Dul copy PLON 65 113 PORT HEALTH AUTHORITY OF THE PORT OF LONDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH To 31st DECEMBER, 1957. 113 PORT HEALTH AUTHORITY OF THE PORT OF LONDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH JOHN GREENWOOD WILSON, M.D., F.R C.P., D.P.H, F.A.P.H.A. (Hon). To 31st DECEMBER, 1957. Port Health Authority of the Port of London, Guildhall, London, E.C.2. Telegraphic Address: "PORTELTH LONDON' Telephone Number: MONarch 3030. The governing body of the City of London, the Corporation of London, was originally constituted the Sanitary Authority of the Port of London by Section 20 of the Public Health Act, 1872. The cost of administration was met from the Corporation's private funds for close on fifty years, when it became rate (and grant) aided. By the Public Health (London) Act, 1936, the term "Port Sanitary" was changed to "Port Health". The limits of the Port Health District of the Port of London are still as originally defined by a Treasury Minute dated 1st August, 1883. They commence at high water mark in the River Thames at Teddington Lock, in the County of Surrey, and extend down both sides of the said River Thames to an imaginary straight line drawn from the Pilot mark at the entrance of Havengore Creek in the County of Essex, to the Land's End at Warden Point, in the Isle of Sheppey, in the County of Kent, such point being the north-western limit of the Port of Faversham, and extend up and include both sides of the River Medway to an imaginary straight line drawn from the south-east point of land westward of Coalmouth Creek, thence across the said River Medway to the western-most point of the piece of land which forms the eastern side of Stangate Creek, or, in other words, the north-west point of Fleet Marsh and thence in a southerly direction to Iwade Church in the said County of Kent, and thence in a north-easterly direction to Elmley Chapel in the said Isle of Sheppey, a supposed direct line from Elmley Chapel to Iwade Church, being the western limit of the Port of Faversham, and the said Port of London includes the Islands of Havengore Creek aforesaid, called Potton and Rushley Islands, and so much of the said Creek and Watercourses as extends from it to the town of Rochford, and also includes all other Islands, Rivers, Streams, Creeks, Waters, Watercourses, Channels, Harbours, Docks and places within the before-mentioned limits contained. The Port of London Authority with which the Port Health Authority works in close co-operation, was established as the administrative body of the Port of London including the docks and tideway of the River Thames, by Act of Parliament in 1909. The limits of its jurisdiction are about the same as, but not quite so extensive as those of the Port Health Authority. SECTION I-STAFF (As at 31st December, 1957) TABLE A Name of Officer Nature of Appointment Date of Appointment Any other Appointment held J. Greenwood Wilson Medical Officer of Health July, 1954 Medical Inspector of Aliens. h.m. willoughby Deputy Port Medical Officer of Health and Medical Officer in charge at Denton Hospital May, 1929 ditto J.A. Jones Assistant Port Medical Officer April, 1935 ditto M.J. Catton ditto (part time) February, 1957 ditto R.G. Newberry ditto ditto February, 1957 ditto J.E.H. Lahaise ditto ditto August, 1957 ditto H.A. Madwar ditto ditto December, 1927 W.T.G. Boul, M.B.E. Infectious Disease Consultant March, 1957 CLERICAL J.A. Gillis Senior Clerk March, 1914 — W.L. McLorg General Administrative Officer February, 1927 — R.C. Ratliff Finance and Establishment Officer March, 1930 — E.V. Smith Clerical Officer October, 1938 — R.H. Lott Clerical Officer May, 1947 — F.B. Osborn Clerical Assistant Grade C May, 1952 Miss I.H. Hamblin Clerical Assistant Grade A October, 1957 T.A. Woods Messenger November, 1955 INSPECTORIAL T.L. Mackie, M.B.E. Chief Port Health Inspector and Supervisory Engineer of Launch Service November, 1934 P.W. Coombe Senior Port Health Inspector December, 1924 — E.H. Johnson Port Health Inspector August, 1929 — T.G. Edwards ditto June, 1929 — D.E. Madeley ditto September, 1932 — C.E. Wright ditto July, 1931 — J.S. Beattie ditto May, 1931 — G. Dring ditto May, 1936 — L.N. Tope ditto August, 1946 — P.A. Traynier ditto October, 1950 — A.C. Good ditto September, 1951 — T.c.H. Rogerson ditto October, 1951 — A.H. Marshall ditto March, 1953 — W.M. Walker ditto October, 1954 — H. Butlin ditto July, 1955 — A.W. Buchan ditto July, 1955 — F. Spencer ditto March, 1957 - MEAT SORTERS G. Simmonds Meat Sorter May, 1955 — J.W. Goods ditto October, 1957 — 2 TABLE K—continued Name of Officer Nature of Appointment Date of Appointment Any other Appointment held RODENT INSPECTORS W.G.Stimson Rodent Inspector February, 1946 - C.W. Moody ditto February, 1929 — E.C. Watkins ditto June, 1929 — S.A. Croft ditto June, 1929 — C. Stockson ditto June, 1940 — D.J. Davis ditto August, 1941 — F.D. Cartman ditto September, 1943 — G. Lamont ditto March, 1945 — RODENT CONTROL SCHEME H.A. Baxter ditto June, 1945 — G.Clark ditto January, 1949 — A.L. Southwood ditto January, 1949 — A.T. Evans Rodent Operative January, 1953 — C.E.W. Eastman ditto April, 1954 — A. Barlow ditto January, 1956 — J. Cook ditto July, 1956 — LAUNCHES AND HULKS P.J. willkins Navigator (Senior) November, 1928 — W.S. Stimson Navigator (i/c Greenwich Station) March, 1944 - J.R. Steen Navigator (Deputy Senior) March, 1926 — W.G.A. King Navigator September, 1939 — C.R. Simons ditto August, 1938 — H.J. Mason ditto August, 1946 — S.J. Crutchley, D.S.M. Engineer (Senior) June, 1939 — J.F. Trice, M.B.E. Engineer September, 1947 — E. Alewood ditto January, 1947 — K. Gittens ditto January, 1955 — A.R.L. Potter Deckhand July, 1945 — A.w. Sutherland ditto November, 1955 — B. Osenton Acting Deckhand December, 1953 — M. East ditto September, 1954 — R. Levy ditto December, 1956 — W. Lawrence Deckboy October, 1955 - J. Mackley ditto January, 1957 — D.W. King ditto April, 1957 — G. Cunningham ditto September 1957 — B. Jacobs ditto April, 1956 — G.W. Heywood ditto September, 1957 - F.B. Morris Steward (part-time) October, 1957 — A.R. Burge Shipkeeper August, 1945 — A.C. Croft ditto October, 1950 — W. Simmons ditto May, 1955 — Launches— Date acquired "Howard Deighton" 1931 "Frederick Whittingham" 1934 "Alfred Robertson" 1938 "Alfred Roach" 1948 Hulk- "Hygeia" at Gravesend 1935 3 January, 1958 TO THE WORSHIPFUL THE PORT AND CITY OF LONDON HEALTH COMMITTEE Gentle men, I have the honour to submit my Annual Report for the year ending the 31st December, 1957, as Medical Officer of Health of the Port of London. A letter from the Secretary, Ministry of Health, dated the 11th November, 1957, contained a reminder that the Medical Officer of Health should prepare his Annual Report on the lines indicated in Form 20 enclosed with Circular 33/52 of the 6th November, 1952, adapted as may be necessary to the special needs of the administration of the London Port Health District. Paragraph 5 of Form Port 20 reads as follows — "The information required by Sections I, V, VI, VIII, XIV and XVI, which has been given in an earlier report and has not since changed, need not be repeated each year. A recapitulation of all information should be made in the Report for the years 1952 and 1955 and thereafter quinquennially. For the intermediate years, only the changes which have occurred during the year covered by the Report need be mentioned in those Sections; if there is no change, "NO CHANGE" should be entered". This Report has been prepared in accordance with the above directive. The following is a summary of the principal items mentioned in this Report:— Shipping. The tonnage of vessels (Fore ign and Coastwise) entering the Port of London during 1957 was 36,810,935 tons as compared with 35,894,117 tons during 1956. 15,415 vessels arrived from foreign ports and of these 1,822 were boarded by your Medical Officers. Communicable Diseases. 1,470 cases of notifiable and other infectious diseases were reported as having occurred on 248 vessels during the year, of which 563 cases were dealt with in the Port. The year was particularly notable for the high incidence of Asian Influenza. Rodent Control. During the year a total of 4,863 rats, 2,372 in ships and 2,491 on shore premises, were destroyed in the Port of London. Sixty-four rats were examined for plague during the year with negative results. The inspection of lighters for rodents was continued with very satisfactory results. International Deratting and Derailing Exemption Certificates. The number of Deratting Certificates issued was 138, the method of deratting in 103 instances being "1080". 1,071 Deratting Exemption Certificates were granted. Imported Foods. The total amount of foodstuffs seized and condemned as unfit for human consumption and either reconditioned or disposed of for animal feeding or for industrial purposes under guarantee or destroyed outright either by burying or burning was 3,409 tons 6 cwts 3 qrs 14 lbs as compared with 3,992 tons 0 cwts 3 qrs 6 lbs in 1956. Shellfish. A new Order was made under the Public Health (Shellfish) Regulations, 1934 controlling the collection of shellfish from the foreshore between Garrison Point, Sheerness, and Warden Point, Isle of Sheppey, Kent. It is with the greatest regret that I have to record the death during the year of Mr. A.J.C. Lickorish, F.R.I.C., who was the Public Analyst to the Authority for 27 years. Mr. J.A. Gillis, Senior Clerk, retired on 31st December, 1957 after nearly 44 years service in the Department. I wish to record my appreciation of the collaboration and assistance rendered by Her Majesty's Customs, the Port of London Authority, the Shipping Federation, the Pilots, members of the staffs of Shipping Companies and Merchants, the staff of the Central Public Health Laboratory, the staff of the Port Health Authority, and indeed all those who have so willingly and generously helped me in every aspect of the work of the Port Health Authority throughout the year. I have the honour to be, Gentlemen, Your obedient Servant, J. GREENWOOD WILSON. 4 SECTION II-AMOUNT OF SHIPPING ENTERING THE DISTRICT DURING THE YEAR TABLE B Ships from Number Tonnage Number Inspected Number of ships reported as having, or having had during the voyage infectious disease on board. By the Port Medical Officer By the Port Health Inspector Foreign Ports 15,415 26,064,481 1,822 10,390 239 Coastwise 12,989 10,746,454 9 1,995 9 Total 28,404 36,810,935 1,831 12,385 248 SECTION III- CHARACTER OF SHIPPING AND TRADE DURING THE Y EAR TABLE C Passenger Traffic Number of Passengers — Inwards 82,300 Number of Passengers — Outwards 109,100 Cargo Traffic Principal Imports All types of produce and merchandise. Principal Exports Principal Ports from which ships arrive. The Port of London trades with all parts of the world. SECTION IV-INLAND BARGE TRAFFIC Numbers and tonnage using the district and places served by the traffic. These barges are of all types and are registered annually with the Port of London Authority. They number approximately 7,000 and their tonnage is some 500,000 tons. The traffic of these crafts extends throughout the length of the Port while a number of them are employed carrying goods and merchandise via the canals to all parts of the country. SECTION V-WATER SUPPLY 1. Source of supply for— (a) The District — No Change (b) Shipping — No Change 2. Reports of tests for contamination — No Change 3. Precautions taken against contamination of hydrants and hosepipes — No Change 4. Number and sanitary condition of water boats and powers of control by the Authority— There were fourteen water boats working in the Port during the year. Water boats are registered annually by the Port of London Authority and such registration is made conditional upon the report of the Medical Officer of Health of the Port as to the fitness of the craft for the carriage of drinking water as also upon the purity of the water thus carried. To this end sampling is carried out from time to time. CONTAMINATION OF SHIP'S DRINKING WATER SUPPLIES There are several ways by which the drinking water aboard ship may be contaminated, some are temporary and intermittent, others may be continuous owing to malpractice or some permanent feature of the construction. In most cases the port health inspector is able to intercept and cause a correction, but where the storage installation is a permanent defect, he is almost helpless apart from indicating the fault. Such circumstances have been encountered with tankers, not of recent construction, where drinking water storage has been associated with the water ballasting compartments normally comprising the forepeak and afterpeak tanks. It has been the custom to use these tanks for ballast water or drinking water according to circumstances and the danger from contamination has been increased by using the ballast water and deck-wash water lines, in conjunction with the general service pump in the pump-room, to transfer the stored water from the peak tanks to the daily-service domestic tanks. As any change of structural installation is the prerogative of the Ministry of Transport and Civil Aviation, this dangerous practice was brought to the notice of the Ministry who appreciated the circumstances at once. As a direct result of this intervention and discussion, it is gratifying to know that Instructions have been circulated by the Ministry to Shipowners and Masters in order to minimise the incidence of contamination. 5 The following is an extract from the Notice M.410 issued on this subject:— STORAGE AND DISTRIBUTION OF POTABLE WATER NOTICE TO SHIPOWNERS AND MASTERS "Cases of typhoid fever have arisen in a merchant ship in circumstances which indicate that the domestic water had become dangerously contaminated through cross connection of the supply lines with the sanitary water system. There was also a possibility that drinking water stored in a peak tank was in itself contaminated. "It will be realised that it is of the utmost importance that water used for drinking and cooking should be free from contamination and particular attention should be paid to the following matters:— "Potable water supply tanks should be cleaned periodically as recommended in Ministry of Transport Notice No. M.358. "Hoses and other apparatus used in filling potable water supply tanks should be clean. "Potable water, supply systems should not be connected with water ballast tanks which have contained estuary or dock water or other water likely to be impure. "Tanks which have been used for water ballast taken from the open sea should not be used for storing potable water unless they have been cleansed. "Whenever there is doubt about the purity of water to be used for human consumption the water should be chlorinated. "The subject is dealt with comprehensively in Paragraph 32 of the Handbook "Crew Accommodation in Merchant Ships." "The standards laid down in the Merchant Shipping (Crew Accommodation) Regulations, 1953, and the Handbook may, however, not be reached in vessels which were built before the Regulations became operative and in order to obtain as high a degree of hygiene as possible shipowners may consider it advisable to review the potable water supply systems in their older ships. In some cases it may be found that the storage capacity for potable water is below that needed to meet present-day standards and the provision of additional storage facilities may be necessary. "In the course of inspections of water supply systems the opportunity should be taken to ensure that there is no risk of contamination of potable water from other water supplies. Water supplied to washbasins (which is liable to be used for mouth washing or gargling) should be as clean as possible." "Potable Water" means water for drinking and cooking. SECTION VI-PUBLIC HEALTH (SHIPS) REGULATIONS, 1952 1. List of Infected Areas (Regulation 6)— The Instructions applying to the Port of London on page 4 of the Declaration of Health were amended during the year so as to exclude the necessity for ships from 'non-infected' areas which use the Panama Canal for transit only to communicate with the Port Health Authority unless there are special circumstances requiring the Boarding Medical Officer. Advantage was taken of the reprinting of the Declaration of Health to amend the Instructions which now read as follows:— INSTRUCTIONS I. THE MASTER of a ship approaching LONDON from a Foreign Port MUST (1) Ascertain the health of all persons on board: (2) Complete and sign this Maritime Declaration of Health. (3) Hand this Declaration to the Customs Officer or Port Medical Officer, whoever first visits the ship. II. If the answer to any question on page one is 'YES', or —EXCEPT IN THE CASE OF TANKERS- If during the last FOUR WEEKS the ship has called at ANY PORT in all ASIA, AFRICA, SOUTH AMERICA OR CENTRAL AMERICA (excluding transit through the Panama Canal)— THE MASTER MUST- (1) Send a wireless message to 'PORTELTII' LONDON stating:— NAME OF SHIP EXPECTED TIME OF ARRIVAL AT GRAVESEND NUMBERS, AGES and SEX of ALL CASES of INFECTIOUS DISEASE 6 This message to be sent 4 to 12 hours before the expected time of arrival at Grave send. (2) SIGNAL - From MUCKING No. 5 BUOY until PRATIQUE is GRANTED. BY DAY FLY the Flag Signal LIM BY NIGHT FLASH "Q" repeatedly from the morse lamp. (3) If a Ship's Surgeon is not carried, have the crew mustered ready for inspection by the Port Medical Officer as soon as he boards the ship. (4) NOT proceed beyond Gravesend Pilot Station until visited by the Port Medical Officer. III. If the answers to all the questions on page 1 are 'NO', and the ship has not called during the previous FOUR weeks at any of the Ports mentioned above, the Master need not communicate with the Port Health Authority unless directed to do so by a Customs Officer. NOTE—(a) When a ship calls at a port in the United Kingdom, makes a declaration of health, and then arrives in London in continuation of the voyage, the Master shall only declare cases of illness that have arisen since the making of the previous declaration, and have thus not already been declared. (b) Article 18(1) of the regulations states:— 'On arrival of a ship from any foreign port or from an infected area which is not a foreign port, no person other than a Pilot, a Customs Officer, an Immigration Officer or an authorised officer shall, without the permission of the Medical Officer, board or leave the ship until it is free from control under these regulations, and the Master shall take all steps necessary to secure compliance with this provision.' J. GREENWOOD WILSON Medical Officer of Health, Port of London. 2. Radio Messages — No Change. 3. Notifications otherwise than by Radio (Regulation 14(1) (b)) — No Change. 4. Mooring Stations (Regulations 22 to 30) — No Change. RIVER COMMUNICATIONS: NAVIGATIONAL INFORMATION SCHEME The Port of London Authority have had under consideration plans for developing a navigational information scheme in the Port of London and have discussed the Scheme at some length with the Port Health Authority. It is possible that Gravesend Reach will be scanned by radar and that the P.L.A. Harbour Services launches will be equipped with radar. By these means and the disciplined use of radio communications it is hoped to facilitate the passage of vessels. It was pointed out that such measures would be of little avail if vessels were to be delayed by Pilotage, Customs, or Port Health formalities and that co-operation between all four interests is essential if the maximum benefit is to be derived from the proposed service. The point was also made that although such co-operation would benefit shipping generally it would be of particular value in assisting to reduce the congestion of shipping (which was tending to increase) in Gravesend Reach, particularly in thick weather. The exchange of Pilots, and Port Health and Customs formalities also tended to delay shipping in Gravesend Reach and thus accentuate congestion in that area. It was suggested that consideration should be given by all three interests to boarding vessels further downstream. It was explained that incoming vessels would be in touch with the Operations Room from the time they entered the seaward limits of the Port and Masters could, if required, be put in touch with the Port Health and Customs Authorities by the Operations Room. There were insufficient channels in the International Maritime Mobile Band to permit the allocation of such channels to each Authority and, in the interests of radio discipline, it was essential that radio control should be exercised by the Operations Room. It was suggested also that all the interests concerned should consider whether they would like to have accommodation in the proposed new building adjacent to the Operations Room. Arising out of the discussions with the Port of London Authority, your Medical Officer came to the following conclusions:— (1) In general it would be desirable for the Port of London Health Service to co-operate as far as possible in the new scheme proposed by the Port of London Authority as and when it develops. The aim of the Port of London Authority is to start the scheme in 1959 but they have a good many things to go into apart from the problems of radar and radio-telephony, for example, mooring facilities and the siting for the new building whence the scheme will operate. As and when the Scheme does develop, the Port and City of London Health Committee would have to consider the practical possibilities of housing in the new P.L.A. Building the duty staffs (Boarding Medical Officer and (?) Shipkeeper) while on duty. 7 (2) Apart from whether staff of the Port Health Authority work in the new building or not, the essential first step towards co-operation in the working of the new scheme would be to equip the two Port Health Authority launches at Gravesend and the "Hygeia" with radiotelephony. (3) At a later stage and for convenience of administration of the whole Service, the two launches operating on the Upper River (from Rainham to Teddington) should be equipped with radio-telephony. The Port Health Staff would then get experience of working radio-telephony pending the completion of the P.L.A. Building, and the radio-telephony facilities could then be readily linked up and transferred into the new building. (4) It seems evident that when the new building is ready with its Operations Room fully working, it will be essential to have the Duty Medical Officer available for instant call to the Operations Room. From there, for example, he could talk to a Master or a Ship's Surgeon of an incoming ship while the ship was still at sea. He could discuss the nature of any illnesson board and the disposal of any patient, and as to whether he could dispense with the usual boarding when the ship approaches Gravesend and allow it to proceed to dock at Tilbury,or elsewhere. Out of this indeed could develop in the Port of London a system of radio-pratique such as they have used for years in New York, a system which greatly facilitates the quick turn-round of shipping. (5) It seemed doubtful to your Medical Officer whether the equipment of any of the Port Health launches with radar would be practicable at any time but he is convinced that itis not necessary to consider it at the present time. With these considerations in mind further consultations were held with the representative of a firm which specialises in this kind of work and which will be doing all the work in connection with the Port of London Authority's new scheme. The representative of this firm put forward a helpful plan which could be implemented in three stages as follows:— Stage 1 That the Hulk "Hygeia" be fitted with a fixed Station equipment and the "Alfred Roach" and the Howard Deighton" be fitted with mobile equipment to work into the "Hygeia". It would be essential to employ high powered equipment in order to give a range extending westward approximately to Rainham and eastward to Chapman Buoy. In stage 1 the three vessels could work as a self contained unit straight away. Stage 2 The office at Guildhall could be fitted with a Fixed Station equipment to work into the 'Alfred Robertson , which would be fitted with mobile equipment. In view of the fact that the "Frederick Whittingham" does not carry any power supply at the moment, this vessel is not included in stage 2. Stage 3 It is assumed at this stage that the "Hygeia" will no longer be required and that the operation of the equipment will be transferred to the new proposed Port of London Authority Operations Room at Gravesend. By placing the aerial on the Tower of the Port of London Operations Building, a considerable increase in range could be obtained. If the maximum possible range from this area is required, it will be necessary to place the Fixed Station equipment at a remote site on a hill near Gravesend (Windmill Hill is ideally suited for this purpose) and control it remotely from the Operations Building. The "Frederick Whittingham" has been brought into the scheme at Stage 3 when it is assumed that the vessel will be fitted with the necessary power supply. By progressing this installation in three stages, no equipment will be wasted or have to be changed unnecessarily and in Stage 3 it will be possible to integrate the Scheme with that of the Port of London Authority and by various switching in the Operations Room enable calls to be put through from the Port Health Authority's vessels to:— (a) Ships in the river (if fitted). (b) The individual Dock Masters of the Port of London Authority (subject to Port of London Authority approval). (c) Customs Authority (if fitted). (d) Any other vessel operating on the Port Health Scheme. The Port of London Health Committee agreed to participate in the Scheme and sanctioned the installation of the equipment envisaged in Stage 1, i.e., that the Hulk "Hygeia" be fitted with a fixed station equipment and the "Alfred Roach" and the "Howard Deighton" be fitted with mobile equipment to work into the Hulk "Hygeia". SECTION vn-SMALLPOX 1. Name of Isolation Hospital to which smallpox cases are sent from the district Long Reach Hospital is situated on the south bank of the River Thames about eight miles 8 above Gravesend. The hospital consists of 10 ward blocks capable of accommodating 170 patients but, except in cases of emergency, only three ward blocks (2 of 20 beds and 1, a cubicle ward of 10 beds), total 50 beds are kept available for immediate use. The hospital includes residential quarters for the staff and a laundry although the administration and staffing is carried out from Joyce Green Hospital, Dartford. 2. Arrangements for transport of such cases to that hospital by ambulance giving the name of the Authority responsible for the ambulance and the vaccinal state of the ambulance crews. A case or cases of smallpox would be removed from the vessel by this Authority's Ambulance launch and conveyed ashore via the pontoon at Denton and from thence conveyed by road ambulance direct to Long Reach Hospital. The Port Health Authority would be responsible for the vaccinal state of their Ambulance Launch crews while the vaccinal state of the Road Ambulance personnel would be the concern of the South-East Metropolitan Regional Hospital Board under whose jurisdiction both Joyce Green and Long Reach Hospitals fall. 3. Names of smallpox consultants available. Dr. W. T. G. Roul Dr. H. S. Banks Dr. J. W. Armstrong Dr. W. J. Coughlan Dr. J. P. Marsden 4. Facilities for laboratory diagnosis of smallpox. Facilities are available at the Virus Laboratory of the Central Public Health Laboratory at Colindale. SECTION VIII-VENEREAL DISEASES Venereal Diseases are not compulsorily notifiable butefforts are made by the Boarding Medical Officers and the Port Health Inspectors to bring to the notice of all seamen using the Port the facilities available for free treatment under the Brussels Agreement. SECTION IX-CASES OF NOTIFIABLE AND OTHER COMMUNICABLE DISEASES ON SHIPS TABLE D (i) Disease Cases landed from ships Passengers Crew Number of Ships concerned Typhoid Fever 1 1 1 Malaria — 2 2 Glandular Fever - 2 2 Chickenpox 10 11 16 Measles 41 2 9 Scarlet Fever — 2 2 Mumps 3 1 3 Pneumonia 2 6 8 Infective Hepatitis 3 4 7 Dysentery — 1 1 Pulmonary Tuberculosis 4 34 37 Fever of Unknown Origin 1 1 2 Influenza 3 416 66 Miscellaneous 1 11 12 69 494 168 TABLE D (ii) Cases disposed of before arrival Disease Passengers Crew Number of ships concerned Typhoid Fever - 1 1 Malaria — 5 4 Dengue Fever — 1 1 Chickenpox 14 3 13 Measles 47 1 12 Mumps 4 3 5 German Measles 7 - 7 Glandul ar Fever — 1 1 Pneumonia 1 1 2 Infective Hepatitis 3 2 5 Catarrhal Jaundice — 1 1 Dysentery 1 3 3 Pulmonary Tuberculosis — 1 1 Fever of Unknown Origin 2 - 2 Gastro-Enteritis 52 131 4 Influenza 149 473 18 280 627 80 9 DENTON HOSPITAL Although Denton Hospital has been taken over by the South-East Metropolitan Regional Hospital Board under the National Health Service Act, the Port Health Authority continue to exercise, through Dr. H.M. Willoughby, the Deputy Medical Officer, and the Assistant Port Medical Officers, the medical supervision of cases admitted to the hospital. The facilities provided by Denton Hospital were particularly valuable during the Asian Influenza epidemic and at times the hospital was filled to capacity. The number of cases admitted to the hospital in 1957 was as follows:— Influenza 155 Malaria 2 Measles 36 Chickenpox 13 Mumps 1 Pneumonia 2 Miscellaneous 6 Total 215 s.s. "BLOEMFONTEIN CASTLE" - TYPHOID FEVER Advance Infomation 27th May, 1957. The Marine Superintendent of the Union Castle Mail Steamship Co. Ltd., telephoned the following cable which had been sent off from the "Bloemfontein Castle" at 2.0 p.m. on the 26th May:— "On 15th May, Mr. "A", a passenger, and on 19th May, Mr. "B", an Engineer, reported ill. Both in hospital since they reported. Only symptoms, continued high temperature. On receipt, 24th May, of a diagnosis of typhoid fever regarding "C", 3rd Radio Officer who was left behind at Cape Town, arranged for laboratory tests at Las Palmas. Message now received states that "B" definite typhoid, "A" strongly suggestive. Both receiving achromycin and both improving but must be landed into hospital on arrival London. No others suspected. Request you communicate Port Health for instructions regarding ship. Will send bulletin each day. At present being delayed adverse weather. Will keep you informed. Master." It was further ascertained that the vessel carried approximately 600 passengers and her schedule was to arrive at Gravesend at about 6.30 a.m. on Wednesday, 29th May, to go on the Tilbury Landing Stage at about 7.0 a.m.; discharge of passengers to commence at about 10.30 a.m.; docking at No. 10 Berth, King George V. Dock during the afternoon. After giving the matter consideration, your Medical Officer decided to allow the vessel to proceed to the Tilbury Landing Stage but nobody would be permitted to leave or board the vessel until medical pratique had been granted and the Marine Superintendent was informed accordingly. As the vessel was going to the Tilbury Landing Stage on the Essex side of the river, Dr. W.T.G. Boul, your Consultant Physician and Medical Officer of the Thurrock Isolation Hospital was informed of the circumstances and readily agreed to keep two beds vacant in his hospital for reception of the cases. In the meantime your Medical Officer consulted with Dr. Willoughby, your Deputy Medical Officer, and it was arranged that the vessel should be boarded on arrival at Gravesend by himself, Dr. Jones, Dr. Boul, Mr. Mackie, your Chief Health Inspector, and Mr. Gillis of the Office staff. The Health Inspectors in the King George V. Dock were also instructed to stand by for any necessary action required when the vessel docked. Action taken on arrival The vessel duly arrived off Gravesend at 09.45 hours on the 29th May, having called at the following ports:— Arrived Departed Durban 22.4.57 26.4.57 Laurenco Marques 27.4.57 28.4.57 Beira 29.4.57 3.5.57 Laurenco Marques 4.5.57 5.5.57 Durban 6.5.57 8.5.57 East London 9.5.57 9.5.57 Port Elizabeth 10.5.57 10.5.57 Cape Town 12.5.57 13.5.57 Walvis Bay 15.5.57 16.5.57 Las Palmas 24.5.57 25.5.57 Gravesend 29.5.57 The vessel was boarded as described above and the Declaration of Health showed three cases of typhoid fever. 10 Case 1. Mr. "C"— 3rd Radio Officer Onset 10.5.57. Complained of cough and cold; found to have a temperature of 102°. On 11.5.57 and 12.5.57 he had rigors and was accordingly landed at Cape Town on 13.5.57 as suspected malaria. It was not until a second and third case arose that the Ship's Surgeon asked for further information about this man and received, on 24.5.57, a cable stating that "C" "was now diagnosed typhoid fever". This man is known to have been ashore in all ports visited and Laurenco Marques, the first time, is considered by the Ship's Surgeon to be the most likely source of infection, possibly through eating shellfish in this port. Case 2. Mr. "A"— Passenger This man came from Salisbury, Southern Rhodesia, by car to Beira where he embarked on 1.5.57. He reported sick on 13.5.57 complaining of shivering fits and was found to have a temperature of 102°. He had a swinging temperature until 21.5.57 since when he has had a continuous temperature of about 100°F. unaffected by successive treatments of penicillin, streptomycin and achromycin. A feature of this man's illness was a complete absence of other symptoms and signs. A blood specimen was taken at Las Palmas for a Widal test, the result of which has been reported as strongly positive. (1 in 80). Case 3. Mr. "B" — Junior Engineer This man reported sick on 19.5.57 complaining of constipation for five days. Temperature 102°. He had a good response to achromycin. A Widal test taken in Las Palmas had been reported positive (1 in 1280) and there seems to be no doubt about the diagnosis. He first stated he had noteaten anything ashore but on detailed questioning revealed that he had had many 'milk shakes' while ashore in Durban on 6.5.57. There seemed to be no close association between the patients although the crew members had at times used the same mess as well as the main saloon. All, however, had a clear history of consuming 'suspicious' food ashore and it was agreed that the source of infection was in all cases most probably a shore one. There were, during the voyage, the usual outbreaks of diarrhoea except that perhaps the crew were rather more affected than is common. In view of this and the unanimous opinion that it was a shore infection it was decided that investigation of the personnel could be restricted to those contacts who still had diarrhoea although all contacts would be questioned. Contacts of the Two Crew Cases (a) All other Radio Officers — None had been sick. (b) All other Engineers — None had been sick. (c) Radio Officers and Engineers' Stewards— Mr. "D" had had several attacks of diarrhoea, one still current and this man was admitted to Thurrock Hospital for investigation when the final diagnosis was NOT typhoid fever. Two others had had slight attacks of diarrhoea but had now fully recovered. Contacts witti Passenger Case (1) Stewardess — Never ill. (2) Stewardess — Diarrhoea in Beira. Fully recovered. (3) Bedroom Steward — Diarrhoea 10 days ago. Fully recovered. (4) Bedroom Steward — Diarrhoea 12 days ago. Fully recovered. (5) Bedroom Steward — Never ill. (6) Bedroom Steward — Never ill. (7) Bedroom Steward — Never ill. (8) Assistant Steward — Never ill. (9) Assistant Steward — Very mild diarrhoea 10 days ago. Fully recovered. Contacts common to all Cases (1) Surgeon — Never ill. (2) Nursing Sister — Never ill. (3) Hospital Attendant — Not been ill until morning of arrival when he had one loose motion, but at no other time. He was left on board under observation. (4) Linen Steward — Never ill. (5) Assistant Steward — Never ill. (6) Laundryman — Never ill. (7) Assistant Laundryman — Diarrhoea 10 days ago. Fully recovered. (8) Four call boys — All never ill. (9) Four laundresses — All never ill. One other passenger reported sick on the morning of arrival, complaining of nausea and diarrhoea. She was interviewed and it transpired that she had been to a farewell party the previous evening, though not admitting to any excess. She had no headache, no temperature and was already feeling somewhat better. She was allowed to proceed to her destination. 11 Sampling— Samples of drinking water were drawn from :— (a) The Primary Filter. (b) From transfer pump connected to No. 6 Double Bottom Tank. (c) Tap over wash basin in No. 423 Cabin. (d) Fresh water supply to ice making machine. (e) Swabs from the taps in the Junior 4th Engineer's Cabin and the 3rd Radio Operator's Cabin. Samples of salad lettuce taken on board at Cape Town. Sample of milk prepared from milk powder and ship's water supply. In all cases the Bacteriologist reported "Organisms of the salmonella group NOT FOUND". One water specimen showed the presence of a very small faecal coli contamination but the whole drinking water system on the ship was cleansed and sterilised. The names and addresses of such persons as had been in close contact with either of the cases were forwarded, with a short explanatory note, to the Medical Officers of Health of the areas in which the addresses were situated. Summary Three cases of typhoid fever occurred during the voyage, one passenger and two crew. They appeared to be entirely unconnected and of shore origin. Investigation included a check on all close contacts, medical, catering and laundry staff, engineers and radio operators. Only one contact was admitted to hospital for investigation. Bedding known to have been in use from the hospitals and cabins concerned was removed to Denton Hospital for steam disinfection. The possibility of all the cases being due to a "carrier" cannot be completely eliminated but is, as already indicated, considered unlikely. Addendum The Surgeon of the "Bloemfontein Castle" informed me subsequently by telephone that a further member of the crew — A Master-at-Arms — who had proceeded home to an address in Battersea, had failed to report back for duty. Enquiry from the Battersea Public Health Department revealed the fact that this man had been admitted to the Bolinbroke Hospital, Wandsworth Common, where he had been diagnosed to be suffering from typhoid fever. The vessel carried two Masters-at-Arms and as they shared a cabin the home address of the second Master-at-Arms was obtained from the crew list of addresses and the Medical Officer of Health of the area in which this man was residing (East Ham) was notified of the circumstances. It was subsequently ascertained that this man had been visited and two samples, one of faeces and one of urine,had been sent to the East Ham Memorial Hospital for examination. Both samples were reported to be negative. In addition and although it was now fourteen days since the patients had left the ship, arrangements were made for the cabin to be fumigated forthwith. Owing to the imminent sailing of the vessel the Ship's Surgeon had obtained a supply of T.A.B. (Anti-typhoid vaccine) and proposed to inoculate the whole of the crew and as many as possible of the out-going passengers. Finally, a report from the Port Health Inspector on the King George V. Dock read as follows:— "The above vessel has now sailed. All work asked to be carried out while the vessel was in port and in dry dock was completed in a satisfactory manner. "Extensive cleansing of kitchens and storerooms was undertaken. All galvanised kitchen equipment was sent ashore for regalvanising or replacement. "All passenger accommodation including alleyways has been completely cleansed throughout. "Double bottom tanks, tunnel tanks and after peak tank normally used for the storage of fresh water have been cleansed and chlorinated throughout. "I wish to report that the Union Castle Line staff and all I came in contact with on the vessel proved very helpful during the course of this investigation and in the work involved. 12 ASIAN INFLUENZA - 1957 The following report was presented to the Port and City of London Health Committee in December, 1957: Influenza and other Acute Respiratory Diseases have been the concern of the Ministry of Health over a number of years and Bulletins issued by the Ministry have stressed the importance of increasing our knowledge of the epidemiology of respiratory infections presumably of virus aetiology and have emphasised that the chance of recurrences of influenza pandemics and the disruption and economic loss caused by the ordinary influenza epidemics make necessary a national study of the disease linked to the international investigations of the World Health Organisation. In October 1956, the Monthly Bulletin of the Ministry contained a note on Winter Epidemics and drew special attention to the scheme of ascertainment which had been operative in previous winters and requested that "in the case of ports and airports, port medical officers are asked to report immediately to the Senior Medical Officer, Med. 3, Ministry of Health the occurrence of influenza-like disease on board ship, or among passengers or air crews arriving in this country". No occurrences of this nature were reported during the latter part of 1956 and the early months of 1957, but in June of that year the Ministry of Health circulated the following memorandum:- OUTBREAKS OF INFLUENZA "Extensive outbreaks of influenza have occurred recently in several countries of the Far East. Brief reports of these have been published in the Medical Press. Cases were first observed, in mid April, at Hong Kong and Singapore where large numbers of persons have been affected. Towards the end of April an outbreak began in Taiwan (Formosa) and it has been estimated that more than 100,000 cases occurred there in the course of two or three weeks. During the first half of May another large outbreak developed at Manila, in the Phillipine Islands, and subsequent outbreaks have been reported from Japan, India, Sarawak, North Borneo, Vietnam, Cambodia and Indonesia. Outbreaks have also been reported among persons travelling by sea or air from the affected regions. "Most of the cases have been described as clinically mild. A report from Singapore refers to severe headache, generalised pains and fever (101° — 103°F.) lasting 2 or 3 days and followed by about 4 days disability. There have been a number of deaths, but the fatality rate has been low. The outbreaks have been explosive in character, but the epidemic wave has passed quickly. "Virus strains from the Singapore outbreak have been received at the World Influenza Centre, London, where they are being extensively studied. Preliminary investigations have shown that they belong to the influenza A group, but are markedly different from strains isolated during past influenza outbreaks. The present strains are not neutralised by any antiserum prepared from previous strains and it is considered that the antigenic variation is the largest that has taken place since the appearance of the A-prime variant in 1946. "It is unlikely that the vaccines, which have been prepared against past influenza strains, will protect against infection by the new variant and the possibility of preparing a vaccine against the recently isolated strains are being actively explored. However favourably this work might proceed there would be an inevitable delay before such a vaccine could be produced in quantity. "In the meanwhile it is of importance that any outbreaks of influenza which may occur in Great Britain, should be speedily investigated, with particular reference to the identification of the causative agent. The Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service for October, 1956 (vol. 15, p. 226) contained, under the title 'Winter Epidemics', recommendations for the ascertainment and laboratory investigations of outbreaks of influenza and other respiratory diseases. It is urged that these recommendations should be applied, by Medical Officers of Health and by other persons concerned, to the present situation and continued until further notice. Port and airport medical officers, in particular, are asked to keep a close watch on the possible introduction of epidemic influenza into the community and to report immediately to the Senior Medical Officer, Med. 3, Ministry of Health, Savile Row, W.l, the occurrence of influenza-like illness on board ships or amongst passengers or crews of aircraft arriving in this country". Immediately on receipt of this note copies were distributed to all the Boarding Medical Officers (including Locums) and to all the Health Inspectors together with the following memorandum ASIAN INFLUENZA "You will have read accounts of this in the Press and I now enclose an official 'handout' from the Ministry of Health. 13 "The main burden falls upon Port Health Authorities and their staffs to put up a good show and one that will appeal to the public as an effort to keep the disease out of the country even though we know within ourselves that scientifically speaking we have little hope of success. "It will be necessary, therefore, to make every endeavour to hospitalise sick persons as they come into the Port and at the first opportunity, i.e., at Gravesend rather than from the London Docks. "Passengers and members of crews that are paid off from ships suspected to be incubating influenza should be handed a yellow warning card, copy enclosed herewith. Further supplies will be sent in a day or two. "Routine measures of disinfection of cabins etc., should be undertaken in respect of recent cases but there is no need to send bedding etc., to Denton or elsewhere for steam disinfection. "There remains the question of hospitalising any considerable numbers of cases and as to this I am in touch with officials of the Ministry of Health in the hope that the necessary emergency arrangements can be made. "Finally there is the question of research into the nature of the virus and as to this I am arranging for equipment to be supplied from the Central Virus Laboratory at Colindale so that specimens may be sent from any cases of influenza that may be admitted to hospital from ships entering the Port of London. The reference above to 'yellow warning cards' was included as the result of a suggestion made by an Honourable Member that I should compare notes with the Medical Officer at the London Airport as to any special measures to be taken in connection with the threatened importation of influenza into this country. I therefore rang up the London Airport Medical Officer and found that in general the measures being taken there are similar to those at a sea port. I was, however, reminded of the practice which is normally confined to airports but which under the present circumstances might be useful in sea ports. With the approval of the Ministry of Health arrangements were made to adopt this practice in the Port of London. It is to issue so called yellow warning cards to persons arriving from abroad if it is thought that they may be about to fall ill of an epidemic disease. The notice which is in English, French and German, reads as follows:- "IMPORTANT NOTICE TO PERSONS ARRIVING FROM ABROAD Whilst abroad you may, without knowing it, have been in contact with some dangerous epidemic disease such as smallpox or typhus. If during the next 21 days — wherever you may be — you or any person living in the same house falls ill, in your own interest call in a doctor immediately and give him this card. NOTICE TO DOCTOR CALLED TO A PERSON RECENTLY ARRIVED FROM ABROAD The holder of this card arrived at the place and on the date stated on the front. It is possible that he may be suffering from some acute infectious disease not normally present in this country. Smallpox should be particularly borne in mind as the rash may be modified by previous vaccination. If you suspect any such illness please notify the Medical Officer of Health by telephone." It is explained to the recipient of these cards that although the wording refers to the quarantinable diseases (smallpox, etc.), they are intended to refer, for the time being, to influenza. Meanwhile at the meeting of the Honourable Court of Common Council held on the 20th June, the following question was put by Mr. Deputy Horner "Has the Chairman's attention been drawn to a leading article in a London Medical Journal that this country is unlikely to escape the new type of influenza now sweeping Asia and what, if any, special precautions are being taken with regard to Passengers and Crew on Liners coming into the Port of London from the Far East." To this question the Chairman replied as follows:- "Extensive outbreaks of influenza have occurred recently in several countries of the Far East. Brief reports have been published in the Medical Press. Cases were first observed, inmid April, at Hong Kong and Singapore where large numbers of persons have been affected. 14 Towards the end of April an outbreak began in Formosa and it has been estimated that more than 100,000 cases occurred there in the course of two or three weeks. During the first half of May another large outbreak developed in Manila, in the Phillipine Islands, and subsequent outbreaks have been reported from Japan, India, Sarawak, North Borneo, Vietnam, Cambodia and Indonesia. Outbreaks have also been reported among persons travelling by sea and air from the affected regions. "Most of the cases have been described as clinically mild with severe headache, generalised pains and fever (101° — 103°F.) lasting two or three days and followed by about 4 days disability. There have been a number of deaths, but the fatality rate has been low. "The Port of London Health Authority and its staffs are ready, as usual, to meet this threat with all the means in their power. Every endeavour will be made to secure the admission to hospital of all sick persons coming into the Port of London when the ship is boarded by the Port Health Authority's Boarding Medical Officers at Gravesend, to whatever number may be needed. "The Medical Officer of Health is in close contact with the Ministry of Health and with the Medical Research Council. Laboratory specimens will be obtained from patients who are admitted to hospital suffering from or suspected to be suffering from influenza and these specimens will be sent to the World Influenza Centre, London, for investigation of the virus strains. This is important to enable the experts to make effective vaccines against the disease. "Arrangements have been made for yellow warning cards to be issued to passengers and members of crews on ships suspected to be incubating influenza so as to warn their own doctors, wherever they may go, of the possibility of their infection. "Hospital accommodation, cabins, etc., on board ships that have been occupied by infected persons will be disinfected under the supervision of the Port Health Authority. "All Boarding Medical Officers and Port Health Inspectors have been made acquainted with the situation and will be on the alert to co-operate in all necessary measures of protection." At this time the threat of Asian influenza reaching the United Kingdom was "front page news" and your Chairman was interviewed by I.T.V. in front of the Television Cameras. In reporting this matter to your Worshipful Committee, I commented on the Chairman's statement (quoted above) as follows 1. 'Yellow warning cards' are not normally issued at seaports. They are used regularly at airports where passengers are in a hurry to get away or fly on to the next airport and may not know the address they will have at their next destination. In the seaport there is ample time, normally, to check addresses of destination of infectious disease contacts and then to warn the Medical Officers of Health of the places where those addresses are. With 1-200 people down with influenza in, say, a P & 0 Liner carrying 1,700 persons (passengers and crew) it would be logical to assume all those who were not actually ill to be contacts. It will not be practicable with such large numbers or justifiable with a non-quarantinable disease like influenza (quarantinable diseases are the 'deadly' diseases, smallpox, yellow fever, cholera, plague, typhus and relapsing fever) to check the vast number of destination addresses and then forward a great number of letters to Medical Officers of Health all over the United Kingdom. Hence the adoption of the same procedure in this 'flu' emergency as at airports where regularly they have great numbers of people arriving every 24 hours. The yellow warning card is issued at airports when the passengers arrive from an 'infected area' whence they may be carrying an infectious disease and urges them to consult a doctor immediately they feel at all ill, showing him the warning card. This will alert him to make a diagnosis of smallpox, typhus, or now of influenza. The card conveys its message to the passenger and (if necessary) the doctor, in English, French and German. 2. We get roughly 100,000 passengers per year into London by sea from abroad. The figures for London Airport are ten times as many, about a million. The incubation period of influenza is 21-72 hours and the period of communicability is one week from the date of onset. Thus, whilst the disease remains in the Far East, epidemics on board ship will normally have burnt themselves out before arrival in the Port of London. We had one ship that had had nearly 100 cases on board affecting the crew and passengers but the last case was more than a week before she docked so we had no need to worry about any further spread of the disease from this ship into this country. These conditions obviously apply differently to travel by air from the East (5 or 6 days) than to travel by sea (a little over three weeks). Obviously passengers can arrive by air on a Monday feeling fit and on Tuesday morning come down to breakfast at their hotel with a 'cold' which is really 'Asian Influenza'. If and when the disease creeps to Europe we, in the seaport, will be more like they are now at the airport. 15 3. Research. At this stage what we need is laboratory specimens to check the virus strains and see if they are the same as those found in the epidemics in the Far East. Attempts may be made to make vaccines from those strains found but its successful use for prevention may not be a 100% success because (a) the vaccine must match almost exactly the virus strain, (b) by the time we have identified the virus strain the epidemic may have burst upon us, (c) the disease spreads rapidly (incubation 24-72 hours) and protection from vaccine does not follow for seven days. 4. Inland. Medical Officers of Health are asking Medical Practitioners to be alert to spot early cases and let the Medical Officer of Health know so that he can inform the Ministry of Health and arrange for the collection of specimens for laboratory test and identifica tion of virus strains. 5. General and Personal Hygiene. It would appear that now is the right time for health visitors and others in a good position to do so to remind as many people as possible that the spread of an epidemic can be minimised by careful observance of such elementary rules of hygiene as the avoidance of spitting, coughing and sneezing, particularly in public transport and other confined, crowded spaces. The following brief account illustrates the truth of the comment I made on paragraph (2) of the Chairman's statement to the Honourable Court, namely that at present the danger of 'Asian Influenza' coming into this country threatens more by air than by sea. On the 15th June a communication, dated 14th June was received from the Medical Officer of London Airport, which read "The 57 Seamen listed as attached arrived from Pakistan. They were inspected and appeared quite well, but as they are only 48 hours out of an endemic area, we forward for your information in case you may wish to exercise any surveillance. Their vaccination certificates are in order. Address to which now proceeding — s.s. 'Stratheden', Tilbury." This is a normal routine notice which is received from time to time from the Airport and its primary significance is for the control of the possible introduction of smallpox into this country. This information was immediately passed to the Health Inspector at Tilbury Dock and, in accordance with the usual practice, arrangements were made for a daily muster and inspection of the seamen by the P & 0 Steam Navigation Company's Medical Officer, during the temporary housing of the seamen on the 'Stratheden', pending their subsequent removal to a Naval vessel lying at Falmouth, for which purpose they had been flown over. Over the week-end a number of the men were found to have developed influenza (11 in number) and they were removed to Denton Hospital. In addition one other man (the first infected) had been.sent to the Orsett Isolation Hospital. It was ascertained that these Pakistanis were to be conveyed by motor coach to Falmouth direct, there to join the Auxiliary Tanker "Wave Governor" which was refitting in Dry Dock at Falmouth. The Medical Officer of Health was immediately notified of the circumstances and of the pending arrival of such of the party of seamen who showed no signs of illness. On the 18th June at a final muster of the ratings a further two cases came to light and they were admitted to the Thurrock Hospital. Although every effort had been made to segregate these naval ratings from their compatriots forming the normal crew of the "Stratheden" during their stay on board, our fears that this could not be done were justified because one of the crew of the "Stratheden" was found to have contracted influenza and he too was admitted to Thurrock Hospital. It was subsequently learned that two other vessels that had been berthed in the Tilbury Dock at the same time as the "Stratheden" had reported cases of influenza among the native crew and it was alleged that in each case there had been an inter-mingling of the crews resulting in a cross infection. It was now obvious that a supply of vaccine should be obtained as soon as possible in order that th members of your Staff at greatest risk should be protected and to this end I got in touch with the Director of the Wright-Fleming Institute at St. Mary's Hospital, in the hope of securing supplies. The vaccine was, however, in very limited supply at that time and was not then past the experimental stage. It has been fascinating to note how the infection has gradually got nearer and nearer these shores. On the 9th June, a vessel arrived on which 63 of the crew and 23 passengers had suffered from influenza but were all well on arrival. Similarly on the 12th June another vessel 16 from the Far East arrived reporting 26 crew and 5 passengers, all recovered, and again on the 18th June a vessel arrived having had 10 passengers down with the disease during the voyage. It was not until the 22nd July that a vessel arrived with actual cases on board. Ninety-two passengers and crew had been affected and whereas 87 had recovered, 3 passengers and 2 crew were ill on arrival and were admitted to Denton Hospital. During August and early September vessels continued to arrive with patients on board but in no case did the number exceed 8 on any one individual ship and they were accommodated without difficulty at this time at Denton Hospital. On the 17th September, however, a vessel arrived with 131 cases (98 crew and 33 passengers) and of these all the passengers had recovered and only 4 of the crew required removal to Denton Hospital. At this stage a certain amount of concern was felt by the fact that if a vessel arrived having on board a large number of cases requiring hospital treatment, the accommodation at Denton Hospital would be inadequate to meet the situation. The maximum number of cases that could be taken into Denton Hospital at any one time would only be 24 and this only if the Hospital was completely empty. I brought this matter to the notice of the Ministry of Health who referred me to the South-East Metropolitan Regional Hospital Board. They in turn requested the Dartford Hospital Management Committee to take all necessary steps in order to be prepared to meet all eventualities and I then decided to discuss detailed arrangements with Mr. Durrant, the Secretary of the Dartford Hospital Management Committee who control the Joyce Green and Southern Hospitals, Dartford, of the South-East Metropolitan Regional Hospital Board. As a result of our consultation the following memorandum was circulated to the Medical and Inspectorial Staff of the Port Health Authority:— Hospitalisation of Cases of Asian Influenza "In view of the increasing number of cases of Asian Influenza arriving and occurring in the Port, I think that for the time being all cases of influenza should be concentrated on Denton Hospital. "All other cases of sickness, depending on the nature of the illness, should be sent to Joyce Green Hospital or, in certain cases requiring clinical investigation, to Thurrock Isolation Hospital. "I have arranged with Mr. Durrant, the Secretary of the Dartford Hospital Management Committee that Joyce Green Hospital will accept infectious cases (other than influenza) at any time, including cases arriving during the night. "Further, in the event of Denton Hospital not being able to accept further cases of influenza, then Mr.. Durrant will arrange to accommodate them elsewhere, but this will apply only if Denton is full and provided that as long notice as possible is given, preferably 24 hours. "In the case of ambulatory patients from the Royal Docks who are being conveyed by the West Ham or East Ham Ambulance Services, the patients will be taken to the Tilbury Landing Stage and, on request by the Ambulance Service, the Boarding Medical Officer should arrange for the launch to transfer the cases from the Tilbury Landing Stage to Denton Hospital, this arrangement being necessary to avoid high charges for the conveyance of the ambulance via the Tilbury — Gravesend Ferry. While it is, of course, always desirable to formulate a policy which it is hoped will cover all foreseeable contingencies, it nearly always happens that some particular circumstances arise which are not covered by that policy. For instance, towards the end of August a small Danish vessel with a crew of 25 arrived from Aalborg and on being boarded off Gravesend by your Boarding Medical Officer it was found that 6 members of the crew were suffering from influenza and they were promptly admitted to Denton Hospital. The vessel proceeded to her berth at Hay's Wharf, Tooley Street, to discharge her cargo and on being visited by the Health Inspector for the Upper River District, it was found that 3 further members of the crew had developed the infection during the voyage up the River. The removal of these cases to hospital raised certain difficulties:— (a) The Seamen's Hospital, Greenwich did not wish to receive them since they would have to be isolated and they did not have the necessary space for so doing.. The same applied 17 to the other London General Hospitals, and even had this been possible the appearance of an ambulance in the very busy Tooley Street area would have immediately caused alarm among the many stevedores and dock workers (b) The transportation of cases by our own launch the 25 miles down river to Denton also seemed out of the question. It was, however, obvious that the cases had to be isolated in order to prevent the spread of the disease to the remainder of the crew, since 9 out of a total of 25 were already out of action. After giving the matter due consideration I decided that since the vessel was of Danish nationality and would shortly be returning to Denmark, and that the three cases on board were none of them seriously ill, I would be justified in leaving them isolated on board and to this end your Chief Inspector, Mr. Mackie, visited the vessel and obtained a written statement from the Master that he would keep the men isolated on board the ship until she sailed. This she did the following day and berthed at a Wharf just below Gravesend. The Medical Officer on Duty on the "Hygeia" was warned of the circumstances and asked to keep the cases under observation. This instruction was carried out and the patients at Denton Hospital, as soon as they were ready for discharge were returned to the vessel which eventually sailed with a full complement. No further cases occurred before the vessel sailed. Another example of the practice of expediency and one that has a romantic appeal is the case of a small collier which arrived from Hartlepool on the 21st September and proceeded to buoys in Galleons Reach, awaiting orders. On the 22nd September (Sunday) the Chief Steward visited Seamen's Hospital, Greenwich, complaining of influenza symptoms, was detained and discharged the following day. On the 23rd September a medical practitioner from Woolwich attended on board at the request of the Shipping Company and diagnosed two members of the crew t o be suffering from influenza, one of whom was admitted to Seamen's Hospital, Greenwich while the other remained isolated on board. The vessel then moved to the Albert Dock Hoists to commence discharge. On the 24th September following my instructions the Health Inspector for the Middle River District visited the vessel and reported that seven members of the crew, including the Master, showed signs of sickness. The vessel was due to complete discharge at 3.00 a.m., on the 25th September. These circumstances being brought to my notice I decided that the health of the crew did not permit of this vessel sailing and after consultation with the Shipping Company it was agreed that the vessel should be moved to buoys in the River until such time as I was satisfied that the health of the crew had so improved as to warrant the vessel sailing or that the outbreak had subsided. Captain Letts, the Port of London Authority's Harbour Master at Woolwich, at my request, very kindly provided a clear berth in the River in the vicinity of the Port Health Authority's Woolwich Station, an arrangement which greatly facilitated easy health surveillance. Arrangements were made with Dr. W.H. Greaney of the Shipping Federation to visit the vessel daily. This he did reporting the situation daily. On the 26th September he reported that the majority of the crew were recovering with the exception of the Master. On the 27th September he reported that all the crew had now sufficiently recovered as to permit the vessel proceeding to sea, with the exception of the Master who, although recovering, required a period of convalescence. Dr. Greaney made arrangements for the Master to be admitted to the Seamen s Hospital for a few days and the vessel sailed on the afternoon tide of the 27th September with a relief Master on board. The success that attended improvisations of this kind, namely that of isolating members of the crew on board who were not seriously ill, made such an appeal, particularly in view of the very limited hospital accommodation at our disposal, that the possibility of applying this course of action to other vessels was considered. If this was to be done, three essential conditions would have to be observed in every case, namely 18 (i) The vessel must be sufficiently heated to ensure that the patients are kept in an equable temperature. (ii) Since vessels in the docks are not allowed to use the water closets on board arrangements must be made for the patients to be supplied with Elsan Chemical Closets, and most important of all— (iii) The doctor who attends the patients in the first instance must give his approval of the patients being allowed to be isolated on board and must then pay a daily visit to the ship until satisfied that his services are no longer required. It was found that save for a vessel that was berthed in a dry dock condition (i) did not present any difficulty. The Port of London Authority very kindly undertook to supply the necessary Elsan Closets as required by condition (ii). Condition (iii) was in the hands of Medical Superintendents of the Shipping Companies concerned and the various doctors of the Shipping Federation who are in attendance in the dock area. This procedure was put into practice where possible and a classical example of the success of such a procedure is amply illustrated in the following report from your Health Inspector on the Tilbury Dock, Mr. D. E. Madeley, in connection with an outbreak of influenza on the s.s. "Arcadia" which affected no fewer than 176 of a total crew of 725. This vessel had been on a Cruise and on return to the United Kingdom all the passengers were disembarked at Southampton. The vessel came round to London with only the crew on board and on arrival at Gravesend all on board were well. It was not until the vessel had been in the Tilbury Dock for three days that the epidemic commenced among the Asian crew (Goanese). At no time was any mention made of the passengers having had influenza but in order to be quite certain of this I contacted the Medical Division of the P & 0 Company who, on consulting the medical records informed me that there were no 'flu' cases among the passengers of the "Arcadia" during the cruise. Tilbury Dock, 15th October, 1957. "The s.s. "Arcadia" arrived at Tilbury on Sunday, 6th October from Southampton, after a season's cruising. "An outbreak of influenza started on 8.10.57 when ten Goanese Catering ratings reported sick and were taken to Denton Isolation Hospital. The following day there were 20 more cases, on the third day 26 cases which now included 6 Engine room ratings.. On the fourth day there were 34 cases including one from the Engine room. "On the fifth day (12.10.57) the incidence amongst the Goanese catering staff showed a sharp decline, but there were now cases amongst the Asian deck and Engine room staffs. "At the start of the outbreak the patients were sent to shore hospitals. The ship was at that time in dry dock. There was little heating and the sanitary arrangements — including washing — presented formidable difficulties. "However the ship's Assistant Surgeon was on board. The Nursing Sister, Hospital Attendant and Dispenser were recalled from leave. One of the P. & 0. Medical Superintendents arrived to co-ordinate the work on board and on 11.10.57, the ship now being out of dry dock, the ship's hospital was opened to take the more seriously ill patients and a section of the Tourist passenger accommodation on "F" Deck aft was appropriated as an auxiliary hospital in which to isolate the less seriously ill. "The ship's midships hospital (7 beds in 3 small wards) was reserved as an emergency or to accommodate any Europeans who might need attention. "Sanitation still presented difficulties and 12 chemical closets were placed in the lavatory compartments of the after hospital and the "F" Deck section to cope with the situation. In fact, with the willing co-operation of the ship's staff, this was much more successful than I had hoped for. "There has been a steady decline in the number of fresh cases since 11.10.57. There were only three new cases amongst the firemen and none amongst the seamen or catering staffs. It is now possible to hope that the worst is past. The ship is due to sail on Tuesday, 22.10.57, and one of the anxieties at the moment is how many of the men now sick will be fit enough to rejoin before then. "Another complication must also be faced. The European catering staff anij Officers have up to the present had a large proportion of their number on leave. There have been a few cases of influenza amongst those who have remained on board but those feeling sick 19 have usually gone to their homes for treatment and rest. The ship's medical staff have been called on to deal with only six so far of whom two spent a day or two in the ship's hospital. "Today (15.10.57) the sea-going European staff are rejoining and though they are very welcome to assist the depleted Asian staff, the risk of increased incidence of influenza amongst them cannot be ignored. In this connection I have impressed on the Heads of all departments the need for increased attention to cleanliness and fresh air in the accommodation. "In an attempt to prevent the spread of infection I have warned all other ships in Tilbury which have Asian crews, that the "Arcadia" has many cases of influenza on board and that ship visiting should not be allowed." In the meantime complete disinfection of all the accommodation that had been occupied by patients had been carried out by your Health Inspector, Mr. Butlin, assisted by Mr. Stockton and Mr. Cook, the two members of the Rodent Staff in Tilbury. On the 21st October, 1957, Mr. Madeley, further reported "The outbreak of influenza in s.s. "Arcadia" has subsided. The ship will sail from the l anding Stage tomorrow according to schedule. "There have been no cases amongst the Asian Seamen since Monday, 14.10.57. There were two cases amongst the Goanese catering staff on Wednesday, 16.10.57, but none since. The last cases amongst the Asian firemen were on Thursday, 17.10.57 (3 cases). No cases have been landed to shore hospitals since 15.10.57. "The feared outbreak amongst the returning European crew did not take place. There were indeed five cases amongst the Europeans on 16.10.57. One of these was the Ship's Dispenser who had done excellent work during the time the ship's hospital was in operation. One was an Engineer Officer. The others were three young Assistant Stewards who had returned from leave decidedly 'off colour' and who were at once sent by the Second Steward for medical attention before they were allowed to mix with the remainder of the crew. The Second Steward is to be commended for his prompt action in this matter." I had occasion to discuss the incidence of influenza on the "Arcadia" with the Medical Superintendent of the P. & O. Company and as a consequence forwarded to him Mr. Madeley's report, in acknowledgment of which he replied as follows "Thank you very much for letting me see the report of Mr. Madeley on the incidence of influenza in "Arcadia". I think it a most excellent report and great tribute to him that with this major outbreak on top of his many other duties he has found time to make such an orderly record of the pressing day to day happenings. "I have delayed in return in g the report to you because I wished to circulate it for the information of the Management and they have asked me to express their very sincere thanks to you, to Mr. Madeley and to your staff for the most excellent job of work done in the ship. "I am sure both you and Mr. Madeley know how heartily I endorse this statement." I offer no apology in reporting at such length on the influenza situation as it has affected the Port of London up to date, since I feel that by so doing I am only endorsing the public statement by your Chairman that "the Port of London Health Authority and its staffs are ready, as usual, to meet this threat with all the means in their power". In conclusion I should like to express my sincere thanks for the whole-h earted assistance I have received from Shipping Companies and their Medical Staffs, the doctors of the Shipping Federation, the Dartford Hospital Management Committee and its staff, the East Ham and West Ham Ambulance Services, the Port of London Authority and last, but by no means least, the Nursing Staff at the Denton Isolation Hospital, your Assistant Medical Officers, Health Inspectors, Rodent Officers and clerical staff in the Central Office. I was particularly gratified by the flexibility of the arrangements I was eventually able to make for hospital admission with the Group Secretary of the Dartford Hospital Management Committee. Appended is a graph relating to the incidence of influenza on the s.s. "Arcadia". 20 21 s.s. "KENYA CASTLE" - MUMPS On the 9th May, 1957, the Union Castle Line telephoned to say that a signal from the above mentioned vessel reported two men and two women passengers suffering from mumps. They also reported that since the vessel would not be calling at the Tilbury Landing Stage but would be proceeding direct to her berth at No. 10 Shed, King George V. Dock, they had been in touch with Dr. Willoughby on the "Hygeia" regarding their disembarkation. Dr. Willoughby confirmed the above and added that while he would be boarding the vessel on her arrival at Gravesend at approximately 19.30 hours and would confirm the diagnosis he was against removing the cases to Denton Hospital via a companion ladder while the vessel was on the move and that with the Medical Officer's approval he was prepared to allow the cases to proceed in the vessel to her berth in dock. Your Medical Officer decided that in the circumstances this was the best course and on approaching the Emergency Bed Service they immediately agreed to co-operate. Since the vessel would not reach her berth in the dock until about midnight it was arranged that the cases would be removed as early as possible the following morning. In the meantime, and at the request of the Emergency Bed Service, Dr. Willoughby was instructed to obtain the names and ages of the patients when he boarded the vessel and telephone this information to the Emergency Bed Service at HOP: 7131 where they have a 24 hour service. These arrangements were passed by telephone to the Health Inspector concerned at the dock and also to the Shipping Company.- It finally transpired that there were in fact only two cases, one male and one female, and they were removed by Ambulance at approximately 09.30 hours on the 10th May, 1957, to Plaistow Hospital and Eastern Fever Hospital respectively. Although the policy of allowing patients to proceed in a ship to her berth in the docks up river is the exception rather than the rule, whenever the circumstances dictate such a procedure, the Emergency Bed Service, as your Worshipful Committee already know, have consistently cooperated with the Authority in a most efficient manner. THE PORT OF HAMBURG The generosity of the Port and City of London Health Committee in sending Dr. Jones to study Port Health Administration in Hamburg has already paid a dividend as is shown by the following report from Dr. Jones of an incident which occurred recently while he was on boarding duty:— s.s. "Baltic Trader" "On Sunday evening, 1st December, 1957, I received a telephone call from the Marine Superintendent, United Baltic Corporation. "He informed me that the "Baltic Trader", bound from the Mediterranean to Hamburg, had, on radio medical advice, landed the 5th Engineer at Dover with suspected poliomyelitis. "The vessel had resumed the voyage to Hamburg and the Captain was now anxious to know if there was any danger of delay on arrival in Hamburg as the cargo was perishable. "I assured him that the Port Health Authority in Hamburg was efficient and that there would be no unnecessary delay and probably none at all. I advised him to instruct the Master to send a radio message to Portelth, Hamburg, informing them of the case. "Shortly after noon on Wednesday, 4th December, I received a further telephone call from the Marine Superintendent. He informed me, with regret, that the man landed at Dover had died, despite being placed in an iron lung as soon as he was landed. The Marine Superintendent had now been informed that another member of the crew had been admitted to hospital in Hamburg, complaining of pains in the legs. The Directors of the United Baltic Corporation were most anxious that everything possible was being done in Hamburg to prevent further cases and were anxious for information about this second case. "I advised the Marine Superintendent that the matter was not one in which we could interfere and again assured him that the people in Hamburg knew their job. I said that it was unlikely that there would be any further cases and that there was certainly no need for any great anxiety until the diagnosis in the second case was known. As it was feared that they might not hear about eithe for some days I agreed to consult the Medical Officer of Health to see if he would ask Hamburg for information. It was understood that the United Baltic Corporation would be happy to meet any expense. I thereupon telephoned the Medical Officer of Health and with his authority sent the following cable to Hamburg, first checking that the diagnosis of the Dover case had bee n confirmed:— 22 Koch. Hafenarzt Hamburg Reference Baltic Trader. Case landed Dover died Poliomyelitis. Owners very anxious about case landed Hamburg. Urgently request opinion, please Jones. Portelth London Reply received 08.30 hours 5.12.57:— Portelth London Hamburg Patient polio. End stage of very light case. No danger for life. Presumably infected Dover case. Portelth Hamburg. "I telephoned this message to the Marine Superintendent and at 10.00 hours on the 6th December, the following day, I telephoned him again to enquire if there were any new developments. He informed me that the ship was in "semi-quarantine" and the crew not allowed ashore. However, a telephone had been placed on board and he had spoken to the Master of the ship. "It appeared that the man in hospital in Hamburg was suspected of being a carrier. number of the crew had become alarmed and the United Baltic Corporation's Hamburg Agent had been told that any member of the crew who so wished should be given a medical "check up" "A request for advice on quarantine matters is not unusual. However, this is the first time that I have been asked to take any action in respect of a ship in another port. I consider that it is reasonable for the Port Health Authority to obtain information on quarantine matters, especially as affecting individual cases, from other ports on behalf of a London Shipping Company. Certainly it was much appreciated in this instance." TUBERCULOSIS CONTROL IN THE PORT HEALTH SERVICE The following paper was read by your Medical Officer at the Joint Conference of the British Tuberculosis Association and the Tuberculosis Society of Scotland, Glasgow, June,1957, and, as it is based largely on experience in the Port of London, it is felt that the inclusion of the paper in this Report is not out of place and will serve to illustrate an important aspect of port health work "Our legislators seem slow to recognise tuberculosis as an infectious disease. "Thus although by the Public Health (Tuberculosis) Regulations, 1952 it is notifiable, it is not included with the infectious diseases notifiable under the Public Health Act, 1936, e.g. smallpox, cholera, diphtheria and scarlet fever. "By the Public Health (Ships) Regulations, 1952, "infectious disease" means a quarantinable disease or any other infectious or contagious disease, other than venereal disease or tuberculosis. This deliberate exclusion could mean that tuberculosis need not be notified in advance to the medical officer of health of the port who, further, has no power to compel hospitalisation of any case from a ship, both of which desiderata would apply in the case of any disease that is labelled "infectious" in terms of the regulations. All that the Port Medical Officer has legal power to do under these regulations is, if the patient disembarks, to notify the medical officer of health of the area of the patient's destination. This is better than nothing but taken at their face value these regulations are obviously not much help in tuberculosis control through the port health service. "Fortunately the enthusiastic case finder in the port health service can do much better than the regulations imply. There is, for example, the Declaration of Health which by the Public Health (Ships) Regulations must be completed and signed by the Master of any vessel coming from a foreign port and handed to the Customs Officer or port Medical officer, whoever first visits the ship. The Declaration includes on the front page a number of questions which must be answered "Yes" or "No", including Question 5 — "Is there any sick person on board now" Give particulars in Schedule". The schedule requires particulars as to name, class or rating, age sex, nationality, port of embarkation, date of embarkation, nature of illness, date of onset, result of illness, disposal of case. With the end of the schedule on page 2, the Declaration of Health comes, "officially", to an end, but most ports add to it a 3rd and 4th page, the 3rd asking, for the convenience of port health administration, further details of the voyage, ships complement, etc., the 4th giving instructions and advice to ships' captains as to advance signals, crew musters, port health mooring stations and the like. "On the 3rd page immediately following the "official" schedule for particulars of illness, most port health authorities give, for the guidance of the ship's captain, a list of typical infectious diseases which would obviously call for reference and particulars in the schedule, but we in London include tuberculosis in that list. Of course the main purpose of the Public Health (Ships) Regulations is to prevent the import, I nearly said "of the seven deadly sins", but I mean of the six quarantinable diseases", (reminiscent of the bad old days when pestilence was still a frequent visitor to these shores) viz. plague, cholera, yellow fever, smallpox, typhus and relapsing fever. But it is arguable that a differential diagnosis involves consideration of most of 23 the other, even though less "deadly", infectious diseases, which if they do not simulate the quarantinable diseases themselves may at least at one stage or another resemble the prodromes of those diseases, particularly smallpox. Hence I think it perfectly justifiable even for purposes of quarantine control to suggest a comprehensive list of infectious diseases (including tuberculosis) which should be reported on the Declaration of Health. Thanks to many years of tradition of co-operation with pilots, customs officers and shipping companies, we in the Port of London seldom experience any difficulty in seeing that the Declarations of Health are very completely filled up in the way that we like. This fact coupled with the fact that the N.H.S. have kindly allowed us to keep the use of our Port Isolation Hospital down river enables us to run a kind of occupational hospital service for the benefit of the individual seafarer — as distinct from his importance as a menace to the community through carrying communicable disease. A further help in this direction is that every ship when it docks or ties up at a mooring station in the Port of London is boarded by a port health inspector who will automatically pursue epidemiological enquiries either on his own initiative or as a result of a telephone call either from the whole time duty medical officer at Gravesend Boarding Station or from head office. "Our Port of London Health Inspectors are particularly well equipped for such enquiries because all of them have held officer rank for years at sea before training in public health. "In all these devious ways we try, and usually succeed, in discovering most cases of tuberculosis coming into the Port of London. The first step then is to hospitalise the case either in our own or in some other hospital such as the Thurrock (Essex) or the Greenwich Seamen's Hospital. If we cannot do that we notify the medical officer of health of the area of the patient's destination on disembarkation from the ship. The next step is to secure x-ray of all likely contacts amongst his shipmates, e.g. those sharing his cabin and/or watch, messmates and so forth. Those who are positive are also hospitalised. These first and second steps apply whether the seafarer is British or Foreign, but if he is British, by means of the co-operation we have built up with the Shipping Federation Medical Services we try to trace the case history. This we do, by sending to the Chief medical officer of the Shipping Federation the full case particulars as ascertained by us, together with the patient's Discharge Book Number. By this means it is possible to ascertain the particulars of the patient's record of attendance at Shipping Federation Medical Centres at major ports throughout the United Kingdom, where his medical examination as far as practicable should have included fluoroscopy — almost invariably for all new entrants and those medically examined for general service or company contracts. Nevertheless it cannot be said that in the British Merchant Navy the organisation has yet reached the stage when the seafarer has a routine fluoroscopy or x-ray at fixed intervals. Personnel of the 'loyal Navy do receive x-ray annually as do those of the Merchant navy in most Scandinavian Countries. Some Scandinavian shipping companies even arrange for Mantoux testing and B.C.G. of all new recruits. One well known British passenger line arranges a routine x-ray of all Asian crews annually. This is important because of the known higher racial incidence in Asians and partly because Asian crews prefer communal sleeping quarters at a relatively high temperature and relatively low rate of air movement. "The need for special measures for the control of tuberculosis in seafarers is no longer in dispute, for although their quarters have been considerably improved since I wrote my paper "Slum Clearance at Sea" (1936) there still remains the fact that from the nature of their occupation, they live round the clock together in a closed community for relatively long periods at a time. "At this point in my dissertation, I think it would be helpful to illustrate by quotation from a few recent case histories. I begin with one that involved Glasgow. This was an AB on a tanker who reported sick at sea. He was seen by a doctor at Baytown in Texas, where he was x-rayed and sent to hospital. A diagnosis of pulmonary tuberculosis was cabled to the London headquarters of the shipping company, which immediately notified me, having previously arranged for the Shipping Federation doctor at Tilbury to undertake fluoroscopy of all contacts when the ship docked there. I then communicated with the head of the Shipping Federation Medical Service, who replied Investigations have shown that this man had a full general medical examination at Glasgow on 10.4.56., this included chest fluoroscopy which was normal. I would add that I have every confidence in the fluoroscopy carried out by our two doctors at Glasgow as with the slightest abnormality seen on screening they always refer the case to Chest Clinic or Hospital for full investigation". "The next case concerned a 2nd steward on a ship bound from South America who had a sudden severe haemoptysis while the ship was at sea. Radio aid was requested by the ship and on the advice of an American ship carrying a doctor, morphia was given and ice to suck. In spite of this the bleeding persisted and the patient died suddenly the following morning. The body was landed at Recife where a post-mortem examination was performed. \ radiogram from the agents stated death was due to pulmonary tuberculosis. The reply from the Shipping Federation Medical Service was that "very extensive enquiries have been made at a large number of Shipping Federation offices about any medical examination of this man but since he started employment with the Blank Line he seems to have re-engaged with this Line on various vessels from 1951 and we cannot trace any full medical examination since 12.2.51. We have taken the matter up with the 24 Blank Line who informed us that this man was not medically examined before engagement on the "Blank" and that the last record of medical examination which they hold is dated October, 1955 — this appears to have been a pre-shipment medical inspection. It is, thus, quite clear that no Federation M.0. had examined this man after he had had his attack of bronchitis with alleged coughing on the outward voyage which started at Newcastle on 4.8.56. I am afraid that there are many seafarers who do not have medical examinations once they have been taken over by a particular Company. We have no power to compel any Company to have their seafarers medically examined but if they are sent to the Shipping Federation they will, of course, receive medical examination or the more brief medical inspection. We do try to impress Shipowners about the necessity for more frequent medical examinations and many Lines co-operate very well in this respect; others, just d o not seem to care and hope for the best". "These case I have just reported well illustrates the enthusiasm for tuberculosis control that animates the Shipping Federation Medical Service, and I should have mentioned that included in the measures taken by them is a routine follow up of all case contacts. Whenever a Shipping Federation Medical Officer diagnoses pulmonary tuberculosis in a seafarer, he at once tries to ascertain the names and addresses of all who shared the patient's room on board ship, and this may necessitate his communicating with the shipping company concerned. "When those who have shared the room have been identified, the Shipping Federation Medical Officers at their home ports interview them and suggest the advisability of a chest investigation which can be carried out at a hospital or chest clinic free of charge. The name of the man who is suffering from the disease is only disclosed to those who must know it in order to identify the contacts. "If a seaman has to be discharged abroad and the ship is to remain abroad for some months every endeavour is made to secure chest investigation of his ship contacts at the first port of call where there are adequate facilities. "If the ship is on her homeward voyage and will be back in a few weeks, the necessary arrangements for chest investigation of contacts at their home ports are made as soon as possible after the ship's return. "Similar follow up of contacts is made in cases where a seaman has been discharged abroad on account of sickness which is subsequently discovered to be pulmonary tuberculosis. "Another case concerned a native seaman on a ship which had been asked to accept him for repatriation. Fortunately before the ship could sail the man was discovered by one of my port health inspectors who, not liking the look of him arranged that he should see the Shipping Federation Medical Officer at the dock concerned. It was ascertained that the native crew superintendent had not been informed of the man's condition and that he had been put into crew accommodation with seven others. On enquiry it was found that this man had been under a Chest Physician in a General Hospital, who had given him treatment but had not seemed to understand the importance of making sure that the man was quite free from infection before allowing him to travel in a ship with other members of a crew. This man with others had been flown from India to make up a crew for the ship concerned, and it was found, upon enquiry, that 3 or 4 others who had been flown over with him had also got pulmonary tuberculosis. Steps were being taken by the Shipping Federation to make sure that this sort of thing in the recruitment of crews should not be allowed to happen again. "My next case illustrates the vigilance of a ship's surgeon, who discovered tuberculosis in a a passenger and through the shipping firm concerned arranged that the man should see a London specialist when he disembarked. We were of course informed of the arrangements, and we notified the medical officer of Health of the London borough where the patient had arranged to spend the night pending his interview with the London specialist. "In all these cases the quarters occupied are fumigated with formaldehyde and bedding taken away for steam disinfection. "My next case illustrates the co-operation between different health authorities, because it began with a letter to me from the Medical Officer of Health of Edinburgh stating that a patient who had died of pulmonary tuberculosis in the Royal Infirmary there had been a member of the crew of a certain vessel which was due in London. I immediately instructed my port health inspector , who would meet the ship when she docked, to arrange for all contacts to attend the nearest Shipping Federation Medical Centre for x-ray. Fortunately they were all found negative but arrangements were made for repeat fluoroscopy in three months' time. "In another case the shipping line themselves sent us an extensive crew list to enable us to trace contacts of a patient who had been a member of that crew. They had received a cable from Canada that he had been admitted to hospital for shingles but the diagnosis then became one of pulmonary tuberculosis. In this case there was not time to arrange for mass fluoroscopy ofall the contacts at the Shipping Federation Medical Centre where the ship docked, so we wrote to the medical officers of health of the areas whence the contacts had proceeded, they having been all 25 paid off when the ship arrived. The medical officers of health of the areas concerned would then normally follow up these cases and arrange for them to be examined at the Chest Clinic. "In another case a notification from a hospital management committee revealed the existence of a wanderer who had been wandering from ship to ship, and who normally lived in lodging houses when he is ashore, particularly one in the borough of Stepney, or alternatively another one in Cardiff. We got the health authorities of Stepney and Cardiff to trace the man and tried to secure his attendance at Chest Clinics, but our success was not 100% because this particular man had the habit of attending the clinic once or twice and then disappearing again. "My last case is one of which we are particularly proud. It occurred on a ship where there was no ship's surgeon and where the Master had put in a clean Declaration of Health. It is our practice when there is no ship's surgeon to demand a crew list and a crew muster, and fortunately our vigilant boarding medical officer noticed that the crew muster was one short of the crew list. This led him to ascertain that there was in fact a sick man in the crews quarters, and when we followed up this case we found he had pulmonary tuberculosis. Meanwhile the ship had proceeded to Bristol, but thanks to information from us, the Port Health Authority there secured the mass radiography of 61 ratings. These were re-called for re-examination, and one was discovered to be suffering from active Tuberculosis with extensive cavitation. The appropriate forward notices were sent from Bristol to Manchester, the next port of call, which again illustrates the co-operation between different ports and towns in the Port Health and Public Health Service of this country. "You may ask what is the size of the problem? Well, in the Port of London, this works out at an average of 42 cases of pulmonary tuberculosis known to be coming into the Port of London every year and it must be very seldom that we miss any cases. Unfortunately I cannot fromthat figure work out a case incidence because I cannot obtain any figures as to the numbers of crew coming to the Port for the first time in any one year. I have a figure of 671,177 by courtesy of H.M. Customs, but this includes seafarers who have come in more than once in the year on repeated voyages. I should have liked to have a figure to compare with that for England and Wales, namely 131 per million population of all groups and ages, (vide Annual Report of Ministry of Health 1955). "I conclude with a quotation from the published papers of Wade Frost, which I humbly suggest does set forth principles that we are trying to follow in the Port Health Service "The soundest principle to follow seems to me that, as the cases become fewer and fewer, preventive measures should be centred more and more upon the open cases; that the protection thrown around these infective cases and their immediate contacts be not relaxed, but steadily and progressively increased. This is a sound principle of epidemiology, for it is to be expected that, as the prevalence of tubercle bacillus in the general environment is diminished, infection and disease will become more distinctly focalized. In fact, there is already evidence of increasingly wide differentiation between the most sheltered and the most exposed groups of our population; and even now we should take more cognizance of this in directing our efforts." ASSISTANCE TO THE SEAFARING COMMUNITY The Port Health Authority is at all times ready to render medical assistance to the seafaring community and the Boarding Medical Officers have always co-operated to the full in rendering this valuable service. An example of this occurred on the 9th March, 1957 last when a deckhand from the tug "SUN XI" was recovered by the Pilot cutter from the River after five minutes immersion. Resuscitation was carried out on board the "HOWARD DEIGHTON" and the boy was able to go home in good condition. Helpful co-operation of another kind is shown by the following letter of appreciation received from the Ministry of Transport and Civil Aviation. Ministry of Transport and Civil Aviation, Berkeley Square, London, W.l. 22nd March, 1957. "Dear Dr. Greenwood Wilson Medical Advice by Radio to Ships at Sea. Since the inception, more than 30 years ago, of the system whereby messages received by General Post Office coast radio stations from ships at sea, requesting medical advice, were forwarded to local Medical authorities in the vicinity of the coast stations, the number of British and foreign vessels using the service has steadily increased year by year. We are informed by the General Post Office that 289 requests for medical advice were received last year involving 921 messages between ships and the medical authorities ashore. These included 129 requests from foreign ships. These figures indicate a considerable increase over those given for the preceding year and, in general, the statistics provided by the General Post Office for recent years indicate a growing demand for the service. 26 "You may be aware that the general question of radio advice to ships at sea has been the subject of international discussion at the International Labour Office Preparatory Technical Maritime Conference held in London in September/October, 1956, and the services provided by the medical organisations working in conjunction with the General Post Office coast radio stations in the United Kingdom, as also those of certain other countries were commented upon with appreciation. "The voluntary participation in the scheme, in addition to their other professional duties must we realise, cause considerable personal inconvenience from time to time to all concerned, but they may be assured that their work is greatly valued by seafarers and by none more than a Master who is fortified in his endeavours to treat a serious case of illness or injury by the knowledge that skilled medical assistance is so readily available and willingly given. "My purpose in writing this letter is to ask you to convey to the medical staff of the hulk "Hygeia" the thanks of the Ministry of Transport and Civil Aviation for the valuable services they have so kindly rendered in the past, and to place on record the Ministry's appreciation of the interest shewn in the care and treatment of men who, by virtue of their calling, are denied the facilities more readily available to persons ashore. Yours sincerely, (Signed) A.W. WOOD." BOARDING MEDICAL OFFICERS The Port of London Health Authority maintains a Boarding Station at the Hulk "Hygeia", moored in the River Thames, off Gravesend, where there is a Medical Officer on duty twenty-four hours every day throughout the year. For many years this service was maintained by three Medical Officers performing 24 hours on duty followed by 43 hours off duty, holiday periods and absences on account of sickness being covered by locum tenentes. Of recent years increasing difficulty had been found in obtaining suitable locum tenentes for the Boarding Medical Service, which apart from absence through sickness required coverage for holidays alone for a period of three months in all every year. Fortunately it was found that a group of five general practitioners in partnership in a district within reasonable distance of the Gravesend Boarding Station would be willing to act as locum tenentes for the BoardingMedical Service whenever required, whether for holiday periods or because of sickness. In addition to their clinical efficiency they all have an interest in seafaring. The arrangement commenced in March, 1956 and has proved a great success. A year after the institution of the arrangement with the general practitioners the junior of the three permanent Boarding Medical Officers resigned to take up another post in the public health service, and the question arose of filling the vacancy. It was appreciated that the same factors which had made it more difficult to obtain a suitable locum tenentes for the Boarding Medical Service might make it more difficult to fill the permanent vacancy. It was felt at this time that any doctors starting their career would be unwilling to take up the rather extreme degree of specialisation involved in be coming a career Boarding Medical Officer. There were beginning to be difficulties in obtaining recruits to any part of the public health service, and it seemed that those that did want to enter it would not want to narrow down their experience to that of a Boarding Medical Officer, in case they wanted to go on from that work to work of a more general nature in the public health and school medical service. It was therefore decided, in consultation with the authorities of the Essex County Council, to try an experiment to appoint two part time Medical Officers to take the place of the one Boarding Medical Officer who had resigned, these two part time Officers to spend the other part of their time working for the Essex County Council on general duties connected with the Essex public health and school medical service. The scheme has worked well, particularly as the firm of general practitioners are constantly gaining experience and becoming themselves more like permanent Boarding Medical Officers. The two part time Boarding Medical Officers first appointed have now left but they have, without difficulty, been replaced. The experiment remains one to be carried on without prejudice to the possibility of reverting to the former system of three whole time Boarding Medical Officers if this should prove to be the wiser choice in the long run. SECTION X - OBSERVATIONS ON THE OCCURRENCE OF MALARIA ON SHIPS Seven cases of malaria were reported on ships during the year under review as compared with twenty-six cases during 1956. All the cases occurred amongst members of the crew. Five of the cases were disposed of prior to the arrival of the vessels in the Port of London. s.s. "SELBO" - MALARIA On the 16th January, 1957, while the above-mentioned Norwegian vessel was lying at the Gravesend Buoys, a member of the crew was taken ill and at the request of the Master, Dr. J.A. Jones, the Boarding Medical Officer, visited the vessel and after examining the patient who had a 27 very High temperature, 104/105°, removed him to Denton Hospital as a suspected case of Malaria, a diagnosis which was subsequently confirmed, following blood and urine tests, by your Consultant Physician, Dr. W.T.G. Boul. The patient rapidly improved following a course of anti-malarial therapy but since it was obvious that the patient would require a fairly long convalescence as soon as he was fit to travel, arrangements were made for his removal to the Norwegian Hospital in London. Dr. H. Willoughby, Deputy Medical Officer and Medical Officer in Charge at Denton Hospital, submitted the following interesting observations:— "It is noteworthy that British ships travelling regularly to and from West Africa take antimalarial prophylactic measures with their crews, but the casual caller does not — especially the foreigner. "This has been accentuated by the closure of the Suez Canal with the need for refuelling at Dakar by ships coming via the Cape who do not normally call there. "The present case is a relapse of an infection acquired on his previous voyage and although we all have malaria uppermost in our minds at the present time, cases of jaundice with very high fever present a perplexing picture." MOSQUITO CONTROL AT THE ISLE OF GRAIN The larvicidal control of mosquitos breeding within the perimeter of the B.P. Refinery at the Isle of Grain was continued throughout the breeding season of 1957. As in previous years the operation was directed by the Refinery Medical Officer and the field work was carried out by an employee of the Oil Company. Control was effected by treating all waters found to harbour mosquito larvae with a Dieldrin larvicide and, as in 1956, a considerable degree of success was achieved. The area under control was somewhat larger than the previous year due to the expansion of the refinery and the increased labour force engaged which provided more "blood meals" for the female mosquito. In spite of these added difficulties the operation succeeded in maintaining a measure of control comparable with 1956. Mr. P.G. Shute, Deputy Controller of the Malaria Reference Laboratory, visited the area while the campaign was in progress and expressed his approval of the manner in which the operation was being conducted. On one occasion during April anopheline larvae were found in an isolated ditch. This infestation was dealt with as a matter of routine and no further anopheline specimens, larvae or adult, were met throughout the rest of the year. Though Mr. Traynier, the Port Health Inspector in this area, continued to be actively associated with the control measures, he was not obliged to devote so much time to them as in 1956. Mention must, however, be made of the interest and enthusiasm shown by the Refinery operator appointed to this work, who, apart from the field work, kept comprehensive records of his activities and carried out larval and adult insect identification. SECTION XI. — Measures taken against ships infected or suspected of Plague The Fourth Schedule to the Public Health (Ships) Regulations, 1952, under the heading "Additional measures in respect to the quarantinable diseases" — Part I — Plague, reads as follows:— "(1) The Medical Officer may — (a) require any suspect on board to be disinsected and place him under surveillance, the period of surveillance being reckoned from the date of arrival of the ship ; (b) require the disinsecting and, if necessary, disinfection of the baggage of any infected person or suspect, and of any other article on board and any part of the ship which the medical officer considers to be contaminated. (2) If there is rodent plague on board, the medical officer shall require the ship to be deratted in a manner to be determined by him, but without prejudice to the generality of this requirement the following special provisions shall apply to any such deratting— (a) the deratting shall be carried out as soon as the holds have been emptied; (b) one or more preliminary derattings of the ship with the cargo in situ, or during its unloading, may be carried out to prevent the escape of infected rodents ; (c) if the complete destruction of rodents cannot be secured because only part of the cargo is due to be unloaded, a ship shall not be prevented from unloading that part, but the medical officer may apply any measure which he considers necessary to prevent the escape of infected rodents." 28 Plague being primarily a disease of rats all vessels are inspected immediately on arrival at their berths in the docks and river for the presence of any mortality among the rats on board which is not attributable to any known cause, such as trapping, poisoning, etc. Incidentally one of the "Health Questions" on page 1 of the "Maritime Declaration of Health" requires the Master to answer "Yes or No" to the question "Has plague occurred or been suspected amongst the rats or mice on board during the voyage, or has there been an abnormal mortality among them ?". Any dead rats are immediately sent to the Central Public Health Laboratory at Colindale for examination for bacillus pestis, each rat being accompanied by a label on which is given precise information as to where the rat was found in order to arrive at a focus of infection should the examination prove positive. This information, is, of course, far more vital when the rat has been found ashore than when found on board a ship. In the event of a positive result the "additional measures" referred to above would be put into operation — the discharge of the cargo would be promptly stopped and arrangements made for the vessel to be fumigated throughout with hydrogen cyanide, with the cargo in situ, the vessel being moved to an approved mooring. Following the initial fumigation and collection of dead rats resulting therefrom, further samples of such rats would be submitted for examination and the discharge of cargo would be permitted under observation. The destination of the cargo would be forwarded to the Medical Officer of Health of the district to which it was proceeding, together with an explanatory note. If any of the cargo had already been discharged overside into lighters before the discovery of plague infection, the fighters would be fumigated immediately. On completion of the discharge of cargo from the vessel a second fumigation would be carried out, again using hydrogen cyanide, to destroy the residual rat population, if any. SECTION XII — Measures against rodents in ships from foreign ports (1) Procedure for inspection of ships for rats. The Port Health Authority employs fifteen Rodent Operatives working in conjunction with and under the supervision of the Port Health Inspectors. The Rodent Operative's first duty is the examination of ships in his area which are due for inspection under Article 19 of the Public Health (Ships) Regulations, 1952, relating to the granting of Deratting and Deratting Exemption Certificates. His second duty is to visit all ships arriving in his district, to search for evidence of rats, paying particular attention to vessels which have arrived from plague infected ports and to visit such vessels during the discharge of cargo. The Rodent Operative's third duty is the examination of shore premises for signs of rat infestation paying particular attention to premises adjoining the berths of vessels from plague infected ports. Some sixteen years ago the Port Health Authority instituted a Rodent Control Scheme in all docks and premises of the Port of London Authority on behalf of that Authority and in the premises of the tenants of the Authority on behalf of the occupiers. The Port of London Authority have made Bye-laws requiring the Master of every vessel to cause all ropes and mooring tackle to be fitted with guards to prevent rats passing from ship to shore. The bye-laws also prescribe that when discharge or loading of cargo is not actually proceeding, one gangway, whitened for a length of 10 feet at the end next the vessel, may be used as a communication between the ship and the shore. (2) Arrangements for the bacteriological examination of rodents, with special reference to rodent plague, including the number of rodents sent for examination during the year. As described in Section XI above, all rats for examination for plague, either by post mortem and subsequently, if necessary, by bacteriological examination are promptly sent to the Central Public Health Laboratory at Colindale. The bodies are placed in polythene bags which in turn are placed inside metal boxes, sealed and labelled so that there is no risk of the escape of any rat fleas during their transit to the Laboratory. The boxes are, of course, delivered by hand. The rat population of the Port is now so small and is under such strict control that it can be said to be almost certain that the arrival of a plague infected rat, even should it manage to get ashore, would be highly unlikely to have any serious significance. In other words, an epizootic 29 could not be introduced into the Port for the simple reason that there are insufficient rats to enable the spread of infection. Nevertheless, fifty-six rats were sent to the Laboratory and were examined for plague with negative results. (3) Arrangements in the district for deratting ships, the methods used, and if done by a commercial contractor, the name of the contractor. (a) The burning of sulphur at the rate of 3-lbs. per 1,000 cubic feet of space for a period of not less than six hours. The destruction of rats, whether it be by the open pot method or by sulphur gas in cylinders, is efficient and the great advantage is that when applied in the holds of ships, the crew need not be put ashore. Unfortunately a number of countries have, for some time past, refused to accept as valid, International Certificates, where this method of rat destruction has been employed; consequently it has fallen out of use. (b) The generation of hydrocyanic acid gas by various methods. For the destruction of rats a concentration of HCN at the rate of 2-ozs. per 1,000 cubic feet of space is required with a minimum of two hours contact. (c) "1080" and "Warfarin". The employment of "-1080" has been used regularly throughout the docks for some time with highly satisfactory results both on shore and in ships. An increasing number of ships have been deratted by this method in preference to the use of cyanide, resulting in a considerable saving of time and cost to the shipowner. Although satisfactory results have been obtained from the use of "Warfarin" a suitable bait has yet to be found, particularly in granaries, with which to mix the poison, so that rats will take it continuously in preference to grain and other forms of cereal on which they are normally feeding. (d) Trapping. Trapping is seldom employed save for the destruction of isolated rats which have escaped a major poisoning operation or which have not yet established themselves. The following are the names of the firms approved for carrying out the deratting of ships:— Messrs. Associated Fumigators Ltd. Messrs. Fumigation Services Ltd. Messrs. London Fumigation Co. Ltd. Messrs. Ridpests Ltd. Messrs. Scientex (Southern) Ltd. Messrs. Insecta Laboratories Ltd. TREATMENT OF MICE INFESTATIONS In some respects mice are more difficult than rats to eradicate by customary methods of control especially where there is adequate attractive food near or forming remote harbourage in which to hide and breed. Such conditions are often provided in dock warehouses where cargo is stored and left undisturbed for indefinite periods. Once the mice have become established in the centre of bulk food, two characteristics of the mice make control almost impossible — they will not venture far from the harbourage and they can live without water for a considerable time; therefore, having the food of choice immediately available and no craving for water they can live inside the stack probably unobserved while they continue to breed and destroy the cargo. Any attempt to poison them by ingestion of toxic substances would involve a risk of poisoning the cargo in one way or other and, to avoid any misadventure, it remains to persevere with poison baits and traps around and about the boundaries of the stacks. In general circumstances this method is laborious and only partially successful, particularly in a warehouse that is not rodent-proof. It is true that claims of successful operations have been carried through by experimental teams, but the circumstances have been rather suitable to the experiment and not those usually encountered in old dock warehouses. There are three main factors to consider in controlling these pests:— (a) To provide mice-proof warehouses. (b) To prevent infested cargo entering the warehouse. (c) To stow the cargo in such a manner as to afford inspection and necessary action. To adopt a system of suitable cargo stowage is not always possible owing to labour difficulties and warehouse economics, but measures to comply with warehouse construction and admission of cleaner cargoes have met with some success. As an example, mice infestations in London Dock have given rise to anxiety for some years and, despite all efforts made to combat the pests, the results have not been encouraging. The real cause of the trouble arose from the importation and stowage of millet seed sprays in rather flimsy containers already infested with mice from the exporting country. Damage to the containers 30 ted other mice and nothing but violence seemed to be effective. To open the containers and repack was considered impracticable, hence the mice remained self-sufficiently housed and left the containers at night only for exercise or spread to other attractive cargo. In joint consultation with the P.L.A. it was decided that all the existing stocks of millet sprays be assembled on two lighters and be treated with methyl bromide gas under the supervision of the Port Health Authority, then to be taken to a mice-proof warehouse set aside specially for this stowage. Ml future cargoes of this highly mice-attractive commodity will be examined by the Port Health Authority before being admitted to the appointed warehouse. Details of this operation were as follows:- METHYL BROMIDE FUMIGATION OF MILLET SPRAYS IN TWO LIGHTERS d.b. "BRISTOL" and d.b. "COLEHOUSE" London Dock 2nd — 3rd December. 1957 Weight of Cargo Approximately 65 tons Nature of containers Wooden cases, plywood drums, bags and baskets Number of containers Approximately 1,200 Total capacity of holds 13,500 cu.ft. Total capacity of cabins 1,500 cu.ft. Total capacity fumigated 15,000 cu.ft. Total weight of fumigant 23 lbs — (368 ozs.) Concentration of fumigant 24.5 ozs per 1,000 cu. ft. Exposure of fumigant 24 hours The cargo was stacked in a reasonably compact bulk, allowing sufficient free space for gas circulation, then covered with hatch boards and double tarpaulins. The liquid methyl bromide was vaporised and expanded in a heated coil and entered the holds under slight pressure to give it a velocity of 2 ft. per sec. After 24 hours exposure, the spaces were tested for gas and declared 'gas free' before the workmen discharged the cargo and transported it to No. 9 Warehouse. During the entire operation, the Port Health representative was in attendance and NO LIVE RODENTS were seen after the fumigation. Some dead mice were seen in the cargo while in transit and it may well be that there were more, but their presence would not be a health hazard and it would be asking too much to have all the containers opened and re-packed only to recover the dead bodies. Dead Rodents Recovered Location Rats Mice "Bristol" — 30 "Colehouse" 12 51 In transit - 7 Killed by violence while loading 32 52 Total for operation 44 140 flats recovered were R. rattus and Mice of agricultural species. All bodies were examined and found normally healthy. So far as the number of bodies recovered and the absence of any live rodents is concerned, the value of the operation is proved successful and there will be other dead bodies in the containers, since it is to be expected that some would take refuge, in the compact millet sprays to escape the chloropicrin lachrymator in the gas. Methyl bromide gas has a relative density of 4.5 and a high power of penetration, so neither escaping rodents nor the nestlings could survive. This method of treating a very difficult rodent problem which, hitherto has defied all known practices may prove to be the best course of action and this principle of treating infested cargo may be extended to similar operations under a gas-tight cover and in a suitable shed. RODENT CONTROL ON LIGHTERS It is encouraging to report that the suppression of rats and mice aboard these thousands of craft has been continued successfully for another year. There has been no faltering on the part of the Rodent Inspector and no lack of collaboration from the Industry. Apparently the Industry realises that the benefits that have accrued from ridding the lighters of rodents and has accepted the policy of rat-proofing the craft within reasonable limits. The trend is that the Industry as a whole has become quite rodent-conscious both afloat and at the repair yards. In the repair yards, it often happens that where there are any indications of rodents present on a lighter under repair, action is taken to destroy the rodents voluntarily in a manner approved by the Authority and records kept of such operations for the information of the R odent Inspector. Besides these voluntary operations others are carried out under the directions of the Authority and supervised by the Inspector. 31 Afloat, repressive measures are taken as required mainly as a result of notification from the Authority and such action may include poisoning operations by the Authority at the request of the Owners. Whatever the destructive measures adopted, by sulphur dioxide, hydrogen cyanide, methyl bromide or poison baits, the decision is determined after close initial inspection and this aspect of the overall control measures is a major task carried out efficiently and methodically by the appointed Inspector with his launch. In these times when lighters are in steady demand and their movements erratic, when delay imposes economic penalties and the human factor must be considered, it is the more gratifying to achieve the results recorded and the friendly understanding that has developed. This control of rodents on lighters is, indeed, an important role in the comprehensive rodent control practices of the Port, for it is by transporting rodents from place to place inside and outside the Port area that rodent-borne diseases could be communicated on a major scale. Records for this year include:— Number of lighters inspected 3,746 Number without evidence of rodents 3,126 Number with negligible evidence of rodents 382 Number of lighters treated for rodents 160 Number treated voluntarily by Owners 78 Total number of dead rodents recovered 849 There is an increase in the number of lighters treated when compared with past years and this is due to the ever growing co-operation aforementioned between the Port Health Authority and the Industry, especially at the repair yards. PREVENTION OF DAMAGE BY PESTS (APPLICATION TO SHIPPING) ORDERS 1951-56 Since 1951 the Port Health Authority has been issuing Rodent Control Certificates to coastwise shipping as provided for by the terms of the Prevention of Damage by Pests (Application to Shipping) Order, 1951. During the year 1957 the Port Health Authority issued 105 such Certificates. TABLE E Rodents destroyed (bodies recovered) Airing the year in ships and in shore premises (1) On vessels Number of Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Black Rats 145 277 199 196 273 313 159 66 133 195 264 150 2370 Brown Rats — — — — — — - — 1 1 - - 2 Rats examined 4 7 2 6 3 — 4 3 3 2 - 2 30 Rats infected with plague (2) In Docks, Quays, Wharves and Warehouses Number of Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Black Rats 182 93 113 136 163 254 120 96 226 133 119 124 1759 Brown Rats 81 43 65 49 57 42 47 8 47 162 95 36 732 Rats examined 5 1 2 — 2 5 2 2 4 2 2 1 28 Rats infected with plague — — — — — — - — — - - - - TABLE F Deratting Certificates and Deratting Exemption Certificates Issued during the Year for Ships from Foreign Ports No. of Deratting Certificates Issued Number of Deratting Exemption Certificates Issued T otal Certificates Issued After Fumigation with After Trapping After Poisoning After Trapping and Poisoning T otal HCN Other Fumigants (state Method) 1. 2. 3. 4. 4(a) 5. 6. 7. 28 s.o2 1 Nil "1080" 103 Nil 138 1,071 1,209 Methyl Bromide 1 "Warfarin 5 32 / SECTION XIII — Inspection of Ships for nuisances TABLE G Inspections and Notices No. of Vessels Number of vessels visited by Port Health Inspector 13,523 Number of vessels on which sanitary defects were found, and details reported to the Master, Owners and/or Ministry of Transport 646 Number of Statutory Notices served NIL Number of vessels on which sanitary defects were remedied 638 Summary of Structural and other Defects Inadequate ventilation 25 Defective Lighting — Natural — Do. do. — Artificial 3 Defective Heating 8 Condensation 11 Leaking Decks 19 Leaking Ports, Decklights, etc. 16 Leaking Sideplates 1 Leaking Hawse and Chain Pipes — Deficient or Obstructed Floor Drainage 17 Water lodging on top of Peak Tanks 1 Defective Bulkheads 2 Do. Floors 17 Do. Doors 6 Do. Chain Pipes — Do. Bunks 17 Do. Clothes Lockers 3 Do. Food Lockers 6 Do. Food Storage 20 Do. Cooking Arrangements 14 Defective or Uncleanly Drinking Water Storage 4 Water Closet Obsolete 5 Do. Defective 14 Do. Foul or Choked 10 Do. Inadequate Flush 10 Wash Basins Defective 15 Do. Foul 4 Neglected Paintwork or Distemper 14 Absence of Washrooms 1 Absence of Messrooms — Misappropriation of Crew Spaces 2 Verminous Quarters 144 Dirty Quarters 484 Miscellaneous 113 Total 1,006 SHIP'S HYGIENE - s.s. "TEANO" The Port Health Inspector on the West India Dock, reported on the 29th October, 1957 on the excellent condition of the quarters on the s.s. "TEANO" and your Medical Officer accordingly sent a letter of congratulation to the Owners, The Ellermans' Wilson Line, Ltd. as follows:— s.s. "TEANO" "The Port Health Inspector in the West India Dock has recently called my attention to the high standard of cleanliness and hygiene on this vessel and to the active encouragement received by the ship's personnel from the supervising shore staff. "When the vessel was inspected after her two recent voyages, on both occasions the galley and storerooms were in an immaculate condition; the paintwork was excellent, and all woodwork, such as benches, lockers and the gratings and battens in the storerooms and I refrigerator, were scrubbed to a "snow" whiteness. "This exceptional cleanliness must portray the great pride felt by the Catering Staff for 'their' ship and entail a lot of hard work. "It gives me much pleasure to commend the good work of your Company, the shore staff and the ship's personnel on this most satisfactory achievement." SECTION XIV - PUBLIC HEALTH (SHELLFISH) REGULATIONS, 1934 Arising out of the cases of typhoid fever in 1956, at Scrapsgate, Minster, Isle of Sheppey, alleged to be due to the consumption of shellfish collected from the foreshore in that area, and the subsequent instructions of the Port of London Health Committee that an Order in respect of that area should be made under the Public Health (Shellfish) Regulations, 1934, an Order in the following terms was made on the 25th July, 1957:— PUBLIC HEALTH (SHELLFISH) REGULATIONS, 1934 NOTICE IS HEREBY GIVEN that the Mayor andCommonalty and Citizens of the City of London, the Port Health Authority of the Port of London and the Local Authority for the purposes of the Public Health (Shellfish) Regulations, 1934, did on the 25th day of July, 1957, make an Order in the following terms:— 33 PUBLIC HEALTH (SHELLFISH) REGULATIONS, 1934 ORDER made by The Mayor and Commonalty and Citizens of the City of London, the Port Health Authority of the Port of London and the Local Authority for the purposes of the Public Health (Shellfish) Regulations, 1934. IN pursuance of the powers conferred on them by the Public Health (Shellfish) Regulations, 1934, the Mayor and Commonalty and Citizens of the City of London, the Port Health Authority of the Port of London and the Local Authority for the purposes of the Public Health (Shellfish) Regulations, 1934, hereby make the following Order:— 1. In this Order "prescribed area" means the public and private layings situated on the foreshores or waters immediately bordering on that part of the Estuary of the River Thames, or any tributary waters thereof, in the County of Kent between Garrison Point, Sheerness and Warden Point, in the Isle of Sheppey. 2. A person shall not sell or expose or distribute or offer for sale or have in his possession for the purpose of sale for human consumption any oysters, mussels or other molluscan Shellfish taken from within the prescribed area unless such oysters, mussels or other molluscan Shellfish have been:— (i) subjected to a satisfactory process of cleansing at an establishment which is for the time being approved by the Minister of Health for the purpose; or (ii) relaid in pure water for such period and in such places as may from time to time be approved for the purpose by the said Port Health Authority; or (iii) subjected to a process of sterilisation by steam under pressure for at least six minutes in an apparatus which is for the time being approved by the said Port Health Authority; or (iv) subjected to any other process of sterilisation which is for the time being approved by the said Port Health Authority. 3. This Order shall come into operation on the 2nd day of September, 1957. EXAMINED (Signed) DESMOND HEAP Comptroller and City Solicitor. The Common Seal of the Mayor and Commonalty and Citizens of the City of London was affixed to this Order at a duly constituted Meeting of the Court of Common Council held on the 25th day of July, 1957, and, in my presence. (Signed) E.H. NICHOLS Town Clerk. AND NOTICE IS HEREBY FURTHER GIVEN that a person who contrary to the provisions of the above Order sells or exposes, distributes or offers for sale or has in his possession for the purpose of sale for human consumption any OYSTERS, MUSSELS or other MOLLUSCAN SHELLFISH taken from the layings above referred to is liable to a penalty of £100, and in the case of a continuing offence, to a further penalty of £50 for every day during which the offence continues. (Signed) E. H. NICHOLS. 55/61, Moorgate, E.C.2. Town Clerk. 26th July, 1957. RIVER ROACH - OYSTER LAYINGS A part of the River Roach in Essex comes within the jurisdiction of the Port of London Health Authority and here a fairly large oyster industry is carried on. A map showing the area is appended to this Report. (Appendix V.) The River Roach has for long been considered to be a clean river, but there have been occasional reports of noxious effluent being discharged into the River from the sludge works at Roper's Farm and it is understood that samples of oysters taken from the district for bacteriological examination had not been entirely satisfactory. The Southend-on-Sea Borough Council approved a sewage scheme costing £30,000 to prevent contamination of the River Roach and on the 24th January, 1957, an Informal Inquiry was held by the Ministry of Housing and Local Government at Southend-on-Sea to consider an application by the Borough Council for a Loan Sanction for the scheme. The Inquiry was attended by Officers of the Southend-on-Sea Council, the Fisheries Laboratory of the Ministry of Agriculture, Fisheries and Food; the local Fisheries Committee; and by Mr. D.E. Madeley, the Port Health Inspector for this area. At the Inquiry emphasis was laid on the importance of the River Roach for "fattening" oysters and of the serious consequences to the local oyster industry if pollution of the River continued. Mr. Madeley spoke of the danger to public health from shellfish polluted by sewage, for instance typhoid and paratyphoid, and stated that two recent samples of oysters from the RiverRoach were only 50% clean which was not an acceptable standard; further, that in the event of pollution of the River being continued, it might be necessary for the Port Health Authority to consider the making of an Order under the Public Health (Shellfish) Regulations, 1934, for this part of the River Roach. 34 The scheme has received the official sanction of the Ministry of Housing and Local Government and I am indebted to Mr. T.B. Hill, M.I.C.E., M.I.Mun.E., A.M.I.W.E., Borough Engineer for the following details of the proposed scheme:— "Since 1934 primary sludge accumulating at the Southend-on-Sea Corporation Works at Prittlewell has been disposed of by pumping to land owned by the Corporation at Barling. On the Barling site, the sludge is run into trenches and the supernatant water drains off to a pond and, following chlorination, then enters the River Roach. "It has recently been ascertained that the system which has been operating in the past has not been entirely satisfactory and on occasions there have been signs of unsatisfactory material reaching the river. "The Council have now resolved to construct a Pumping Station at Barling and to lay a line of some 4 miles of 8" diameter cast iron pipes in order to return the sludge liquor to the main Works at Prittlewell, where it will then be subjected to primary settlement before being discharged to the Thames through the 60" outfall pipe from the Prittlewell Works. "The capacity of the pumping plant at Barling will be arranged so that all flows less than 7.2 x the dry weather flow of pumped sludge to Barling will be returned to the works. Any excess of sludge liquor over this figure will be chlorinated for a period of 1 hour in the existing tanks before reaching the River Roach. "It is anticipated that only on very infrequent occasions in times of exceptional storms will any run-off from the Barling Sludge Farm enter the River Roach." SECTION XV - MEDICAL INSPECTION OF ALIENS 1. List of Medical Inspectors of Aliens holding warrants of appointment on 31st December, 1957. Dr. J. Greenwood Wilson, Dr. H.M. Willoughby, Dr. J.A. Jones, Dr. R.G. Newberry, Dr. M.J. Catton, Dr. J.E.H. Lahaise 2. l ist of other staff engaged on the work. Clerical staff at the Central Office. 3. Organisation of the work. All vessels carrying aliens are intercepted on arrival at Gravesend and the aliens are examined by the Medical Inspector of Aliens who is, in fact, the Boarding Medical Officer on Duty. Complete liaison exists between the Port Medical Staff and the Immigration Staff at Gravesend and should any doubtful cases arrive, the Medical Inspector is immediately communicated with by telephone and an opinion given. 4. Nature and amount of alien traffic. (a) Total number of arriving vessels carrying aliens 2,217 (b) Total number of aliens (excluding transmigrants, seamen and airmen) (i) Arriving at the port 25,674 (ii) Medically inspected 15,698 (iii) Medically examined 106 (c) Certificates issued Nil (d) Transmigrants landed and medically inspected Nil 5. Accommodation for medical inspection and examination is provided on Tilbury Landing Stage, though in practice, the majority of aliens are inspected in the ship on arrival and any necessary chaperonage is provided by nursing sisters or stewardesses borne in the ship. SECTION XVI - MISCELLANEOUS Arrangements for the burial on shore of persons who have died on board ship from infectious disease. No change. FOOD INSPECTION The total amount of foodstuffs seized and condemned for human consumption and either reconditioned or disposed of for animal feeding or for industrial or technical purposes under guarantee or destroyed was 3,409 tons 6 cwts. 3 qrs. 14 lbs. The following is a summary showing the method of disposal of the foodstuffs seized:— Method of disposal Weight Weight (1956) Tons cwts. qrs. lbs. Tons cwts. grs. lbs. Burnt 282 13 1 14 448 3 1 19 Boiling down 229 18 3 23 250 13 1 10 Buried 1,850 16 0 1 1,137 10 3 23 Animal feeding 78 7 2 5 281 0 0 13 Other districts 111 5 3 3 609 18 0 5 Industrial purposes 50 16 3 19 44 6 0 12 Reconditioning 644 2 0 11 1,034 1 1 11 Refining 143 4 1 13 181 16 0 25 Re-export 18 1 3 9 4 11 1 0 TOTAL 3,409 6 3 14 3,992 0 3 6 35 Of the 3,409 tons listed in the table above, the principal items and methods of disposal were as follows:— Burnt Approximately 375 cartons and cases and 17,190 cans fruits, juices, pulps, vegetables, meats and fish (burst, blown, leaky, crushed and pierced); 96 tons bananas(wasty and decomposed); 322 cases oranges (contaminated with dock water whilst in sunken barge); 3 chests of tea (dock water damaged); 293 cartons and boxes fresh and dried fruit (dock water damaged and wet damaged); 8 casks of gherkins (mouldy, soft, sour and dirty); 406 bags onions (wasty); 1,160 cases canned sardine fillets (blown and metallic contamination); 1,138 packages tomatoes (dock water damaged and oil damaged when loaded lorry ran into dock); 1,327 packages carrots (wasty); 386 packages tomatoes (wasty). Boiling down 179 lambs (oil damaged); 1,017 quarters of beef (mis-shapen, damaged, stained, and slightly tainted); 882 cases and 16 cans luncheon meat (blown); 298 cases canned corned beef (blown); 160 cans boneless ham (burst, blown and leaky). Quantity of carcase meat and offals (various reasons for condemnation). Buried 1,550 tons bananas (wasty and decomposed); approximately 460 cases and 9,420 cans fruits, juices, pulps, vegetables, meats and fish (burst, blown, leaky, crushed and pierced); 367 barrels grapes (decomposed and dock water damaged); 2,575 cases pears (soft and wasty); 7,435 baskets tomatoes (mouldy and wasty); 549 bags onions (wet and rotting); 529 packages melons (wasty); 377 cases oranges (soft and wasty). Animal feeding 18 cases and 81 boxes macaroni (dirty); 24 bags full cream milk powder (wet damaged); 12 bags machine skimmed milk powder (out of condition); 59 bags loose collected potatoes; 131 bags flour and wheat sweepings (dirty); 39 bags groundnut sweepings (dirty); 41 bags sugar maize sweepings (dirty); 12 bags flour (dirty); 108 bags wheat sweepings (dirty); 23 cases walnuts (dirty and fly infested); 188 bags flour and wheat (wet and dirty and ship's rejected stores); 31 tons 14 cwts. ships' rejected stores meat — released to London Zoo. All above released with agreement and under supervision of local Medical Officers of Health. Other districts 65 tons 16 cwts. ships' rejected stores; 253 bags sugar sweepings — released for storage at Ministry of Agriculture, Fisheries and Food Buffer Depot; 53 bags peas and beans (dirty); 519 cartons canned cucumbers, pineapple juice and peaches (bad rust, crushed, burst, blown and leaky). All above released under supervision of local Medical Officers of Health, mainly for sorting. Industrial purposes, etc. 10 P ackages lard (dirty — released for soap making); 25 bags sour oranges (dirty — released for marmalade making); 18 bags salt (dirty — released for de-icing purposes); 145 bags flour (oil damaged); 579 cartons margarine (wet damaged); 236 drums lard (crushed and dirty — released for soap making); 15 cartons butter (dirty); All above released under supervision of local Medical Officers of Health. Reconditioning 36 bags peas (dirty); 79 cartons lard (dirty); 6 cartons butter (dock water damaged); 178 boxes currants (wet damaged); 13 cartons lard (heat damaged); 531 boxes butter (linseed oil damaged); 6 crates of cheese (paint damaged); 42,473 lambs, quantity boneless beef, veal, hind quarters beef (mis-shapen, damaged stained and slightly tainted). All above released under supervision of local Medical Officer of Health. Refining 1,839 bags sugar sweepings (dirty — released under supervision of local Medical Officers of H ealth). Re-export 440 bags peanuts (old and soft — subsequently re-exported voluntarily by Importer as not being in agreement with order); 100 cartons of lard (no official certificate); 183 cans hams (progressive blowing). MEAT INSPECTION SERVICES At no time has the importation of meat and the port health inspection service thereof assumed greater significance than at present. The increased economic value of meat and demands for a higher selling quality of imported meat have led to a more competitive industry which, in various ways, reflects its moods and policies on the attitude and the skill of the meat inspectors at the Docks. If a free flow of this perishable food is to flourish without unnecessary restraint and interruption and only meat fit for human consumption allowed to pass through the Port, it becomes absolutely necessary that there be an efficient inspection service available and complete understanding between the Industry as a whole and the Authority's staff in attendance. 36 Adequate experience of the trade and co-operation with its representatives has contributed towards a relatively complete understanding at operational level, while the provision of a suitably equipped meat examination centre for detailed investigation and reconditioning within the premises of a large cold store has added considerably to the overall efficiency of the inspection service, allowing both detention and treatment of the meat inside the same building. The amenities of the examination centre are particularly helpful and the efficiency enhanced by the employment of skilled butchers to assist under the supervision of the port health inspectors. This innovation is apparently unique in any port health meat inspection service and enjoys the blessing of all concerned. Its real value can hardly be assessed, but records of activities in the Royal Docks alone indicate that the number of official detentions for the separate years 1955-56-57 has doubled and the amount of unsound meat seized as unfit for human consumption has risen from 85 tons to 259 tons in the year 1957. In addition to the examination aspect of the work, large quantities of carcase meat are detained from time to time until they have been reconditioned at this centre and other suitable premises within the Docks under the direct supervision of the port health inspectors. The greater burden of the meat inspection service must naturally fall to the lot of the Inspectors at the Royal Docks where most ofthe meat is imported. The field of meat inspection is not confined to dockside inspection nor to the more detailed examination at the centre. Comprehensive control must include sanitary aspects of transport and handling, occasional chemical tests and organised bacteriological investigations, all of which are vital if meat is to be passed as free from disease, sound, wholesome and fit for human consumption. Anything short of this standard is rejected and temporarily detained for destruction, animal feeding or industrial processing by permission of and directly or indirectly under the supervision of the Port Medical Officer. There is an increasing need at times for improved and direct sanitary control during transport and handling at the Docks and this will be the more difficult to achieve without adequate legislation. MEAT LANDED TO COLD STORES IN THE ROYAL DOCKS FROM VESSEL IN COLLISION On the 24th August, 1957, the s.s. "Sydney Star" arrived in the Royal Docks with a cargo of meat in No. 1 Hold showing signs of being generally mis-shapen, damaged, stained and slightly tainted, with evidence of slight decomposition of some carcases. The vessel had been involved in a collision and the meat landed at Cristobal (Panama) where some was re-loaded, some left in store for shipment by a later vessel and the remainder destroyed. It was known in advance that the vessel was due in London and accordingly your Medical Officer called a meeting of representatives of all interested parties to decide on a policy for the inspection and disposal of the cargo. Some 22,966 carcases of mutton and lamb were removed to No. 7 P.L.A. Cold Store. 2,668 quarters of beef in the cargo after inspection were found to be generally sub-standard due to much handling and there was slight taint. As is the practice in such circumstances it was agreed that the major part of the beef be allowed to go for ozoning to approved premises under the supervision of local Medical Officers of Health whose agreement was obtained. In view of the very large quantity of mutton and lamb involved it was agreed with the Salvage Association, acting on behalf of the Importers, to allow the meat to go to 15 approved Cold Store Depots throughout the country for reconditioning under the supervision of the local Medical Officers of Health whose agreement was obtained,and who were notified whenever parcels were released from the dock. The remainder of the beef and various sundries were found on further inspection to be not worth reconditioning and accordingly approximately 99 tons were sent for rendering down to your contractors for the disposal of unsound meats, Messrs. Hen son and Burbidge Ltd. The last parcel of mutton and lamb for reconditioning was released from the docks in October, 1957. On 5th September, 1957, it was ascertained that the remainder of the cargo of the "Sydney Star" weighing approximately 700 tons and consisting of 19,507 carcases of lamb, 7 sides veal, 610 bags boneless beef and 215 hinds and 360 fores frozen beef and 240 hinds and 1,478 fores chilled beef, would be arriving on the s.s. "Tacoma Star" due in the Royal Docks on 22nd September, 1957. A further meeting of representatives of interested parties was called and it was agreed that on arrival the meat be detained in No. 7 P.L.A. Cold Store and after inspection be dealt with on similar lines to the meat from the s.s. "Sydney Star". Again the Salvage Association took over the meat on behalf of the Importers. After inspection at the Cold Store it was agreed that the meat be disposed of as follows:— Lambs and frozen beef and veal, including boneless beef, to be sent to eleven Cold Store Depots throughout the country for reconditioning under the supervision of the local Medical Officers of Health whose agreement was obtained and who were notified when parcels were released from the dock. 37 The 2,406 chilled hind quarters of beef to be reconditioned at the Cold Stores in the Docks. 1,478 chilled fore quarters to be disposed of for animal feeding purposes under guarantee and supervision and released as required, the local Medical Officer of Health being informed of releases. In November a request was received from the Salvage Association that, as the reconditioning of the chilled/frozen hind quarters of beef on the Dock would take a very long time, they be allowed to arrange for quantities to be taken to a specified Cold Store for reconditioning under the supervision of the local Medical Officer of Health. As the Cold Store specified was already reconditioning lambs from the vessel this was agreed after the consent of the local Medical Officer of Health had been obtained and this relieved your Inspectors on the Royal Docks of part of a considerable amount of extra work. As a result of reconditioning on the dock 28 tons of meat from some 1,017 quarters of beef were sent to your contractors, Messrs. Henson and Burbidge, Ltd. From the foregoing it will be seen that a very high standard of co-operation and mutual goodwill is required from all concerned, i.e., P.L.A., Importers, Shipping Companies, Insurance Assessors and Surveyors and the Port Health Authority staff, and it is gratifying to report that this co-operation was given to the fullest extent by all concerned, enabling the arrangements to work smoothly throughout the discharge of the cargoes and the disposal of two large consignments of damaged meat, both presenting very different problems. BANANAS CONTAMINATED BY HUMAN EXCRETA The s.s. "Jamaica Producer" arrived from Kingston in the Royal Albert Dock on the 29th July 1957. On arrival in dock the vessel was visited in the course of normal routine inspection by your Health Inspector, Mr. T.G. Edwards, who was informed that a "stowaway" had been found in No. 1 Hold, "C" Deck, Starboard Side "bin". The stowaway was discovered in the above position, seven days after leaving Jamaica. It would appear that he moved sufficient bananas stowed in the bin to make a "nest" to lie in. He had obviously little room to move and his weight had caused a considerable amount of damage to the bananas in the bin beneath him and there was evidence of a soiling of the bananas by urination, but no human excreta was seen. Mr. Edwards reports that bearing in mind a previous similar occurrence some twelve months ago, he instructed the Importers and the Shipping Company that all the bananas in this particular bin were not to be discharged unless he was present. In the meantime the remaining bananas from this hold were discharged. On completion he then made a further inspection of the bananas that were suspected to be contaminated, and these were taken out by men provided with gloves and disinfectant and placed on the orlop deck in the hold, the sound bananas from the bin being discharged in the usual manner. The contaminated portion amounted to 106 stems and these were discharged overside into a refuse lighter, the discharge being carried out by the ship's gear and winches in order that none of the elevators and conveyors normally used in the discharge of bananas were subjected to any risk of contamination. The suspected area of contamination, viz., the decks and bulkhead were treated with a strong solution of carbolic acid as a disinfectant. Mr. Edwards concludes his report with an appreciation of the co-operation he received from the Importers, the Jamaica Producers Marketing Co. Ltd., and the Port of London Authority, in dealing with this incident. AMENDMENTS TO MEMO. 3/MEAT On 17th May, 1957, the Minister of Agriculture, Fisheries and Food issued a Circular FSH 3/57 directing that, in the light of experience gained in the detection of cysticercus bovis, it had been decided to amend the recommendations set out in Memo. 3/MEAT which was issued by the Ministry of Food in 1952. The amendments were as follows:— PART III - POST MORTEM INSPECTION SECTION B 1. (1) (d) Delete and substitute: "The external and internal masseter muscles should be examined by making several incisions parallel to the lower jaw." 33 3. (2) Delete and substitute: "HEARTS: The pericardium should be opened and the heart muscles examined and, if necessary, incised; in adult cattle the heart should be opened by an incision through the wall of the left ventricle and, if necessary, further incisions should be made into the heart wall from the inside." HOUSEBOATS AT BENFLEET The Essex County Council Act, 1952, provides that the mooring of any houseboat within the County shall not be lawful without the consent of the Council of the district in which the houseboat is situated, and that the Council may require the owner or occupier to remove or demolish any houseboat not authorised by them. The Port of London Health Authority are, however, still responsible under the Public Health (London) Act, 1936, for the sanitary supervision of houseboats coming within the jurisdiction of the Port Health Authority, although under the Essex County Council Act, 1952, the local Councils in Essex are now responsible for the licensing and drawing up of conditions under which they are prepared to grant licences to houseboats. The duties of the Port Health Authority in regard to the sanitary supervision of houseboats are safeguarded by Section 212 of the Essex County Council Act, 1952, which provides inter alia that no consent shall be given to the mooring of any houseboat within the Port of London without the previous written consent of the Corporation of London as the Port Health Authority of the Port of London. A letter dated the 9th August, 1957 was received from the Clerk to the Benfleet Urban District Council to the following effect:— Houseboats — Benfleet Creeks — Temporary Consents "With reference to your letter of 11th October last, the temporary consents then issued expired on 31st May of this year, and the Council have recently passed two resolutions in the following terms:— "(1) That, subject to the approval of your Authority, consents be issued in respect of the following houseboats for the period ending 31st May, 1958; the owners to be informed that the boats must be removed at the expiration of that period unless a previous application has been made and renewal granted: — "West Creek: Emma Jane; Blake; Haven; Lowestoft; Jewel; Lydia; Nisene; Geojean; Sans Souci; Patsy Ann; Bill Busty; Iris. "Ferry Road: Yacht Club Head quarters. "(2) That, subject to the approval of your Authority, consents be issued in respect of the following houseboats for the period ending 31st May, 1958, subject to the condition that they shall not be used for permanent habitation; the owners to be informed that the boats must be removed at the expiration of that period unless a previous application has been made and renewal granted:— "West Creek: Wee Peg; San Rita. "I shall be glad to receive your Authority's consent to issue the 15 temporary licences." No objection was raised by the Port and City of London Health Committee to the-proposal of the Benfleet Urban District Council to grant 'temporary consents' to the houseboats mentioned in the letter quoted above. CLEAN AIR ACT, 1956 There is probably no more topical subject within the scope of environmental health than atmospheric pollution and it is also very probable that there will be at least initial difficulties when the awaited Regulations come into being for the control of dark smoke from railway engines and vessels. Indeed, it will need much tact and initiative on the part of the Inspectors when the full impact is felt on the 'appointed day'. So far, the section of the Act which requires that notification of all new furnaces installed in buildings, or in boilers and industrial plant within the Port, shall be given to the Authority, has been exercised in relation to those with a capacity of no less than 55,000 B.T.Us. per hour. 39 In anticipation of the Regulations and the expected basic demands, a considerable amount of preparatory work has been done, including conferences between the Authority and other interested representatives, personal contacts with shipping supervisors and the P.L.A., while every opportunity has been taken to abate current smoke offences and make known the principles of smoke control among the actual operators. Generally, this advanced attitude has paid very satisfactory dividends and has contributed substantially towards giving the Regulations a fair chance of success in this Port. Improvements have incurred effort and expense, but the increased efficiency of combustion should bring its reward to all concerned. Pressure will be continued in connection with harbour vessels and port installations, some of which are old and burning bituminous coal without yet effecting any improvements in furnace design. However, the trend is to avoid the limitations of the hand-fired furnace and unsuitable coal by installing diesel engines wherever possible with the result that the majority of the tugs in the Port are now motor driven and this change has been supplemented by other tugs converting from coal to oil-firing. Of the remainder, it is clear that the supply of suitable fuel is vital and much will depend on the availability and acceptance of hard steam coal. Progress can also be reported ashore where railway locomotives are steadily being replaced by diesel locomotives and installations converted to electricity. Those exemptions which involve lighting up from cold, installations, and quality of available fuel, together with allowances for soot blowing are bound to create difficulties, but it is hoped to press forward with such determination that the principles of smoke control will be fully appreciated by the maritime industry as a whole in time for the 'appointed day' and dark emission will be kept to a minimum. It would be unwise to minimise the strain that will probably be imposed on the strictly limited resources of the Authority in carrying through the obligations to be imposed, particularly in relation to vessels under way and outward bound, but nothing will be gained by a pessimistic attitude and, meanwhile, every effort will be made to reduce the possible obstacles to success. LIGHTERAGE OF REFUSE From time to time complaints have been received from the Port Health Inspectors, the River Police, and the Port of London Authority about the failure of lighterage companies to conform with the Byelaws made by the Port Health Authority of the Port of London in 1948 relating to the transport by barge of refuse and other offensive cargo. These complaints have in all cases been taken up by the Port Health Authority with both the management and the personnel of the lighterage companies concerned. Towards the end of 1956 it was felt that the lighterage industry might welcome the opportunity of a round-table discussion on the subject and at a meeting with members of the Association of Master Lightermen and Barge Owners, the body which represents the principal lighterage firms using the Port of London, a most frank and cordial survey was made of the problems confronting all parties. The Association admitted that there had been justifiable complaints by the Port Health Authority but such complaints had been comparatively rare and had always received prompt attention. This particular industry faced many difficulties. For example, refuse trimming, covering hatches and cleaning of the deck is the responsibility of the loading wharf employees and not the lightermen. In the circumstances, the lightermen who take over the loaded craft disregard these aspects while in transit. Indeed, any attempt by them to man-handle wooden hatch covers or tarpaulins while in transit during stormy weather could be dangerous to limb and property. It was stated that the material losses involved through misadventure and carelessness on the part of employees has been considerable and, although spare wooden hatches, canvas sheeting and fastening were usually forthcoming, adequate equipment was often not maintained owing to the human factor. It was emphasised by the representatives of the lighterage side that the method of covering refuse as prescribed in the Byelaws is not reasonable in practice, even to the extent that it is almost impossible to comply with the requirements. It was eventually decided to investigate a suggestion that a lighter with suitable coaming fittings be loaded and trimmed to a height of four feet above coaming level to allow for subsidence over a period of forty-eight hours, during which time it would be properly sheeted with tarpaulins and the refuse barge left to weather the elements. This experiment was undertaken by Messrs. Cory & Son, Ltd. early in 1957 on behalf of the Association of Master Lightermen and Barge Owners, and your Medical Officer and Chief Port Health Inspector were present at the demonstration. After the forty-eight hours, the refuse had subsided to one foot above the coaming level along the centre line of the craft and six inches below at the coaming. The tarpaulins were secure and had an overlap on each other of three feet. The overlap at the coaming was not less than nine inches and the numerous fastenings were spaced at intervals of two feet. A special feature of the arrangements was the provision of a "tying rail" right round the coamings instead of rings at intervals, so that the tarpaulin cords can be tied to the rail just where they lie without any 40 trouble to look for the nearest ring. This is important from the labour point of view. The whole covering was intact and secure. The loaded craft was left for another four days undisturbed and when seen at the unloading wharf, the refuse had sunk below coaminglevel with the cover tarpaulins still secure and refuse intact. The results of the experiment indicated a large measure of success. Arising from this demonstration the Association of Master Lightermen and Barge Owners have suggested that Byelaw 2 of the present Byelaws, which prescribes the use of close-fitting hatches and overall waterproof sheeting securely fastened to the coamings, should be amended to permit the use of the proposed new method. This suggestion has been accepted in principle by the Port and City of London Health Committee and the revision of the Byelaws is now under consideration. REFUSE CHUTES The following observations illustrate the interest taken by the Port Health Authority to reduce the nuisance caused by the refuse chutes on the river front and the almost insurmountable difficulties to be overcome in obtaining a satisfactory solution to the problem. The fact is that wherever dust is disturbed in an air stream, the dust will get caught up with the air current, and unless the space is totally enclosed, the cloud so formed will drift with the air stream. This applies sometimes to other light matter, such as paper, if some screening is not provided. To overcome major nuisance, some effort is made to control the magnitude of refuse disturbance by conducting it from the chute to the barge with as little exposure to the wind as possible during the slide and to minimise the drop from the chute into the barge. To that end, some chutes are totally enclosed and are capable of being lowered and trimmed to meet the state of the tide, while in others some form of textile screening is used to arrest drifting paper only. At worst, we are faced with the feeble efforts made in one district where no real provision is made and the refuse may cascade as much as 20 ft. from the edge of the open chute into the barge at low tide. The standards vary at each refuse wharf and only our efforts to uplift the standards are constant. Improvements are made from time to time as a result of our intervention and advice. Poplar has intricate mechanised equipment to help overcome the difficulties. The City Corporation s place at Letts Wharf is now enclosed and is a great improvement on the conditions of the past. There are other refuse chutes that are very undesirable and are given much attention by the River Inspectors. It is necessary to be most careful about where to start and stop in the control of this industry. Any major hold-up in the clearance of refuse at these riverside tips would cause chaos in the London area. We can only proceed in the hope that conditions do not get worse and at all times endeavour to secure improvements whenever possible. It must not be implied that we are held to ransom by the operators at the refuse wharves, but it is clear that the only satisfactory method for refuse disposal at the riverside wharves must be to tip and cover the refuse in an entirely closed premises and the only semblance of these conditions at the present time is at Westminster and to a lesser extent at Letts Wharf. When the City Corporation's new Public Cleansing Depot and Wharf at Upper Thames Street is completed, something as near perfection as possible in these matters will have been achieved. "THE PORT HEALTH AUTHORITY" Your Medical Officer is pleased to include in this Report the following paper read at the Annual Conference of the Association of Public Health Inspectors at Eastbourne in September, 1957 by Mr. T.L. Mackie, M.B.E., F.R.S.H., M.I.N .A., Chief Inspector: "The human suffering for which the epidemic diseases have been and are responsible is beyond calculation; but there are also economic consequences which, arising from the restrictions necessary to confine the outbreaks as well as out of the diseases themselves, inflict great hardship and losses on the community. Obviously it is essential that the right steps should be taken at the right time to localise epidemics and it is also important that the measures should be no greater hindrance to the normal traffic of the world than the objective demands. To help reduce the international spread of disease and yet to avoid restrictions, is at all times the vital concern of Port Health Authorities." "It is not surprising that a maritime nation like the British should cast a wistful eye towards safeguarding their ports — seaports and airports. With seaborne trading connections in all parts of the world, these islands, though favoured by geographical location, would nevertheless have been vulnerable to the importation of devastating communicable diseases unless properly organised defensive measures were constantly maintained. 41 "Mankind has dreaded the spreading capacity of certain communicable diseases since time immemorial and has realised that the causal agents of these diseases cannot be confined naturally within territorial frontiers which they neither respect nor recognise; nor do they owe allegiance to anybody; they obey neither laws nor conventions. "It was not, however, until the Middle Ages that any really serious attempts were made to curb the spread of these diseases into seaports, thence to adjoining territories. In these attempts, the control of bubonic plague was given priority and the Venetians of that time, who were prominent sea-traders with the East, decided to implement laws and operate a maritime quarantine organisation, which was probably the first of its kind in the world. The basic principles included the isolation of ships and crews as well as the cargoes when they were suspected of carrying communicable disease. This period of detention was extended to a minimum of forty days. Subsequently, this example was adopted by other seaports and the substantial share of these quarantine demands imposed on men, ships and cargoes has served as a pattern for quarantine regulations until comparatively recent times. "Notwithstanding all the precautions taken, bubonic plague managed to invade Europe on more than one occasion and once, during the fourteenth century, took toll of a considerable portion of the population to the extent of at least one-third in England. In the seventeenth century, London was revisited and suffered heavily and in the early eighteenth century, Marseilles suffered another catastrophic blow. "So far as England was concerned, although certain measures had been introduced in the middle of the seventeenth century, it was not until early in the next century that Parliament passed an Act to establish the practice of quarantine; thereafter, a number of Quarantine Acts were passed which imposed specific penalties on ships arriving from various overseas ports. Of these Acts, the last came into force in the year 1825 and remained on the statute book until repealed by the Public Health Act 1896. The principles of quarantine were upheld and the powers to execute the provisions of the Act were invested in H.M. Customs at the various seaports to which Quarantine Medical Officers were attached. "During the lifetime of the Quarantine Act 1825, the various countries with maritime interests also practised the principles of quarantine, but it was noted that the measures adopted were not consistent and differed considerably in some respects, due partly to lack of scientific knowledge and undoubtedly sometimes influenced by local custom and circumstances. "In order to create some standard of uniformity, the first International Sanitary Convention was drawn up by representatives of nine foreign governments in the year 1851. Unfortunately, this was not a success owing to the divergence of opinions concerning the origin and causesof the major communicable diseases. Nevertheless, it proved to be the forerunner of the more successful efforts that followed and which eventually resulted in the World Health Organisation with its universal influence on human health. "During the lifetime of the Quarantine Act 1825, there was a great revival of thought directed towards improved sanitation on a national scale and the health of the massed population in particular was being very seriously considered. It was no wonder that attention was paid to the ever present threat of communicable diseases arriving at seaports — diseases, which could assume serious epidemic proportions and possibly decimate the population in spite of improved health and sanitation standards achieved throughout the country. No doubt the sponsors of the drive for improved health conditions were ever conscious of the havoc wrought by the black death epidemics and they appreciated the advantage of having a single governmental department to exercise overall control of the health activities at seaports and of the country as a whole. And how right they were in doing so, for the efficiency at the ports is indispensable to the welfare of the hinterland and the ultimate benefits to be gained in terms of nationalhealth must depend on the combined efficiencies and the amount of collaboration between the seaport and inland authorities. I. PORT SANITARY AUTHORITIES "Eventually the Public Health Act 1872 empowered the Local Government Board to constitute Port Sanitary Authorities with assigned powers which were practically limited to the detection and isolation of the more dangerous communicable diseases. Thereafter followed the more decisive instrument contained in the Public Health Acts of the years 1875 and 1891, which added considerably to the powers and scope of the Port Sanitary Authorities to inspect vessels and shore premises within their districts. Although the basic principles continued to be observed in these ports, it was decided to abandon the practice of putting ships into isolation anchorages and to substitute this measure by an immediate medical inspection and to allow ships, together with their crews , to be dealt with according to the health conditions prevailing during the voyage. And so ended a memorable period of seventy years constructive effort which was to herald a new era of stimulated endeavour and continued achievement. (a) Initial Responsibilities To deal effectively with a perpetual movement of international shipping and a variety of port premises is a feature peculiar to port sanitary administration. Overseas commerce being so vital to the nation's economy and an unhampered distribution of sound imported food so essential to the nation's larders, it was essential for the port health authorities to function properly without unduly impeding the flow of trade. 42 "The newly appointed Medical Officers and Sanitary Inspectors had ample scope for hard work and enthusiasm. Of course, no organisation could ever function in a progressive society without exposing some form of imperfection. In spite of all the limitations and the relatively intolerable sanitary conditions then encountered aboard ships and in the ports, these few officials tackled their assignments quite undismayed and acquitted themselves in a manner worthy of admiration. "The new era confronted them with arduous and extraordinary experiences, where unruly crews and floating slum conditions were not exceptional circumstances and their conveyance from one ship to another was almost entirely dependent on the open rowing boat and their legs. "Fortified with statutory powers and established firmly on the foundations of the earlier quarantine principles, the constituted Port Sanitary Authority was charged with the primary responsibility of ascertaining andintercepting infectious diseases and eliminating any conditions deemed as nuisances and prejudicial to health. "Coinciding with this commitment, the officers of H.M. Customs retained the right to withhold 'pratique' from ships arriving from certain foreign ports until the Port Medical Officer had satisfied himself concerning the health conditions present and prevailing over the voyage. Pending his decision, the ship had to be denied any contact with the shore or any unauthorised person, even to the extent of being ordered to isolation at a designated anchorage to undergo a form of quarantine procedure. Discharging these measures effectively has always required the closest collaboration between H.M. Customs and the Port Sanitary Authority. "The authorities were also made responsible for the provision of adequate means to transport and isolate infectious patients as well as the immediate contacts who were to be detained for a period of medical surveillance. They were obliged to make available a steam disinfector installation to sterilise infected bedding and articles of clothing, and possess equipment to disinfect the appropriate spaces aboard ship. "Briefly, it was the responsibility of the Port Medical Officer to determine the nature of any disease and arrange for the hospital treatment and surveillance; whereas the Port Sanitary Inspector, acting directly under his instructions, was responsible for the movement of the patient, contacts, bedding, etc. and the disinfecting of the infected accommodation. The Sanitary In spector had the additional responsibility of controlling nuisances and conditions prejudicial to health ashore and afloat and of inspecting imported food as occasion required. In this connection and for the purposes of the Public Health Acts, a ship must be considered a house and the Master as the Occupier, providing the vessel is not in charge of an Officer bearing H.M. Commission or is the property of a foreign government. (b) Additional Responsibilities "With the course of time, the statutory provisions were changed and the range of activity increased. Legislation relating to rats and mice, handling and transport of meat, preservatives in food, control of shellfish, all added to the duties of Port Sanitary Authorities. A significant international movement culminated in the signing and ratifying by no less than forty-four countries of the International Sanitary Convention, 1926 whereby Port Sanitary Authorities were committed to a more vigorous participation in the control of rats, particularly aboard foreign-going ships. In order to give further effect to this Convention, and consolidate certain other regulations in force at the seaports, new regulations became statutory and titled as The Port Sanitary Regulations, 1933 to be exercised by all Port Sanitary Authorities in the United Kingdom. Subsequently, there came into being the Public Health Act, 1936 to bolster public health from the national aspect and it will be particularly identified as the Act which changed the designation of the Port Sanitary Authority to Port Health Authority. "While these variations were in progress, another important change in transportation was taking place. The volume of air traffic was intensifying and in the year 1933 a comparable code of practice was drafted as a Convention and presented for signature at the Hague. Unfortunately, only a few countries, including the United Kingdom, appended their signatures to this Aerial Navigation Convention 1933 which set the pace for public health control at the airports. II. PORT HEALTH AUTHORITIES "Whatever the significance in the change of title as far as seaports are concerned, this change did occur at a time immediately preceding a distinct improvement in the influence and activities of the Port Health Authorities. The labours of the past, added to the increasing pressure of the times, brought fresh rewards. Whether or not attributable to the zealous efforts of Port Health Authorities, but certainly to their influence, there was a particular revival of sanitation consciousness in the British shipping industry which is still very much in evidence today and has provided seafarers with living and sanitation conditions that contrast enormously with those of the not very distant past. Appropriate improvements have developed simultaneously in connection with port installations, although the stages of advancement may vary considerably from place to place. "In the sphere of food inspection, the regulations which became operative in 1937 have proved very useful in spite of some limitations. Subsequently, the legal provisions appertaining to pest control and the new health regulations applicable at the seaports and airports, enabling effective interception of diseases associated with international travel, have strengthened further the organised health defensive measures. 43 (a) Legal Aspect "Quite apart from local byelaws, the main functions are governed by legislation for preventing the importation and spread of infectious diseases, controlling nuisances and other conditions prejudicial to health, examining imported foods destined for human consumption, preventing damage by rodents and control of shellfish layings. Medical inspection of arriving aliens is added to these by arrangement with the Home Office. "The legal provisions are contained accordingly in:— The Public Health (Ships) Regulations 1952-1954. The Public Health (Aircraft) Regulations 1952-1954. The Public Health Act 1936. The Public Health (Preservatives in Food) Regulations 1927. The Public Health (Imported Food) Regulations 1937-1948. The Prevention of Damage by Pests Act 1949. The Prevention of Damage by Pest (Application to Shipping) Order 1951. The Public Health (Shellfish) Regulations 1934. (b) Practical Application "Since there are 91 Port Health Authorities in the United Kingdom and functioning with the status of Local Government, it is to be expected that there should be some variation in the application of Regulations at the seaports and airports according to the adaptability and the overall significance of the port. This does not imply any statutory modifications or complacency, but simply the wisest application of the provisions as are required, depending on the nature and magnitude of the trade of the port. Variation can also be influenced by the constitution of a Port Health Authority insofar as an authority may represent a number of Riparian Authorities that share in the responsibility of imported food inspection or it may be a port health district of a Local Authority, or as in the case of London, it may have jurisdiction within districts detached from the City of London. "Nevertheless, every effort is made to fulfil the legal requirements according to circumstances, although it must be conceded that there is some lack of uniformity in doing so. The basic principles, however, are clearly understood by all. "In addition, there are those commitments which necessitate the closest collaboration with the Home Office, Ministry of Transport and Civil Aviation, H.M. Customs, Ministry of Health, Ministry of Agriculture, Fisheries and Food, and Trinity House Brethren. (1) Ship Medical Inspection "As a ready guide to Port Medical Officers, W.H.O. issue a confidential Weekly Record of Quarantine Diseases regarding the prevalence and the distribution of the quarantinable diseases — plague, smallpox, cholera, yellow fever, typhus fever and relapsing fever — throughout the world, thus alerting Port Health Authorities to meet any arrivals from the 'infected' or 'suspected' areas. "Accordingly, certain formalities have been introduced for foreign arrivals in normal circumstances and particular care is taken of the arrivals from the recorded areas or when it is understood that there is a case of illness even resembling the symptoms of a major communicable disease from any area. No time is wasted nor effort spared in taking effective measures to ensure the interception of quarantinable disease with a minimum of delay to shipping. To this end, a ship may be boarded at sea and operations begun well in advance of arrival at the seaport. This procedure, in the case of smallpox, for instance, would require medical inspection and all protective measures to be adopted, certain clerical routine and the arrangement of facilities at the port for the prompt reception and transfer of the patient, contacts and bedding. Such procedure must be completed in readiness to enter the port and in time to advise the Medical Officers of Health of the various districts, to which the remaining passengers and crew are destined, of the circumstances and the need of personal surveillance during the particular incubation period. Especially in this respect, co-operation between Local Authorities and Port Health Authorities is absolutely indispensable. "All ships that have called at an 'infected' or 'suspected' port during the previous four weeks, should be boarded by the Port Medical Officer or the Inspector. (2) Ship Sanitary Inspection "After qualifying for 'pratique', the ship normally proceeds to the terminal berth and henceforth receives the attention of the Port Health Inspector. His visit should be timed to make his enquiries and observations as early as possible after the ship has been secured. By so doing he is able to assess day to day conditions undisturbed, some of which are key points of the inspection; besides, time and decision are important factors with which he must reckon. Asa 'house' the ship is inspected to cover all domestic problems involving environmental health. Unlike his counterpart ashore, he is not empowered to demand structural alterations, although he does advise and the ultimate decision may rest with the Ministry of Transport and Civil Aviation which holds this prerogative. Otherwise, defects and deficiencies in the standards prescribed for living accommodation can be dealt with at once as well as nuisances arising from neglect or 44 pest infestation. In general terms, his responsibility covers the well-being in health of the crew with the exception of the food stores, very odd though it may be. Outside the accommodation, other health factors must be considered including drinking water storage, refuse disposal, smoke abatement and rodent control to meet the international and national obligations, which includes the systematic deratting of ships and the examination of specimens for evidence of P.pestis. Such precautions, whether afloat or ashore, are complementary in the defence of national health. "It is imperative that the smaller craft of the port should receive consistent attention for nuisances. Action must be directed especially towards exterminating rodent infestations aboard barges, since any colony may comprise specimens from various ships and these are ferried from place to place so constituting a vulnerable reservoir for spread of plague. Other small craft include Canal Boats and Houseboats, both of which need regular sanitary inspection and powers to do so are provided in the Public Health Act 1936 and in local byelaws. (3) Shore sanitary inspection "In the broadest sense the Inspectors duties resemble those of any urban district colleague as far as the allotted sections of the Public Health Act 1936 permit and pests are to be controlled. Quite naturally there are some features of the task that are peculiar to docks and wharves, but the principles of sanitation are universal. Here again the international commitment must be acknowledged; the Port Health Authority must subdue any reservoir of disease vectors in the district, thereby taking account of rodents and mosquitoes. "Not least among the health precautions taken is the investigation of the drinking water supplies. Since foreign-going ships replenish the water storage tanks from supplies at various foreign ports and because this drinking water is available to all who board the ships, it is a desirable practice to take routine samples with reasonable discretion and submit them for examination. In extension of this protection afforded to those whose business takes them aboard the ships in port, routine samples are taken to check port fresh water supplies to the ships, some from licensed water-boats and others from the quay hydrants, to ensure the health of the seamen and thus the operational efficiency of the outward bound ships. "Refuse collection points need and get considerable attention as also does the disposal equipment. A fair proportion of the refuse from the ships consists of putrescible matter from the catering department and this provides attractive feeding for rats; open dumps are therefore to be deplored and nothing less than suitable mobile containers, distributed over the port and at a convenient distance from the ships, should be accepted if pests and nuisance are to be discouraged. (4) Food inspection "This branch of the port health organisation is, in some respects, more spectacular, probably because decisions immediately reflect on a complex system of food marketing and national distribution, to mention nothing of financial interests. A very large amount and an increasing variety of foods for human consumption pass through the ports and, although inspection practice recognises and adopts the generally accepted standards, some knowledge of stowage and transportation complications is a distinct advantage when arriving at a conclusion in the restricted time at the Inspector's disposal, particularly when dealing with perishable commodities such as fish, fruit and meat. "Formal action can only be taken after the foods have been given a clearance by H.M. Customs and the examinations are preferably carried out'simultaneously as a measure of expediency. It is customary to make a token detailed examination, then support it by an overall superficial inspection of the consignment. Furthermore, sampling has become the more important on account of the various suggestions to introduce antibiotics and anti-oxidants as preservatives. Without any suggestion of prejudice towards the exporting country and trade practices, the inspector must be unrelenting in vigilance and resist any tendency to complacency. Even documents or certificates should not always be accepted as bona fide evidence. There is provision in the Regulations for detention and seizure which is taken into good account, but the short time limit of 48 hours detention could be embarrassing failing the goodwill of the importer. (5) Shellfish 'Imported molluscan shellfish are submitted to the same careful inspection as any other article of food, but those developed in home waters are controlled on different lines with the same objective. The Port Health Authority has jurisdiction over the layings within the district and requires that molluscan shellfish gathered by traders for human consumption from 'prescribed areas shall be subjected to a process of cleaning or sterilisation by steam cooking according to type. Bacteriological examination of the final products is essential and reference is made to the standards laid down by the Worshipful Company of Fishmongers and the Ministry of Agriculture, Fisheries and Food. The type of sterilising plant must be approved by the Port Health Authority and frequent inspections are made to ensure that the correct procedure is being maintained. 45 (6) Additional "It is anticipated that additional scope for port hygiene will be given in the near future when regulations are made to control dark smoke emissions and food hygiene in harbour vessels. The merits of each have claimed much attention already and will receive the close attention they deserve. In regard to smoke abatement, some difficulty will surely arise at the outset since international shipping is involved, some sections of which have inferior installations and may be obliged to bunker inferior quality coal according to circumstances. However, bridges cannot be crossed until they are met. "It has been the intention to outline the development of the Port Health Authority as it is known today and dramatise the process with brief references to the historical creation of quarantine' and the dreadful epidemics of earlier centuries from which Europe is so fortunately free today. The imagination and wisdom of the British Government and the pioneers of environmental health alike have been recognised and tribute extended to those who shouldered the mounting responsibilities of port sanitary authorities. "In making contrast with the present day organisation and the high degree of security enjoyed by the nation against imported infectious diseases, there must develop a deep sense of gratitude towards those who have contributed to this victory over the centuries and no less to those even of recent years. "To consider any more than the main functions of port health activities has not been possible, but it may be freely accepted that there are minor duties and moral obligations involved also. "Both seaport and airport health authorities share a common task and can be considered as 'sound insurance investments' for the protection of national health. The amazing expansion, popularity and ramifications of international travel and commerce has drawn countries, otherwise distant, much closer together, reducing the time factor proportionately with the effect of hazarding security on incubation period calculations. "An outstanding feature of the larger port health authority activity is that international flavour and commitments are so interwoven that it can be very difficult to divorce the national from international obligations. The field of interest has grown to include health, welfare and education regardless of nationality and, in this pursuit, no mean share of the credit is due to port health authorities for the various spectacular improvements which have overtaken the unhealthy conditions of the past in which seafarers had to live. Their influence has made its impress upon parallel conditions within the ports also. "No emphasis has been laid on the important meat and fish inspection aspects, since these are to be dealt with separately and in detail. PUBLIC HEALTH ACT, 1936, PART X - CANAL BOATS Fifty inspections of canal boats were made during the year, as a result of which twenty-two boats were found to have a total of twenty-seven defects, as follows:— no. of defects Cabin in need of general overhaul 5 Cabin in need of painting 8 Dampness in cabin due to defective top, sides, etc. 7 Height of cabin not sufficient 1 Defective ventilation 3 Defective door 1 Defective locker woodwork 1 Defective water can 1 The owners and Masters of the defective craft were in each case notified and requeste d to carry out the necessary repairs. The following infringements of the Act were also found:— Certificate not on board 1 Incorrect certificate on board 1 Registered Number not painted correctly on boat 1 Boat occupied by one child in excess of limit 1 The owners and Masters of the craft concerned were informed of the requirements of the Act in these respects. No new registrations were effected during the year. DANGEROUS DRUGS During the year sixty-one certificates authorising the purchase of scheduled Dangerous Drugs were issued under the Dangerous Drugs Regulations, 1953, Regulation 13 (2) of which is as follows:— 46 "(a) The master of a foreign ship which is in a port in Great Britain shall be authorised to procure such quantity of drugs and preparations as may be certified by the medical officer of health of the port health authority within whose jurisdiction the ship is or, in his absence, by the assistant medical officer of health, to be necessary for the equipment of the ship until it reaches its home port. (b) A person who supplies a drug or preparation in accordance with a certificate given under this paragraph shall retain the certificate and mark it with the date on which the drug or preparation was supplied and keep it on his premises so as to be at all times available for inspection." VISITORS AND STUDENTS Facilities have been provided during the year to students of the London School of Hygiene and Tropical Medicine, the Royal Institute of Public Health, the Army School of Health, the National College of Food Technology, and the Battersea College of Technology to see aspects of port health work relating to their studies. The Port Health Authority also received visitors from Cyprus, Eire, France, Malta, Spain and Sweden and accorded training in specialised work to Health Inspectors from the Admiralty and the Newhaven Urban District Council. It is always gratifying to receive letters from overseas students who have visited the Port of London, particularly so when they appreciate the attention which has been given to them. An example of this is quoted below from a letter received by the Chief Port Health Inspector from a Health Inspector in Ceylon "You may be glad to know that I have been promoted to the Special Grade of the Public Health Inspectors Service with effect from the 1st October, 1956. The special training I had under you had helped me to obtain this promotion. Whenever I do any work I always think of your hard work, perseverance and enthusiasm that had brought great success and attainment in your career. I am always following your footsteps and I hope that I will bear the torch of progress high in Ceylon and see that the confidence which you have in me would not be betrayed." LAUNCHES AND STATIONS It has become a feature of the launch service to report the regular and efficient performance throughout the year and this is in good measure due to the enthusiasm and interest taken by the crews who are not reluctant to carry out running maintenance from day to day. They genuinely realise that 'a stitch in time saves nine'. Only one launch was withdrawn from continuous service during the year. The "ALFRED ROACH" was returned to the builders for routine repairs and overhaul, which included the opportunity to conduct a complete survey of engines and construction. Nothing unexpected was discovered; wear and tear defects were normal and the chemical action attributed mainly to the polluted river water did not appear to have unreasonably affected the underwater fittings. Having completed satisfactory trials, the launch was returned to service and continued with efficient performance and appearance on the Lower River district. Unfortunately, a major crack developed in the port engine cylinder block late in December, but this was promptly reported and repaired by the crew without any substantial dislocation of the Station duty. The "HOWARD DEIGHTON" is particularly engaged on boarding duties and performs quite well in spite of age and relatively slow speed for this class of work nowadays. Although the Hulk "HYGEIA" continues to function satisfactorily as a Station and launch moorings, some doubts must naturally be raised about the condition of the underw ater shell plating. It is twenty years since the plates were exposed for inspection and the only means of a proper survey are provided in slipping the hulk in a repair yard. Such an undertaking will derange the normal functions at Gravesend and no definite time limit can be established which considers the slipping, survey, possible defects and repairs. To some extent,any decisions taken c oncerning the futur: of the " HYGEIA" and the "HOWARD DEIGHTON" must be related to future policy relevant to the Station. Operational benefits have accrued since transferring from the mooring barge "UPLEES" to the pier at Woolwich and these have added to the satisfaction of all concerned. It is hoped that an arrangement between the P.L.A. and this Authority will mature and the launches will be able to take fuel from stocks at the pier, thereby saving much valuable time and effort spent in fuelling at the upper and lower reaches of the river. Both the "ALFRED ROBERTSON" and "FREDERICK WHITTINGHAM" will soon be due for periodic overall survey and refit which ought to be undertaken early in the new year. Neither show evidence of major deterioration, although the shell plating at the stern has suffered from erosion and vibration is increasing. Loss of speed will also be investigated. At present, all launches are in regular and satisfactory service. 47 APPENDIX I MEDICAL INSPECTION—From 1st January to 31st December, 1957 GRAVESEND Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total No. medically inspected 173 140 157 153 148 149 163 157 141 155 134 161 1,831 No. of passengers 566 503 558 1,543 1,661 4,003 4,834 3,398 2,548 780 467 628 21,489 No. of crew 320 135 444 499 705 477 1,143 689 325 796 493 741 6,767 No. of Foreign Arrivals 1,062 1,017 1,246 1,096 1,174 1,179 1,231 1,074 1,143 1,123 1,065 1,083 13,493 APPENDIX II INFECTIOUS DISEASES Disease 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 (a) Cases reportedCholera (including suspected cases) - - - - - - - - - - Plague do. — — — — — — — — — — Yellow fever do. — — — — — - — — — — Typhus fever do. 1 5 — — — — — - — — Smallpox do. 3 2 4 6 — 1 1 1 — — Scarlet fever 3 3 7 3 — 2 — 2 2 2 Enteric fever 10 82 9 7 8 8 6 8* 5 3 Measles 99 80 58 74 56 97 31 64 67 91 German Measles 3 3 17 67 13 6 7 5 3 7 Diphtheria 2 1 — — 2 — — 1 — — Erysipelas 1 — 1 — — 1 — — 1 — Pulmonary tuberculosis 32 43 41 53 67 46 43 35 32 39 Other diseases (including Chickenpox) 106 124 114 130 128 184 347** 368 212 1,328 TOTALS 260 343 251 340 274 345 435 484 322 1,470 (b) Admitted to HospitalCholera (including suspected cases) - - - - - - - - - - Plague do. — — — — — — — — — — Yellow fever do. — — — — — — — — — — Typhus fever do. 1 3 — — — — — — — — Smallpox do. — — — — — — 2 — — — Scarlet fever 3 — — 1 — — — — — 2 Diphtheria 2 — — 1 — — — — — — Enteric fever 3 — 6 — 1 1 — 3 — 2 Measles 24 8 5 12 3 16 21 12 20 35 Parotitis 4 3 1 13 4 2 1 10 5 3 Dysentery 3 1 — 1 1 — 6 6 — 1 Other diseases (including Chickenpox) 80 34 56 35 35 48 32 53 63 271 TOTALS 120 49 68 63 44 67 62 84 88 314 * Includes 2 'carriers' ** Includes 221 cases of gastro-enteritis 43 APPENDIX III RETURN OF RATS CAUGHT AND DESTROYED DURING THE YEAR 1957. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total London Dock- Warehouses 64 36 33 78 75 157 61 55 130 79 64 65 897 Vessels - - - - - - - - - - - 12 12 St. Katharine Dock- Warehouses - - 3 - - 6 1 - - - - - 10 Vessels — - - - - - 18 - - - - - 18 Surrey Commercial dock- Warehouses 14 3 - 16 5 5 - 8 - - 1 9 61 Vessels - - - - - - - - - - - - - Regent's Canal Dock- Warehouses - - - 1 - 4 2 - - - 1 - 8 Vessels - - - - - - - - - - - - - East India Dock- Warehouses - - 15 - 8 - 15 1 - 2 5 — 46 Vessels - - - - - - - - - - - - - West India Dock- Warehouses 46 23 19 13 23 43 21 26 17 10 42 11 294 Vessels 1 95 — — — — 5 — — — — 1 102 Millwall Dock- Warehouses 13 12 16 8 40 15 9 1 27 8 12 19 180 Vessels - 3 - - - 32 1 7 - 9 - - 52 Royal Victoria Dock- Warehouses 61 38 57 36 21 31 14 3 34 134 52 20 501 Vessels 25 7 23 1 - 38 4 - 9 47 131 — 285 Royal Albert Dock- Warehouses 32 9 16 12 19 21 30 7 17 35 4 12 214 Vessels 39 37 30 20 16 6 2 - 31 13 9 7 210 King George V. Dock— Warehouses 2 8 10 12 6 3 5 - 16 19 5 8 94 Vessels 9 10 - 10 2 - 2 21 30 — — 24 108 Tilbury Dock- Warehouses 31 7 9 9 23 11 9 3 32 8 28 16 186 Vessels 35 13 43 100 133 103 51 11 - 50 87 48 674 River- Vessels 36 112 103 65 122 134 76 27 64 77 37 58 911 Totals 408 413 377 381 493 609 326 170 407 491 478 310 4863 49 APPENDIX IV— General Summary and Analysis of the Sanitary Inspections, etc., in the Port of London for the year ended 31st December, 1957, Foreign Going Steam— Inspected 10,390 Defective 138 To be cleaned 379 Sail- Inspected Nil Defective Nil To be cleaned Nil Coastwise Steam— Inspected 1,989 Defective 18 To be cleaned 45 Sail— Inspected 6 Defective Nil To be cleaned 1 Inland Navigation Steam— Inspected 280 Defective 6 To be cleaned 48 Inland Navigation- Continued Sail— Inspected 3 Defective Nil To be cleaned 1 Lighters- Inspected 855 Defective Nil To be cleaned 10 Canal Boats— Inspected 50 Defective 22 To be cleaned Nil Shore Premises Inspected 8,877 Defective 99 To be cleaned 191 Sick Seamen referred to Hospital 85 Water Barges No. in district in good condition on 31st December, 1956 13 New Barges 1 Condemned Nil Use discontinued Nil Previously withdrawn and since resumed work Nil No. in district on 31st December, 1957 14 Inspections Dock and River No. Nationalities No. American (U.S.A.) 153 Total Inspections London and St. Kats. 1,058 Argentinian 43 1st January to Belgian 59 31st December, 1957Regent's Canal 513 Brazilian 31 Foreign Going 10,390 Surrey Commercial 1,698 British 8 642 Coastwise 1,995 Bulgarian 2 Inland Navigation 1,138 Costa Rican 30 Shore Premises 8,871 Danish 138 East India 214 Dutch 1,231 Total 22,400 Eire 5 Finnish 199 West India 1,028 French 86 Millwall 652 German 941 Ghana 1 Number of Vessels inspected in Greek 60 the Launches Royal Albert 1,335 Honduras 2 Icelandic 11 Royal Victoria 729 Indian 17 "Alfred Roach" Israeli 31 "Howard Deighton" King George V. 915 Italian 53 Japanese 48 "Frederick Liberian 57 Whittingham" River—Upper 771 Monrovian 13 "Alfred Robertson" Panamanian 66 Polish 31 River—Middle 636 Portuguese 3 Puerto Rican 5 River-Lower 1,314 Russian 165 Spanish 68 River-Medway 1075 Swedish and Norwegian 1,265 Turkish 7 Yugo Slavian 60 Tilbury 1,585 In Docks, etc. 10,802 Total Vessels 13,523 Total Vessels 13,523 Shore Premises 8,377 Shore Premises 8,877 Shore Premises 8,877 Total 22,400 Total 22,400 Total 22,100 50 APPENDIX VI DOCKS WITHIN THE JURISDICTION OF THE PORT HEALTH AUTHORITY Dock Group Docks Water Area Acres Lineal Quayage Miles I London 34 3 St. Katharine 10 1 Regent's Canal 11 ½ II Surrey Commercial 135 8 III West India 97 4 East India 23 1 Millwall 35 2 IV Royal Victoria 85 4 Royal Albert 84 3 King George V 64 3 V Tilbury 106 4 The River distance between the Western and Eastern limits of the Port is about 68% miles. POWERS The principal Acts of Parliament and Statutory Instruments affecting the work of the Port Health Authority of the Port of London are: ABATEMENT OF NUISANCES AND REMOVAL OF REFUSE Public Health (London) Act, 1936. ADMINISTRATION Public Health (London) Act, 1936 Order of the Local Government Board dated 30th June 1898, assigning further powers to the Port Sanitary Authority of London Sanitary Officers Order, 1926, S.R. & O. No. 552. Sanitary Officers (London) Regulations, 1951. S.I. No. 1021. Sanitary Inspectors (Change of Designation) Act, 1956. AIRCRAFT Public Health (Aircraft) Regulations, 1952 and 1954. S.I. 1952, No. 1410; 1954, No. 674. ALIENS Aliens Order, 1953. S.I. No. 1671. Ministry of Health Instructions to Medical Inspectors, 1955. ANIMALS Export Cattle Protection Order, 1957, S.I. No. 170. Export Cattle Protection (Amendment) Order, 1957. S.I. No. 1254. CANAL BOATS Public Health Act, 1936. CONSTITUTION OF THE AUTHORITY Public Health (London) Act, 1936. CREW ACCOMMODATION Public Health (London) Act, 1936. Merchant Shipping (Crew Accommodation) Regulations, 1953. S.I. No. 1036. DANGEROUS DRUGS Dangerous Drugs Regulations, 1953. FERTILISERS AND FEEDING STUFFS Fertilisers and Feeding Stuffs Act, 1926. Fertilisers and Feeding Stuffs Regulations, 1955. S.I. No. 1673. FOOD Public Health (Preservatives, etc. in Food) Regulations, 1925 to 1948. S.R. & 0. 1925, No. 775; 1926, 1557; 1927, No.577; 1940, No. 633; 1948, No. 1118. Public Health (Imported Milk) Regulations 1926. S.R. & 0. No. 820. Public Health (Imported Food) Regulations, 1937 and 1948. S.R. & 0. 1937, No. 329; S.I. 1948, No. 886. 52 FOOD (Contd.) Food and Drugs (Whalemeat) Regulations, 1949 and 1950. S.I. 1949, No. 404; 1950, No. 189. Food and Drugs Act, 1955. Food Hygiene Regulations, 1955. Food Hygiene Regulations, 1955 and 1957. S.I. 1955. No. 1906; 1957, No. 2157. Colouring Matter in Food Regulations, 1957. S.I. No. 1066. FUMIGATIONS Hydrogen Cyanide (Fumigation of Ships) Regulations, 1951. S.I. No. 1760. Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1951. S.I. No. 1759. HOUSEBOATS Public Health (London) Act, 1936. City of London (Various Powers) Act, 1933, Part III, Sections 6 and 7. INFECTIOUS DISEASE Public Health (London) Act, 1936. Public Health (Ships) Regulations, 1952 and 1954. S.I. 1952, No. 1411; S.I. 1954, No. 675. Public Health (Infectious Disease) Regulations, 1953. S.I. No. 299. RATS AND MICE Public Health (Ships) Regulations, 1952 and 1954. S.I. 1952, No. 1411; S.I. 1954, No. 675. Prevention of Damage by Pests Act, 1949. Prevention of Damage by Pests (Application to Shipping) Order, 1951. S.I. No. 967. Prevention of Damage by Pests (Application to Shipping) (Amendment No. 2) Order, 1956. SHELLFISH Public Health (Shellfish) Regulations, 1934. S.R. & O. No. 1312. Order dated 23rd April, 1936 made by the Port Health Authority under the P ublic Health (Shellfish) Regulations, 1934 in respect of a "prescribed area" in Essex. Order dated 25th July, 1957 made by the Port Health Authority under the Public Health (Shellfish) Regulations, 1934 in respect of a "prescribed area" in Kent Medway (Shellfish Regulations, 1935, S.R. & O. No. 1221. SMOKE ABATEMENT Public Health (London) Act, 1936. Clean Air Act, 1956. BYE-LAWS Bye-laws have been made by the Port 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 diseases, 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.