AC.43 2 nd copy LIBRARY PLON 57 105 PORT OF LONDON HEALTH COMMITTEE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, To 31st DECEMBER, 1949. 105. PORT OF LONDON HEALTH COMMITTEE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH (MONTAGU TRAVERS MORGAN, C.M.G., M.C., M.D. , Ch.B., D.P.II.) TO 31st DECEMBER „ 1949. Port of London Health Authority, 5, Church Passage, Guildhall, E.C.E. Telegraphic Address "PORTELTII LONDON". Telephone Number MONarch 3030. LIMITS OF THE PORT OF LONDON. THE LIMITS OF THE PORT OF LONDON AS AT PRESENT DEFINED COMMENCE AT HIGHWATER MARK IN THE RIVER THAMES AT TEDDINGTON LOCK, IN THE COUNTY OF SURREY, AND EXTEND DOWN BOTH SIDES OF TIE RIVER THAMES TO AN IMAGINARY STRAIGHT LINE DRAWN FROM THE PILOT MARK AT TIE ENTRANCE OF HAVENGORE CREEK, IN THE COUNTY OF ESSEX, TO THE LAND'S END AT WARDEN POINT, IN TIE ISLE OF SHEPFEY, IN TIE COUNTY OF KENT, SUCH POINT BEING TIE 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 TIE SOUTH-EAST POINT OF LAND WESTWARD OF GOALMOUTH CREEK, TIENCE ACROSS TIE SAID RIVER MEDWAY TO TIE WESTERN-MOST POINT OF THE PIECE OF LAND WHICH FORMS TIE EASTERN SIDE OF TIE STANGATE CREEK, OR, IN OTHER "WORDS THE NORTH-VEST POINT OF FLEET MARSH AND FROM THENCE IN A SOUTHERLY DIRECTION TO IWADE CHURCH IN TIE SAID COUNTY OF KENT, AND THENCE IN A NORTH-EASTERLY DIRECTION TO ELMLEY CHAPEL IN TIE SAID ISLE OF SIEPPEY, A SUPPOSED DIRECT LINE FROM ELMLEY CHAPEL TO IWADE CHURCH, BEING THE WESTERN LIMIT OF TIE PORT OF FAVERSIIAM, AND TIE SAID PORT OF LONDON INCLUDES TIE ISLANDS OF HAVENGORE CREEK AFORESAID, CALLED POTTON AND RUSHLEY ISLANDS , AND SO 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 TIE BEFOREMENTIONED LIMITS CONTAINED. STAFF. List of Officers forming the Staff of the Port Health Authority, 31st December, 1949. Office Name of Officer Date of entering the service Medical Officer of Health M.T. Morgan, C.M.G., 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. Willoughby, V.D., M.R.C.S., L.R.C.P., D.P.II, D.T.M. & II. , R.N.V.R. May 1929. Assistant Port Health Officer d.A. Jones, M.B., Ch.B., D.P.H. April 1935 ditto. ditto. (vacant) Sheerness Boarding Station (Tempy: Part Time). J.R.Davies,M.R.C.S., L.R.C.P., D.T.M. & H. H.A. Madwar , L.R.C.P., L.R.F.PoS. January 193 9 De cember 1927 Office. Name of Officer. Date of entering the Service. CLERICAL - Principal Clerk W.C. Barham March 1901 Assistant Senior Clerk J.A. Gillis March 1914 First Glass Assistant Clerk A.W. Moore (Seconded to Civil Defence) January 1920 Personal Secretary to Medical Officer of Ilea 1th W.L. McLorg February 1927 Clerical Officer R.C. Ratliff March 1930 General Grade Clerk E.V. Smith October 1938 ditto. R.H. Lott May 1947 INSPECTORIAL - Sanitary Inspector and Inspector of meat and other foods. W. Gray September 1921 ditto. R. Clifford July 1925 ditto. P.W. Coombe December 1924 ditto. E.H. Johnson August 1929 ditto. T.G. Edwards June 1929 ditto. D .E. Made ley 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. *7 November 1934 ditto. G. Dring February 193 7 ditto. J. Aiken July 1946 ditto. A. Trevethick August 1946 ditto. L.N. Tope August 1946 RODENT OFFICERS - C.W. Moody February 1929 E.C. Yv'atkins June 1929 S.A. Croft June 1929 C• Stockton June 1940 F.D. Cartman (Vacant) January 1943 RODENT CONTROL SCHEME Rodent Officers. D. J. Davis August 1941 G. Lamont March 1945 H.A. Baxter June 1945 J.E. Carrington January 1946 W.G. Stimson February 1946 G. Clark January 1949 A.L. Southwood January 1949. DENTON HOSPITAL (transfer red to the State on 5th July 19 Health Service Act) 48 under the National Medical Officer in Charge HoM. Willoughby May 1929 LAUNCHES AND HULKS - Launches Hulks Howard Deighton Alfred Robertson Frederick Whittingham Alfred Roach Hygeia at Grave send Uplees at Greenwich (2) Office Name of Officer Date of entering the service Navigator (senior) P.J. Wilkins November 1928 ditto. J.R. Steen March 1926 ditto. H.J. Debnam April 1931 Navigator W.S. Stimson March 1944 ditto. W.G.A. King September 1939 ditto. C.R. Simons August 1938 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 A.R.L. Potter July 1945 do. W» Simmons July 1945 do. L.J. Nicholls September 1945 do. (vacant) do. (vacant) Deckboy (Acting deckhand) G.A. Simmonds February 1947 do. B. Bowen June 1947 do. A.R. Watkins August 1948 do. D.C. Houghton June 1949 do. P. Pay August 1949 do. W.G. Cripps September 1949 do. F. Strickland September 1949 Steward (part time) J.F. Smeed July 1927 Shipkeeper A.R. Burge August 1945 do. E. Ale wood January 1947 Watchman E.W.S. Edmonds September 1933 do. H.J. Mason August 1946 January, 1950. 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. The report is based on the Ministry of Health Memo. 302/S.A. , and the directions of that Memorandum have been followed in so far as the information is available. Tonnage. The tonnage of vessels entering the Port of London during 1949, -was 24,463,725 tons as compared with 22,116,113 tons during 1948. Nine thousand two hundred and twenty vessels arrived from foreign ports and of these 1,684 were inspected by your Medical Officers. (Table A). Communicable Disease. Three hundred and forty three cases of notifiable communicable diseases (including malaria) were reported as having occurred on 141 vessels during the voyage, of which 200 were landed in the Port (Tables C & D). Forty nine cases, particulars of which are given in Appendix 11(b) were admitted to the Port Isolation Hospital at Denton. No case of human or rat plague occurred during the year on any vessel bound for London. (3) Fumigations» One hundred, and twenty three vessels were fumigated for rodent destruction and the issue of International Certificates under the supervision of your Inspectors. The fumigant in every case -was hydrogen cyanide and resulted in the recovery of 1,729 rats and 474 mice. (Table "H"). Rodents - A total of 5,896 rats were destroyed and their bodies recovered during the course of the year, 2,497 in ships and 3,399 on shore premises in the Port. In addition 2,393 mice were destroyed, 471 in ships and 1,922 on shore premises. (Tables "E" and "F"). Of the 816 rats examined bacteriologically, 428 were from vessels and 388 from shore premises. No rat was reported to be infected with plague. (Tables "E" and "F"). Psittacidae. The work under the Parrots (Prohibition of Import) Regulations, 1930, still in operation, is reported on page 34. Water Barges. Fourteen water barges were in use during the year. The registration of these craft by the Port of London Authority is made conditional upon the report of your officers as to the fitness of the barges for the carriage of drinking water as also upon the purity of the water thus carried. To this end a number of samples were taken for examination during the year (see page 34).. House Boats. The new Houseboat Bye laws are still in draft form. Action under the existing Byelaws was taken in respect of two houseboats (see page 34). Imported Foods. 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 outright either by burying or burning was 1,711 tons as compared with 937 tons during 1948. (See page 30). Shellfish. Action taken under the Public Health (Shellfish) Regulations, 1934 is reported on page 35. Instruction of D.P.JI. and D.I.H. class in Port Health work. Arrangements have continued during the year for giving practical instruction to Post-Graduate Students of the Royal Institute of Public Health and the London School of Hygiene and Tropical Medicine taking their course for the Diploma in Public Health and in Industrial Hygiene. The students paid visits to one or other of the Dock groups and have been given practical demonstrations of the day to day work of the Port Health Services on the River and Docks. Your Medical Officer wishes 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. Your Medical Officer also has 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. (4) 1. AMOUNT OF SHIPPING ENTERING THE PORT DURING Tffl YEAR. 1949. NUMBER TONHA G£ NUMBER INSPECTED NUMBER REPORTED TO BE DEFECTIVE NUMBER OF VESSELS ON WHICH DEFECTS WERE REMEDIED NUMBER OF VESSELS ON WHICH DEFECTS WERE FOUND AND REPORTED TO MINISTRY OF TRANSPORT SURVEYORS NUMBER OF VESSELS REPORTED AS HAVING OR HAVING HAD OURING THE VORAGE,INFECTIONS DISEASES ON BOARD Br -THE. MEDICALOfficer OF HEALTH BY -rn£ SANITARY INSPECTOR forign STEAMERS 4,563 10,552,443 1,208 6,964 682 63 5 15 141 MOTOR 4-, 657 5,087, I 36 396 SAILING — - — - - - — - FISHING — — — ~ - — — - 9,220 15,639,581 1,684 6,964 662 635 15 141 EAST- WISE STEMERS 7,621 7,266,968 - 2,169 368 296 25 — MOTORS 4,260 20,166 - — SAILING 292 - 249 20 20 - — FAISHING — - — TOTAL COASTWISE 12.173 8,824,144 - 2,418 388 3i6 - TOTAL FOREIGN COASTWISE 21,393 24,46.3,725 1,684 9,382 1,070 951 40 141 II. CHARACTER AND TRADE OF TITS PORT. TABLE B. (a) Passenger traffic during the year. (l; To and from Non-European countries. 1st Class. 2nd Class"1" 3rd Class Tourist Class. Total. INWARD 17,969. 1,012. 375. 24,778. 44,134. HJTWARD . . 23,727. 3,545. 1,195. 35,128. 63,595. + Includes Cabin Class. (11) To and from the Continent of Europe. INWARD 37,464. OUTWARD 33,839. Countries from which passengers principally arrive: India, Australia, New Zealand, South America, South Africa, the Far East and the United States of America. (b) Cargo Traffic (Imports and Exports). Particulars for the year 1949 are not available. (c) Foreign ports from which vessels arrive The Port of London trades with all parts of the world. MEDICAL INSPECTION OF ALIENS. Annual Return by the Medical Inspector of Aliens for the year ended 31st December, 1949. TOTAL NUMBER INSPECTED BY THE MEDICAL INSPECTOR NUMBER SUBJECTED TO DETAILED EXAMINATION BY THE MEDICAL INSPECTORS Certificates Issued. MIGRANTS LUNATIC IDIOT OR M.D UNDEGIR- ABLE FOR MEDICAL REASONS PHYSICALLY ITATED SUFFERING FROM ACUTE INFECTIOUS DISOROEA LANDI NG NECESSARY FOR ADEQUATE MEDICAL EXAMINATION TOTAL NUMBER OF FORIENS LANDING AT THE PORT 27,669 18,849 916 2 - - - - - ALIENS REFUSED PERMISSION TO LAND BY THE IMMIGRATION OFFICER - - - - — - - - - TRANSMIGRANTS - - — — — — — — - TOTAL ALIGNS ARRIYING AT THE PORT 27,760 18,849 916 2 - - — — - Total number of vessels arriving carrying Alien passengers - 1,693. (5) 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 barge s. (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 a ship is lying at buoys in th river, supplies are obtained from water barges. 2. Hydrants and Hosepipes - Hydrants within the dock area are of the standard type in use by the Metropolit 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 again used. 3. Number of water boats and their sanitary conditions - There were fourteen water boats working in the Port during the year. IV. PORT HEALTH REGULATIONS, 1935 and 1945 (1) Arrangements for dealing with Declarations of Health. (2) Boarding of vessels on arrival. (3) Notifications to the Authority of inward vessels requiring medical attention. (4) Mooring Stations designated under Article 10. (5) Particulars of any Standing Exemptions from the provisions of Article 14. (s) Experience of working Article 16. The above remained the same as reported in detail in my Report for 1947. (7) 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 ships, persons and clothing and other articles. Disinfection of infected quarters is usually carried out by the Sanitary Inspector in whose area the vessel is berthed. 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. (6) Although Denton Hospital in now under the management of the South-East Metropolitan Regional Hospital Board, arrangements have been made for the Disinfecting Station, which contains a Washington Lyons Steam Disinfector, to be 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. No special provision on a large scale has been necessary, but if such 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. In the event of a major infectious disease arriving in the Port, the patient or patients would be removed from the vessel to Denton Hospital pending arrangements for the transference of such cases to the appropriate hospital under the management of the South-East Metropolitan Regional Hospital Board. DENTON HOSPITAL. Under the National Health Service Act 1946 the Authority's Isolation Hospital, used solely for cases of infectious disease found on ships and among crews in the precincts of the port, was transferred to the State on July 5th, 1948 and fell, for administrative purposes, into the Seamen's Group of hospitals attached to the South-East Metropolitan Regional Hospital Board. The Port Health Authority is therefore free of all financial and administrative obligations in regard to the hospital but it continues, by arrangement with the Board, to provide the medical supervision and treatment. Continuity of service is thus assured. The Boarding Medical Officer on duty can admit without discussion or delay, any case or suspected case of infectious disease, secure the necessary isolation and provide immediate treatment. While your Medical Officer is in administrative charge of the medical services at the hospital, your Deputy Medical Officer is in local charge. (e) Ambulance Transport - The launch "Howard Deighton" used by the Medical Officers as a boarding launcl is fitted with an ambulance room on deck with accommodation for four stretche: cases or eight walking cases. The launch "Alfred Roach" normally used as a Sanitary Inspectors' duty launch was designed so as to relieve the "Howard Deighton" should occasion arise. In this connection the vessel was constructed so that the saloon could be rapidly converted into a sick-=bay capable of carrying three stretcher cases while the cockpit has a sufficiently large open space to receive a stretcher and deep enough to protect the occupants from storm water. It is capable of accommodating eight sitting cases. The middle river launch the "Alfred Robertson" has a fairly spacious after cabin in which a stretcher case can be carried. (f) Supervision of contacts. Those persons intending to leave a ship on which there has been a case or cases of a major infectious disease, 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. These particulars, together with an appropriate note of the circumstances, are then forwarded to the Medical Officer of Health of the district in which the contact's address is situated. The other half he is asked to keep and use only should he change his address during a specifiad period. This half of the card is on the "Business Reply Card'' System so that the person concerned does not have to stamp it. Arrangements for the Bacteriological or Pathological Examination of Rats. Arrangements made for other Bacteriological and Pathological Examinations. (7) Arrangements for the diagnosis and. treatment of Venereal Diseases among sailors. Arrangements made under the Brussels Agreement, 1924. Arrangements for the interment of the dead. All these remain as reported in my Annual Report for 1947. TABLE C. CASES OF INFECTIOUS SICKNESS LANDED FROM VESSELS. Disease Number of cases during the year Number of vessels concerned. Average number of case for previous 5 years. Passengers Crew Enteric Fever 20 55+ 9 1.6 Influenza - 2 1 - Measles 14 8 12 17.8 Pulmonary Tuberculosis . 14 23 33 16.8 Chickenpox 7 9 11 11.4 Mumps 3 31 6 3.0 Diphtheria - 1 1 4.2 Smallpox 2 - 1 - Malaria 1 2 3 16.6 Dysentery - 3 3 4.2 Typhus - 3 1 0.2 Pneumonia - 2 2 4.0 Includes 10 "Healthy Excretors" Report of Typhus Infected. Vessel. s.s. "MONTE MONJUICH" (Spanish). This vessel arrived at Gravesend at 8.10 p.m. , on the 17th August, 1949 off a voyage from Melilla (Morocco) with a cargo of iron ore for Ford's Works at Dagenham. She left Melilla on 9th August. Owing to shipping congestion following the recent dock strike she anchored in Gravesend Reach for a few days before proceeding to her berth. She was boarded on arrival by the Boarding Medical Officer, and the Master not only produced a clean Declaration of Health but assured him verbally that there had been no sickness among the crew of 41 men. On 21st August a message was brought by the waterman in attendance that a member of the crew had a "fever" and the Medical Officer on duty went to the ship to investigate. This was the patient 0.... He had a mild degree of fever and no symptoms other than the pyrexia. He was prescribed for and a further visit from the Medical Officer on duty arranged for the next day» On 22nd August this man was seen again together with a second member of the crew, P..... who had a high temperature and both patients were removed to Denton Isolation Hospital for observation and treatment on this day. Blood films were negative for Malaria. Dr. Willoughby personally visited the ship with Mr® Beattie and found strong evidence of rats on board together with a most insanitary state of affairs in the pantry, stores, lavatories etc. Examination of the current Deratisation Certificate showed a kill of over 400 rats at Balboa within the previous six months, after HCN fumigation. (En passant the exposure was a short one of 2 - 4 hours only). The ship proceeded to Dagenham and was there visited daily by lira Beattie, the last time being a.m., on 25th August. In the afternoon a third patient, G fell ill (he was well in the morning at the time of Mr. Beattie's visit) and was removed to Seamen's Hospital, Greenwich later that day before the ship sailed, empty of cargo, for the Bristol Channel. The patients P. and 0.. in Denton Hospital ran high temperatures , had dirty tongues, enlarged spleens and slow dicrotic pulses. The temperature exhibited "staircase" rises and eventually fell by lysis at the end of the second reek. One week after admission both had "rose spots", about a dozen spots only in each case, on their chests and backs. Clinically both were typical of fever of the Typhoid Group. Blood, stools and urine were taken and dispatched to the laboratory at Greenwic on 24th August and proved negative for Typhoid, Para-typhoid A and B, and negative also for the Weil Felix reaction and Brucella abortus. Further blood samples were taken on 28th August and gave l/200 Parao B (H) positive in both patients, which, on further tests, on samples taken on 6th September had risen to l/800 in the case of P.. and l/400 in 0 ..for Para.B (H) and the Weil Felix reaction was still negative. On arrival of the ship at Newport (Mon) two further cases had arisen and were taken to hospital there where one gave a positive Weil Felix reaction.. On hearing this the Ministry of Health arranged for blood samples to be sent to the Ministry's Virus Laboratory at Hendon and these were sent on 8th September, together with a sample from the case in Greenwich Hospital. All three were returned positive for Weil Felix OX 19 (typhus fever) on 10th September;, and the case in Greenwich Hospital, G was transferred to Denton (9) P..was positive to a titre of 1/2500 and 0 1/300. By this time all three patients were convalescent and had had normal temperatures for more than a week. It is interesting to note that at Newport fumigation of the ship gave a kill o 800 rats I G,the Greenwich case had a profuse papulomascular rash on 29th August and produced a positive Widal 1/400 Para B (H) on 7th September and a positive resued ]/l50 Proteus X 19 on 9th September. He appeared to have been more typical of Typhus than the cases in Denton. Further specimens of blood, faeces and urine were forwarded to both Greenwich Laboratory and the Hendon Laboratory on the 12th September, so that the Para B complication could be further investigated. The patients in Denton were seen repeatedly by Drs. Willoughby, Jones, Davies and Malcolm and by Dr. Pinching and Mr. Leeson of Seamen's Hospital, Greenwich. All agreed that clinically the cases were Paratyphoid. Both patients were examined for lice on heads and bodies but none were found. Typhus was considered as a possible differential diagnosis from the beginning. SMALLPOX - s.s. "MOOLTAN" Peninsular & Oriental Steam Navigation Co. The s.s. "MOOLTAN11 began her voyage from Australia to London at Brisbane on the 8th February, 1949 and the following list shows the ports of call and the dates:- Brisbane 8.2.49 Bombay 10.3.49 Sydney 18.2.49 Aden 15.3.49 Melbourne 19.2.49 Port Said 18.3.49 Adelaide 22.2.49 Marseilles 25.3.49 Fremantle 26.2.49 London 2.4.49 Colombo 7.3.49 HISTORY OF CASE. 1. A passenger Mr. R.A. and his wife occupying the same cabin on board went ashore at Bombay for a few hours. It is not known exactly what they did ashore but presui ably they visited various parts of the town. Neither Mr. A. nor his wife had ever been vaccinated. 2. On the 24th March Mr. A. complained of stomach pains and obtained from the senior of the two Ship Surgeons, a bismuth mixture. 3. On the 25th March the ship arrived at Marseilles and it appears that Mr. A. kept to his cabin and was not seen by anyone. It is believed that he had the beginnings of a rash on that day and kept quiet in his cabin for fear that if he reported his condition to the Ship's Surgeon, the Marseilles Quarantine Authorities might remove him from the ship. 4. The "Mooltan" sailed from Marseilles on the night of the 25th March at 10.30 p.m., and he then called in the Ship's Surgeon who discovered a prolific papular rash accompanied by fever and prostration. The rash is said to have appeared rapidly in the following order - chest, back, face, arms, thighs, legs and feet* Both axillae and groins were eventually involved and he had two melaenotic stools on the second and third days after the onset of the rash. 5. The Ship's Surgeon called two Indian medical men, passengers on board, into consultation on the patient's condition and either they pronounced that the disease \vas, or concurred with the Ship's Surgeon's diagnosis of, chickenpox. 6. The Ship's Surgeon based his diagnosis on what he regarded as a centri-petal (10) distribution of the rash and no prodromal signs. 7. The Ship's Surgeon promptly isolated Mr® A. and his wife in the ship's Isolation Hospital and there they remained until the end of the voyage® 8. The ship, on arrival in the English Channel was delayed some hours by fog and did not arrive in the Gravesend Reach of the River until 2.0 p.m., on Saturday, 2nd April. Mr. A. died at 11.30 p.m, on Friday, 1st April® 9. On the 31st March, Dro Corbett, the Medical Superintendent of the P. & 0. Co, informed me by telephone that he had received a signal from the Surgeon of the "Mooltan" as follows "Have serious case diagnosed chickenpox man aged 69 years. Wife also isolated. Shall require isolation ambulance and isolation hospital accommodation. Also female passenger aged 65 acute pneumonia. Shall require hospital accommodation. Please advise Port Health Authority". 10. In view of the Ship Surgeon's statement that it was a "serious case diagnosed chickenpox", I suggested to Dr. Corbett that he should send a signal to the ship asking if the Surgeon was sure that it was a case of chickenpox, also for information on the vaccinal state of the case, whether he had gone ashore during the voyage and whether any precautionary measures, such as vaccination of possible contacts, had been taken. 11. The Ship's Surgeon replied by signal received by Dr. Corbett on the 31st March to the effect that the passenger was unvaccinated, had been ashore at Colombo and Bombay and that the Surgeon could not definitely exclude variola. He was considering vaccination and would require 1,000 doses on arrival. Incidentally he was carrying 600 doses on board. The signal having raised my suspicions I got into touch with Dr. Boul, the Medical Officer of Health of the Thurrock Urban District Council and one of the Ministry's Smallpox Consultants, and asked him if he would accompany Dr. Willoughby when he boarded the ship, to make sure that the diagnosis was correct. 12. Dr. Boul very kindly agreed to do this and on Saturday, 2nd April, the ship was boarded while in the Gravesend Reach by Dr® Boul and Dr. Willoughby who inspected the cadaver. Both had no hesitation in diagnosing the case as one of smallpox. 13. I had already discussed with Dr. Willoughby the measures he might take in the event of the case being one of smallpox and I had informed him that, in principle, I saw no reason for isolating the ship in mid-stream longer than was necessary to carry out the vaccination of the crew and passengers and to obtain their names and addresses. 14. I gave Dr. Willoughby authority to send into Denton Isolation Hospital anybody whom he considered to be a very close contact with the case and who refused vaccination, but otherwise to secure the vaccination of as many as possible and to release them under 'surveillance'. 15. Dr® Willoughby, in agreement with Dr® Boul, decided that there was no reason why the ship should not tie up at the Tilbury Landing Stage, under strict isolation, allowing none but authorised persons on board, since the disembarkation of the large number of passengers involved would be a matter of great difficulty if the ship was lying in mid-stream. The number of passengers and crew in the ship was as follows CREW - PASSENGERS - White 172 +British 941 (Tourist Class) Coloured 269 = 441 Alien 12 - 953, + Includes 4 D.B.S. Total personnel - 1,394. 16. Actually only six persons were admitted on board while the ship lay at the (11) Landing Stage prior to the release of passengers for disembarkation - Captain Bridges the Marine Superintendent of the P. & 0. Co, and five Baggage Clerks. These six persons were vaccinated on the Stage before they boarded the ship. Incidentally the Pilot and seven P. & 0. Officials who boarded the ship at Brixham were vaccinated with the rest of the passengers and crew on arrival at Tilbury, i.e., two days aftc boarding. 17. The body of the deceased was intorred at Tilbury under Dr. Boul's supervision and the deceased's wife, Mrs. A. .as sent directly by ambulance to the Clandon Isolation hospital, near Guildford, where she died of smallpox two days later. 13. Each passenger and member of the crew was furnished with a yellow "Business Reply" card instructing them to notify any change of address during the next sixtec days. This was completed by Dr. V.illoughby and the members of the Port Health Staff by 2.30 a.m., on Sunday morning, 3rd April, and the passengers were then permitted to disembark and proceed to their destinations. The members of the Port Health Staff returned to the Central Office in Guildhs on Sunday morning and the addresses of the 1,136 persons (passengers, crew, pilots Customs Officers, Immigration and other Port officials) disembarking from the ship were traced to the local sanitary areas to which they were proceeding. These persons proceeded to 342 addresses in 233 different administrative areas throughout the United Kingdom and Eire and by 7.0 p.m., the samo evening notifications had been addressed and dispatched via the G.P.O., to the 283 individual Medical Officers of Health concerned together with a covering note prepared by myself informing the Medical Officers of the circumstances and advising daily medical supervision until the 18th April, i.e., 16 days after disembarkation. 19. The ship having disembarked her passengers, proceeded later the same day to No® 4 Berth in the King George V. Dock. Measures taken to sterilise all probable sources of infection in cabins and other compartments on board the ship. 20. The Ship's Surgeon on transferring Mr. A, and his wife from their cabin to the Isolation Accommodation fumigated the cabin with formaldehyde and locked it up. This cabin actually remained locked until 14th April when it was opened up for the purposes of cleansing and re-painting. 21. First steps taken were to ascertain the cabins occupied by the steward, stewardess and any other attendants upon Mr. and Mrs. A. These cabins were promptl closed and fumigated. In addition the cabins of the two nursing sisters and the Ship Surgeons were also fumigated, as was also the isolation hospital. 22. This, it was thought, was sufficient as the first stage for combating obvious sources of infection from close contact with the patient. Meanwhile it had been ascertained that a large quantity of dirty linen comprising some 55,000 pieces used by passengers, which included linen from close contacts such as sisters, stewards, stewardesses, medical staff and others, had been dispatched in accordance with routine as soon as the vessel had arrived in the King George V. Dock, to a public laundry for washing. 23. The laundry was said to be situated in the Lambeth area and immediate contact was therefore made with the Medical Officer of Health, Dr® Thompson, who undertook to make enquiries and if this was in fact the case to carry out the necessary vaccination and supervision of the laundry staff that might be involved. It was, however, ascertained later that the linen had not been dealt with at this branch of the Advance Laundries but had been transferred to another Advance Laundry in trie Hendon area at Childs Hill. Contact was therefore made with Dr. Adamson the Medical Officer of Health of Hendon, who in turn undertook to carry out the necessary preventive measures. 24. A further supply of laundry which had not been sent to the public laundries referred to above but was awaiting disposal was sent to Denton Isolation Hospital for steam disinfection as also were a number of mattresses from the cabins of knowi close contacts. These pieces were eventually collected, the mattresses being returned to the ship and tho Laundry sent to the Advance Laundry Branch in Dagenham for laundering. A Certificate was issued declaring that the pieces had been subjected to steam disinfection and were free from all infection and could be loan died in the normal manner. Notification of the circumstances was made to the Medical Officer of Health, Dagenham, Dr. Herington. Meanwhile discussions took (12) place with Dr. Corbett as to further disinfection that might be required and the action eventually taken will be referred to later in the report. 25. On Monday 4th April the Ship's Dispenser, aged 56, was reported by the Ship's Surgeon to be ill with Photophobia, irritability, Dysarthia, inability to understand what was said to him and unable to act on instructions (patient was very deaf). No pyrexia, normal pulse and respirations. He was thought to be suffering from Haemaplegia or cerebral thrombosis. 26. After some delay due to the inability to find suitable side -ward accommodation for him in any hospital, he was admitted to Denton Hospital on the 5th April and was seen by myself and on the next day by Dr. Boul. A diagnosis of meningismus was made due possibly to (a) alcoholism (b) fracture of the skull or (c) concussion. 27. There was clearly no evidence whatsoever of smallpox and the patient was eventually transferred, on the 6th April to the London Hospital. 28. Incidentally the patient was conveyed to Denton from the Royal Docks in an ambulance obtained from East Ham, the driver of which had never been vaccinated and the attendant had been vaccinated in infancy in 1898. Both were vaccinated by Dr. Willoughby on arrival at Denton and the blankets from the ambulance were held for steam disinfections 29. On Thursday, 7th April, the Ship's Surgeon was called to a cabin to see a lascar who was said to be ill and developing a rash. It appears that the man had felt seedy the night before and had therefore been moved by the Serang out of the compartment in the afterpeak which he occupied with ten other men into an empty cabin. The Ship's Surgeon discovered that the man was feverish and had a rash and he promptly notified Dr. Corbett who in turn notified the Port Health Office. 30. I went down without delay to the ship and in company with Dr. Corbett made an examination of the patient. I found him to be a well developed man of about 30 years of age, lying in bed with fever and malaise. His temperature vias 100.4°F. On examination he was found to be developing a papular vesicular rash practically confined to the trunk, thighs and upper arms. The rash was profuse and rapidly developing. No spots could be found on the face and head, other than two small papules on the forehead. There were two small papules on the thenar eminence of the right hand. There were no papules to be found on the feet. There was a history of repeated previous vaccinations though only one mark could be clearly seen and an immune reaction to the vaccination of the 2nd April at Tilbury. 31. In view of the history of smallpox in the ship I got into touch with Dr. Boul, the Ministry Smallpox Consultant who kindly agreed to come to the ship as soon as possible . 32. Dr. Boul agreed with my provisional diagnosis of chickenpox in the light of the appearance of the rash and its distribution but he also agreed that in view of the circumstances no risk whatever should be taken and that the case should be transferred to Clandon for observation and bacteriological investigation. This was done later in the day. 33. Meanwhile another case of fever in a lascar, was reported to me and I asked Dr. Boul to look at the man. This turned out to be the result of a positive vaccina reaction to the vaccination performed on Saturday, 2nd April. 34. A discussion took place between Dr• Boul, Dr. Corbett, the Marine Superintendent, the Chief Officer and myself as to the measures to be taken following the discovery of the case of chickenpox and it was agreed that measures should promptly be taken as if the case were one of smallpox and -until confirmation of the provisional diagnosis of chickenpox was obtained. 35.This involved the taking of preventive measures in regard to a large number of shore gangs working on the ship and by arrangement with representatives of Messrs. Green & Silley Weir, the Dock Labour Board, H.M. Customs and several other organisations, lists were prepared of all the men concerned. Notices were set up in the ship to the effect that a further case of suspected smallpox had been discovered on (13) board and that all persons who were or had been working on board could be vaccinated forthwith by attending at the Ship's Dispensary.In this my a large number of vaccinations were performed on the afternoon of April 7th and also onApril 8th. 36. Meanwhile yellow "Business Reply" cards were issued to the 510 men involved a their names and addresses forwarded to the 55 individual Medical Officers of Ilealt of the districts in which they resided together with a covering note explaining th circumstances and asking for daily medical supervision of the men until 25rd April 37. The compartment normally occupied by the case and the cabin in which he had been isolated were closed and fumigated and his bed and bedding sent to Denton for steam disinfection. 38. On Saturday, 9th April, I was informed by Dr. Coneybeare, that, in regard to the first lascar, "the complement fixation test was negative and that no bodies had been found in the scrapings of the papules or vesicles and I received a telephone call from Dr. McPherson, the Medical Officer at Clandon to the effect that he agre with the opinion of Dr. Boul and myself that the case was clinically one of chickenpox. 39. On Monday, 11th April, Dro McCallum reported that the egg culture was negativ to smallpox and Tt was agreed that the case could now be regarded definitely as on of chickenpox. 40. Consequently on Tuesday morning, 12th April, I sent a notice to the Medical Officers of all the districts in which the men working on the ship resided stating that the case was now regarded clinically and bacteriologically as one of chickonp and that therefore the daily supervision of the shore workers could be discontinued. Further measures of precautionary disinfection. 41. On Monday and Tuesday, 11th and 12th April, I discussed with Dro Corbett such further measures as might be thought necessary or desirable to remove all trace of infection from the ship and, to that end, I asked Dr. Coneybeare if ho would convene a meeting at the Ministry of Health to discuss the matter. This meeting took place on Wednesday, 13th April, when certain principles were discussed and agreement reached. (a) It was agreed that the infectivity of a developing case of smallpox began in all probability not earlier than 48 hours preceeding the development of the rash and that for practical purposes it would bo safe to regard the period of potential infectivity as definitely not excoeding three days. 0 that assumption secondary cases arising from contact with Mr. A* were probably infected during the 24th and 25th March during which time Mr. A. was either in his cabin or possibly moving about the ship complaining only on the 24th at any rate, of indigestion. (b) As to the persistence of the virus it was considered that the virus contained in naso-pharyngeal droplets was unlikely to persist in the publi rooms for any length of time. Virus in scabsiwas, of course, a different matter altogether but the possibility of infection by this means could be ruled out in this case. (c) Consequently there might possibly be traces of virus in the public rooms and in the dining saloon, visited by Mr. A. and it would be desirable to have this accommodation fumigated. It was considered that fumigation carried out in the cabins occupied by Mr. and Mrs. A. the stewards, nursing and medical staff, that had been in close contact was already sufficient but the meeting was glad to hear that it was proposed thoroughly to wash down these spaces and then to re-paint or re-spray. (d) As regards the public rooms it was agreed that it would be desirable to have them fumigated (not sprayed) with formaldehyde to be followed by a thorough washing down of the decks. Dr. Corbett subsequently informed me that the Company had decided to engage Messrs* Associated Fumigators Ltd., to carry (14) out a formalin fumigation of the whole of the accommodation in the ship, public rooms, cabins and Officers and crews quarters. This would be carried out over the Easter week-end under the supervision of the Inspectors of the Port Health Authority. Secondary cases of Smallpox arising among passengers. 42. A number of cases, some fatal, have occurred among passenger contacts including Mrs. the wife of the first case, who was undoubtedly in the early prodromal stage even on the evening of the 2nd April when she vra.s transferred to Clandon. None of the secondary cases occurred within the area of the Port Health Authority and consequently are not referred to in this report in detail. The cases confirmed as smallpox reported to me by the Ministry of Health (20th April) were as follows :- Place Onset of illness Died Port of London 3.4.49 6.4.49 Paddington M.B 5.4.49 St.Pancras M.B 5.4.49 Isle of Axholme R.D.C 5.4.49 9.4.49 Paddington M.B. 6.4.49 14.4.49 Liverpoool C.B 6.4.49 Wembley B 7.4.49 9.4.4-9 Sutton & Cheam B 7.4.49 Torquay B 8.4.49 Aylesbury B 12.4.49 Richmond B. 12.4.49 43. There remains some uncertainty concerning the diagnosis in patients reported from Southwark M.B. and Abertillery. 44. In numerous other persons who travelled on s.s. "Mooltan" and who subsequently came under medical observation suspicion of smallpox was not confirmed. 45. It is interesting to note that none of the fatal cases, so I was informed, had been previously vaccinated. 46. The disease was a severe form of variola major. Two patients died in the prodromal phase. The disease was haemorrhagic in some - in others there was marked modification resulting from vaccination. 47. It is clear from the history of each of the secondary cases and from the date of onset of their illness that they contracted the disease on board the "Mooltan" on various dates between 25rd March when the original patient first became infective and the date of arrival of the ship. This indicates that isolation of the first case on board the ship was not completely effective. The following observations arise from the somewhat unusual circumstances surrounding the incident on board the "Mooltan". 1. Mistaken Diagnosis. 48. There is little doubt that Mr. A's infection occurred as a result of his visit to the town of Bombay and the period of incubation confirms this. He went ashore at Bombay on the 10th March and if indigestion is to be regarded as a prodromal symptom of the disease the incubation period was 13 or 14 days. The evidence goes to show that the rash began to develop on the 25th and was well out on the 26th. 49. The distribution of the rash failing to involve the face and head in the first instance and the absence of a prodromal rash were probably the reasons which misled the Ship's Surgeon and caused him to make a diagnosis of chickenpox. But he clearly was in doubt from the fact that he called in two Indian medical men, passengers on board, to see the case. Their confirmation of his diagnosis (one of them said that he had dealt with many thousands of cases of smallpox) was to say the least, unfortunate and was probably a strong contributory cause to the decision of the Surgeon to regard the case unquestionably as one of chickenpox and to take no (15) preventive measures such as the vaccination of the passengers and crew; he had some 600 doses of lymph on board, 50. This disastrous mistake compels one to take the view that there should be a review of present day policy in regard to the vaccination or the offer of vaccination to passengers travelling to or via the Far East and more particularly to those who have not previously been vaccinated or have been vaccinated in infancy or many years ago. Passengers who have no experience of the East cannot be expected to appreciate the grave risks they run in going ashore at certain ports such as Bombay where virulent smallpox is endemic and one cannot, help feeling that if such risks were brought home to them many would readily agree to be vaccinated or alternatively would forego their shore visit. 51. It is suggested, therefore, that, at the very least» and this, of course, applies to all passengers whether travelling by sea or air via the Far East, they should be warned of the dangers and urged to be vaccinated before embarkation. To this end a notice might be issued by the Companies concerned at the same time as the passenger takes his ticket. 52. In addition, on approaching a port such as Bombay the warning might be repeated to the passengers on board offering those who have not already been vaccinated, vaccination before they go ashore. Incidentally, I understand that most of the States in the Commonwealth of Australia have laws requiring vaccination in infancy but that these are a dead letter, consequently a large majority of the population, even up to 80^, is unvaccinated. 2. Instructions to Ships' Surgeons. 53. I feel that in general Ships' Surgeons fail to appreciate the significance and the menace of smallpox, particularly to passengers and no less to countries not adequately protected against the disease. 54. Smallpox is a most subtle disease always lying in wait to pounce upon the unwary and it is of the greatest importance that ship surgeons should realise that smallpox modified by previous vaccination is the most dangerous form of all from the point of view of its spread, because the most difficult to diagnose. 55. Consequently when they are confronted with a rash which might appear to them to indicate an attack of chickenpox but which presents features which lead to some doubt in their minds, they should invariably and without hesitation, if they have the slightest suspicion that it might not be chickenpox, take all precautionary measures as if the case were in face one of smallpox. In other words unless they are confronted with signs and symptoms and a history which enables them to diagnose chickenpox beyond all reasonable doubt, they should treat the case as one of suspected smallpox and act accordinglyo Indeed they should adopt the attitude that there is no such thing in International traffic as suspected chickenpox! The measures they should take should, of course, include strict isolation of the suspected case and vaccination of all persons on board who do not present clear evidence of recent successful vaccination. 3 o Measures taken on arrival. 56o Some criticism has been made of the fact that the Boarding Medical Officer in association with Dr. Boul, the Ministry's Smallpox Consultant, permitted the "Mooltan" to tie up to the Tilbury Landing Stage and persons on the Stage to go on board the ship. The ship should, it is asserted, have been kept in the River in isolation, amy from the shore. Such an action would have unnecessarily disturbed the landing arrangements and although the ship was tied up to the Stage her isolation was complete and no unauthorised person gained access to her. The six authorised persons who were allowed on board were the P. & 0. Co's Marine Superintendent whose attendance was essential to arrange the further movements of the ship and five Baggage Clerks who were also essential for arrangements for the landing and disposal of baggage. These six persons were vaccinated on the Tilbury Stage before they were allowed on board ship. 57, It was, in any event, in accordance with the current policy in this country, (16) necessary to disembark the passengers when all names and addresses had been taken and vaccination completed and it will be appreciated that so large a number of passengers carried in the "Mooltan" could only be rapidly and expeditiously disembarked if the ship were tied to the Stage. To take them off by tender from the ship lying in the River would have involved many complications and much loss of time, 58. A further criticism took the form of an expression of doubt as to whether the ship should not have been put into quarantine and kept in quarantine with all passengers and crew until all risk of the appearance of further cases had been eliminated. Such criticism fails to appreciate the innumerable difficulties in feeding 1,400 souls for a period of 16 days in isolation in the ship. It was even suggested that as an alternative the passengers should have been disembarked and kept in isolation ashore during the period of quarantine - an equally difficult proposition. 59. Above all the criticism fails to appreciate the present day policy in this country as regards its protection against smallpox. The procedure is that actual cases should be disembarked and isolated and contacts, after offer of vaccination, should be placed under 'surveillance' but not isolation. The only power given to a Port Medical Officer to isolate a contact is one in which he considers, either by a refusal of vaccination or as a result of such close contact with an infected person in point of time, that the contact is immediately threatened with an attack of smallpox, such a person oan be kept under observation until the immediate risk to himself and to others is past. These powers were only recently given to Port Health Author it ie s. 60. "Business Reply" Cards. The system of handing the contact a yellow card of the "Business Reply" type, instructing him to notify any change of address during the 16 days after disembarkation has on the whole, worked well on this occasion. One hundred and forty six cards have been returned to this office during the 16 days following disembarkation notifying change of addresses. So far as one can judge, notification of the Medical Officers of Health of the districts into which the passengers were proceeding has also worked remarkably to 11 and it is believed that with only one or two exceptions, all passengers and crew contacts liave effectively been kept under daily medical supervision. 51. In an appreciable number of instances there has been some delay in the receipt of the 'Business Reply' cards notifying a change of address to this office. I have taken the matter up with the Post Office Authorities and I have been assured there should be no delay what soever. These cards should be delivered by the same delivery as normal correspondence and the individual instances of delay have been taken up to ascertain how the delay lias occurred. 62. In any case they have been very few in number but it is obviously important that there should be no delay at all if supervision of contacts is to be continuous. In one instance, owing to delay, a contact embarked on the "Queen Elizabeth" two days before the receipt of her card at this office notifying that she was about to embark . 63. It is clear that there are defects in the system which call for investigation© I have received today (l9th April) fifteen cards most of them with a London postmark, notifying change of address, bearing the Post Office stamp of the 14th April, a delay of five days due in part, but not wholly, to the Easter holidays. 54. Finally although there have been a very large number of enquiries from the public as to the risk of harbouring or coming into contact with a contact passenger, generally speaking my impression is that the public have played up very well indeed and there has been very little nervousness, a fact which I think demonstrates confidence arising from the daily supervision of contact cases by the Medical Officers of Health. (17) TYPHOID FEVER - SS "MOOLTAN" The ss "Mooltan" arrived, off Gravesend at 0630 hours on the 15th December, 1949 and was boarded by the Port Medical Officer on Duty PORTS OF CALL Outwards - Port Said, Aden, Colombo, Fremantle, Adelaide, Melbourne, Sydne Brisbane Homewards - Brisbane 27/l0, Sydney 2/ll, Melbourne 5/ll, Adelaide 8/ll, Fremantle 12/11, Colombo 2l/ll, Bombay 24/ll, Aden 29/ll, Port Said 3/12, Marseilles 8/l2, London 15/l2 PERSONNEL Crew European » 162 Asiatic 269 Total 431 Passengers Tourist British 338 Alien 9 Total 347 Passenger Crew for "Empire Fowey" European 83 Asiatic 151 Total 234 Grand Total 1,012 1 The Boarding Medical Officer found that a Joiner, an Assistant Steward and a Distressed British Seaman were reported by the Ship's Surgeon as having a rise of temperature of unknown origin and a Lascar as a case of dysentery Seeing that there was no evidence of a rash on any of these men nor obvious signs of epidemic disease, the ship was permitted to proceed to her berth in the King George V Dock with these men on board and arrangements were made for their removal by ambulance to the Seamen's Hospital, Greenwich, as soon as the ship had tied up at her berth- 2 On the following day a further member of the crew, a Bell boy (European) was found to be feverish and was admitted to the Seamen's Hospital, Greenwich Five samples of the drinking water were taken and delivered to the Seamen's Hospital Laboratory at 340 pm for bacteriological examination 3 17.12.49 The Port Medical Officer of Health was informed that some of the cases admitted to hospital were very suspicious of enteric fever and he consequent!; visited the ship and after conference with Dr Corbett, the Medical Superintendent of the P & 0 Steam Navigation Company, and other Officers, drew up a number of measures for the prevention of the spread of infection Such measures included s- (a) The removal of all bedding, blankets, towels and personal clothing of the suspected cases for steam sterilisation (b) All water taken in abroad to be chlorinated up to 1 part per million, then discharged through the service pipes, the tanks to be then refilled with London water and again to be chlorinated up to 05 parts per million The chlorine content of the water to be maintained at approximately 05 parts per million by daily control and, if necessary, re-chlorination (c) Arrangements were made with the Ministry of Health Laboratory, Colindale to receive samples of stool from all members of the crew for bacteriological (18) examination for B. Typhosus. Golindale Laboratory agreed to accept up to seventy specimens of stool each day, priority to be given to the gallery staff and stewards. 4. On the 19th December, two of the patients in hospital - T.J. W. (joiner) and 5.F. (Lascar) were reported as bacteriologically positive Typhoid and at least five other members of the crew were suspected to be suffering from Typhoid fever. The names and addresses of 80 members of the crew who had gone on leave were obtained and forwarded to the Medical Officers of Health of 67 districts to which they had proceeded, together with an explanatory note. 5. On December 20th the Ministry of Health informed the Port Medical Officer that a passenger, a child aged 9, had been admitted to hospital in Belfast, suffering from Typhoid fever, which diagnosis was later confirmed bacteriologically. The same day the names and addresses of all the passengers, 347, were forwarded to the Medical Officers of Health of 123 districts to which they had proceeded, together with an explanatory note. It was found that the ship had taken on block ice in Brisbane and Bombay and samples of this ice were sent to the Davenport Laboratories for examination. The ice chambers were closed and use of the ice forbidden. 6. On De cember 24th a number of the crew were permitted to proceed on Christmas leave. The names and addresses of 92 members of the crew were notified to the Medical Officers of Health of the 75 districts to which they were proceeding together with a covering note. 7. On December 26th further cases having been reported on the ship to be ill were removed to hospital for isolation and treatment. Seeing that in most instances the cases were symptomless, other than showing some fever, it was decided to institute a daily muster of all the members of the crew for the purpose of taking their temperature in order to detect any unsuspected cases of fever. It vas realised that cases with some mild fever not associated with Typhoid would probably be included in the numbers found but it was considered that such cases could be eliminated in due course after they had undergone observation in hospital for a few days. Consequently all cases found with a rise in temperature over 99°F» were sent to Hospitalo 8. On the afternoon of the 26th a telephone message was received from the Colindale Laboratory to the effect that the stools of two butchers matess both Goanesej were positive for Typhoid. These men were found to be afebrile but vie re promptly sent to hospital. 9.Owing to the number of febrile cases found among the crew, accommodation in the Seamen's Hospital was no longer sufficient and a certain number of cases vie re transferred to the Brook Hospital and in the later stages of the outbreak, to other isolation hospitals in the metropolitan area. Cases picked up by General Practitioners were admitted to nearby hospitals. 10. whenever a case of Typhoid fever or of suspected Typhoid fever was reported, the quarters occupied by the case were closed and fumigated and the bedding and other material liable to have been contaminated sent away for steam disinfections 80 Cabins or compartments were fumigated by Inspectors Aiken and Tope. Approximately 3,400 pieces of bedding and laundry were dealt with. Steam sterilization of so large a quantity involves much organisation and presents many difficulties particularly as regards transport and storage accommodation. The County Borough of West Ham and the Fulham Borough Council very kindly dealt with the major portion of the material and transport was provided by Association Fumigators Limited. (19) WATER SUPPLY. 1 .. Some interesting points emerge from an investigation of the supply of drinkin water in the ship. Water is ptimped from the shore or from water harges lying alongside the ship through two main intakes, one on the port side amidships just abaft the main galley and one on the port side astern, situated in the lascar quarters and openi into the ships side through a port-hole. These intakes are about 6" diameter and the method of delivering the water is to hoist a hose up the ship's side either from the quay or from the water barge, to pass a length of it into the intake pipe and then to pump the water up. The hoses or at least the outsides of them are, of course, liable to consider able contamination on the quayside or on the deck of the water barge and some of the contamination must inevitably be introduced into the water intake when the hose is inserted. Water was taken on board at all the ports on the homeward voyage, that is, i Australia, at Colombo, Bombay Aden, Port Said and Marseilles. It is the practice in the P. & 0. Company, whatever the purity of the water taken on and its chlorine content, to chlorinate the water in the tanks at the time of filling to an amount equivalent to 0.5 parts of chlorine per million. 12. Water taken in at Bombay on this voyage was not chlorinated for some reason which is not clear but apparently rested on some specific instruction having its origin in Bombay itself. The amount of water taken on in Bombay on the voyage home was as follows Into No. 7 Tank (which contained 15 tons of water left over from the Colombo supply) 91 tons from a stand pipe and 383 tons from four P. & 0. Water Barges. A further 150 tons of mixed water from stand pipe and barges - the amounts from each are not known - were taken into the Tunnel Tank. To repeat, the water taken into No. 7 Tank and the Tunnel Tank was not chlorinated. The water in No. 7 Tank was used immediately while the ship was lying in Bombay on the 24th November and also on the following day, by which time the tank was empty. The water in the Tunnel Tank was used on the 3rd and on the 4th December, when the ship arrived at Port Said. Both tanks were topped up with Port Said water but no further use was made of the water in these tanks until the 8th and 9th December when the Tunnel Tank water was again used. The Tunnel Tank was topped up again at Marseilles on the 9th December but was not used at any time before the ship arrived in London on the 15th December. 13. Reference to the annexed graph will show the incidence of cases in relation to the use of the Bombay water. (20) (21) It is important to note that the cause of the outbreak cannot definitely be attributed to the water taken on at Bombay but the relationship of the use of this water and the grouping of cases is somewhat suggestive. All the tanks in the double bottom of the ship used for the storage of water are inter-connecting and when drinking water is required, the valve between the particular tank and the pump is opened and the water pumped up through filters to a gravity tank on the top deck of the ship. From the gravity tank the water flows through three main outlets, to the forward section of the ship, to the galley and to the stern section of the ship respectively. The outlets split up into a large number of branches which distribute the water throughout the ship. Scattered throughout convenient parts of the living accommodation are eleven public drinking water fountains situated in a convenient alleyway. To reach each drinking fountain the water passes through a small carbon filter, the object of which is to remove from the water any small particles of rust or other deposit which otherwise would fall into the dr inking receptacle when the water is turned on. It is stated that these filters are taken apart and cleaned once a fortnight but there is some doubt about this. It cannot be denied that the system of using small filters for this purpose is not satisfactory in that these filters, unless frequently and carefully cleansed, tend to promote the growth of organisms in the water and thus to become a source of contamination of the water. SANITATION. 14. The sanitation of the ship follows the usual ships' practice but the dispositii of soil pipes in certain parts of the ship is not altogether satisfactory. In this connection it must be remembered that this ship was converted for use as an armed cruiser in the early days of the war which necessitated the removal of much of her passenger accommodation and considerable interference with the plumbing arrangements. Later on she was again converted, for use as a transport and again her plumbing underwent considerable change. The result is that plumbing lines are in some instances found to wander about before they discharge overside and to be laid in proximity to water pipe lines. 15. Plumbing defects were carefully examined but no evidence was found of any leakage between the waste pipes and water supply. The usual blockages of soil pipes occurred d\iring the voyage and were, as far as possible, attended to-by the ship's staff. Defects were corrected by the shore plumbers during the ship's stay in port. It is doubtful whether the defects were such as to occasion the contamination of the drinking water or other services connected with the food supply to the extent that would produce an outbreak of Typhoid fever so widely distributed through the ship's crew and involving a certain number of passengers. CASES. 16o The incidence of Typhoid and of "excretors" among all persons on board, is shown in the following table Number Cases of Typhoid including carriers Percentage Crew. European (including crew of "Empire Fowey") 245 18 7.3 (ditto) 420 31 7.4 347 18 5.1 Total 1,012 67 6.6 (22) It is interesting to note that the incidence among the European and Asiatic crews was approximately the same and was not much less among the passengers. It is not, however, certain that all cases of Typhoid fever among the passengers may have been diagnosed as such or reported either to the Ministry of Health or the Port Medical Officer, which may account for the apparently slightly Loirer attack rate among the passengers than among the crew. Of the 67 cases reported, ten were carriers (or rather, symptomless excretors), nine among the Asiatic crew and one in a member of the European crew. In this connection it is important to note that the crew of the "Empire Fowey" although regarded as passengers were available for duty on board the ship during the voyage and a number viere , from time to time, employed in their several capacities® Thus for instance, the two positive excretors first discovered were a butcher's mate of the "Mooltan" crew and a butcher's mate of the "Empire Fowey" crew<> The latter individual was, from time to time, employed as a butcher's mate in the galley during the voyage home from Bombay. The "Empire Fowey" crew with the exception of the Lascars, that is the Goanese members of the "Empire Fowey" crew, vrere all housed in the after part of the passenger accommodation on "B" and "C" Decks in cabins in double tier bunks, four to six men being accommodated in each cabin. 17. There is a considerable difference between the mode of living of the Goanese and Lascar elements of the crow. The diet of the Goanese is the same as that of the European members and their food is drawn from the galleys supplying the passengers and the European crew. On the other hand the la scars have a different dietary and their food is prepared in separate galleys used exclusively by them. Lascars being Mohammedans eat meat that is specially slaughtered according to their religious rites. They are supplied with flour with which to make their own bread in their own galley. They eat ghee instead of butter and their milk supplies are derived from tins of condensed milk which are handed out to the Lascar galley cooks. Water is, of course, drawn from the common stock. This separation of dietary and preparation of food is significant to the extent that only 4 Lascars from both crews were found to be infected. CARRIERS. 18. The bacteriological examination of a sample of stool from all the crew on board, both of the "Mooltan" and the "Empire Fowey", revealed 10 members of the crew to be carriers of B. Typhosus» In an outbreak of this kind the carrier rate would be expected to rise and it is questionable whether these persons should be properly labelled "healthy carriers". They may in fact be symptomless cases of the disease. In other words, cases of Typhoid from a bacteriological though not from a clinical point of view or they may be early "excretors" in the course of incubating the disease which reveals itself at some later stage through one or more signs or symptoms. These so-called carriers, or more properly speaking "excretors' were, of course, regarded as if they were true cases of Typhoid and as soon as they vie re found were promptly isolated in hospital. As regards the significance of the so-called carriers it will be noted that because the occupation of the first two is that of butcher's mate and they were consequently working in the main galley ostensibly handling meat, that does not necessarily mean that their activities were confined solely to the handling and preparing of meat and they may well have, and in fact did, perform other duties in the galley as and whon required. MILK. 19. The milk for European and Goanese consumption is carried in powder form and is mixed with water in churns as required. If the total quantity prepared on any (23) given day is in excess of that day's requirements it is kept in cold store for use on the following day. Investigation showed that the milk was prepared in strict cleanliness and apart from the fact that it was mixed with water there was no evidence to show that it could have been the source of the contamination. Nevertheless it is evident that if the water used in preparing the milk mixture was itself contaminated the mixture would serve as a good culture medium for the development of any Typhoid organisms which might have gained access to the mixture from the water used. Powdered milk is not issued to the Lascars who are supplied with tinned sweetened condensed milk. ICE. 20. There is no ice making plant on the "Mooltan" and consequently block ice is taken on board at various ports during the voyage and on this occasion five tons were taken on in Brisbane and six tons in Bombay. This ice was kept together in a cold room in which, incidentally, also was stored some frozen fish. A very thorough bacteriological analysis of the ice was carried out and it was found that it was definitely contaminated with excremental organisms, though no Typhoid organism was recovered. This contamination appeared to be a surface contamination and no doubt resulted from the unhygienic handling of the ice in the course of its transport from the factory to the ship; not an uncommon occurrence even in London! Samples of ice taken from the centre of the block failed to produce B.Goli. It is possible, therefore, that the ice may have become contaminated, either the Brisbane ice or the Bombay ice, by a Typhoid carrier, but it is unlikely that the Typhoid organisms would develop in the ice in store and other circumstances would have to intervene to produce the development of growths likely to cause so wide spread an outbreak in the ship. The ice is used in keeping pats of butter cool, for cooling soft fruit and other drinks of which quantities are consumed during the voyage and it is also used for cooling bottles of mineral water that are served out in the bars and saloons. Incidentally, all mineral water is carried in bottles. Since the analysis of the ice showed the presence of B. Coli in considerable quantity and also showed the ice to be dirty both physically and bacteriologicallyi the ice as a medium of the origin of the infection and of its spread cannot be ruled out. Measures were taken at an early date after the arrival of the ship to lock up the ice and it was eventually melted down. ICE CREAM. El. Large quantities of ice cream were taken in at Sydney 500 quarts Chocolate Ice - 375 qts. remained when the ship arrived in London 1,000 " Strawberry Ice - 688 " ditto. 1,000 " Vanilla Ice - 761 " ditto. The ice cream is supplied in grease-proof paper and cartons and the only process through which it goes on board is cutting up into suitable sizes for consumption. Analysis of samples of the ice cream revealed the presence of B. Coli in 0.01 c.c. This is not surprising since ice cream is made from cow's milk and it would be unusual if the ice cream were completely free of animal faecal contamination. No Typhoid organism was found, LABOUR CONDITIONS IN PORT. 22. It is not surprising that in view of the publicity that this ship has bad in (24) the Press and the somewhat alarmist accounts that were published and further, having regard to the unfortunate incidence of smallpox on the previous voyage , that the shore men working the ship were nervous of infection. In view, however , of the severe measures that were taken to control the most obvious sources of infection as soon as the ship arrived, for example the chlorination of the residual 'water in the tanks, followed by its discharge overside and the taking on of London water and its chlorination, the locking up of the ice and ice cream and the separation of the lavatory accommodation of the crew and furthermore the injunction applying to all shore workers that they were not to eat any ship's food nor, in the first days to drink ship's water, the Port Medical Officer considered it safe to issue a notice that, subject to the precautions to be taken by shore men working on board, i.e. no food or water to be consumed on board and a thorough washing of the hands in soap and water before consuming food, there was no risk in working on board the ship . Nevertheless there still remained some nervousness and the men's Representatives insisted that the Company should declare that any man or member of his family, who was found to have contracted Typhoid fever as the result of working on board, should be indemnified and this the Company accepted on the advice of the Port Medical Officer. Following a conference with the men's Representatives when all aspects of the matter were discussed with the Port Medical Officer and with Medical Officers of the Ministry of Health, further trouble ceased and so far as is known up to the time of writing this report, no case of Typhoid fever has occurred in any shore worker nor in any member of his family. MINISTRY OF HEALTH. 23. The Port Medical Officer had been in close contact with the Medical Officers of the Ministry of Health right from the beginning. The rapid succession of cases among the crew discovered during the last week of December and the early days of January overwhelined the available accommodation in the Dreadnought Hospital, Greenwich, and rendered it necessary to transfer a certain number of cases from that Hospital to isolation hospitals in the Metropolitan area and to distribute succeeding cases among these hospitals, notably the Brook Hospital, the Park Hospital, and Rush Green. The result was that the distribution of cases to these hospitals became unknown and their diagnosis uncertain to an extent that the Port Medical Officer rapidly became completely out of touch with this important aspect of the outbreak. Furthermore , the fact that the ship had been in port for some time and that despite the measures that had been taken cases "were still occurring, led the Port Medical Officer to feel that the assistance of the Ministry of Health in providing Medical Officers to pursue enquiries into the possible cause of the infection was urgently required. Consequently, the Port Medical Officer, after consultation with the Medical Superintendent of the P.& 0. Steam Navigation Co., invoked the assistance of the Ministry of Health and on January 4th a conference was held between the Medical Officers of the Ministry, the Port Medical Officer, and representatives of the Company, on board the "Mooltan" and a programme of further investigation was drawn up. At the same time Medical Officers of the Ministry rent round all the hospitals in which patients were known to be or to which they night have been sent to find all cases that had been evacuated from the ship and to ascertain the diagnosis, if any, that had been made in each case. The action taken by the Port Medical Officer in the matter of the chlorination of the water supply and of investigating the plumbing arrangements, food distribution, and other possible factors, was reviewed and further more detailed investigations were planned. Subsequently several conferences were held on board and while the investigations failed to reveal any cause to which the outbreak might definitely be attributed, the Port Medical Officer was very grateful for the assistance and advice of the Ministry, and particularly for the additional personnel it enabled him to bring in on the investigations. (25) The policy of examining specimens of the stools and urine of every member of the ship's crew was continued, and it was decided that no member of the crow should return to sail in the ship unless three specimens of stool and one specimen of urine had been found to be negative to typhoid. Incidentally, over 2,000 stool and 500 urine specimens were collected on board and sent to Colindale for examination during the period of the outbreak. Further samples of the ice, ice cream, and water from the various parts of the pipe lines in the ship were sent for investigation but none of them revealed Typhoid organisms. DECISION AS TO DATE OF SAILING. 24. The number of cases rapidly dropped after January 3rd and though one or two excretors were discovered it looked as if the end of the outbreak had been reached by January 13th. It was consequently decided, after consultation with all concerned, that providing things went well and there was no further recrudescence of cases the ship might be considered fit to sail on Wednesday, January 25th. It will be appreciated that a decision to be reached as to the date of Sailing of a large passenger vessel of this kind is not a light responsibility. Quite apart from the weighing up of the risk of fresh infections, passengers must be informed at least ten days in advance of the date of sailing, particularly where a considerable proportion of them are leaving this country for good and have many domestic arrangements to conclude . The Company in issuing the preliminary notice of the proposed sailing date warned all intending passengers that there had been an outbroa. of Typhoid fever on board the ship. On Thursday, January 19th a further case in a European Quartermaster was discovered on board. This man had been feeling unwell since January 16th but without fever, and it was only on the 19th that he was found at the daily muster to have a temperature of 102°. He was promptly transferred to hospital and was eventually found to be suffering from Typhoid fever. This man had been a close contact with another member of the crew who bad been occupying the same cabin and had been one of the first cases to be found when the ship arrived. It is possible, therefore, that he contracted the disease from this first case by direct contact though there is, of cours, no proof of this. The Company decided, therefore, to issue a further notice to passengers informing them that a further case had been found but since this did not constitute a recrudescence of the outbreak of the disease it was decided to adhere to the sailing date. No further cases were discovered and in due course the ship sailed on January 25th. 25. During the course of the close investigation of the complicated water supply in the ship - drinking water, ballast water, and engine room water - certain possibilities, however unlikely in practice, of an interchange between these pipe lines were discovered and though no definite proof that such an interchange had occurred during the voyage it was felt that this was a potential source of contamination which ought to be pursued. The Port Medical Officer decided, therefore, to ask the Company to allow one of the Port Health Inspectors, Mr. T.L. Mackie, who is a fully qualified Marine Engineer with long experience of engineroom practice, to accompany the ship on her outward voyage as far as Port Said and during that time to make a thorough investigation of the whole of the water supply lines in the ship, together with plumbing arrangements that might have any link with the galleys, under operating conditions at sea. The Company at once accepted this request and Mr. Mackie sailed with the ship. Dr. Morgan obtained the permission of the Chairman of the Port Health Committee to this proposal. CONCLUSIONS. 26. The outbreak of Typhoid fever in the "Mooltan" , in view of the numbers involved and the wide distribution through the ship, must be regarded as a serious outbreak and it was of the first importance to trace the cause. This has not been possible and its origin is sufficiently perplexing. Nevertheless, there are certain indications which point toward the probable source or sources of the infection. As has alreadv been stated, the wide distribution among; all on beard, save (26) among the lascar elements of the crew, points fairly strongly towards a -water borne infection. The fact that a water supply is originally sound and free from contamination at the source, does not mean that it is not subject to contamination during its transit from shore to ship., It has to be transferred from the shore through pipes which are liable to pollution and also at times in water barges which are also liable to pollution. Ships tanks are notoriously uncertain elements for the storage of water and there may conceivably have been pollution in the tanks and in the water lines throughout the ship. Pollution of this kind is generally harmless and may continue so for years until certain factors meet i.e. a water supply open to pollution and a polluter ashore or in the ship in the shape of a carrier or a case of Typhoid fever whose germs gain access to the water. This is probably what has happened at some stage in the events of the voyage. 27. But vra.ter itself, unless very heavily polluted with Typhoid organisms, will not cause Typhoid because the germs will not develop even in a moderately clean water but requires, like all other living things, some nutriment for life and propagation. It may be that the nutriment supplied on this occasion was the milk powder mixed with the polluted water. In this connection it is interesting to remember that the lascar crew, which remained practically free from infection, had not consumed milk powder, their milk being supplied in the form of condensed milk in tins. On the other hand, lascars drink plenty of water and if the water were polluted with typhoid a few might receive a threshold dose sufficient to cause the disease to develop. 23. The fact that the water taken on in Bombay was not chlorinated renders one very suspicious that the source of infection was through this water. and the chronological distribution of cases in relation to the days on which the Bombay water was consumed, strengthens this hypothesis. 29. Any defects there may have been in the plumbing system are only of importance, qua source of infection, in relation to the water supplies. It is not very likely that the plumbing alone would cause contamination of foods consumed. 30. Of other potential sources of infection the ice cannot be completely absolved from defect and it is true that lascars are seldom provided with ice. The fact that it has not been possible to recover Typhoid organisms from the ice (technically very difficult) does not mean that the ice was not infected, and the ice and the methods of handling it must remain a possible, though unlikely, source of the infection. The ice cream can very probably be ruled out altogether. 31. There remains the possibility of infection by a carrier and the only means whereby this could come about and produce widespread infection of the ship would be through food prepared in the galley and distributed equally among passengers and crew. It is known that excretors were working in the main galley whence food for all persons on board is derived but this possibility must remain an unknown quantity. 32. A frequent source of an outbreak of Typhoid fever in this country for example, is the presence of a Typhoid carrier in a food preparing establishment. It may be that the infection gained access to the powdered milk and water mixture from the hands of a carrier and this must remain one of the more likely hypotheses. 33. In conclusion, every conceivable measure was taken to render the ship free from infection at the time of her sailing. None of the crew who had Typhoid fever or were found to be excretors returned to the ship, nor were they allowed to sail in any other ship until they were proved to be free from the disease. All the drinking water and every other water supply that was in any way associated with the drinking water lines was thoroughly chlorinated and continued to be chlorinated daily during the voyage. All plumbing defects, however slight, were put right. V. MEASURES AGAINST RODENTS. 1. Steps taken for the detection of Rodent Plague. (27) 2. Measures taken to prevent the passage of rats between ship and shore. 3. Methods of Deratisation. 4. Measures taken for the detection of rat prevalence in ships and on shore. 5. Rat-proofing. The action taken under the above headings was fully described in my Report for 1947. "1080" Experimental work with "1080" - fluoro-acetate of sodium was continued during the latter part of the year with highly satisfactory results. "1080" has been used for some years past in the United States of America as a rodenticide not only in ports and ships but in a variety of infestations on land, with remarkable success. "1080" is highly poisonous to all animals , the lethal dose for rodents being about 4 milligrams per kilogram of body weight. It is a highly dangerous poison for which there is no known antidote. It is a white odourless and colourless crystalline substance, readily soluble in water. On account of its poisonous properties it must be handled and used only by trained personnel under closely supervised conditions. Only small quantities have so far been obtainable - it is not manufactured in this country. Results so far, at this early stage, have been remarkable. Colonies of rats that have become trap and bait shy have been rapidly exterminated. Further experimental work is being pursued. In the United States "1080" is replacing 50% of ship fumigations resulting in a great saving of labour and expense to Port Authorities and shipowners. (28) RATS DESTROYED DURING 1949. TABLE E. (1) ON VESSELS. number of Jan Feb Mch Apl May Jne Jly Aug Sep Oct Nov Dec Total in year. Black Rats 261 362 209 92 193 337 219 222 150 80 197 175 2,497. Brown Rats - - - - - - - - - - - - - Species not Recorded. - - - - - - - - - - - - - Rats examined 58 54 44 27 74 24 28 15 28 15 28 33 428. Rats infected With plague. - - - - - - - - - - - - - TABLE P. (2) IN DOCKS, QUAYS, WHARVES AND WAREHOUSES. Number of Jan Feb Mch Apl May Jne Jly Aug Sep Oct Nov Dec Total in year. Black Rats 137 140 110 87 158 172 158 138 252 251 326 273 2,202. Brown Rats 82 145 140 55 61 72 54 81 85 154 68 200 1,197. Species not Recorded. - - - - - - - - - - - - - Rats examined 38 34 17 9 31 3 22 4 58 110 35 27 388. Rats infected With plague. - - - - - - - - - - - - - TABLE G. MEASURES OF RAT DESTRUCTION ON PLAGUE "INFECTED" OR "SUSPECTED" VESSELS OR VESSELS FROM PLAGUE INFECTED PORTS ARRIVING IN THE PORT DURING THE YEAR. Total No Of Such vessels Arriving Number or Such vessels fumigated By So2 NO of rats Killed Number of Such vessels Fumigated By HCN NO OF Rats killed No of Such Vessel on which trap- ping, pisoning etc., was Employed No of Rats Killed No of Such Vessel on which Measures of rat Destruction were not carried out. 1,801. — — 96 1,345 (298 mice) 333 175 1,468. TABLE H. DERATISATI0N CERTIFICATES AND DERATISATI0N EXEMPTION CERTIFICATES ISSUED DURING THE YEAR. Net Tonnage No of ships Number of Deratistion certificates issued Number of Deratistion Exemption certificates Issued Total Certificates Issued After Fumigation With After trapping Poisonings ETC. Total HCN So2 HCN and So2 Ships up to 3OO tons 121 - - - - - 121 121 „from 301 To 1,000 Tons 127 5 - - - 5 122 127 ” ” l,001 TO 3,000 „ 128 22 - - - 22 106 128 ” ” 3,001 TO 10,000 „ 386 - - - - 84 302 386 ” over 10,000 tons 31 12 - - - 12 19 31 Totals 793 123 - - - 123 670 793 (29) VI. HYGIENE OF CREWS' SPACES. TABLE J. CLASSIFICATION OF NUISANCES. Nationality of Vesse1. Number in- spected during the year. Defects of Original constructtion. Structural defects through wear and tear. Dirt, vermin and other conditions prejudicial to health. BRITISH 8,332 158 236. 925 OTHER NATIONS 2,515 6 3 86 TOTALS 10,847 164 239 1,011 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 1,711 tons 13 cwts. 3 qrs. 10 lbs. as compared with 93 7 tons in 1948 and 1,094 tons in 1947. The following is a summary showing the method of disposal of the foodstuffs seized Method of Disposal WEIGHT Approximate percentage of total seized. Tons. cwts. qrs. lbs. Boiling Down 73 0 1 4 4.2 Cattle Food 765 5 2 20 44.7 Re-export 171 11 0 3 10.0 Re conditioning 8 4 3 25 0.4 Industrial Purposes 4 3 2 5 0.2 Refining 139 7 0 24 8.1 Other Districts 45 11 3 6 2.6 Buried 497 15 0 19 29.0 Burnt 6 14 0 16 0.3 1,711 13 3 10 99.5 It will be noted that, of the 1,711 tons destroyed the principal methods of destruction were Cattle feeding, Burying, Re-exportation and Refining. Of these, the items so destroyed were as follows Cattle Feeding - wasting oranges, bananas, onions, tomatoes and grapes, 253 tons and a quantity of sweet pickles, mouldy and broken down, 167 tons. Buried - wasting bananas, 708 tons, from 32 shipments, and decomposing cauliflowers date s and potatoes, 28 tons. Re-exportation - 12 tons of Tomato Ketchup with an excess of preservative 30 tons of Gherkins, burst, blown and leaky and 124 tons of Chinese lard for which (30) there is no approved "Official Certificate". Refining - 927 Bags of sugar sweepings, contaminated with extraneous matter, 139 tons. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1937 and 1948. Circular MF4/49, dated 6th April, 1949 issued by the Ministry of Food, reads as follows:- "I am directed by the Minister of Food to state, for the information of the Authority, that he has caused to be published in the London Gazette of the 5th April, 1949, a notice containing in the Schedule thereto the description of a label issued by the Government of Italy which has been recognised as an Official Certificate for the purposes of the Public Health (imported Food) Regulations, 1937 and 1948". The notice reads as follows "The Minister of Food gives notice, in pursuance of the above-named Regulations, that he hereby recognises the Official Certificate, of which particulars are given in the Schedule thereto, as showing (a) that the meat to which it relates or the meat from which the meat product to which it relates was prepared, ms derived from animals inspected ante and post mortem and passed in accordance with criteria satisfactory to the Minister, and (b) that all necessary precautions for prevention of danger to public health vrere taken in the dressing or preparing and packing of the meat or meat product. The certificate being in the form of a label, recognition will apply only if the label is securely affixed to the meat or to the package containing the meat or meat product and if the label has not in any other circumstances or on any other occasion been used as an Official Certificate. The label hereby recognised is in substitution for the label having on it the design reproduced in Part I of the Schedule to the Notice published in the London Gazette of the 15th July, 193 8 which is hereby revoked" . A similar Circular MF13/49 dated 31st August, 1949 was issued by the Ministry of Food in respect of a label issued by the Government of Hungary and which has been recognised as an Official Certificate for the purposes of the above mentioned Regulationso The label hereby recognised is in substitution for the label having on it the design reproduced in Part I of the Schedule to the notice published in the London Gazette of the 6th August, 1937, which is hereby revoked. X X X X X X X Your Medical Officer referred, in his last Report, to the difficulties that were being experienced in the supervision of the variety of foodstuffs which are increasingly entering the Port from countries all over the world. These difficulties have in no way diminished during the year and on a considerable number of occasions foodstuffs, particularly canned foods, owing to inexperience in the packing house and to the use of inappropriate cans made of tin-plate of too light a gauge and poorly tinned, have had to be condemned. Many of the products are of very poor quality but are nevertheless welcome to the housewife distracted by difficulties in finding suitable additions to the rations for her family, (31) It is to be hoped that a number of importing firms will automatically eliminate themselves from the trade under the severe conditions of competition that are now taking place and that the quality of imported products will consequently improve. With regard to fresh meat - frozen mutton showing marked evidence of caseous lymphadenitis continues to be imported and your Medical Officer, seeing that this type of mutton is now permitted, has reduced the amount of sampling as being a vjaste of time and labour. The fact is that the big exporting countries know exactly the condition of the product that they are exporting to this country and can vary it in accordance with the precise requirements of the buyer. FOOD AND DRUGS (TJIIALEMEAT) REGULATIONS, 1949. On the 12th March, 1949, Circular MFl/49 from the Ministry of Food directed attention to the above-mentioned Regulations which came into operation on the 20th March,1949. Part I - General - deals only with definitions. Part II of the Regulations prohibits the importation into England and Wales for sale for human consumption of whalemeat or whalemeat products (other than those products excluded by definition namely whale-oil, whale liver oil, whale-meat extract, vitamin concentrates or pharmaceutical products) unless accompanied by a "veterinary certificate" and prescribes the manner in which uncertificated whalemeat or whalemeat products shall be dealt with. Parts III, IV and V contain provisions for securing the observance of hygienic conditions with the sale, transport and handling of whalemeat. The Regulations will be executed and enforced by local authorities, except that Parts II and V will be enforced by Port Health Authorities in their districts. The Regulations are additional to the Public Health (imported Food) Regulations and Part II of these Regulations relating to the importation of "All Food" will continue to apply to whalemeat and to whalemeat products as previously. The Regulations vrere accompanied by a memorandum 1/Whalemeat dealing with the inspection of whalemeat and the conditions under which whalemeat is prepared etc. on floating factories, auxiliary vessels and at land stations. The Authority have no statutory responsibilities in regard thereto but a copy of the memorandum was forwarded for information. The memorandum will be reviewed in the light of the experience gained as the result of this season's whaling expeditions in the Antartio. FOOD AND DRUGS (Y.IIALEMEAT) REGULATIONS, 1949. Circular MP2/49 of the Ministry of Food, dated 25th March, 1949 directs that the Ministry of Food has caused to be published in the "London Gazette" of the 18th March, a notice containing in the Schedule thereto the description of a certificate, which he lias recognised as a Veterinary Certificate for the purposes of the Food and Drugs (Whalemeat) Regulations, 1949 and points out that this is the only certificate, so far, which lias been recognised under the Regulations. The notice reads as follows "The Minister of Food gives notice, in pursuance of the above-named Regulations) that he hereby recognises the Veterinary Certificate, of which particulars are given in the Schedule hereto, as certifying (a) that the whalemeat to which it relates or the whalemeat from which the whalemeat product to which it relates was prepared, was derived from whales inspected post-mortem and passed as fit for human consumption in accordance with criteria satisfactory to the Minister and (b) that all necessary precautions for the prevention of danger to public health were taken in the preparation, classification, packing marking, storing and transporting of the whalemeat or whaleneat product in accordance with conditions satisfactory to the Minister. The Certificate is completed by the addition of the name of the Ship/floating (32) factory and the place of production and the insertion of the signature of the Veterinary Surgeon, facsimilies of which are reproduced in the notice. THE FOOD AND DRUGS (WHALEMEAT) REGULATIONS, 1949. NEW ZEALAND VETERINARY CERTIFICATE. Circular MF8/49 of the Ministry of Food, dated 6th July 1949, calls attention to a notice published in the London Gazette containing in the Schedule thereto the description of a label issued by the Government of the Dominion of New Zealand which is recognised as a Veterinary Certificate for the purposes of the Food and Drugs (Whalemeat) Regulations, 1949. The certificate is in the form of a label and is completed by the insertion of the number of the Establishment. X X X X X X X WHALEMEAT. An interesting situation arises in connection with the large imports of whalemeat that have arrived and are expected to arrive in the near future. The greater proportion of the whalemeat is not intended for human consumption and bears a certificate to that effect. It is packed, ho-wever, in very much the same my as whalemeat that is fit for human consumption and it would be very easy, merely by removing the wrapping, to render the meat indistinguishable from meat fit for human consumption. On the other hand the market for whalemeat for human consumption seems to be diminishing and, therefore, there may be little danger in a manoeuvre of this kind. There is a further interesting point in the matter of the supervision of the destination of large quantities of frozen whalemeat labelled unfit for human consumption. In the case of all other meat and meat products, if unfit for human consumption, the Port Medical Officer would make certain that it only passed into industrial channels but the whalemeat, being kept in cold storage for long periods before disposal, renders such supervision impracticable. In any case most of the whalemeat condemns itself by its unpalatability so that the danger is more theoretical than real. DANGEROUS DRUGS. During the year fourteen 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 obtain a 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 it 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, 1950, 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, (33) 1936, relating to Canal Boats within the district of the Port Health Authority, during the year ended 31st December, 1949. Four boats were inspected during the course of the year, all of which were found to comply with the Act, No new boats were registered during the year under review, the actual number of Canal Boats on the Register on the 31st December, 1949, being 156. PARROTS (PROHIBITION OF IMPORT) REGULATIONS, 1930. The number of notices issued in accordance with the above-mentioned Regulations during the year was 31 in respect of 50 birds of the parrot family. Forty five birds were re-exported, 3 were destroyed on board under the supervision of your Officers and 2 were released under Ministry of Health permit. HOUSEBOATS. During the course of the year Summonses were issued in respect of two houseboats lying within the Jurisdiction of the Authority. Houseboard "MARGARET" lying at Benfleet Creek - In accordance with the instructions of the Port Health Committee, the Town Clerk on the 3rd January, 1949 served a Statutory Notice on the owner of the houseboat "Margaret" in the following terms "Take notice that under the provisions of the Public Health (London) Act 1936 as modified by an Order of the Local Government Board dated 25th March, 1892, the Mayor, Commonalty and Citizens of the City of London, the Port Health Authority for the said Port, being satisfied of the existence at the houseboat "Margaret" lying at Benfleet Creek, River Thames in the said Port, of a nuisance, being a vessel in such a state as to be a nuisance or injurious or dangerous to health, do hereby require you within twenty-eight days from the service of this Notice to abate the nuisance and the said Port Health Authority do hereby require you within the said period to do what is necessary for preventing a recurrence of the nuisance. If you make default in complying with the requirements of this Notice, a Summons will be issued requiring your attendance before a Petty Sessional Court to answer a complaint which will be made for the purpose of enforcing the abatement of the nuisance or prohibiting the recurrence thereof, or both, and for recovering the costs and penalties that may be incurred thereby". The owner having failed to comply within the specified period with the requirements of the notice 18 was summoned to appear before a Court of Summary Jurisdiction sitting at the Petty Sessional Court House at Southend-on-Sea on the 6th April, 1949, which summons was successful and a Closing Order made. Houseboat "BABETTE" lying at Pitsea» A similar Statutory Notice to that served on the houseboat "Margaret" was served by the Town Clerk on the 9th November, 1949 on the owner of the houseboat "Babette". This resulted in a Summons returnable at the Court House, Billericay on the 20th December, 1949, the summons being successful and a Closing Order made. WATER BARGES. During the year samples of water were taken from eight of the water barges in operation in the Port. Seven of the samples were found to be satisfactory and licenses were granted. In the case of the unsatisfactory sample the owners were communicated with and informed that they must withdraw the craft from service and take such measures (34) as were necessary for the thorough cleansing of the tank, nozzles, hosepipes, connections etc., in order to eliminate the source of contamination. It was necessary to take five samples before the -water rns found to be satisfactory. PUBLIC HEALTH (SHELLFISH) REGULATIONS, 1934. Early in September there was an outbreak of Food Poisoning in the Borough of Southend-on-Sea and in some other localities in South East England, which ms in part attributed to the consumption of Shellfish which had been gathered in the Thames Estuary, mainly within the district of the Port Health Authority, and which had been cooked and distributed at Leigh-on-Sea. In all there -were 43 7 cases from 45 localities mainly between London and Southend-on-Sea, but a few were from localities as far afield as Croydon and Leicester. The figures are from the report of the Medical Officer of Health for Southend-on-Sea, to whom the notifications were sent and who conducted an inve stigation. Of the twelve Cockle Sheds at Leigh, six were involved to a greater or lesser degree. The Medical Officer of Health, Port of London, cooperated in the investigation since the Shellfish layings and the treatment of the Shellfish when first landed are controlled by the Port of London Health Authority by an order made in 1936 under the Public Health (Shellfish) Regulations 1934. Shellfish gathered from the "prescribed area" are mostly cockles. A few mussels are collected, but there are no oyster layings within the "prescribed area". There is no "establishment which is for the time being approved by the Minister of Health" in the area. There is also no "pure water" near enough to be of practical value. Shellfish taken from the "prescribed area" for sale for human consumption must therefore be "subjected to a process of sterilization by steam under pressure for at least six minutes in an apparatus which is for the time being approved by the said Port Sanitary Authority" (now the Port Health Authority). There are twelve Establishments at Leigh, one at Southend, and one at Canvey Island having approved apparatus where the steaming is carried out. The Procedure is as follows:- Gathering the Cockles. The Cockle boats are mostly of post-war construction, 40 ft. long and 3 ft. draft, and carry a crew of up to 10 men. There are a few older and smaller boats. All the boats are propelled by motor. They leave Leigh on the ebb tide and arrive at their selected ground with just enough water to floats As the tide recedes the crew go override and work on the exposed sand banks for six or eight hours collecting cockles and carrying them to the boats. liVhen the rising tide makes it impossible to continue, the crews rejoin their boats and as soon as the boats float they return to Leigh, On arrival the boats are discharged at once and are cleaned up for the next days work. The raw cockles are washed in tidal water during discharge. In summer, cooking usually takes place at once since the life of the raw cockle is very short in warm weather. In cold weather it is not unusual for cooking to be postponed over-night. Cooking and hashing. Each Establishment is fitted with a boiler, cooking pots, a riddle, a number (35) of large galvanised iron tanks and a supply of tap water from the local mains. The raw cockles are first washed in tap water, steamed for six minutes in the cooking pots, riddled to separate the fish from the shell, and the fish is then washed in four changes of water to remove sand, weed and pieces of broken shell. Preparation for sale. Cockles for sale locally for immediate consumption are put into a very light brine for flavouring only and not for preservation. Cockles so treated are known as "fresh cockles". On a Summer day they will remain fit for consumption for a few hours only. It is certain that by the end of a warm day the "fresh cockles" will have started to decompose unless great care is taken to protect them and to keep them cool. The fishermen are well aware of this and will only sell "fresh cockles" locally and in comparatively small quantities. Cockles for sale in distant markets are salted down in concrete tanks, using a very heavy brine. When so treated they will keep for several days even some weeks if the weather is cool. They are known as "salt cockles" and must be soaked to remove some of the salt before being eaten. Even when soaked they are not so palatable as the "fresh cockles". Marketing. The cockles both fresh and salt are sold by the gallon. Each gallon being put up in a stockinette bag and up to 20 gallons being packed into a wicker basket. Some of the firms liave their 07m motor vehicles fitted with metal tanks for delivery. The majority of cockles, however, still go by rail to the distant markets. Jurisdiction. The Port Health Authority by virtue of the Public Health (Shellfish) Regulations 1934 and the Order made thereunder, exercises supervision over the gathering grounds which are within the Port of London, and also controls the operation of cleansing the Shellfish - in this instance the sterilization by steam for six minutes. The marketing of the Shellfish is supervised by the local Authority and Food and Drugs Authority in whose area the Shellfish are offered for sale. During the Summer, samples of Shellfish had been taken for bacteriological examination. The results did not give cause for anxiety. But on receipt of the information of food poisoning, further samples were taken in cooperation with the Borough of Southend-on-Sea. A "short term policy" was devised to ensure as far as possible that Shellfish) especially cockles landed and cooked at Leigh, should be marketed in good condition. There were four main points. 1. The period of steam contact in the cooking process was temporarily increased from six minutes to seven minutes. 2. The practice of washing the raw cockles in tidal water was discontinued and the cockles were washed in fresh water from the town mains. 3. The use of certain gathering grounds was temporarily discontinued. 4. The method of handling the cooked cockles was carefully examined with a view to an improvement in hygiene where possible. (36) The considerations which prompted, this policy were as follows 1. Due to the abnormally hot dry summer the esturial mters and the Shellfish layings might reasonably be considered more heavily contaminated than usual. The normal process of steaming for six minutes, although adequate to deal with normal contamination, might not be adequate to deal with abnormally heavy contamination. 2. It ms considered inadvisable to wash the raw cockles in water , which might be heavily contaminated, until bacteriological tests had been completed. 3. It was generally conceded by the Shellfish Industry that certain gathering grounds were more likely to be heavily contaminated than others. The use of these "suspected" grounds was therefore voluntarily discontinued. 4. The possibility that cockles were contaminated after the cooking process was not overlooked, and more detailed attention to hygiene in the Sheds was considered the remedy. Sampling of the cockles, and bacteriological examination at all stages of their preparation, ms continued in an endeavour to find the cause of the trouble. The bacteriological examinations indicated that in cockles taken direct from the cooking pot the edible portion was sterile after six minutes steaming. But when samples were taken from the first washing tank under the riddle a very considerable growth of bacteria vjas found in nearly every case. Thereafter the bacteriological condition of the cockles was found to improve as the cockles were washed in three and sometimes four changes of cold fresh water. But never again vie re the cockles found to be sterile. This lead to further experiments and sampling. First it was conclusively shown that cockles rapidly lose flavour and texture and therefore marketability when subjected to steam cooking for periods in excess of six minutes. Secondly, although the edible portion of the cockle is sterile after six minutes steam cookings the outside of the shell and the mud and sand thereon is found to be not sterile after much longer contact with the steam. It was therefore evidently necessary first to remove as much sand and mud as possible from the cockles before they are cooked. This was done by reverting to washing the cockles in tidal water at the time of discharge and, in addition, washing them in fresh waster from the town supply immediately prior to cooking. Secondly it was necessary to devise an apparatus which would separate the cooked sterile cockle from the unsterile shell as rapidly and completely as possible, and which would at the same time provide for the rapid cooling of the cooked cockles. An apparatus for this purpose has been devised and is now being tried experimentally. It v.as further decided that every Establishment should have some means of sterilizing their apparatus at the end of each days work, and therefore every Establishment has been requested to fit a steam sterilizing hose for this purpose. A paper "Advice on the handling of Cockles at the Cockle Sheds" was circulated to all members of the Industry, and at a meeting at Leigh on 18th October 1949 the Medical Officer of Health, Port of London, and the Medical Officer of Health, Borough of Southend-on-Sea, addressed the Shellfish Industry on the food poisoning epidemic in so far as Shellfish were implicated, and made known their requirements to prevent similar occurrences in future. (37) It is remarkable that during the epidemic the only Shellfish to which suspicion was attached was "fresh cockles". There were no cases attributed to "salt cockles", probably because the very heavy salt content is sufficient to inhibit the growth of food poisoning organisms. There were no cases attributed to mussels. This was probably because the trade in mussels is small and also possibly because mussels when prepared for sale are invariably kept in cold water which protects them to some extent from casual contamination by air-borne bacteria. Consideration was given to the possibility of asking the Industry to discontinu the, supply of "fresh cockles". After much thought, however , it was concluded that the more satisfactory course of action would be to assist the Industry to produce a "safe" "fresh cockle". A large measure of success has been attained in this. Sampling for bacteriological examination continues. But there has been no instance of an unsatisfactory sample for some months. It is to be hoped that with continued vigilance conditions will continue to be satisfactory through the coming Summer. (38) APPENDIX I. MEDICAL INSPECTION - From 1st JANUARY to 31st DECEMBER,1949. GRAVESEND. Jan Feb mch apl May Jne Jly Aug Sep Oct Nov Dec Total Medically Inspected. 137 128 144 148 144 152 120 153 142 144 138 134 1,684 Of Passenger. 8l7 710 646 3063 2685 4511 5724 5364 4657 1730 700 373 30,988 of Crews. 479 436 863 1293 643 903 860 246 414 965 539 482 8,203 of Foreign Arrivals 644 580 691 661 767 732 617 842 7 53 748 744 742 3,521 APPENDIX II. INFECTIOUS DISEASE. Disease 1940 1941 1942 1943 1944 1945 1946 1947 1948 mean. annual No for 10 years ending 31st December 1949 1949. Cases Reported incuoding Cholera( suspected cases) - - - - - - - - - - - low Fever - Do- - - - — — — — — League - Do- - - - - - — - — — - — PhuS Fever. - - - - - 1 - - 1 07 5 Smallpox. 1 1 1 - 1 - 5 2 3 1.6 2 Exarlet Feve. 3 1 2 5 4 5 2 10 3 3.8 3 Diphtheria. 4 11 5 3 5 5 8 5 2 4.9 1 Intreic. Fever. 7 1 1 - - 4 9 5 10 119 82* Measles. 9 1 1 1 1 8 11 26 99 23.7 80 German measles. 7 5 2 1 - 2 6 5 3 4.4 3 Erysipelas. 1 2 - — — - — 1 - 0.4 - Tuberculosis- Pulmonary 19 4 5 12 6 14 21 27 32 18.3 43 Other kinds - - — — - - - - - - Other Diseases (Including Chickenpox) 178 88 179 273 180 115 79 102 106 142.4 124 Totals 239 114 196. 295 197 154 141 183 259 212.1 343 * includes 10 "healthy Excretors" Admitted to Hospital Including cholera (Suspected cases) - - - - - - - - - - - Yallow Fever -Do— - - - - - - - - - - - AGuE - Do- - - - - - - - - - - - Plague Fever - - - - - - - - 1 0.4 3 Smallpox — — — - - - - - - - - Scarlet Fever - - 2 5 4 4 2 — 3 2.0 - Diphtheria. - 9 5 2 4 5 7 4 2 3.8 - Icteric Fever 1 - 1 - - 3 — 2 3 1.0 - Measles 5 - 1 - 1 4 6 10 24 5.7 8 Erysipelas. - 2 - - - - - — — 0.2 - Parotitis - - — 2 - 1 5 l 4 1.9 3 Dysentery 2 - - - - 1 8 9 3 24 1 Other Diseases ( Including Chikenpox 52 26 15 l6 34 50 43 60 60 41.0 34 Totals 50 37 24 25 46 68 71 86 120 50.4 49 (39) APPENDIX III. DENTON HOSPITAL. DISEASE Admitted discharged Transferred to Other Hospitals Died Remaining in Hospital Chickenpox 5 5 - - - mumps 3 3 - - - Measles 8 5 2 - 1 pulmonary Tuberculosis 7 5 - - 2 Typhus Fever 3 3 - - - Dysentery 1 1 - - - Other Diseases 22 21 - - 1 49 4.3 2 - 4 + Includes 2 contacts. Remaining in Hospital on 31st December,1948. NIL. Admitted during 1949 49. Discharged. Transferred or Died 45. APPENDIX IV. BACTERIOLOGICAL EXAMINATION OP RATS DURING 1949. Source Total Examined Black Rats Brown Rats S>eci6S Unknown Mice Rats Infects With Plague Found Dead Trapped Poisoned, etc Found Dead Trapped Poisoned etc Found Dead Trapped Poisoned etc Found Dead Trapped Poisoned etc Vessels 428 250 173 5 - - - - - - London Dock 75 9 42 1 23 - - - - - St KATHARINE Dk 12 1 11 - - - - - - - Royal Albert Dk 39 9 19 2 9 - - - - _ Victoria Dock 25 14 6 2 1 - - - — - King George V.Dk 24 1 15 2 6 - - — - - Surrey Commercial Dk 35 - 25 2 6 - - — - - Regents Canal Dk 2o - 15 - 5 - - — - - Millwall Dock 61 11 36 11 1 - - - - - West India Dk 36 10 12 5 11 - - - — _ S. West India Dk 25 18 7 - - - - — - - East India Dock. 19 - 14 - 5 - - — — - Tilbury Dock 7 2 5 2 8 - — — — - Totals 816 325 384 32 7 5 - - — — Nil (40) APPENDIX V. RETURN OP RATS CAUGHT AND DESTROYED DURING THE YEAR 1949. Jan. Feb Mch. Apl. may Jne . Jly. aug Sep Oct. Nov. Dec Total London Dock- Warehouses 71 69 13 32 54 77 30 2l 90 50 109 83 699 Vessels 15 - - 4 3 9 5 1 - - - - 37 St Katharine Dock - Warehouses 3 5 I5 7 11 4 6 5 2 4 8 - 7o Vessels - - - - - - - - - - - - - Surrey Commercial Dk Warehouses 36 36 18 11 14 19 19 34 13 40 16 25 285 Vessels - 15 — 35 2 - — — 3 7° — 125 East India Dock - Warehouses 11 11 24 5 4 16 4 3 11 2 2 4 97 Vessels - 36 - - - - - - - - - - 36 West India Dock- Warehouses 3 9 10 24 6 9 7 52 55 77 36 130 438 Vessels 58 215 9 7 21 125 61 39 - 9 36 - 600 Millwall Dock - Warehouses 10 31 9 2 21 8 70 28 8 47 34 150 418 Vessels l 7 - 1 2 33 2 7 1 — 15 3 92 Royal Victoria Dock- Warehouses 25 22 45 8 10 14 7 13 101 32 76 20 395 Vessels 5 17 15 10 - 31 — 35 39 47 5 204 Royal Albert Dock- Warehouses 5 24 30 20 42 7 30 23 24 - 68 9 381 Vessels - 15 6 2l 44 7 30 10 14 — 18 10 267 King George V. Dock Warehouses 12 16 27 7 29 30 16 13 7 7 22 11 206 Vessels 53 45 41 19 36 63 31 99 47 6 9 44 495 Tilbury Dock- Warehouses 28 58 40 26 16 18 11 15 17 44 23 14 3l0 Vessels 35 2 138 30 52 57 70 13 49 13 44 l18 621 Regent's Canal Dock- Warehouses 13 3 19 - 12 2 2 12 9 13 - 17 102 Vessels - - - - - - - - - - - - - River - Vessels - - - - - - - - - - - - - Totals 480 647 459 234 412 581 431 441 487 485 591 64S 5,896. (41) APPENDIX VII. HYGIENE OF CREW SPACES. CLASSIFICATION OF NUISANCES 1949. British owned Vessels. Foreign owned Vessels. Smoke Nuisances: No. of complaints received 8 - No. of recurrences reported - - Offensive Cargoes No. of infringements reported 2 - Structural and other Defects Inadequate ventilation 34 3 Defective Lighting - Natural 1 - do. do. - Artificial 8 - Defective Heating 27 - Condensation 40 1 Leaking Decks 40 - Leaking Ports, Decklights etc 26 - Leaking Sideplates 1 - Leaking Hawse and Chain Pipes 3 - Deficient or Obstructed Floor drainage 11 - Water lodging on top of Peak Tanks 1 - Defective Bulkheads 5 - do. Floors 13 - do. Doors 4 - do. Chain Pipes - - do. Bunks 4 - do. Clothes Lockers 6 2 do. Food Lockers 11 1 do. Food Storage 34 1 do. Cooking Arrangements 13 - Defective or Uncleanly drinking water storage 5 - Water Closets Obsolete 8 1 do. Defective 20 1 do. Foul or Choked 18 1 do. Inadequate Flush 18 - Wash Basins Defective 7 - 4 - Neglected Paintwork or Distemper 29 - Absence of Washrooms 12 - Absence of Messrooms 21 - Misappropriation of Crew Spaces 1 - Verminous quarters 60 6 Dirty quarters 795 78 Miscellaneous 39 - TOTALS 1,3 29 95 Total number of vessels on which sanitary defects were reported 991 84 Total number of vessels on which sanitary defects were remedied 874 79 (43) 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 1,134 East India 31 2,878 1 1,242 Millvrall 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. POVERS. 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 OF LONDON HEALTH AUTHORITY. CONSTITUTION OF THE AUTHORITY. Public Health (London) Act, 1936. ASSIGNMENT OF POWERS. L.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. & 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, 1923. 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 July, 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. (44) INFECTIOUS DISEASE. Infectious Disease (Notification) Act, 1389 to 1899. Public Health Act, 1896. Public Health (Ports) Act, 1896. S.R. & 0. 1910. No. 1155. Prevention of Epidemic Diseases Regulations as to Plague. Destruction of Rats, 1910. 10th 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. 1926. 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, 1927. 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, 1933. S.R. & 0. 1945 No. 1282. The Port Health Amendment Regulations, 1945. 10th October, 1945. CANAL BOATS. Public Health Act, 193 6. FOOD. Public Health (Regulations as to Food) Act, 1907 S.R. & 0. 1924. No. 143 2. Public Health (Meat) Regulations, 1924 (Part IV). 20th December, 1924 S.R. & 0. 1925 No. 775 S.R. & 0. 1926 No. 1577 Public Health (Preservatives, etc. S.R. & 0. 1927 No. 577 in Food) Regulations, 1928. S.R. & 0. 1926 No. 820. Public Health (imported Milk) Regulations, 1926. 6th July, 1926. S.R. & 0. 193 7 No. 3 29. Public Health (imported Food) Regulations, 1937 16th April, 1937. Statutory Instrument No. 886. Public Health (imported Food) Amendment Regulations, 1948 27th April, 1948. Statutory Instrument No. 404. The Food and Drugs (Whalemeat) Regulations, 1949. 20th March, 1949. SHELLFISH. S.R. & 0. 1934, No. 1342. Public Health (Shellfish) Regulations, 1934. 7th December, 1934. S.R. & 0. 1935 No. 1221. The Medway (Shellfish) Regulations, 1935. 11th December , 1935 (45) RATS AND MICE Rats and Mice (Destruction) Act, 1919. SMOKE ABATEMENT Public Health (London) Act, 193S. ABATEMENT OF NUISANCES AND REMOVAL OF REFUSE. Public Health (London) Act, 1936. FERTILISERS AND FEEDING STUFFS. Fertilisers and Feeding Stuffs Act, 1926. S.R. & 0. 193 2 No, 658. Fertilisers and Feeding Stuffs Regulations, 193 2. 11th August, 193 2. S.R. & 0. 1923. No. 43 9. Order appointing 1st July, 1928 as the date for the coming into oporation 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, 192 ALIENS. S.R. & 0. 1920. No. 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 4th November, 1930. Part III, Article 22; Part IV, Articles 23 , 24 and 25. 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 (46)