) Act, 1947, Regulations 33A of the Defence (General) Regulations, 1939, would expire on 31st December, 1947 and that the Scabies Order, 1941 which was made under that Regulation, would accordingly cease to be operative after that date. The Circular added that "the time has come to revert to reliance on normal statutory powers, as contained in the Public Health Acts, for d ealing with verminous conditions, and the Minister, is confident that Authorities will, continue, as before the war, to do all they can in tracing the existence of such conditions and in taking appropriate measures within those powers to remedy them". V. MEASURES AGAINST RODENTS. 1. Steps taken for the detection of Rodent Plague- The Port Health Authority employs 12 Rodent Officers working in conjunction with and under the guidance of the Sanitary Inspectors. The Rodent Officers' first duty is the examination of such ships in his area as are due for inspection under Article 28 of the International Sanitary Convention relating to the granting of Deratisation and Deratisation Exemption Certificates. His second duty is to visit ships arriving in his district, to search for dead rats, paying particular attention to vessels which have arrived from plague infected ports, to visit such vessels during the discharge of cargo and, if possible, obtain specimens of any rats on board for bacteriological examination. The existence of rodent plague on board should thus be detected at the earliest possible moment. The Rodent Officers' third duty is the examination of shore premises for signs of rat infestation or rat plague, paying particular attention to premises adjoining the berths of vessels from plague infected ports. Specimens of the shore rat population are regularly examined bacteriologically. In 1941 the Port Health Authority instituted a Rodent Control Scheme in all the docks and premises of the Port of London Authority, on behalf of that Authority, and in the premises of the tenants of the Authority on behalf of the occupiers. This scheme, in its early days, relied principally on trapping but with experience and the application of a more up-to-date knowledge of the habits of rats, new and scientific methods of poisoning gradually took the place of trapping, the latter now only being used to clear up residual rats, if any, which have escaped a major poison operation. The work done under the Rodent Control scheme is the subject of separate reports. (21) 2. Measures taken to prevent the passage of rats between ships and shore- The Port of London Authority have made bye-laws requiring the master of every ship to cause all ropes and mooring tackle, to be fitted with guards, to prevent rats from passing from ship to shore. The bve-laws also prescribe that, when the discharge or loading of cargo is not actually proceeding, one gangway, whitened for a length of 10 feet at the end next the vessel, may be used as a communication between the ship and the shore. 3. Methods of Deratisation of - (a) SHIPS. (i) The burning of sulphur at the rate of 3-lbs. per 1,000 cubic feet of space for a period of not less than 6 hours. (ii) The generation of hydrocyanic acid gas by various methods. For the destruction of rats a concentration of 0.2 per cent of HON is required with a minimum exposure of 2 hours. If the fumigation is for the destruction of insect life, bed bugs, cockroaches etc., two or three times the concentration is employed and the exposure increased up to twelve or even twenty-four hours, according to the time available. (iii) Trapping. All vessels from plague infected ports are required to have traps set on board in order that specimens may, if possible, be obtained for bacteriological examination. All other vessels, on which there is evidence of rats, but not of such a number as to justify a demand for fumigation, are required to carry out trapping and this may be done, either by private firms approved for the work, or by the staff of the Port Health Authority. (b) PREMISES IN THE VICINITY OF THE DOCKS AND QUAYS. This is now done under the Rodent Control Scheme referred to else where in this Report. 4. Measures taken for the detection of rat prevalence in ships and on shore. Examination by Inspectors and Rodent Officers, as already described. 5. Rat-proofing. (a) To what extent are Docks, Wharves, Warehouses etc.,rat-proof? During the war years nothing was done to render the dock premises rat-proof, indeed many of the wharves and warehouses suffered severely from enemy action but when the rebuilding of these premises is possible, every effort will be made to see that the recommendations made before the war are carried into effect. (b)Action taken to extend rat-proofing ( i) in Ships (ii) on shore. This action has remained in abeyance during the war period but will be actively pursued as soon as the post-war conditions make this possible. (22) RATS DESTROYED DURING 1947. TABLE E. (1) ON VESSELS. Number of Jan Feb Mch Apl May Jne Jly Aug Sep Oct Nov Dec Total in year. Black Rats 329 450 512 506 457 194 465 507 234 316 184 322 4,476. Brown Rats - - - - - - - - - - - - - Species not recorded - - - - - - - - - - - - - Rats examinee 1 85 38 74 91 63 75 66 45 59 60 50 54 760. Rats infected with plague - - - - - - - - - - - - - TABLE F. (2) IN DOCK, QUAYS, WHARVES AND WAREHOUSES. Number of Jan Feb Mch Apl May Jne Jly Aug Sep Oct Nov Dec Total in year. Black Rats 334 145 228 1 80 238 94 274 178 133 238 1 67 183 2,392. Brown Rats 168 1 06 108 130 166 106 138 114 126 174 170 164 1,670. Species not recorded - - - - - - - - - - - - - Rats examined 16 1 37 23 34 12 16 17 14 29 25 25 249 Rats infected with plague - - - - - - - - - - - - - TABLE G. MEASURES OP RAT DESTRUCTION ON PLAGUE "INFECTED" OR "SUSPECTED" VESSELS OR VESSELS PROM PLAGUE INFECTED PORTS ARRIVING IN THE PORT DURING THE YEAR. Total of such vessels Arriving Number of Such vessels fumigated by So2 No. of Rats Killed Number of such vessels Fumigated by HCN. No. of Rats Killed No. of such vessels on which trad- ding, poison. ing rte was Employed No. of Rats Killed No. of such yessels on which measures of rat destruetion were not garried out. 1,311 — — 113 2,572 (333 mice). 306 No record 1,005. TABLE H. DERATISATION CERTIFICATES AND DERATISATION EXEMPTION CERTIFICATES ISSUED DURING THE YEAR. NET TONNAGE No.OF SHIPS Number of Deratisaton Certificates issued Number of deratisation exemption Certificates issued Total certifictes issued After Fumioation with After trapping poisoining etc. Total HCN SO2 HCN and SO2 ships up to 300 tons. 112 4 — - - 4 108 112 „from 301 to 1000 tons. IZI 7 - - - 7 114 121 „ „ 1001 to 3000 tons 121 28 - - - - 93 121 " " 3,ooi To 1O.OOO tons. 391 108 - - - 108 283 391 „ over 10000 tons 19 7 - — — 7 12 19 Totals 764 154 - - - 154 610 764 (23) VI. HYGIENE OF CREWS' SPACES. TABLE J. CLASSIFICATION OF NUISANCES. Nationality of Vessel. Number inspected during the year. Defects of Original construction. Structural defects through wear and tear. Dirt, vermin and other conditions prejudicial to health. BRITISH 6,543. 166. 439. 951. OTHER NATIONS 785. 10. 9. 76. TOTALS. 7,328. 176. 448 1,027. The routine inspection of ships entering the Port to ascertain the hygiene and sanitation of spaces occupied by crews and passengers has continued to be carried out by the Port Health Inspectors. Table 'J' shows a summarised classification of the nuisances discovered and Appendix VII gives details of the types of nuisances dealt with. Defects are dealt with in two ways depending on whether their remedy would require a structural alteration or not. In the latter case direct contact is made with the owners or agents who are requested to remedy or improve minor defects along suggested lines. If the remedy of a defect would require a structural alteration, attention of the Inspectors of the Ministry of Transport is drawn to the matter and it rests with the Ministry to decide whether the owners should be called upon to remedy the defect, having regard to its nature and the amount of work involved. It is satisfactory to record that it is very seldom that owners fail to comply with requests to improve the accommodation and the sanitary condition of their vessels and in no instance has it been necessary to issue an Order. While certain vessels still fall far below modern standards in their accommodation for crews they are, for the most part, old and it will not be long before they will be replaced by modern ships. Ships built during and since the war show a vast improvement in crews accommodation and in many cases leave nothing to be desired save the proper care and maintenance of the accommodation by the crews themselves. It is to be regretted that, despite the powers now given to masters to secure a proper observance of hygiene and cleanliness, crew accommodation is often found in a filthy condition and showing obvious evidence of neglect. This is more frequently seen in British than in foreign owned vessels and is a reflection on the attitude of certain crews towards their living quarters. Nevertheless, despite these isolated instances, the maintenance of crew accommodation has generally shown a great improvement all round, PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS.1937. Circular No.110/47 dated 30th June,1947, from the Ministry of Health authorises the recognition of an Official /Certificate (24) Certificate of the Municipality of Guatemala City in respect of meat and meat products. The Certificate is in the form of a stamp which will be impressed upon the meat or package containing the meat or meat product and will apply only if the stamp is clearly impressed on the meat or the container as the case may be. Circular No.141/47 dated 10th September, 1947, from the Ministry of Health authorises the recognition of an Official Certificate of the United States of America in respect of meat and meat products. The Official Certificate is in the form of a label and recognition will apply only if the label is securely affixed to the meat or to the package containing the meat product and if the label has not in any other cirumcstances or on any other occasion been used as an Official Certificate. This label supercedes that referred to in the Notice published in the London Gazette of the 6th August, 1937. Circular No.157/47 dated 29th October, 1947. issued by the Ministry of Health, reads as follows:- "I am directed by the Minister of Health to refer to PartlX of the Schedule to Circular 1675, dated 24th March, 1938, and to state that he has caused to be inserted in the London Gazette of the 10th October, 1947, a Notice revoking his Notice published in the London Gazette of the 15th day of March, 1938, in so far as it relates to the recognition of an Official Certificate in respect of the importation of meat and meat products from the International Settlement, Shanghai, into England and Wales". The Notice reads as follows "The Minister of Health in pursuance of his powers under Article 2(2) of the above-mentioned Regulations hereby gives notice that his notice published in the London Gazette of the 15th day of March, 1938, in so far as it relates to the recognition of an Official Certificate for the purposes of the said Regulations in respect of the importation of meat and meat products from the International Settlement, Shanghai, into Englard and Wales, is hereby revoked". VII. FOOD INSPECTION, The total amount of foodstuffs seized and condemned for human consumption and either reconditioned or disposed of for animal consumption or for industrial purposes under guarantee or destroyed was 1,094 tons as compared with 630 tons in 1946 and 720 tons in 1945. The following is a summary showing the method of disposal of the foodstuffs seized:- Method of Disposal. Weight. Approximate percentage of total Tons. cwts. qrs. lbs. CATTLE FOOD. 223. 15. - 19. 20,44 BOILING DOWN. 86. 17. 3. 11. 7.94. RECONDITIONING — 19. - 2. 0,08. REFINING 58. 8. 2. 2. 5.30. INDUSTRIAL 9. 14. - 4. 0.88. RE-EXPORT 1. — 3. - 0,09. BURIED 631. 12. 2. 20. 57,70. BURNT 82. 2. 1. 4. 7.50. Total 1,094. 10. 1. 6. 99.93. (25) MUTTON AFFECTED WITH GASEOUS LYMPHADENITIS. During August 1946 your Food Inspector on the Royal Docks called the attention of your Medical Officer to a consignment of Patagonian mutton and lamb (some 800 tons)due to arrive in the dock and that against the entry of this consignment in the ship's manifest appeared the word "caseous". Your Medical Officer acting on this information immediately informed the Minsitry of Food that he had instructed his Officer to put an immediate stop on the consignment pending further information as to why the term "caseous" had been mentioned in the manifest and that if the intention was thereby to declare that this consignment contains mutton infected with Caseous Lymphadenitis and the destination of the meat. Your Medical Officer subsequently made a personal examination of a small sample of this consignment in company with the Ministry of Food representatives and it was decided that the whole consignment should be discharged into a Dock Cold Store, there to remain until a decision as to its disposal was reached. A further examination of 517 carcases of mutton conducted at the request of the Ministry of Food and in the presence of their Representative gave the following results Diseased 41; Glands removed 405; Sound It was subsequently decided that this consignment should be re-exported to the Continent. Again on the 13th November, 1946, your Food Inspector reported the arrival of another consignment of 565 tons of mutton, shipped in Patagonia and manifested as "European Quality". This gave rise to a suspicion that this consignment also was infected with caseous lymphadenitis. A subsequent examination of 100 carcases gave the following results:- Diseased 5; Glands removed 50; Sound 45. Here again it was mutually agreed that the consignment should be re-exported to the Continent. In January of this year your Medical Officer received a communication from the Ministry of Food, Meat and Livestock Division, informing him that, although it was the Ministry's intention to despatch the whole of the two above-mentioned consignments to the Continent, because of a hitch somewhere, the Ministry found itself with a balance in hand of 6,364 carcases in the Dock Store, and the question of the eventual handling of these carcases in England had arisen. The Ministry referred to the results of the test examinations carried out in both shipments, when definite lesions of disease were found to be few in number and minor in degree and asked your Medical Officer favourably to consider releasing the balance of carcases for manufacture for human food, it being clearly understood that by so doing your Medical Officer should in no way prejudice any action he might care to take with future consignments. After further consultation with the Ministry of Food, your Medical Officer agreed to release these carcases for manufacturing purposes under the following conditions:- 1. That the meat will be employed only for manufacturing purposes and will not, in any circumstances, be delivered direct to the public in its present form,i.e., without being cooked during the process of manufacture. (26) 2. The meat shall only be released to reputable manufacturers to be nominated by the Ministry of Food. 3. The Medical Officers of Health of the districts in which such manufacturers' premises are situated give their consent to receiving the meat into their area and to deal with it under their supervision. 4. The manufacturers ther.selves to furnish your Medical Officer with a signed guarantee that the meat shall be removed to their premises and that the local Medical Officer of Health shall be immediately notified when the goods arrive at such premises; none of the material shall be removed from such premises without the permission of the local Medical Officer of Health; and that the material shall be used for manufacturing purposes only, involving the boiling of the meat at some stage during the processing. These conditions were accepted and the Ministry of Food subsequently informed your Medical Officer of the names and addresses of five reputable manufacturers who were prepared to take the meat. The local Medical Officers and the manufacturers were communicated with as indicated above and as soon as the necessary agreement was received from each, your Medical Officer gave instructions for the meat to be released from the Dock. The carcases were released as follows:- 650 carcases to each of two manufacturers in the City of London area. 2,000 carcases and 650 carcases respectively to two manufacturers in the Borough of Finsbury, and 2,414 carcases to a manufacturer in the Letchworth Urban District Council area. The following is a report made to the Port Health Committee on the subject of "caseous" mutton:- PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1937. Your Worshipful Committee will recollect that your Medical Officer has from time to time drawn your attention to the difficulties that have been experienced for some time past in carrying out the inspection of certain imported foodstuffs, particularly meat, in accordance with the requirements of the Imported Food Regulations and to the fact that much of the meat at present coming into this country took the form of boned meat, often in small pieces, and that, as such, fell within the category of scrap meat, which is 'prohibited meat' under the Regulations. Your Medical Officer, and your Inspectors working under him, have felt it necessary in the present state of shortage of foodstuffs to turn a blind eye to this contravention of the Regulations, particularly if they have been reasonably satisfied that the material is sound and healthy and fit for human consumption and carries the approved certificate of ante and post mortem inspection in the country of origin. Recent consignments of boned mutton and mutton scrap emanating from the Argentine have, however, been found to show evidence of disease and the following is a specific instance. On the 3rd July the "Highland Brigade" arrived with 56o bags of boned mutton, each bag weighing approximately 120-lbs. A proportion of these bags was unloaded overside and dispatched to Nelsons Wharf, Southwark, and a smaller proportion went to a Cold Store in Finsbury, leaving 314 bags in No.6 Cold Store, Royal Albert Dock. (27) Dock. My Inspectors caused 30 of these bags to be de-frosted and made a careful inspection of the contents. They found them to consist of an outside wrapping of larger pieces of mutton and inside a large quantity of smaller pieces averaging about ten to the lb. Evidence of caseous lymphadenitis was found in a certain number of smaller pieces. A stop was put on the whole of the consignment in the Royal Albert Dock and I got into contact with the Medical Officers of Health of Southwark and Finsbury and obtained their agreement to take similar action. I sent a number of samples of the diseased meat direct to the Ministry of Health and said that I proposed to condemn the consignment as unfit for human consumption and to permit its release only for industrial purposes. To this action I obtained the consent of Dr.Lethem, Medical Officer in charge of the Food Division of the Ministry of Health. One of your Inspectors, Mr.Clifford, went to Nelsons Cold Store and there examined portions of the consignment at that store in company with Dr.Stott, the Medical Officer of Health, and Dr.Stott agreed to take the same action. Dr.Blythe Brooke of Finsbury agreed likewise. It was not long before representatives of the Meat and Livestock Division of the Ministry of Food got into contact with me and requested they might be allowed to inspect the material at the Royal Albert Dock. In due course I went to the Royal Albert Dock accompanied by Mr.Grace, F.R.C.V.S., and Mr.Penman, representatives of the Ministry of Food, together with two representatives of Messrs,, Armours, the exporting firm, and we there inspected a further sample of the consignment. Both Mr.Grace and Mr.Penman agreed that the material was diseased but they put up the usual plea that the definition of 'scrap meat' was always in doubt and that provided a small piece of meat could be traced to a particular part of the carcase, then it could not be regarded as 'scrap'; a view which I have always disputed. I was very strongly urged, in view of the extremely serious shortage of fresh meat in this country, to release the material for manufacturing purposes (pies, mince, sausages, etc.) on the strict undertaking that the material would only be sent to firms agreed to by myself, where the strictest supervision could be carried out and where the rejection of any diseased or doubtful pieces of meat would be assured. Seeing that the larger portions of meat were for the most part free from disease and that the total consignment represented a considerable tonnage of meat, I finally consented, under much pressure, to agree to this line of action on the understanding that the smaller portions of material, which in any case were mostly unsuitable for human consumption, would be rejected whether they showed signs of disease or not, and also on the understanding that the Medical Officer of Health of the area to which the meat was going would accept t.he meat into a factory in his area for manufacturing purposes. But I also said that I would report the matter to the Port of London Health Committee and make certain recommendations to the Committee. On the 1st August the "Highland Chieftain" arrived in the Royal Albert Dock with a consignment of 2,554 bags of boned mutton and mutton scrap also from Messrs.Armours, La Plata, and the same action has been taken in respect of this consignment. Your Medical Officer has long been dissatisfied with the facilities that are available, under the conditions of unloading in the docks, for the proper inspection of boneless meat. This meat is invariably imported in large bags or sacks and to carry out a satisfactory inspection requires the defrosting of several of these bags, a process which takes time and means that the consignment, /of which (28) of which the defrosted bags are a sample, must await the results of inspection. The arrival of scrap meat found to be diseased renders the situation more difficult and when the disease is found in what is in any case 'prohibited meat' and pressure by the Ministry of Pood officals is put upon your Medical Officer to release the meat for manufacture, even under strict conditions of supervision, the position becomes well nigh intollerable. Your Medical Officer wonders, therefore, whther the time has not arrived when the Ministry of Pood should be informed that the Port Health Authority propose no longer to carry out any inspection of boned meat under the Imported Pood Regulations either for disease or for condition and to leave any arrangements for inspection of this product entirely to the Ministry itself. The Ministry might also be informed that this decision also arises from the fact that repeated reports have been made to the Pood Division of the Ministry of Health on this subject by your Medical Officer urging that some policy should be formulated by the Ministries concerned in regard to the action to be taken under the Imported Pood Regulations and standards laid down for the acceptance or rejection of these foodstuffs which could be applied with some degree of uniformity in the ports and by the local authorities responsible for the administration of the Imported Pood Regulations. At the present moment there is no policy and but little uniformity of action. A consignment of meat may be distributed on arrival, even in the Port of London, among two or more Authorities, having powers under the Imported Food Regulations and it is by no means certain that the decision to accept or condemn any portion of the consignment will be the same. Since writing this report two consignments of meat have arrived in the Port- (a) 1,585 bags Boneless Mutton have arrived from the River Plate„ Ten bags were examined and abscesses were found in three pieces of the meato This consignment is at present under stop by your Medical Officer who is awaiting an approach from the Ministry of Food as to its disposal. (b) The s.s."TWEED" arrived on the 9th September with the following consignment of "caseous" carcases of mutton;- 69,526 carcases lamb. 84 yearlings. 86,418 carcases mutton. 2,772 bags lamb cuts. 1,068 bags mutton cuts. Owing to the lack of space in the dock stores this meat has been distributed to various stores in the metropolis under "detention" pending a decision as to its disposal. (29) This consignment is not of boned mutton but of carcases of lamb and mutton and a preliminary examination of 350 carcases of Patagonian Mutton and Lambs and River Plate Lambs reveals the following conditions:- Glands Removed Glands in Situ Examined Sound Diseased. Examined Sound Diseased 200 carcases Patagonian Mutton 118 110 8. 82 76 6 50 Patagonian Lambs 34 31 3. 16 16 Nil 100 River Plate Lambs 57 56 1. k3 31 12 350 carcases Mutton & Lamb 209 197 12. 1U1 123 1 8 Percentage diseased 5.74 12.76 Total percentage diseased 8.57 It is to be noted that the carcases showing no evidence of caseous disease are not necessarily free from the disease. In all probability caseous disease was found in the viscera, which were rejected at the time of dressing. It is possible, therefore, that abscesses may be found on cutting into the mutton despite the lack of evidence of the disease on the surface. A conference of the Medical Officers of Health of the .principal ports into which meat is being imported is shortly to be held at the Ministry of Health to discuss standards for the acceptance or rejection of caseous mutton and there is little doubt that the standards will be lowered. There may be some satisfaction in obtaining uniform action even though the standards are to be lowered. But the point your Medical Officer wishes to stress is the difficulty of inspecting boned meat and the pressure put upon him • and his colleagues to accept diseased "scrap" meat. DANGEROUS DRUGS. During the year eight certificates authorising the purchase of scheduled Dangerous Drugs were issued under the Dangerous Drugs (no.3) Regulations, 1923, amending the Dangerous Drugs Regulations, 1921, regulation 15 of which is as follows:- "If a foreign ship in any port in Great Britain requires to obtaina supply of any of the drugs in order to complete the necessary equipment of the ship, the master of the ship is authorised to purchase and be in possession of such quantity of any of the drugs as may be certified by the Medical Officer of Health of the Port where the ship is (or in his absence by the Assistant Medical Officer of Health) to be necessary for the purpose, the quantity not to exceed what is required for the use of the ship until it next reaches its home port. The certificate given by the Medical Officer or Assistant Medical Officer of Health of the Port shall be marked by the supplier with the date of the supply, and shall be retained by him and kept available for inspection". PUBLIC HEALTH ACT. 1936. PART X - CANAL BOATS. On the 19th January, 1948, the Port Medical Officer made a report on the steps taken to carry into effect the provisions of Part X of the Public Health Act, 1936, relating to Canal Boats within the district of the Port Health Authority, during the year /ended (30) ended 31st December, 1947. No Canal Boats were encountered within the district of the Port of London by your Inspectors during the year. No new boats were registered during the year under review, the actual number of Canal Boats on the Register on the 31st December, 1947, being 216. PARROTS (PROHIBITION OF IMPORT) REGULATIONS.1930. Fifty-five parrots etc.,came under the notice of your Officers during the year. Thirty-five Notices were issued in respect of 48 parrots etc. One parrot died on board and the body was sent to the Ministry of Health for examination. Number exported in respect of Notices served 36 Number destroyed (Notice issued to export) 6 Number admitted under Ministry of Health permit 12 Total 54. APPENDIX I. MEDICAL INSPECTION - From 1st January to 31st December, 1947. (a) GRAVESSND. Jan Feb. Mch. Apl. Mar. Jme. Jly. Aug. Sep. Oct. Nov. Dec. Total. Number medically Inspected 141 116 154 135 136 126 132 138 106 95 112 112 1,503 No. of. Passenger 1567 971 2100 2084 1934 6125 9754 5202 3829 2164 980 745 37,455 No.of Crews 51 148 404 469 199 350 670 613 674 360 492 604 5034 Number of Foreign Arrivals 410 344 453 475 512 594 695 683 566 570 503 555 6360 (b) SHEERNESS. Jan Feb. Mch. Apl. May. Jnn. Jly. Aug. Sep Oct. Nov. Dec. Total. Number Medically - - 8 10 14 13 - - - - - - 45 No. of Passengers - - - - - - - - - - - - - No. of Crews - - - - - - - - - - - - - Number of Forign Arrivls. 15 6 10 12 21 26 - - - - - - 89 (31) APPENDIX II. INFECTIOUS DISEASE. Disease. 1930 1939 1940 1941 1942 1943 1944 1945 1946 Mean Annal No. of 10 years ending 31st December 1947 1947. (a)Cases Reported Cholera(including suspected cases) 1 - - - - - - - - 0.1 - Yellow Fever - Do- - - - - - - - - - - - Plague -Do- - - - - - - - - - - - Smallpox 4 .5 1 1 1 - 1 - 5 20 2 Scarlet Fever 16 13 3 1 2 5 4 5 2 6'l 10 Diphtheria 9 13 4 11 5 3 5 5 8 6.8 5 Enteric Fever 36 16 7 1 1 - - 4 9 79 5 Measles. 49 40 9 1 1 1 1 8 11 14.7 26 German Measles 25 34 17 5 2 1 - 2 6 9.7 5 Erysipelas 4 2 1 2 - - - - - 1.0 1 Typhus Fever - - - - - - - 1 - 01 - Tuberclosis- Pulmonary 75 83 19 4 5 12 6 14 21 26.6 27 Other kinds 3 1 - - - - - - - 0.4 - other (incuding) Diseases(chickn pox) 540 388 178 88 179 273 180 115 79 2l2.4 102 Totals 762 595 239 114 196 295 197 154 141 287.6 183 Disease 1938 1939 1940 1941 1942 1943 1944 1945 1946 Mean Annal No. of 10 years ending 31st December 1947 1947. (b) Admitted to Hospital Cholera(Including Suspected cases) - - - - - - - - - - - Yellow Fever -Do- - - - - - - - - - - - Plague -Do- - - - - - - - - - - - Smallpox 2 - - - - - - - - 02 - Typhus Fever - - - - - - - - - - - Scarlet Fever 14 - - - 2 5 4 4 2 3.1 - Diphtheria 5 4 - 9 5 2 4 5 7 4.5 4 Enteric Fever 12 8 1 - 1 - - - - 2.7 2 Measles 28 7 3 - 1 - 1 4 6 6.0 10 Erysipelas 1 - - 2 - - - — - 0.3 - Parotits 4 9 - - - 2 3 1 5 2.5 1 Other (including) Diseases (Cuiken pox) 133 79 52 26 15 16 34 50 43 50.8 60 Dysentery - - 2 - - - - 1 8 2.0 9 Totals 199 107 58 37 24 25 46 68 71 72.1 86 (32) APPENDIX III. HOSPITAL. Number of Gases Admitted 1947. (Hospital re-opened 18th August 1947. Disease. Admitted Discharged Transferred to other Hospitals Died Remaining in Hospital Chickenpox 6 5 - - 1 Diphtheria* 2 - - - 2 Dysentery 4 4 - - - Malaria 1 1 — - — Measles 2 2 — — — -do- Contacts 4 4 - — — Mumps 2 - 1 - 1 Paratyphoid 1 - - - 1 Scarlet Fever* 1 1 10 — - 1 Whooping Cough 1 1 - - — -do- Contacts 1 1 - — — Other Diseases* 16 11 4 - 1 Totals 51 39 5 - 7 (*Includes 2 Diphtheria, 2 Scarlet Fever and 1 Erysipelas admitted from local Boroughs). Remaining in Hospital on 31st December 1947 7 Total number of days treatment (from re-opening on 18.8.47) 404 Average number of days treatment for each case 7.9 Average daily number of patients in Hospital 3 APPENDIX IV. BACTERIOLOGICAL EXAMINATION OF RATS DURING 1947. Source Total Exam-\ ined. Black Rats Brown Rats Species Unknown Mice. Rats Infected With Plague. Found dead Traped Poisoned Etc. Found dead Traped Poisoned Etc. Found dead Traped Poisoned Etc. Found dead Traped Poisoned Etc. Vesscls 760 418 338 4 - - - - - Nil London Dock 98 5 80 - 13 - - - - Nil St Katharine 7 - 6 - 1 - - - - Nil Regent's Canal 1 - - 1 - - - - Nil Surrey Commercial 7 • - - 7 - - - - Nil West India 14 - 13 - 1 - - - - Nil South West India - - - - - - - - - Nil Millwall 8 5 3 - - - - ~ - Nil East India 8 - 2 6 - - - - - Nil Royal Victoria 19 3 6 6 4 - - - - Nil Royal Albert 53 1 16 16 20 - - - - Nil Ktis<s George V. 35 - 10 7 16 - - - - Nil Tilbury 1 - 1 - - - - - - Nil 1..9 432 475 39 63 - - - - Nil (33) APPENDIX V. RETURN OP RATS CAUGHT AND DESTROYED DURING THE YEAR 1947. Jan. Feb. Mch.. Apl. May Jne. Jly Aug. Sep. Oct Nov. Dec. Total LONDON DOCK- Warehouses 61 29 84 50 99 41 105 71 43 104 80 82 849 Vessels. - — 12 125 6 18 27 3 4 13 7 1 216 Stkatharine Dock- Warehouses 7 15 1 18 10 12 5 2 3 13 4 4 94 Vessels - - - - - - - - - - - - - Surrey Commercial Dk Warehouses 16 3 26 20 37 31 49 44 37 47 36 45 391 Vessels 21 17 - 9 2 14 — 59 4 8 - 37 175 East India Dock— Warehouses 1 5 - - 2 17 13 2 5 10 2 1 58 Vessels - - - — 19 - - - - - - - 19 West India Dock- Warehouses 180 63 64 22 62 3 25 24 19 27 21 30 542 Vessels 26 - 63 22 64 29 26 - 40 86 9 2 367 Millwall Dock — Warehouses 40 21 25 32 40 10 28 32 17 26 13 39 32 Vessels 14 1 - 1 2 10 46 — 2 38 — 2 116 Roval Victoria Dock— Warehouses 37 20 30 50 44 27 48 30 37 44 40 46 467 Vessels 15 3 23 73 56 2 120 21 26 - 20 3 362 Royal Albert Dock- Warehouses 56 47 34 56 60 22 21 27 43 91 61 48 566 Vessels 164 100 356 182 110 82 237 379 112 133 117 137 2109 King George V DOCK- Warehouses 61 30 50 36 33 33 76 44 34 41 65 47 550 Vessels 58 282 26 75 53 27 2 29 14 - 19 132 717 Tilbury Dock — Warehouses 19 6 10 7 — — 30 3 3 2 3 2 85 Vessels 3 / 47 32 19 145 12 7 16 30 38 12 8 397 Regent's Canal Dock — Warehouses 24 12 12 19 11 4 12 13 4 7 12 3 139 Vessels - - - - - - - - - - - - - River- Vessels 831 701 848 816 861 394 877 799 493 728. 521 669 8,538 (34) APPENDIX VI - General Summary and Analysis of the Sanitary Inspections of Vessels etc., in the port of London for the year ended 31st December, 1947-» Foreign Coastwise Inland Navigation Shore Premises Sick Seamen Referred To Hospital Water Barges STEAM Sail. STEAVI SAIL. Stbam Sail /ONINMAA Canal Boa-ts 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 on 31st December, 1946 New Barges. Condemned.. Use Discontinued. Previously With- Drawn and Since resumed Work. No. in District 31st December1947. 6737 375 741 4 3 - 1690 71 105 96 - - 40 - 3 6 - - 4-63 3 33 - - - 10,241 361 549 254 11 - — - - 11 INSPECTION DOCKS AND River NO. NATIONALITIES No. Total Inspections from 1st January To 31st December, 1947:- St. Katharine 3 American 285 Belgian 60 Foreign 6,741 London 966 British 6,998 Coastwise 1,786 Inland Navign 509 Regent's Canal 225 Chinese 8 Shore Premises 10,241 Total 19,277 Millwall 597 Danish 137 Dutch 556 Cleansing of Crew's Quarters Etc. Total Number of Vessels from 1st January To 31st December, 1947. 822 West India 612 Egyptian 2 East India 193 Finnish 76 French 45 Royal Victoria 629 German 60 Royal Albert 889 Greek 31 King George V. 649 Honduras 1 NUmber of Vessels Inspected in the launches:- Icelandic 3 Surrey Commercial 838 Italian 4 "Hwoard Deighton" 225 Tilbury 1233 Panamanian 52 Philipine 1 "Frederick Whittingham" 1,276 River- Upper District 1276 Polish 34 -Do- Middle -Do- 701 Russian 39 "Alfred Robertson" 701 Swede. & Norwegian 621 -Do- Lower -Do- 225 "Yufio- Slavian 14 -Do- Medway Span1SH 3 Total 2,202 Total Vessels 9,036 9,036 On the Docks &c. 6,834 Shore Premises 10,241 Shore Premises 10,241 Total 9,036 Total 19,277 Total 19,277 (35) APPENDIX VII. HYGIENE OP CREW SPACES. CLASSIFICATION OP NUISANCES 1947. British owned Vessels. Foreign owned Vessels. Smoke Nuisances:- No. of complaints received - - No. of recurrences renorted - - Offensive Cargoes:- No. of infringements reported - - Structural and other Defects:- Inadequate ventilation 34 - Defective Lighting - Natural 11 - do. do. - Artificial 7 1 Defctive Heating 36 2 Condensation 26 1 leaking Decks 78 1 Leaking Ports, Decklights etc 51 - Leaking Sideplates 4 — Leaking Hawse and Chain Pipes 2 - Deficient or Obstructed Floor drainage 17 - Water lodging on top of Peak Tanks 2 - Defective Bulkheads 9 1 do, Floors 10 - do. Doors 10 - do. Chain Pipes 2 - do. Bunks 3 - do. Clothes Lockers 24 1 Do. Food Lockers 18 3 do. Pood Storage 36 3 do. Cooking Arrangements 8 - Defective or Uncleanly drinking water storage 9 - Water Closets Obsolete 8 1 do. Defective 45 5 do. Foul or Choked 24 - do. Inadequate Plush 22 - Wash Basins Defective 17 - Do. Foul 25 - Neglected Paintwork or Distemper 56 1 Absence of Washrooms 18 2 Absence of Messrooms 22 2 Misappropriation of Crew Spaces 1 - Verminous quarters 93 5 Dirty quarters 785 64 Miscellaneous 43 2 Totals 1556 95 Total number of vessels on which sanitary defects were reported 928 75 Total number of vessels on which sanitary defects were remedied 841 70 (36) APPENDIX VIII DOCKS WITHIN THE JURISDICTION OF THE PORT HEALTH AUTHORITY. DOCKS. Water Area. Lineal Quayage Acres. Yards. Miles. Yards. Regent's Canal 11 38 - 966 St.Katharine 10 488 - 1,654 London 34 4,460 3 119 Surrey Commercial 161 2,717 16 200 west India 97 3,957 4 1,131+ East India 31 2,878 1 1,242 Millwall 35 3,217 2 155 Royal Victoria 95 1,772 5 1,479 Royal Albert 87 213 3 905 King George V 64 997 3 663 Tilbury 104 2,166 3 1,667 The River distance between the Western and Eastern limits of the Port is about 68½ miles. APPENDIX IX. POWERS The work of the Port of London Health Authority is carried out under the following Acts of Parliament and Statutory Rules and Orders:- EXISTING ACTS AND ORDERS APPLICABLE TO THE PORT OP LONDON HEALTH AUTHORITY. CONSTITUTION OP THE AUTHORITY. Public Health (London) Act, 1936. ASSINGHENT OP POWERS. I.. G. B. Order, Port Sanitary Authority Assignment of Powers, Port of London. 25th March,1892 L.G.B.Order, Port Sanitary Authority Assignment of Further Powers, Port of London 29th December, 1894 L.G.B.Order, Port Sanitary Authority Assignment of Powers, Port of London. 30th June, 1898. S.R. A 0. 1922, No. 781. London Port Sanitary (Additional Powers) Order, 1922. 18th July, 1922. S.R & 0. 1923. No. 812. London Port Sanitary (Additional Powers) Order 1923. 16th July, 19230 S.R & 0. 1933, No. 803. The Port of London (Assignment of Powers) Order, 1933. 11th August,1933. ADMINISTRATION. Port Sanitary Administration and Medical Inspection of Aliens under the Aliens Order, 1920. (Grants in Aid) 14th Huly, 1920. City of London (Various Powers) Act, 1922. Part IV. Section 30. City of London (Various Powers) Act,1933. Part III. Sections 6 and 7. S.R & 0. 1926, No. 552. Sanitary Officers Order, 1926. 27th May. 1926. (37) INFECTIOUS DISEASE. Infectious Disease (Notification) Act, 1889 to 1899. Public Health Act, 1896. Public Health (Ports) Act, 1896. S.R & 0.1910. No.1165. Prevention of Epidemic Diseases Regulations as to Plague. Destruction of Rats, 1910. 1Oth November, 1910 S.R & 0.1912. No.1226. Public Health (Cerebrospinal Fever and Acute Poliomyelitis) Regulations, 1912. 15th August, 1912 S.R & 0.1918. No. 67. Public Health (Notification of Infectious Diseases) Regulations, 1918. 19th January, 1918 S.R.&.0.1 926. No.972. Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. 31st July, 1926. S.R & 0. 1927. No.1207. Infectious Diseases (London) Regulations, 1927. 22nd December, 1 927 S.R & 0.1930. No.299. Parrots (prohibition of Import) Regulations, 1930. 24th April, 1930 S.R & 0.1933. No.38. The Port Sanitary Regulations, 1933. 4th February, 1 933 S.R & 0. 1 9U5.No. 1282. The Port Health Amendment Regulations,1945. 10th October,19U5 CANAL BOATS. Public Health Act, 1936. FOOD. Public Health (Regulations as to Food)Act,1907. S.R & 0.1924. No. 11+32. Public Health (Meat) Regulations, 1924 (Part IV). 20th December, 1924 S.R & 0. 1 925. No. 775 ) Public Health S.R & 0. 1926. No. 1577 \ (Preservatives, etc. , S.R & 0. 1927. No. 577 ) in Food) Rangulations, 1928 S.R & 0.1926. No. 820. Public Health (Imported Milk) Regulations, 1926. 6th July, 1926 S.R & 0. 1937. No. 3290 Public Health (Imported Food) Regulations, 1937. 1 6th April, 1937. SHELLFISH. S.R & 0. 1931+. No.1342. Public Health (Shellfish) Regulations, 1934. 7th December, 1934 S.R & 0. 1935. No.1221. The Medway (Shell-Fish) Regulations, 1935. 11th December, 1935 RATS AND MICE. Rats and Mice (Destruction) Act, 1919. SMOKE ABATEMENT Public Health (London) Act, 1936. ABATEMENT OF NUISANCES AND REMOVAL OF REFUSE. Public Health (London) Act, 1936. (38) FERTILISERS AND FEEDING STUFFS. Fertilisers and Feeding Stuffs Act,1926. S.R & 0.1932. No.658. Fertilisers and Feeding Stuffs Regulations, 1932. 11th, August,1932. S.R & 0. 1928. No. 439. Order appointing 1st July,1928 as the date for the coming into operation of the Fertilisers and Feeding Stuffs Act, 1926. 30th May, 1928. DANGEROUS DRUGS. S.R & 0. 1923. No. 1095. Dangerous Drugs (No.3) Regulations, 1923. 10th September,1923. ALIENS. S.R & 0. 1920. N0.448. The Aliens Order, 1920. AIRCRAFT. S.R & 0.1938. No.229. Public Health (Aircraft) Regulations, 1938. 7th April, 1938. IMPORTATION OF CATTLE. Ministry of Agriculture and Fisheries Animals (importation) Order, 1930, dated 1+th November, 1930. Part III, Article 22; Part IV, Articles 23, 24 and 23. Ministry of Agriculture and Fisheries Animals (Landing from Ireland, Channel Islands and Isle of Man) Order 1933, dated 17th January, 1933. Part II, Article 17. BYE-LAWS. Bye-laws have been made by the Port of London Health Authority:- 1. For preventing nuisances arising from barges or vessels carrying offensive cargoes. 2. For removing to hospital any person suffering from dangerous infectious disorders, and for the keeping therein of such persons as long as may be deemed necessary. 3. With respect to Houseboats used for human habitation within the limits of the Port of London. (39)