115 PORT HEALTH AUTHORITY OF THE PORT OF LONDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH To 31st DECEMBER, 1959. 115 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). Fellow of King's College, London. To 31st DECEMBER, 1959. Telegraphic Address: "PORTELTH LONDON" Telephone Number : MONarch 3030. CONSTITUTION AND JURISDICTION 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 cooperation, 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. 2 SECTION I—STAFF (As at 31st December 1959) TABLE A Name of Officer Nature of Appointment Date of Appointment Any other Appointment held J. Greenwood Wilson, M.D., F.R.C.P., D.P.H., F.A.P.H.A.(Hon.) Medical Officer of Health July, 1954 Medical Officer of Health, City of London. Medical Inspector of Aliens. H.M. wllloughby, V.R.D. & Bar, M.R.C.S., L.R.C.P., D.P.H., Deputy Port Medical Officer of Health and Medical Officer in charge at Denton Hospit al May, 1929 Medical Inspector of Aliens. D.T.M. & H., Surgeon Capt. R.N.R. (Retd.), Late Q.H.P. J.A. Jones, M.B., Ch.B., D.P.H., First Assistant Port Medical Officer April, 1935 ditto Late Lieut. Col. R. A. M. C. P.J. Roden, L. M. S. S. A., Capt. R. A. M. C. (Retd.) Assistant Port Medical Officer (part-time) February, 1958 ditto D.T. Jones, B. Sc., M. B., B. Ch., Major R. A. M. C. (T.A. ditto ) March, 1958 ditto Marion Ravell, M. D., M. B., B. S., M. R. C. S., L.R.C.P., D.P.H. Late Surgeon, M.N. Assistant Port Medical Officers (Locum Tenentes) March, 1956 - C.D. Mac Carthy, M. B., B. Sc., B. A. O. Major R.A.M.C.(T.A.) March, 1956 - A. W. Bagger, M. B., B. S., Y V. R. D. Surg.Cdr. R.N.R. March, 1956 — R.G. Dewhurst, M. R. C. S. L.R.C.P., D. R. C. O. G. Late Fl. Lieut. R. A. F. (M. S.) March, 1956 - R. G. W. Moore, M.B., B.S., Late Surg.Lieut.R.N.V.R. March, 1956 - H.A. Madwar, L.R.C.P., L.R.C.S., L.R.F.P.S. Assistant Port Medical Officer (part-time) December, 1927 - J.O. Murray, M.D., M.B., Ch.B., D.P.H. ditto July, 1959 Medical Inspector of Aliens. W.T.G. Boul, M.B.E., M.D., M.B., Ch.B., D.P.H. Infectious Disease Consultant March, 1957 - ADMINISTRATIVE STAFF (Port and City of London) H.F. Blunt Food Administrative Officer May, 1924 — W.L. McLorg General Administrative Officer February, 1927 — R.C. Ratliff Finance and Establishment Officer March, 1930 - J.E. Stout Senior Assistant August, 1930 — C.W.R. Betts ditto April, 1926 — E.V. Smith ditto October, 1938 — R.H. Lott First Class Assistant May, 1947 — F.B. Osborn ditto May, 1952 — Miss M.L. Gurney General Grade Clerk May, 1939 — Mrs. I.R. West ditto September, 1956 — Miss I.H. Hamblin ditto October, 1957 Mrs. F.I.M. Smith ditto May, 1959 - A.W. Bourne Messenger March, 1956 — T.A. Woods ditto November, 1955 — INSPECTORIAL T.L. Mackie, M.B.E., Chief Port Health Inspector November, 1934 — M.I.N.A. and Supervisory Engineer of Launch Service - P.W. Coombe, F.A.P.H.I. Senior Port Health Inspector December, 1924 — T.G. Edwards ditto June, 1929 — D.E. Madeley ditto September, 1932 — G. Dring ditto May, 1936 — A.H. Marshall ditto March, 1953 — E.H.Johnson Port Health Inspector August, 1929 - C.E. Wright ditto July, 1931 — J.S. Beattie ditto May, 1931 — 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 W.M. Walker ditto October, 1954 — H. Butlin ditto July, 1955 — A.W. Buchan ditto July, 1955 — F.Spencer ditto March, 1957 - 4 Name of Officer Nature of A ppointment Date of A ppointment Any other Appointment held MEAT SORTERS G. slmmonds Meat Sorter May, 1955 — J.W. Goods ditto October, 1957 — 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. Stockton ditto June, 1940 — D.J. Davis ditto August, 1941 - F.D. Cartman ditto September, 1943 — G. Lamont ditto March, 1945 — J.J. Harvey Rodent Operative November, 1959 — RODENT CONTROL SCHEME H.A. Baxter Rodent Inspector June, 1945 G. Clark ditto January, 1949 - A.L. Southwood ditto January, 1949 — A.T. Evans ditto January, 1953 — C.E.W. Eastman ditto April, 1954 - A. Barlow Rodent Operative January, 1956 — J. Cook ditto July, 1956 — LAUNCHES AND HULKS J.R. Steen Navigator (Senior) March, 1926 W.S. Stimson Navigator (i/c Woolwich Station) March, 1944 - C.R. Simons Navigator (Deputy Senior) August, 1938 — W.G.A. King ditto September, 1939 — H.J. Mason ditto August, 1946 — B. Osenton ditto December, 1953 — S.J. Crutchley, D.S.M. Engineer (Senior) June, 1939 — E. Alewood Engineer January, 1947 K. Gittens ditto January, 1955 - W. Simmons ditto May, 1955 — A.R.L. Potter Deckhand July, 1945 — W. Lawrence ditto October, 1955 — J. Mackley ditto January, 1957 — g.W. Heywood Acting Deckhand September, 1957 — D. W. King ditto April, 1957 - B. Jacobs Deckboy April, 1956 — G. Cunningham ditto September, 1957 - R. Dossett ditto March, 1958 — K.B. Frost ditto September, 1958 — F. Sandys ditto May, 1959 — J.L. Pay ditto September, 1959 — F.B. Morris Steward (part-time) October, 1957 — A.R. Burge Shipkeeper August, 1945 — A.C. Croft ditto October, 1950 — L.C. Parish ditto May, 1958 Launches- Date acquired "Howard Deighton" 1931 "Frederick Whittingham" 1934 "Alfred Robertson" 1938 "Alfred Roach" 1948 Hulk — "Hygeia" 1935 5 January, 1960. To THE WORSHIPFUL THE PORT AND CITY OF LONDON HEALTH COMMITTEE Gentle men, I have the honour to submit as Medical Officer of Health for the Port of London my Annual Report for the year ending 31st December, 1959. A letter from the Secretary, Ministry of Health, dated 14th January, 1960, 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, Vm, 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 (Foreign and Coastwise) entering the Port of London during 1959 was 43,424,411 tons as compared with 39,223,322 tons during 1958. 16,135 vessels arrived from foreign ports and of these 1,788 were visited by the Boarding Medical Officers at Gravesend. The Port Health Inspectors made 14,086 inspections of vessels. The Port Health Authority's own radio-telephone service between the Hulk "Hygeia", the m.v. "Howard Deighton" and the m.v. "Alfred Roach" has been in use throughout the year and has proved of considerable value, especially to the Port Health Inspector in the Lower River District. The Thames Navigation Service of the Port of London Authority came into operation in May, 1959, and the willing co-operation provided by this Service has been a great help to shipping and the Port Health Authority. Communicable Diseases. 429 cases of notifiable and other infectious diseases were reported as having occurred on 160 vessels, of which 166 cases were dealt with in the Port. 93 cases were admitted to various hospitals, including 15 to the Port Isolation Hospital. This hospital was closed for part of the year when it was designated the smallpox hospital for the area. No cases of smallpox reached the Port but full precautionary measures were taken on one vessel followingthe landing of a suspected case of smallpox abroad, the diagnosis of which was not confirmed later. The Boarding Medical Officers and the Port Health staff have continued to afford medical assistance to shipping, the use of the radio-telephone service often saving valuable time in getting a patient to hospital. Medical advice to ships at sea has also been given through the North Foreland W/T Station. Health Education. Following the issue of the folder on the Social Services available to the seafarer and his family, the Port Health Authority produced for free distribution to shipping companies and catering personnel on ships a booklet, with photographic illustrations, on food hygiene. Rodent Control. During the year 5,091 rats, 2,512 in ships and 2,579 in shore premises, were destroyed in the Port of London. In addition, 2,516 mice were destroyed, 698 in ships and 1,818 in shore premises. 81 rats were examined for plague with negative results. International Deratting and Deratting Exemption Certificates. The number of Deratting Certificates issued was 129, the method of deratting in 112 instances being '1080'. It is not understood why '1080' is not used to a greater extent in other ports. 1,181 Deratting Exemption Certificates were granted. Shellfish. No cases were reported of food poisoning or other illness resulting from the consumption of shellfish taken from layings within the district of the Port Health Authority. Medical Inspection of Aliens. 16,000 aliens arriving by ship were medically inspected by the Port Health Authority's Medical Officers on behalf of the Immigration Department of the Home Office. 6 Imported Food. 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 3,010 tons 18 cwts. 1 qr. 10 lbs. as compared with 4,133 tons 18 cwts. 3 qrs. 3 lbs. in 1958. Transport of Refuse by Lighters. The relaxation of the Bye laws in 1958 eased the burden of responsibility of the Contractors. Nevertheless, infringements continued and during 1959 eight offences were reported officially. Legal proceedings were taken in respect of seven offences and a penalty imposed in every instance by the Magistrate. Clean Air Act, 1956. 1959 was the first complete year that the Dark Smoke (Permitted Periods) (Vessels) Regulations were in operation and the overall result achieved was most satisfactory. Owners and agents of vessels have invariably been most co-operative in doing everything possible to prevent smoke emission. In spite of warnings, reprimands, patience and persuasion there have been defaulters and it was necessary to serve 25 Notices during the year for Black Smoke offences, 8 of the cases being dealt with by the Magistrates and fines imposed. Radiation Hazards. While it is premature to assume that any nuclear powered ship will come to the Port of London in 1960, the problems that might arise have already been discussed and the Port Health Inspectors have attended a specialised course on the hazards of radio-activity. Canal Boats. 113 inspections of canal boats were made, 44 defects being found on 25 boats. Launches. The Port Health Authority's Boarding Station at Gravesend, the Hulk "Hygeia", was taken out of water for complete overhaul and it should render useful service for many years to come. The ambulance launch "Howard Deighton", which has been in service since 1934, is not now really fast enough for boarding work and plans are in preparation for replacing her by a larger and faster cutter of improved design. Finally, 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 staffs of the Central Public Health and St. Bartholomew's Hospital Laboratories and of the 'Dreadnought' Seamen's Hospital, the South-East Metropolitan Regional Hospital Board, the Dartford Hospital Management Committee, the staff of the Port Health Authority, and indeed all those who have so generously helped me in every aspect of the work throughout the year. I have the honour to be, Gentlemen, Your obedient Servant, J. GREENWOOD WILSON. 7 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 16,135 33,272,151 1,788 10,944 155 Coastwise 11,139 10,152,260 5 1,616 5 Total 27,274 43.424,411 1,793 12,560 160 SECTION III- CHARACTER OF SHIPPING AND TRADE DURING THE YEAR TABLE C Passenger Traffic Number of Passengers — Inwards 92,809 Number of Passengers —Outwards 112,273 Cargo Traffic Principal Imports [ All types of produce and I 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. THE SUPPLY OF DRINKING WATER TO SHIPS A pure drinking water supply is a prerequisite of good health and it is difficult to imagine any circumstances of human society where this is more significant than that aboard ship, particularly while at sea. Palatability is a desirable quality, correct physical properties another, but probably the most important is the freedom from organisms of disease. This factor has not always been taken into proper account and such ignorance must have been responsible for much discomfort and outbreaks of gastric disorders among crews and passengers alike. There are, of course, certain safeguards provided in Regulations implemented by the Ministry of Transport which relate to the supply, storage and chlorinating of drinking water. There is also a responsibility upon the Port Health Authority to ensure as far as practicable that the drinking water supply aboard ship is not prejudicial to good health and the commitment is undertaken conscientiously by the Port Health Inspectors. In addition to health enquiries and other observations appertaining to the quality of the drinking water when inspecting ships on arrival, the purity of water supplied to the ships while in the Port is also taken into account and samples of the water are drawn systematically and frequently for bacteriological examination. The frequency is regulated according to necessity and expedience. Drinking water as supplied to ships in the Port of London is derived from the Metropolitan Water Board and the Essex Water Board mains. It is conveyed to the ship through a hose directly from hydrants on the dock quay or indirectly from registered water-boats. Experience has proved that, apart from any exceptional mishap, there is no quarrel concerning the high standard of these supplies to the main hydrants. It follows, therefore, that the Inspectors are chiefly concerned 8 with the treatment given to the water from the hydrant fitting until it reaches the ship's storage tanks in the first instance. With regard to water boats, the Port Health Inspectors are content to disregard the actual hydrant in normal circumstances and consider the water boat tank as the source of supply for routine sampling purposes. The systematic sampling practice in this Port is to sterilise the hydrant coupling and bathe it in the cascade of the supply before taking the sample at this stage. Subsequently, the supply hose is connected to the hydrant coupling and led to the filling point aboard ship where the hose terminal may be fitted with a screwed metal coupling for a closed filling system or a nozzle to insert into an open gravity-fed system. It is only after having allowed a quantity of the water supply to flush the hose and run to waste that a second sample is drawn to test the potability of the water actually delivered to the ship's tanks and affords a means of checking the cleanliness of the hose and fittings. Thereafter, a third sample may be drawn from a drinking water supply point or a suitable part of the distribution circuit to check and eliminate any point of contamination within the ship. So far, this procedure has been sufficient to provide a warning of impending danger and helped to rectify unsatisfactory incidents which have arisen from time to time. It has proved also that there is a real danger of contamination where the drinking water is supplied to a closed system without a safeguarding device to prevent back-flow from ship to hose and mains. From the results of nearly 150 samples involving supplies to ships from numerous hydrants within the docks and to a considerably less extent from water-boats operating inside and outside the docks, it is apparent that the water service embracing the usage and maintenance of hoses and associated fittings within the docks warrants attention and action which in fact has already been initiated. It would be pointless to continue the promotion of better transport, storage, preparation and handling of food aboard ship were the purity of the drinking water to be ignored. The values of both commodities are equally important and for the promotion of health dependent on one another. SECTION VI— PUBLIC HEALTH (SHIPS) REGULATIONS, 1952 1. List of Infected Areas (Regulation 6) — No change. 2. Radio Messages — No Change. 3. Notification otherwise than by Radio (Regulation 14(l)(b)) — No change. 4. Mooring Stations (Regulations 22 to 30) — No change. QUARANTINE PROCEDURE AND THE THAMES NAVIGATION SERVICE To appreciate possible developments in quarantine procedure at Gravesend, which could result from improved communications, it is desirable to examine certain aspects of the present practice. A vessel coming to the Port of London from a "listed" port (i.e. a port actually or periodically infected with quarantinable disease), or having sickness to declare, has, at present, to be visited by both the Port Health and the Customs Quarantine Officers. In the normal course of events the launches of the two Services aiTive alongside in close succession so that "all are informed". However, if the Boarding Medical Officer completes his clearance before H.M. Customs' launch arrives, he signifies this in writing on the Declaration of Health, which is left aboard the ship for the Quarantine Preventive Officer. If the Preventive Officer "clears" first, he makes out the "Pratique" from the Declaration of Health and then leaves both documents aboard the ship in an envelope addressed to the Boarding Medical Officer. It is also usual for the two Services to "call" each other when necessary by blowing "Q" (I want Port Medical Officer) or "C" (I want Customs) as appropriate. Operating from their present bases, for both Services to clear a ship by radio it is necessary for them to have radio-telephonic communication with each other and with the Thames Navigation Service Operations Room. Also the ship has to be equipped to communicate with the Operations Room. It has always been possible for either Service to clear a ship on behalf of the other, provided this was arranged in advance. To do so "on the spot", a Port Health-Customs radiotelephone link is required, and, of course, one launch must go to the ship. In this case it is not necessary for the ship to be equipped. Should the Port Health Service be based ashore, in addition to the radio-telephone facilities, it is necessary for the Duty Medical Officer to have ready access from the shore office, adjoining the Operations Room, to the Boarding launch, so that he may go, without delay, to any ship having sickness or regarded as a major risk calling for a muster of the crew. The position at the end of 1959 in regard to these several factors was as follows :— 9 1. Ships equipped to communicate with the Thames Navigation Service The Thames Navigation Service came into operation on 1st May 1959, as forecast in last year's report, and by the end of that month there were 72 "London" ships fitted with the radio equipment necessary to use the service. The number increased steadily and by 31st December 1959 had reached 266 ships. Out of the monthly average of 163 ships cleared by the Boarding Medical Officers there was only an average of 13 ships equipped and this number did not show any significant increase as the year progressed. From this it is apparent that, from the Port Health Authority point of view, to some extent the "wrong" ships have been equipped. Amongst factors affecting this must be frequency of their arrival in London and in other ports where the ships can use the equipment. Thus, the Tanker Companies, who can use the equipment in the Persian Gulf and through the Suez Canal, are well advanced in fitting but rarely trouble the Quarantine Service. However, such information as is available points to a considerable increase in the fitting of "Port Health" ships in 1960. 2. Radio-Telephones of the "Sister" Services The Port Health Authority's own radio-telephone service between the Hulk "Hygeia", the m.v. "Howard Deighton", the m.v. "Alfred Roach", and the Operations Room, has been in service throughout the year and has proved of considerable value, especially to the Port Health Inspector in the Lower River District. Direct communication between the m.v. "Howard Deighton" and the Operations Room worked well whenever tested. This, used in conjunction with the radar screen of the Thames Navigation Service, could be of great assistance in navigation should the launch be under way in bad visibility. It is understood that the Quarantine Launch of H.M. Customs is to be fitted with radiotelephone operating on the same wavelength as that of the Hulk "Hygeia". 3. Access from the Port Health Office in the Thames Navigation Service Building to the launch. This is at present, necessarily, from the Terrace Pier. Whilst no actual 'obstruction' to the use of the Pier has been offered to the staff of the Port Health Authority, the Pier has heavy traffic with the pilot cutters and tugs having prior official rights. Thus to embark on the boarding launch may involve clambering over several tugs but they are always prepared to give way for patients, usually emergencies, to be landed, particularly so as on several occasions the cases have been their own. Phase Two of the P.L.A. Scheme includes a new pier with direct access from the Thames Navigation Service and a berth for the Boarding Launch of the Port Health Authority, but no date for construction is yet known. From this information it will be appreciated that the value of the improved communications has so far been lafgely "domestic". In addition, during a time when the world incidence of quarantinable disease, and indeed of all infectious disease, has been extremely low, it was only to be expected that results would be largely of a negative value. The following examples, however, may serve to give some indication of the potential of the Service. (a) 31st May 1959. The m.v. "Bloemfontein Castle" reported a case of Chickenpox. The Boarding Medical Officer was able to obtain from the Ship's Surgeon direct information and opinion confirming the diagnosis. However, had the diagnosis been in doubt, the Boarding Medical Officer would have had four hours before the ship arrived in which to make any necessary arrangements. (b) 8th September 1959. The m.v. "Gothic", anchored in Gravesend Reach in dense fog, reported a case of acute appendicitis. The Boarding Medical Officer arranged removal by the tug in attendance which was fitted with Radar. Whilst this was being done, arrangements were made for an ambulance to meet the tug and for admission to hospital. (c) 17th October 1959. The m.v. "Durban Castle" and m.v. "Highland Monarch" both sent the same Expected Time of Arrival. The Boarding Medical Offioer used the Thames Navigation Service to enquire about the sickness so that he could, if necessary, concentrate on one ship and request H.M. Customs to clear the other. Both ships were "all well" and again there was nothing positive to show for the service. (d) On numerous occasions the Operations Room has kept the Hulk "Hygeia" informed of the exact position of ships and passed instructions to Masters to have the crew mustered. This has on occasion saved a ship time at a critical state of the tide. SECTION VH-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 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. 10 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. Boul Dr. H.S. Banks Dr. J.V. Armstrong Dr. W.J. Coughlan Dr. J.P. Marsden 4. Facilities for laboratory diagnosis of smallpox. Facilities are available at the Virus Laboratory at the Central Public Health Laboratory at Colindale. SUSPECTED SMALLPOX— S.S. "IVERNIA" (a) Itinerary Sailed London 24.4.59 for Montreal Called Le Havre 25.4.59 Left Montreal 7.5.59 Called Quebec 7.5.59 Called Le Havre 14.5.59 Arrived Gravesend 15.5.59 (b) Information Information was received by telephone from the Cunard White Star Line at 10.00 hours on 14th May 1959 that the s.s. "Ivernia" from Montreal had landed at Le Havre a 2nd Class Bedroom Steward who had been diagnosed by the French Authorities as suffering from Smallpox. (c) Account of action taken It was decided that in view of the diagnosis made at Le Havre full precautionary measures would have to be taken on the vessel's arrival off Gravesend. To that end Dr. Willoughby (who was on duty) contacted the Customs, Immigration and P.L.A. and arranged for the "Ivernia" to be anchored on arrival in the river. The ship's E.T.A. was 01.00 hours 15th May. Arrangements were also made for a team of Clerks (4) and the Health Inspectors to be available at 08.00hours to check address lists of passengers disembarking and also those ofthe crew, and for such disinfection as might be required. Drs. J.A. Jones, P.J. Roden and D.T. Jones were requested to be present to assist in inspecting all crew and passengers in daylight and perform any vaccinations which might require to be carried out, but a message was sent to the Ship's Surgeon, asking him tore-vaccinate as many as possible of the ship's company on the way from Le Havre to London. At their own request the duty crew of the m.v. "Howard Deighton" were re-vaccinated before the arrival of the "Ivernia". The "Ivernia" was boarded off Owen's Buoy in Higham Bight at 00.15, her progress in the Estuary being reported to us by the new P.L.A. Control Room. This is the first occasion of its practical assistance being used by our Authority. On boarding the vessel Dr. Willoughby interviewed the Ship's Surgeon and made as much preparation as possible for the smooth working of the arrangements to take place at 08.00 later on that day when the ship would be boarded by the Immigration Officers and the Medical Officer of Health with the Port Health staffs. Destination cards for issue to all passengers (468) and crew (437) were handed to the Chief Purser for distribution at breakfast with instructions by ship's broadcasting system that they were to be produced, duly filled in, with passports on arriving at Immigration Control tables. Duplicate address lists of all passengers landing in London and landed at Le Havre were already available. At 08.00 hours on the morning of the 15th May, the Medical Officer of Health with Port Health staffs, including Dr. Willoughby who had met them with the launch at Gravesend Pier boarded the "Ivernia" off Tilbury landing stage, and after further discussion with the Ship's Surgeon, the usual arrangements were set in motion, namely (1) Muster of passengers to file past tables manned by Immigration and Port Health staffs. At each table a member of the Port Health staff received part of a tear-off card giving passenger's destination address, the passenger retaining the other part of the card to post to head office in case of change of address (this is normal surveillance procedure in the Port of London). Similar arrangements were made with members of the ship's personnel. 11 (2) The patient's bedding and effects and the bedding of his three ex-cabin mates were taken off by launch to Denton Hospital for disinfection. In view of the doubt about a firm diagnosis of smallpox, permission was given for the ship's laundry to go through the usual channels. (3) Pratique had already been given on the advice of your Medical Officer soon after his boarding the ship, and the passengers were allowed to disembark as soon as they had received their landing cards from the Immigration Officers. The crew were allowed to disperse as soon as they had completed their muster. (4) Whilst passengers and crew were mustering in connection with surveillance procedure, they were also observed by your Medical Officers for any evidence of illness and none was seen. (5) Between Le Havre and London the entire ship's company except those in possession of International Vaccination Certificates not more than six months old, were re-vaccinated, but there were three "conscientious objectors". The Ship's Surgeon had already re-vaccinated 210 of those passengers who landed at Le Havre. (Thirty-five Customs' Officers employed at Tilbury were also vaccinated by Dr. J.A. Jones). On return to head office the various surveillance cards were sorted out into districts and sent on to the Medical Officers of Health concerned, with a circular letter reporting the nature of the incident, and stating that although through our own Ministry of Health the French Ministry of Health had been requested for any further particulars, no reply had at that time been received. Towards the end of the day a reply was received through our Ministry of Health from France confirming the hospitalisation at Le Havre of a clinically suspected smallpox case which had not then been confirmed by laboratory tests, but further details were promised later. By 20th May still no details as promised had been received from France through our Ministry of Health. In the end the Liverpool Public Health Department (in whose area several of the crew were staying) sent a telegram to the Le Havre Port Health Authority, and had in reply a report of negative laboratory tests on the suspected smallpox case. (The Public Health Laboratory at Colindale can get these tests through in 72 hours). This was on 20th May, and as Liverpool were good enough to let your Medical Officer know of it, he at once sent out a circular throughout the country to all the Medical Officers of Health concerned, and also telephoned Medical Officers of Health of all Metropolitan Boroughs. This same information obtainable "officially" by the Liverpool Public Health Department had also been obtained "unofficially" by the Cunard Line City office from their agents at Le Havre on 19th May. The nature of the clinical details, as recounted by the Ship's Surgeon, showed an extraordinarily complicated case, the true diagnosis of which is still in doubt, and it is readily understandable that the five French doctors who examined the patient at Le Havre should have played for safety in a provisional diagnosis of smallpox. (d) Team Work It was a privilege to witness the team work on board the "Ivernia" and the exercise of the spirit of co-operation between the members of the ship's company from the Captain downwards, the representatives of Cunard Head Office, the Immigration Officers, Customs Officers and your own Port Health staff, as well as the Officers of the Port of London Authority. The smoothness with which the arrangements proceeded could only have occurred on a ship that is "happy" in the best sense of that word, and your Medical Officer wrote to the Cunard Head Office accordingly. The ability shown by the Ship's surgeon was also outstanding, and that opinion was expressed to the Medical Superintendent of the Cunard Line (this happens to be a Dr. Cadman, who in the early days of his career served with the Port of London Health Authority). It is this type of Ship's Surgeon who would be so helpful to us when more and more ships become equipped with radiotelephony by which we hope to be able to talk to them as they enter the Port of London, with a view to making decisions in advance as to their disposal from the port health point of view. One of the "Ivernia" passengers, a distinguished Canadian doctor, wrote as follows "In notifying you of a temporary change of address I wish to express my admiration as a medical man, of the way things were handled in the case of the suspicion of a case of smallpox on the "Ivernia". Both the Ship's Surgeon, Dr. Brown, and the Sisters worked hard and cheerfully with little if any rest, and their organisation for vaccination was most efficient. I feel that the control of World Health through epidemics is efficient and in good hands." s.s. "INDIA TRADER" - CHICKENPOX (? SMALLPOX) The s.s. "India Trader", which left Calcutta on the 21st January 1959, arrived at Gravesend on the 2nd March and was boarded by Dr. J.A. Jones. On enquiry he learned that a native seaman had reported sick on the 4th February with a high temperature and spots on the face and abdomen. The man, who had signed on in Calcutta on the 16th lanuary, had been vaccinated in infancy and again in November 1958. The patient had been isolated at once in the ship's hospital, his 12 quarters thoroughly cleansed, and his clothes boiled. When the ship arrived at Aden on the 10th February, the case was diagnosed as chickenpox and the man was kept in isolation on the ship until the 21st February when he returned to work. Dr. Jones saw the man when the ship arrived in London and, in spite of the diagnosis made at Aden, considered, having regard to the heavy marking and the distribution of the lesions, that the case might well have been one of smallpox, though it was at this very late stage impossible to be definite. All the crew held valid vaccination certificates and there was nothing that could be done except to keep a careful watch on the crew until the vessel sailed, by which time the remote possibility of secondary cases would have passed. No further cases of sickness occurred, a fact which Dr. Jones thinks may be partly due to the commendable thoroughness with which the Second Mate had organised cleansing and disinfection of the patient's quarters and personal effects as soon as he had been isolated. SUSPECTED SMALLPOX - s.s. "UMTATA" On the afternoon of 20th May 1959, the Medical Officer of Health for Poplar telephoned that a Medical Practitioner had been to the s.s."Umtata", lying in the South West India Dock, to see an Indian seaman who had a rash which could be chickenpox but might be A-typical smallpox. Arrangements were made forthwith for a visit to the s.s. "Umtata" by Dr. William Gunn of the Royal Free Hospital, one of the Smallpox Consultants of the Ministry of Health. The opinion of the Consultant was that the seaman was suffering from chickenpox in its final stages and that the man should be fit to return to work in a day or two. SUSPECTED SMALLPOX - s.s. "PANDORIAN" On the 26th September 1959, the Plymouth Port Health Authority reported by telephone that the s.s. "Pandorian" from Colombo had made an emergency call at Plymouth on the 25th September and that a suspected case of smallpox, a seaman, had been removed from the ship to a smallpox hospital. The following details of the case and of the action taken were passed to this Authority because the ship was proceeding to London : History of Case. A seaman, aged 20, last ashore in Colombo 27th August; re-vaccinated 19th March, very small vaccination scars. Complaint of headache, pains in legs and weakness about 15th September. Stated that he first noticed spots about 20th September. Unwell with temperature 101° on 30th August. Returned to duty 1st September. Sparse pustules and scabs on arms, legs and face. Action taken in Plymouth. Bedding and clothing of patient and crew's quarters disinfected. Remainder of crew (38) inspected and vaccinated. All personnel remained on board. Specimen of skin lesions sent to the Central Public Health Laboratory, Colindale, for serological and egg culture tests. On the arrival of the vessel at Gravesend late on the 26th September each member of the crew was inspected by the Boarding Medical Officer. None of them felt unwell or looked at all ill. The ship was therefore allowed to proceed into dock. Here all the crew remained on board, no cases of illness being reported to the Port Health Inspector. The vessel sailed for Antwerp on the 29th September and the Medical Officer of Health for that port was notified of the incident. Shortly after the vessel sailed the Central Public Health Laboratory Service reported that all tests on the skin lesions had proved negative to smallpox. This information was telephoned to the Medical Officer of Health for Plymouth who then accepted that the diagnosis was not smallpox but one of septic skin disease. This was at once communicated to the Shipping Company and to the Antwerp Port Health Authority. SECTION VIII—VENEREAL DISEASES Venereal Diseases are not compulsorily notifiable but efforts 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. 13 SECTION IX— CASES OF NOTIFIABLE AND OTHER COMMUNICABLE DISEASES ON SHIPS TABLE D (i) Disease Cases landed from ships Crew Number of Ships concerned Passengers Chickenpox 12 3 8 Dysentery 2 5 7 Fever of Unknown Origin 1 5 6 Gastro-Enteritis — 9 5 Infectious Hepatitis 2 1 3 Influenza 1 23 10 Malaria 1 5 6 Measles .. 13 2 9 Miscellaneous 2 26 24 Mumps 7 1 3 Pneumonia 4 — 3 Pulmonary Tuberculosis 4 33 34 Scarlet Fever - 1 1 Typhoid Fever - 3 3 TOTALS 49 117 122 TABLE D (ii) Cases disposed of before arrival Disease Passengers Crew Number of Ships concerned Chickenpox 36 2 18 Dysentery 5 6 5 Gastro-Enteritis 9 1 3 Fever of Unknown Origin 1 — 1 German Measles 1 1 2 Infectious Hepatitis 1 2 3 Influenza 64 42 5 Malaria 4 7 7 Measles 46 2 13 Miscellaneous 9 2 4 Mumps 3 2 5 Pneumonia 3 3 6 Poliomyelitis 1 - 1 Pulmonary Tuberculosis 1 4 5 Scarlet Fever 2 1 3 Typhoid Fever - 2 2 TOTALS 186 77 ~83 DENTON HOSPITAL Although Denton Hospital has been taken over by the South East Metropolitan Regional Hospital Board under the National Health Services Act, the Port Health Authority continues 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 nursing and administrative control lies with the Dartford Hospital Management Committee. Consultant advice on difficult cases is available through Dr. J. Pickford Marsden, PhysicianSuperintendent of Joyce Green Hospital, Dartford, who whenever necessary transfers cases there for special investigation and treatment. Early in 1959 Long Reach Hospital, the smallpox hospital at Dartford, was out of action owing to serious drainage trouble and it was decided by the South-East Metropolitan Regional Board that Denton Hospital must become the first line smallpox hospital for the area, i.e. County of Kent, East Sussex, Brighton, Canterbury, Eastbourne, and certain Metropolitan Boroughs, comprising a population of over three million. Denton Hospital was in consequence closed for all purposes, except the reception of smallpox patients and the disinfection of bedding, from 20th February till 11th May 1959. During this time cases of infectious disease were admitted to the Thurrock Isolation Hospital, Joyce Green Hospital, and, by arrangement with the emergency Bed Service, to other hospitals in the vicinity of the River and docks. 14 The number of cases admitted to Denton Hospital in 1959 was as follows:— Chickenpox 2 Chickenpox (Contacts) 2 Constipation 1 Diarrhoea Simplex 1 Follicular Tonsillitis 1 Herpes Zoster 1 Influenza 2 Influenza and Carcinoma 1 Quinsy 1 Suspected Smallpox 1 Toxic Erythema 1 Dysentery Boyd 1 Total 15 The photograph of Denton Hospital appearing in this Report is reproduced through the courtesy of the Dartford Hospital Management Committee. DERMATITIS AFFECTING CREW AND STEVEDORES s.s. "BECKY" OF HELSINGBORG The s.s. "Becky" arrived in the Port of London on 16th October, 1959 from various Mediterranean ports with a general cargo which included hides, pulses, fresh and dried fruits, etc.land part cargo destined for other Continental ports. Some hours after cargo had been broken and worked at Mark Brown's Wharf, some stevedores developed a body rash and assistance was sought by the employers from the Port Health Authority. This was on Saturday morning of the 17th October and the assistance was immediately given. Mr. Marshall, Port Health Inspector in the Upper River District, and Mr. W.G. Stimson, Senior Rodent Inspector, visited the ship. The Stevedores with the rash were sent to Guy's Hospital and two of the Ship's Officers went to Seamen's Hospital for diagnosis and treatment. An immediate search was carried out for rats and insects, the stevedores ceasing work pending the investigation by the Port Health Authority. On account of the remaining cargo for the Continent, a thorough fumigation was discounted and it was decided to carry out an effective spraying of all holds the next day, Sunday. This was done by private enterprise under the supervision of the Port Health Authority. After twelve hours exposure the holds were ventilated and the men resumed work in all compartments, except No.2 Hold, on Monday morning. It was in No.2 Hold that the greater infestation was found and it was decided to satisfy completely the stevedores by giving an additional treatment in this space. Throughout the operation, no rats were found dead or alive and the numerous insects collected were sorted and submitted to expert opinion at the Natural History Museum. All the insect pests were found to be of the food parasite types and some could give rise to skin rash, but it was concluded that the dermatitis was more probably caused by mites on fruits and lentils stowed in No.2 Hold. The Port Area Division of the Ministry of Agriculture, Fisheries and Food was advised and contact made with the Officer concerned after the major treatment with insecticide. All the stevedores were working the ship on Tuesday morning and the work proceeded without further delay. No more cases of dermatitis were reported during the time the ship was under surveillance of the Port Health Inspector. The whole operation was carried out to the entire satisfaction of all concerned and earned the praise and gratitude of employers and workmen alike. FIFTY YEARS AGO From THE MEDICAL OFFICER, 21st August, 1909 Cholera Regulations in London Port The magistrate at the Tower Bridge Police Court lately fined the master of the steamship "Irkutsch" £20 and three guineas costs for wilfully neglecting to obey a notice requiring that none of the passengers were to be allowed to leave his vessel until their addresses had been verified and permission to disembark given in writing. Evidence showed that the vessel arrived at Gravesend from St. Petersburg, in which city there was a serious epidemic of cholera, and the medical officer of the Port of London Sanitary Authority served a notice on the master in accordance with the regulations of the Local Government Board issued last August. In spite of this, nine passengers were allowed to leave the ship before she was docked higher up the river. The master's excuse was that he had not read the instructions which were printed in a footnote to the notice, and he had tendered an apology. The magistrate, after commenting on the gravity of the offence, imposed the penalty stated above. ("The Medical Officer", 21st August, 1959) 15 MEDICAL ASSISTANCE AFFORDED TO SHIPPING BY THE PORT HEALTH STAFF The Bearding Medical Officers and indeed all the Port Health staff are always ready to afford medical assistance for 'humanitarian' as opposed to strictly 'quarantine' purposes. A few examples of this help to shipping and seafarers are given below Medical Cases— s.s. "Sinop" — At 23.30 hours on the 19th January, 1959, a telephone message was received at the Hulk "Hygeia" from Watkins' tug office at Gravesend, saying that the s.s. "Sinop", a Turkish ship on passage direct from London to Turkey, would be anchoring in Gravesend Reach on her way down river and had asked for a doctor to see a member of the crew. Dr. D.T. Jones, the Boarding Medical Officer on Duty, went aboard and examined a member of the crew and came to the conclusion that the patient was suffering from acute renal colic. It was decided to transfer the patient to hospital and he was lowered over the side of the ship into the ambulance launch "Howard Deighton" and taken to Terrace Pier, Gravesend, and from there to St. Barts' Hospital, Rochester. s.s. "Finnmaid" — At approximately 12.15 hours on the 2nd September, 1959, Dr. J. A. Jones First Assistant Port Medical Officer, received a message from the Gravesend Ambulance Service to say that a stevedore had collapsed in the hold of the s.s. "Finnmaid" which was lying at Greenhithe Buoys. Although an ambulance and a boat were standing by, they were unable to contact any of the local doctors. Dr. Jones at once proceeded in the "Howard Deighton" and boarded the ship atl2.45hours where he found the man was dead. He had collapsed at about 11.45 hours and, in Dr. Jones' opinion, had died within five minutes. The Port Health staff landed the body at Terrace Pier, Gravesend, into the charge of the Gravesend Police. Although no treatment would, presumably, have made any difference in this case, it might have been more expeditious to have landed the patient at once and taken him to the nearest hospital. It is doubtful, however, if we shall ever break the British attitude of "Send for a Doctor". m.v. "Gothic" — The m.v. "Gothic" due at 03.00 hours on the 8th September, 1959, was forced to anchor in dense fog in the Lower Hope. On board was a child of seven suffering from acute appendicitis. Contact with the ship, via the Thames Navigation Service, disclosed that one of the "Gothic's" tugs had, by means of Radar, got alongside and the tugmaster was willing to remove the patient to Gravesend working his way back by Radar navigation. Arrangements were made for an ambulance to stand by and for a bed to be reserved at the Gravesend and North Kent Hospital where the patient duly arrived. The ship was well below the Quarantine Station and, of course, without Radar, it was an impossibility for the "Howard Deighton" to reach the ship. This instance, however, showed very close co-operation between the Boarding Medical Officer on Duty (Dr. Roden), the Thames Navigation Service, and the local tugmaster. s.s. "Pando" — At about 13.55 hours on the 16th October, 1959, Dr. J.A. Jones received a telephone call from Shell-Mex asking for assistance for the s.s. "Pando". A deckhand had vomited blood about a quarter of an hour earlier and was now stated to be "almost unconscious". Once again Tilbury Hospital and Thurrock Ambulance immediately agreed to accept and transport the case. On boarding the ship, Dr. Jones found the patient had recovered to a remarkable degree. He was in fact standing on deck waiting to be transferred to the "Howard Deighton". There was evidence of a considerable haematemesis on the deck, so no time was lost in landing him at Tilbury Stage where the ambulance arrived within two minutes. The whole 'operation' was completed in half an hour. Radio requests for medical advice s.s. "Clan Maclean" — The following notes on an 'incident' which occurred on the 4th February, 1959, were submitted by Dr. J.A. Jones: 12 noon. Telephone message from North Foreland W/T Station to Hulk "Hygeia" asking for medical advice for a seaman on the s.s. "Clan Maclean". He had suffered serious injury from falling down a hold, having fallen on his right shoulder. Fracture of shoulder suspected and other injuries. Vessel could arrive off Isle of Wight at 1700 hours. 12.5 p.m. This information reported to Clan Line, Tilbury Dock, who asked Dr. Jones to await a telephone call from their London Office. 16 12.10 p.m. Marine Superintendent, Clan Line, telephone Dr. Jones saying he would instruct the ship to put into Southampton. Would the London Port Health Authority (1) Give medical advice to the ship; (2) Inform the Southampton Port Health Authority and ask them to inform the local agents of the Shipping Company and to assist with the landing and admission to hospital of the patient. The Clan Line would arrange for a tug to land the patient. 12.15 p.m. Dr. Jones telephoned the North Foreland W/T Station with the following message for s.s. "Clan Maclean":— "Order from Clan Line to put into Southampton follows. Meanwhile, if possible, make more accurate diagnosis of injuries and treat as 'Ship Captain's Medical Guide'. If unable to do this, keep flat on back, put arm in sling. General treatment for shock with Morphine gr.% if pain severe." 12.25 p.m. Dr. Jones telephoned Southampton Port Health Authority who agreed to give all possible help. 12.30 p.m. Dr. Jones informed Marine Superintendent, Clan Line, that message had been passed. The Clan Line said a lifeboat would now meet the ship to save time. m.v. "Border Sentinel" — At 19.10 hours on the 6th December, 1959, the North Foreland W/T Station telephoned the Hulk "Hygeia" for advice on behalf of the tanker "Border Sentinel". The time of the origin of the message was 18.50 hours and it stated: "Man on board while eating suddenly collapsed. Face flushed deep red at onset of attack and heavy breathing. Grey after two minutes. Breathing ceased after five minutes." The ship had no radio-telephone and Dr. Jones asked the North Foreland operator to enquire if the man was apparently dead. There was some difficulty in communications with the ship and the North Foreland operator said he would ring back. Some ten minutes later the operator said he had not got a proper answer to the query but instead had a request for a doctor to meet the ship when she was off Cromer. With a south-east gale blowing this seemed a mo6t unreasonable request if the man was dead. Dr. Jones therefore advised North Foreland to refer the Master of the ship to the Section on "Signs of Death" in the "Ship Captain's Medical Guide" and to demand a clear answer to "Is the man apparently dead"? This was done and in due course the answer was given as 'in the affirmative'. No further action was taken. m.v. "Crichtoun" — At 11.20 hours on the 27th December, 1959 the North Foreland W/T Station telephoned a request for medical aid from the m.v. "Crichtoun". North Foreland were able to connect Dr. J.A. Jones with the Master of the vessel by radio-telephone. The 2nd Engineer complained of severe pain in chest. Onset p.m. 26th. Temp. 102. Pulse 108. Respiration "quite rapid". Pain present all the time, "sharp" on taking breath. No relief from Codein but some ease when lying on right side. On this report a diagnosis of Pleurisy with (probably) pneumonia was made. The vessel of only 455 tons was anchored in Margate Roads, being outward bound for Le Havre. In view of the size of the vessel, the bad weather and the possibility of pneumonia, Dr. Jones advised the Master to land the patient whilst he had the opportunity. The North Foreland Radio Operator informed Dr. Jones the Pilot Cutter was handy and that he, the Operator, would ask her to collect the patient. The Operator would also arrange an ambulance to meet the Cutter and inform Margate Hospital to expect the case. HEALTH EDUCATION - FOOD HYGIENE In 1958 the Port Health Authority produced for distribution to shipping visiting the Port of London a folder on the numerous Social Services available to the seafarer and his family. The matters covered included financial assistance; homelessness of wife and children; aged parents in need of care and attention; moral problems; 'home helps'; legal advice, etc. This publication was very favourably commented upon by shipping organisations and welfare societies. With regard to the broader question of health education generally, it was concluded, after consultation with shipping and catering interests, and having regard to some unfortunate incidents of food poisoning in ships, that the most urgent need was to issue a 'popular' booklet on catering which could be circulated widely to catering staffs both at sea and ashore. With the help of the Food Hygiene Division of the Ministry of Health and the advice of a number of leading firms in the catering, air transport and shipping industries, a booklet of twelve pages of text and eight pages of photographic illustrations of catering hygiene has been produced for distribution, free of charge, to shipping companies and by the Port Health Inspectors to catering personnel on ships in the docks and on the River. 17 SECTION X - OBSERVATIONS ON THE OCCURRENCE OF MALARIA ON SHIPS Seventeen cases of malaria (5 passengers and 12 crew) were reported on ships during the year under review. This is the same number as in 1958. One passenger and five crew were admitted to hospital on arrival in London; all other cases had recovered. A Notice giving advice on the General Precautions and Treatment of Malaria is issued by the Ministry of Transport and should be on board every British ship. The text of this Notice was reproduced in my Annual Report for 1958. MOSQUITO CONTROL AT ISLE OF GRAIN Mr. P.A. Traynier, the Port Health Inspector, stationed at the Isle of Grain, has reported as follows Mosquito control activities were again in progress within the perimeter of the B.P. Refinery during the breeding season of 1959. As in past years the field work has been carried out by a "Mosquito Control Operator" attached to the Medical Department of the B.P. Company. Weekly meetings have been attended with the Refinery Medical Officer and the Operator, and a very high standard of control has been reached. This has been achieved by the use of a larvicidal treatment of dieldrin but we also have been very fortunate in having had a very dry summer which has allowed nearly all the temporary water collections to dry up and so make the work of the operator very much easier. There was only one finding of Anopheles this season; this was in a small pool and was Anopheles claviger. No adult species were found. The saltmarsh mosquito larva was prevalent, as is to be expected in a coastal area, but prompt action was taken and very few adults caused us any trouble. A large increase was noted in larval infestations of Theobaldia annulata, which were dealt with as discovered, and once again the adults did not cause any concern. This being a domestic species, it could with advantage be attacked during hibernation but this might prove a costly process, and it could well be thatthe eggs laid within the refinery are from adults which have been in hibernation outside the perimeter, areas over which we have no control. For many years Mr. P.G. Shute of the Malaria Reference Laboratory, has advocated the filling in of some disused gravel pits, which are situated adjacent to Grain village, as these have been prolific mosquito breeding grounds for a very loug time. At present some of this work is in progress and this fact alone will have a very noticeable effect on the mosquito density on the Grain peninsula. 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 hoMs 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." 18 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. The 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 lighters 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 sixteen 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 eighteen 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. (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 could not be introduced into the Port for the simple reason that there are insufficient rats to enable the spread of infection. Nevertheless, eighty-one rats were sent to the Laboratory and were examined for plague with negative results. 19 (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. (b) The generation of hydrocyanic acid gas by various methods. For the destruction of rats a concentration of 1ICN 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. (e) Methyl Bromide. This is a very effective and lethal fumigant which has been used in this Port as an insecticide, particularly in the dry fruit industry. It has considerable penetrating powers and is not difficult to disperse after an operation. It is also possible to use this gas as a rodenticide and where there is an infestation of rodents and insects the combined problem can be solved with one operation. The following are the names of the firms approved for carrying out the deratting of ships:— Messrs. Associated Fumigators Ltd. Messrs. D is infestation Ltd. Messrs. London Fumigation Co. Ltd. Messrs. Ridpests Ltd. RODENT CONTROL ON LIGHTERS The control of rodents on lighters is of great importance in the general scheme for rodent destruction in the Port of London. Apart from the fact that the transport of rodents by lighters from place to place could be a means of communicating rodent borne disease on a major scale, there must also be considered the discomfort and possible infection of the lightermen, as well as the damage to cargo, resulting from rat colonies on board. The suppression of rats and mice on lighters is given constant attention by the Port Health Authority and where infested craft are found prompt measures of destruction are carried out in co-operation with the lighterage industry. An essential to all rodent control work is to ensure, as far as practicable, that there are no spaces where rodents can remain undisturbed,possibly with an adequate supply of food and water. While it is almost impossible to deny rodents access to lighters, it is possible to deny them accessible hiding places and the means of communication to gain access from one compartment and another. To do this, especially with older craft, means the adoption of rat-proofing principles which can only be done with the goodwill of the lighterage companies, the trade unions and the Port Health Authority whose officers are always ready and willing to advise but have no legal powers to insist on rat-proofing. Following correspondence with the Association of Master Lightermen and Barge Owners and the Trade Union concerned, it was decided to invite representatives of both sides to a meeting at Guildhall. This took place on the evening of Tuesday, 14th July, 1959. About thirty-five members of the two organisations attended and were addressed by your Medical Officer, Mr. T.L. Mackie, Chief Port Health Inspector; and by Mr. W.G. Stimson, the Senior Rodent Inspector. Coloured slides were shown to illustrate the various rat harbourages on lighters and examples of rat-proofing already carried out or incorporated in new craft. Mr. W.G. Stimson, the Senior Rodent Inspector, in his report for 1959 states: "As a result of the joint meeting the rat-proofing measures recommended by the Port Health Authority have been adopted by the industry and are now more or less standardised. The objection raised at the meeting as to the removal of the deckhead linings to eliminate the harbourage where rats can live and breed has been overcome by most firms. Instead of treating the deckhead with anti-condensation paint and cork dusting, the principle adopted now is to have waterproof hardboard fixed flush to the deckhead, thus avoiding the cavity and preventing condensation over the bench in the cabin." The method of rodent destruction to be employed on lighters is determined after initial inspection, one of the following methods being employed — sulphur dioxide, hydrogen cyanide, methyl bromide and poison baits. 20 As a routine check and in compliance with international requirements, specimens of rats caught are sent to the Central Public Health Laboratory for bacteriological examination. Records for 1959 include:— Number of lighters inspected 2,217 Number without evidence of rodents 1,797 Number with negligible evidence of rodents 293 Number of lighters treated for rodents 127 Number treated voluntarily for insects by owners with Methyl Bromide, which would also exterminate any rodents present 44 Total number of dead rodents recovered from lighters after treatment 723 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 1959 the Port Health Authority issued 86 such Certificates. TABLE E Rodents destroyed (bodies recovered) during 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 116 296 294 195 63 222 286 142 252 340 184 122 2,512 Brown Rats - - - - - - - - - - - - - Rats examined 3 8 3 6 6 1 4 5 7 6 1 4 54 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 108 61 65 126 182 288 93 125 239 188 213 126 1,814 Brown Rats 43 48 68 85 80 82 88 49 63 27 92 40 765 Rats examined 2 4 — 2 - — — 3 2 7 2 5 27 Rats infected with plague - - - - - - - - - - - - - Mice: 2,516 mice were also destroyed; 698 in ships and 1,818 in shore premises. 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 C ertificates Issued Total Certificates Issued After Fumigation with After Trapping After Poisoning After Trapping and Poisoning Total HCN Other Fumigants (state Method) 1. 2. 3. 4. 4(a) 5. 6. 7. 13 Methyl Bromide 1 NIL "1080" 112 NIL 129 1,052 1,181 Warfarin 3 21 SECTION XIII-Inspection of Ships for nuisances TABLE G Inspections and Notices No. of Vessels Number of vessels visited by Port Health Inspectors 14,086 Number of vessels on which sanitary defects were found, and details reported to the Master, Owners and/or Ministry of Transport 737 Number of Statutory Notices served Nil Number of vessels on which sanitary defects were remedied 732 Summary of Structural and other Defects Inadequate ventilation 20 Defective Lighting—Natural 1 Do Do. — Artificial 3 Defective Heating 8 Condensation 12 Leaking Decks 16 Leaking Ports, Decklights, etc. 18 Leaking Sideplates 4 Deficient or Obstructed Floor Drainage 22 Defective Bulkheads 2 Do. Floors 22 Do. Doors 14 Do. Bunks 19 Do. Clothes Lockers 3 Do. Food Lockers 6 Do. Food Storage 17 Do. Cooking Arrangements 14 Defective or Uncleanly Drinking Water Storage 9 Water Closet Obsolete 5 Do. Defective 32 Do. Foul or Choked 14 Do. Inadequate Flush 10 Wash Basins Defective 14 Neglected Paintwork or Distemper 10 Absence of Washrooms 1 Misappropriation of Crew Spaces 1 Verminous Quarters 95 Dirty Quarters 567 Miscellaneous 66 Total 1,025 SECTION XIV —PUBLIC HEALTH (SHELLFISH) REGULATIONS, 1934 The Public Health (Shellfish) Regulations, 1934, confer powers on a local authority whereby on receipt of a report of their Medical Officer of Health that the consumption of shellfish taken from a laying is likely to cause danger to public health, they may make an Order prohibiting the distribution for sale for human consumption of shellfish taken from the laying either absolutely or subject to such exceptions and conditions as they think proper, having regard to the interests of the public health. Two such Orders have been made. The first in 1936, covering the public and private layings bordering that part of the foreshore of the Estuary of the River Thames between Canvey Island and Shoeburyness; and the second, in 1957, covering the foreshore or waters bordering on that part of the Estuary of the River Thames or any tributary thereof, between Garrison Point, Sheerness, and Warden Point in the Isle of Sheppey. No cases were reported during the year of food poisoning or other illness resulting from the consumption of shellfish taken from layings within the district of the Port Health Authority. SECTION XV-MEDICAL INSPECTION OF ALIENS 1. List of Medical Inspectors of Aliens holding warrants of appointment on 31st December, 1959. Dr. J. Greenwood Wilson, Dr. H.M. Willoughby, Dr. J.A. Jones, Dr. D.T. Jones, Dr. P.J. Roden, Dr. D.J. Avery, Dr. J.B. Maguire, Dr. J.O. Murray 2. List 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. 22 4. Nature and amount of alien traffic. (a) Total number of arriving vessels carrying aliens 2,704 (b) Total number of aliens (excluding transmigrants, seamen and airmen)— (i) Arriving at the port 26,752 (ii) Medically inspected 15,689 (iii) Medically examined 311 (c) Certificates issued 10 (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. MEDICAL INSPECTION OF ALIENS I am indebted to Dr. J.A. Jones, First Assistant Port Medical Officer at Gravesend, for kindly preparing the following note on the medical inspection of aliens in the Port of London: London, one of the largest cargo ports in the world, has a relatively small passenger traffic. In 1959 some 140,000 passengers, four-fifths of them British, were landed. This figure is slightly higher than for the previous year but below that of several other ports in the Country, and only one tenth of the number at London Airport. For Immigration purposes the seaport has three divisions — "Adelaide House", "King George V Dock" and "Gravesend". These correspond with the Port Health Authority's Upper, Middle and Lower River Districts, but include the adjoining docks. "Adelaide House" also covers the train ferries at Victoria but the numbers arriving there are not included in this report. For statistical purposes, "Adelaide House" and "King George V Dock" are combined as "London" and their returns show an interesting contrast with "Gravesend". For example, in July 1959, the number of alien passengers landed at Gravesend was 4,117, of whom 2,739 were carried by the Swedish Lloyd vessel in 13 trips. "London", in the same month, had only 810 aliens, but these were spread over no less than 317 ships. It is also interesting to note that during the year more than 3,000 aliens were granted "Temporary Shore Leave". These aliens are often "supernumeraries", including relatives of the crew, and friends and employees of the shipping companies who get a free trip to London and who use the ship as a hotel. On the Declarations of Health these persons are often included under the crew figures but the Immigration Officers treat them as passengers. This is of no great importance, for whilst they may be the only "passengers" in the ship concerned, they are not included in the returns of the Immigration or Medical Inspectors. All passengers are interviewed on or before landing by H.M. Immigration Officers and any alien passenger is subject, at the discretion of these officers, to a medical examination. By arrangement with the Home Office and the Ministry of Health, the Port Health Authority provides the Medical Inspectors under the Aliens Order, 1953. Most of the "Gravesend" Alien passengers are landed at Tilbury Stage, which is reasonably close to the Hulk "Hygeia", and, though the first responsibilities of the Boarding Medical Officers are under the Port Health Regulations, it may be said that a Medical Inspector is always available within a reasonable time. For the medical inspection of alien passengers landing in "London", the Port Health Authority uses the services of two part-time medical practitioners who are able to proceed to a ship at short notice. This latter provision was only made in 1959 and it is still fortunate that the Port has largely a "visitor" class of alien passenger, only rarely requiring the Immigration Officer to ask for a medical examination. The full figures for 1959 of the various Immigration classes of alien passengers, are given below:- Visitors (staying less than six months) 17,990 Business Visitors 1,209 Long Visits (six to twelve months) 87 In Transit 2,881 Diplomats 235 Contract Seamen 295 Short Ministry of Labour Permits (under 12 months) 404 Long Ministry of Labour Permits (over 12 months) 845 Long Term Admissions (over 12 months) 1,401 Returning Residents 1,405 TOTAL 26,752 Sixty per cent of all aliens arriving are of Swedish nationality. The U.S.A. provides 10%, Finland 8%, and Belgium, Holland, Germany, and the Iberian Peninsular provide nearly all the remainder in approximately equal numbers. A fair number of Swedish and Finnish girls arrive with Ministry of Labour permits to take domestic employment and are normally liable to medical examination. The main object of these girls is to improve their English. The great majority are of good social and excellent physical standard so that a full examination is rarely necessary. 23 "Refusals" in this class, on medical grounds, are virtually nil, and indeed the total refusal amongst all classes for all reasons was only 57 for the year. From the foregoing it will be appreciated why, although 15,689 of the 26,752 aliens landing in London in 1959 were medically inspected, only 311 were subjected to a detailed examination. In only 10 cases did the Medical Inspectors have to issue certificates under the Aliens Order, the reasons being:— Class A Mental Illness 3 Class B. 2(a) Medical conditions which may interfere with ability to support themselves. Class B. 2(b) Medical conditions which may require treatment in this Country. 7 It is usually difficult to separate B 2(a) and (b). Three of the aliens classified under B 2 were coming for medical reasons. All satisfied the Immigration Officer that they had means to pay for consultations and treatment and were granted conditional landing for periods from two to three months. In a medical emergency the patient's well-being is always the first consideration and although he may, technically, be refused permission to land, admission to hospital is not delayed. On recovery, if the other Immigration considerations remain unaltered, the refusal will come into operation. The shipping company which brought him to this Country is responsible for repatriation. There were no important changes in the regular passenger services during the year. The Batavier service from Rotterdam, which ceased in 1958 after more than 100 years, was not resumed. The Greek ship "Arkadia" from Montreal, and the Russian ships "Mikhail Kalinin" and "Mikhail Uritzkij" from Leningrad, which started in the Autumn of 1958, again ran services to Tilbury Landing Stage. The position as to the use of the National Health Service both by aliens and by British Commonwealth citizens is well summed up in "Question and Answer" form in the "British Medical Journal" Supplement of 28th June 1958, as follows : Q. —In what circumstances may (1) foreigners and (2) citizens of the British Commonwealth overseas use the National Health Service? How is the use of the Service denied to those who are not entitled to it? A. —No one normally resident outside the United Kingdom, whether in a foreign country, a Commonwealth country, or the Irish Republic, has any right to come here solely or mainly for the purpose of getting treatment through the Health Service for a condition from which he already suffers. This is regarded by the Government as an abuse of the Service, and steps are taken to secure, so far as possible, that such people obtain treatment privately. Aliens are not allowed to enter the country for the express purpose of obtaining free treatment. If permission is given to enter the country for private treatment or if an alien who is known or thought to be intending to undergo treatment is admitted for some other temporary purpose, the appropriate hospital authorities for the area to which the alien is going are asked to watch for any attempt to obtain free treatment and to do what they can to secure that all treatment is obtained privately. These arrangements cannot apply to Commonwealth citizens or citizens of the Irish Republic, since there is no power to restrict their entry. Hospitals generally are aware of the Government's views, and, where it seems from inquiries made before treatment is given that a patient has recently arrived in this country and is seeking treatment of a non-urgent nature for a condition which existed before he came here, administrative action may be taken to prevent free treatment being obtained. People who are already in the United Kingdom when they become ill and need treatment may choose to be treated privately or they may seek treatment within the Service. In the latter case the same conditions apply to them as to everyone else. The general medical practitioner is at liberty to treat them privately or through the Service, and if necessary he may refer them to hospital either as private patients or as patients under the National Health Service. Similarly a dental practitioner has freedom to accept them as private patients or as patients within the Service — if he does the latter they will, of course, be subject to the current charges. SECTION XVI-MISCELLANEOUS Arrangements for the burial on shore of persons who have died on board ship from infectious disease. No change. 24 Inspection of frozen meat at ship's side, showing the department's utility car used for conveyance of the Inspectorate throughout the Royal Docks Group. Water Barge: Port Health Inspector drawing a sample of drinking water for bacteriological examination. FOOD INSPECTION The total amount of foodstuffs seized and condemned for human consumption and either reconditioned or disposed of for animal feeding or for technical or industrial purposes under guarantee or destroyed was 3,010 tons 18 cwts. 1 qr. 10 lbs. The following is a summary showing the method of disposal of the foodstuffs concerned:— Method of Disposal Weight Comparable Weight 1958 Tons Cwts. Qrs. Lbs. Tons Cwts. Qrs. Lbs. Burnt 255 13 0 10 233 15 2 9 Boiling down 143 7 3 13 82 1 0 26 Buried 1605 15 0 5 2535 3 3 7 † Animal feeding 336 13 1 8 411 16 3 16 † Refining 131. 9 0 22 272 18 0 20 † Manufacturing etc. purposes 42 12 2 24 73 16 3 12 † Released to other districts 495 0 3 2 517 15 3 13 Re-exported — 6 1 10 5 12 3 8 Reconditioning - - - - - 17 2 4 3010 18 1 10 4133 18 3 3 Of the 3,010 tons listed above, the principal items and methods of disposal were as follows: Burnt 1,260 cartons and cases and approximately 17,490 cans fruits, juices, pulps, vegetables, meats and fish (burst, blown, leaky, crushed and pierced) 71 cartons various fats (crushed, wet damaged, dock water damaged, rancid and dirty), a quantity of ships' rejected stores meat, 28 cartons chocolate wafers (rancid and old stock) 19 bags rice (acid damaged) 50 packages melons, 18 packages grapefruits, 4 packages apples, 2 packages limes, 1552 packages onions, 124 packages oranges, 150 packages Brazil nuts, 659 packages tomatoes, 272 packages garlic, 35 packages sultanas, 1120 packages potatoes ("wasty" and dirty), 4 lambs (dock water damaged), 32 cartons lemons (oil stained), 112 cartons dried apricots (damaged by D.D.T. powder), a quantity of bananas ("wasty"). Boiling down 5 fores, 158 wethers, 4515 lambs, 219 ewes, 95 hinds, 114 bags livers, 4 ox crops, (dirty, diseased, brinestained, dock water damaged, soft, dirty, iced and partially decomposed) 4 cartons lard (dirty) 753 lamb sides (rodent damaged at port of loading). Buried 933 tons "wasty" bananas and banana waste, 326 cartons and cases and 5245 cans fruits, juices, pulps, vegetables, meats and fish (burst, blown and leaky), 31,790 half bags onions ("wasty") 11 barrels orange juice (rancid and fermented), 33 packages potatoes ("wasty"), 10 cartons apples (dock water damaged), 2 casks chutney (dirty). t Animal feeding 32 bags dhall, 354 bags flour, 59 bags rice and a quantity of other ships' rejected stores including 75 packages meat released to London Zoo, 123 bags wheatgerm (wet damaged), 789 bags buttermilk powder (storm water damaged), 90 bags tapioca and 24 bags sago (damaged in fire on board ship), 25 cases walnuts (moth infested), 621 half bags potatoes ("wasty"), 52 bags milk powder (wet damaged), 49 bags groundnuts (stained). t Refining 1,468 bags sugar sweepings and loose collected sugar (dirty). t Manufacturing etc. purposes 1 barrel sheep casings (for test purposes), 48 casks plum pulp (excess preservative — released for Jam making), 571 bags damaged tea and sweepings. t Released to other districts 1 chest tea (wet damaged), 92 cartons lard (stained cartons) 141 bags rejected stores rice (for cleaning), 23 cases almonds (moth infested), 550 cartons canned fish (for sorting), 7 cases 47 tins tomatoes (for use in catering trade), 74 cartons butter (damaged), 1 bag flour (dirty), 280 bags onions ("wasty"), 67 cases desiccated coconut (wet damaged), 159 boxes cheese (wet damaged), 44 cartons Chinese hen egg albumen (Salmonella infected), 13,011 packages potatoes ("wasty" — for sdrting). Re-exported 2 casks casings (no "official certificate"). Items marked t released with agreement and under supervision of local Medical Officers of Health. IMPORTATION OF DISEASED LIVERS The Meat (Staining and Sterilisation) Regulations, 1959 For many years the importation of animal livers in large quantities marked "for animal feeding purposes" created a problem to which, in the absence of controlling legislation, there appeared to be no answer. 26 A high percentage of the livers were affected with hydatid cyst—a stage in the life cycle of the dog tape worm—and the absence of any powers of control in regard to meat and offals not intended for human consumption presented the danger of the sale of these livers for human consumption, apart from the obvious objection to the use of this offal for pet food. The problem had become so acute and the volume of importations reaching such proportions that in July 1958, all such offals in the City of London were seized and taken before a Justice, who condemned the same as unfit for human consumption and ordered that they be so disposed of as to prevent them from being used for human consumption. In this way a measure of control was established, and shipments were released only on proof as to their disposal other than for human consumption. The Ministry of Agriculture, Fisheries and Food issued on 6th January 1959 the draft of the Meat (Staining and Sterilizing) Regulations, 1959, which were to become operative on 1st April 1959. These Regulations provided for the staining or sterilization of all meat, offals, etc. unfit for human consumption, and for sterilization of all such meat on sale retail. It would be an offence for any person to have in his possession unstained or unsterilized meat unfit for human consumption, exceptions being made only for sales from slaughterhouses and knackers' yards to zoos, menageries, etc. The maximum penalty for offences under the Regulations was a fine of £100 or imprisonment for a term not exceeding three months, or both. Arrangements had been made for compliance with the regulations both in the Port and City of London by the provision of facilities for staining all condemned unsound meat, etc. coming into the possession of the Corporation as a result of rejection during the normal course of inspection. In the Port of London, the Port of London Authority provided means for the spraying of all unfit meat with a specified dye, and at Smithfield Market it has always been the practice for such meat to be stained before removal by the Contractors. Before these Regulations came into force,however, they were withdrawn, an action which was followed by immediate instructions of the Worshipful the Port and City of London Health Committee that a strong protest be made on behalf of the Corporation. It is hoped that these very necessary Regulations will be re-issued at the earliest possible time in order that proper control of this import may be exercised in safeguarding the public health without interfering with legitimate trade. TEA IMPORTATION By Section 1(1) of the Food and Drugs Act 1955 "no person shall add any substance to food, use any substance as an ingredient in the preparation of food so as (in any case) to render the food injurious to health, with intent that the food shall be sold for human consumption in that state". Section 1(5) provides that "in determining for the purpose of this Act whether an article of food is injurious to health, regard shall be had not only to the probable effect of that article on the health of a person consuming it, but also to the probable cumulative effect of articles of substantially the same composition on the health of a person consuming such articles in ordinary quantities". Tea dust, tea fannings and broken leaf teas are regularly examined on importation for the presence of extraneous matter, i.e. sand, metal chafings etc., and whilst such adulterants are not necessarily injurious to health, they are "not of the nature, or not of the substance, or not of the quality" of tea and therefore their presence constitutes an offence under Section 2 of the Act: 'If a person sells to the prejudice .of the purchaser any food or drug which is not of the nature, or not of the substance, or not of the quality of the food or drug demanded, he shall be guilty of an offence." Such instances of adulteration are not often found. Teas are by their nature and packing susceptible todamage by unsuitable or lengthy storage, and examination is regularly made for moulds,staleness, contamination arising from oil and water damage as a result of unsuitable storage or accident, or one of the many other possible hazards attendant upon transportation and storage. Analysis for metallic contamination is revealing many instances ofexcessive lead contamination of Formosa Teas. Although these Teas normally are not used unblended, nevertheless they are "Articles of food, or an ingredient used in the preparation of food" and by Section 1(1) and (5) of the Food and Drugs Act 1955 quoted above, any excessive lead content renders them unfit for human consumption. Whilst there is no statutory standard limiting the lead content of foods, the Food Standards Committee reported in 1954 recommending a limit of 10 parts per million in tea. The Public Analyst has reported lead contamination as high as 140 parts per million in Formosa Teas. 27 To quote from the Food Standards Committee's Report: "Lead is one of the most widespread and serious of the metallic contaminants of food and drink. Many foods contain naturally small amounts of lead; but the principal sources of lead contamination are the use of lead, lead alloys and lead compounds in food processing plant, in the piping by which water and other fluids are conveyed, and in agriculture insecticides. Lead, unlike most other poisons, is stored in the body, and however little is absorbed and stored, there is always the danger that this stored lead may be released and produce toxic effects. Lead poisoning may be brought to light following acute infection and certain other clinical conditions may result in release of immobilised lead. The daily amount of lead ingested is the sum of the minute quantities present in the components of the diet, each of which may contribute apparently insignificant amounts, but the total daily intake in the food may, in course of time, add up to a possible hazard to health. The only way of removing this hazard is to eliminate lead from foods and drink." Such contaminated Teas are detained in the Port of London or at City Warehouses until acceptable arrangements have been made for blending with other teas in such proportions that the lead content is reduced well within the recommended limit of 10 parts per million. The source of this contamination in Formosa teas has not been established but investigations are being carried out at source. Lead foil linings, at one time generally used for chested tea, have been replaced by aluminium foil linings as a contribution towards the elimination of this type of contamination. The circumstances arising from the control of tea imports have accentuated the anomaly of differing standards applicable by the Port and City of London. In the City of London, the Corporation are the Food and Drugs Authority and the powers of the Food and Drugs Act 1955 are exercisable by them. The Port Health Authority are not a Food and Drugs Authority and are limited to the exercise of the powers granted by the Public Health (Imported Food) Regulations 1937 and 1948. Under the Imported Food Regulations the criteria justifying condemnation are disease, unsoundness, unwholesomeness or unfitness for human consumption. These Regulations would doubtless justify action in the case of excessive lead content as being unfit for human consumption, and for mould or staleness as being unwholesome, but it is very doubtful whether action could legally be taken in the case of an adulterant such as sand. The Public Analyst also finds himself in difficulties in applying differing criteria to the same commodity. This unsatisfactory position has been referred to the Ministry of Agriculture, Fisheries and Food, who in conjunction with the Ministry of Health, are giving the matter consideration. TEA SAMPLING During the period covered by this Report 3,571 samples of tea have been taken and submitted for examination. Of these 3,571 samples, 3,567 have been found to be satisfactory. The remainder were reported upon as having excessive amounts of lead present and the owners were asked to use the tea in a blend in such proportions that the final blend contained lead in amounts less than the recommended 10 parts per million, or the tea was re-exported. PUBLIC HEALTH (PRESERVATIVES ETC. IN FOOD) REGULATIONS, 1925-1958 COLOURING MATTER IN FOOD REGULATIONS, 1957 Shipments of oranges are regularly sampled in the Docks and at City Wharves for chemical analysis, specifically for the presence of prohibited colouring matter and the rot and mould suppressant Thiourea, the use of which, being a preservative, is prohibited. Routine sampling is normally carried out informally without detention of the cargo. In June, 11 samples of Brazilian oranges were taken from a shipment in the Port of London of which the Public Analyst reported 3 contained Thiourea and 2 prohibited colouring matter. In view of these reports it was decided to detain future cargoes of Brazilian oranges for the analyses of samples taken formally in accordance with the procedure required by the Public Health (Preservatives etc. in Food) Regulations, 1925-1958. The first shipment which was detained and from which formal samples were taken consisted of 4,000 cases of Brazilian oranges. There being a ready market on the Continent for oranges, the importers immediately requested a release for re-export to Rotterdam, which was agreed. The Public Analyst's reports subsequently received showed that of 21 samples, 9contained Thiourea and 2 prohibited colouring matter. 28 14 shipments were examined with results as shown:— Shipment Samples Thiourea Prohibited Colouring Matter A 11 (informal) 3 2 B 5 — 2 C 21 (formal) 9 2 D 15 „ — 6 E 14 „ — 5 F 23 „ 1 10 G 16 „ — - H 13 „ _ — I 9 (informal) — 2 J 4 „ — — K 10 „ — 2 L 7 „ — — M 4 (formal) — - N 2 (informal) - - 154 13 31 Owing to the perishable nature of this cargo, all applications for release for re-export to the Continent, where generally the presence of Thiourea and certain colouring matters in such food is not prohibited, were agreed to and it was not necessary in any case to take formal action of seizure and condemnation. The Ministry of Agriculture, Fisheries and Food were kept informed of the results of analysis and representations were made to the Brazilian Authorities. IMPORTED DESICCATED COCONUT In the course of routine sampling of imported foods, samples of desiccated coconut were taken on importation and submitted for bacteriological examination early in December. Of three samples submitted, one each of "fine", "medium" and "thread", the "fine" was reported contaminated with organisms of the Salmonella group, later identified as Sal. Newport. It was found that this shipment of "fine" coconut had already been distributed to eight different firms and the Medical Officers of Health of the areas concerned were immediately informed of the circumstances. Remaining stocks held in Hackney, Leyton and Richmond were sampled, and Sal. Newport was isolated from those taken at Hackney and Leyton, and Sal. Paratyphi B. from those taken at Richmond. All shipments of "fine" coconut are being detained at the docks pending bacteriological examination and samples of "medium" and other grades continue to be taken without detention of cargoes. Imports through the Port of London average 400-500 tons monthly. It has been agreed that shipments found to be contaminated with Salmonella organisms and condemned as unfit for human consumption may be removed under detention for oil extraction involving sufficiently high temperatures during the process to destroy the organisms present. This process will be carried out under the supervision of the Medical Officer of Health of the area in which the mill is situate. The results of examinations carried out by the end of the year are as follows:- Fine Medium Chippings, Flake, &c. By Port Health Officers of this Authority 14 negative. 20 negative. 10 negative. 3 positive Salmonella. 1 positive Salmonella. By M.O.H. Hackney of suspected shipment already distribed. 1 negative. 4 negative. 1 positive Salmonella. By M.O.H. Leyton of suspected shipment already distribbed 1 negative, 1 positive Salmonella. By M.O.H. Richmond of suspected shipment already distributed. 13 negative, 1 positive Salmonella. s.s. "TWEED" FROM SOUTH AMERICA, BERTHED AT "F" SHED, VICTORIA DOCK The abovementioned ship arrived with a full refrigerated cargo of Lambs and bags of Beef, Sheep and Lamb Offals. It was evident from the commencement of discharge that all was not well, as many misshapen carcases were landed. Between the 22nd and 27th July 1959, a quantity of mouldy and partly decomposed carcases were sent to the Port of London Authority Dock Cold Store for further examination by the Port Health Authority. 29 Enquiries elicited the information that there bad been refrigeration trouble during the voyage, resulting in fluctuating temperature. On the 27th July, the quantity of mouldy and decomposed carcases and offal increased to an extent when it was deemed expedient to order the contents of No. 5 Lower Hold to be sent to No. 7 P.L.A. Cold Store. The conveyance to the cold store over the next two days was made by insulated lighters, some 12,233 carcases being moved. On the 28th July, it was evident that the contents of No. 3 Lower Hold was in the same condition as No. 5 Lower Hold, so the meat from this space was ordered to No. 6 P.L.A. Cold Store. The conveyance to store over the next two days was by road transport, some 17,604 carcases and 802 bags of offals being moved. Sorting of the carcases in No. 7 store commenced on the 5th August, and was completed on 31st, when 735 had been rejected for condemnation or reconditioning. Sorting of the carcases in No. 6 Store was commenced on the 17th August and was completed by the 29th, when 5,800 had been rejected for condemnation or reconditioning. After each day's sorting the sound carcases were released and removed by the Importers. The rejected carcases at No. 7 store were removed to No. 6 Store to be dealt with by the Port Health Authority. Reconditioning of the 6,535 carcases and offal at No. 6 Store commenced on the 27th August, the operation being completed by 24th September. The result of the reconditioning resulted in the condemnation of 5 tons l cwt. 2qrs. and 8 lbs. livers, hearts and kidneys, and 44 tons 19 cwt. 3 qrs. 12 lbs. lamb carcases and parts of carcases, the total weightof meat sent to the Corporation contractor being 50tons 1 cwt. 1 qr. 20 lbs. The sorting and reconditioning was done under the supervision of Mr. P.W. Coombe, Senior Port Health Inspector, and Mr. W.M. Walker, Cold Store Inspector, with Mr. Simmons, Meat Watcher, giving valuable assistance at the ship's side. The work necessitated every single carcase and bag of offal being examined by your Officers. Throughout the operation the fullest assistance and co-operation was received from the Senior Traffic Officer, Meat Department, P.L.A. and his staff, and the Importers themselves. ARSENIC CONTAMINATION OF CARGO Bound for London, the s.s. "Arcadia" called at Marseilles where she loaded 449 drums Arseneous Acid (AS2O3). This is a normal cargo, consisting of a fine white powder packed in steel drums. During loading, one set was accidentally dropped, some of the drums burst, and a considerable quantity of the chemical was spread over the cargo lying in the hold. Although an attempt had been made by the French Stevedores to remove as much of the contamination as possible, a considerable amount still remained when the ship arrived at Tilbury and, on the advice of Mr. D.E. Madeley, the Senior Inspector at Tilbury, gloves and respirators were issued to the stevedores when working in the hold. The drums of arsenic were discharged overside into a lighter and the remaining cargo consisting of leather, skins, wool, canned tomato juice, meat and butter was discharged to No. 33 Shed and isolated from any other cargoes. On completion of discharge the ship's hold was thoroughly cleansed, and all sweepings were put in paper sacks for destruction at sea. DRIED FRUIT CONTAMINATED WITH INSECTICIDE As an illustration of "behind the scenes" activity which results in a report of "112 cases dried apricots destroyed" the following may be of interest. In December, 1958, a vessel arrived at Regent's Canal Dock with a cargo of 1,000 cases dried apricots, 2,200 bags milk powder and 540 bags insecticide, a number of which were marked "poisonous", in the same hold. During discharge of the insecticide, white powder was spilled from leaking bags, several of which also fell down from the sling, spilling their contents over the undischarged apricots. The milk powder had already been discharged and during the process some of it had also spilled on the apricots. Mr. C.E. Wright, the Port Health Inspector at Regent's Canal Dock, placed the 1,000 cases of apricots under detention for examination, and samples of powder were collected from cases in various positions of stowage. The analysis varied according to position of stowage from 600 parts per million D.D.T. (Dicophane) 140 parts per million Copper (in compound form), to D.D.T. (Dicophane) 94%, and oat flour and milk powder 6%. 30 Those cases showing no evidence of contaminating powder were separated from those that did, and were released, leaving 377 cases contaminated in varying degrees. After much correspondence with the importers and underwriters, the importers decided that 100% examination of the affected cases might justify the expense involved. In May 1959, labour was engaged by the Dock Company and sorting commenced under the supervision of Mr. Wright, special accommodation being placed at their disposal for the purpose. A compressed air generator was used for the removal of all gross contamination. The cases were unpacked and separately examined by your Officer, the contents of those passed as sound being re-wrapped in new wrapping, re-cased in new containers and re-banded. The examination resulted in the repacking and subsequent release of 265 cases and the report "112 cases dried apricots destroyed". WITHOUT COMMENT "Vet Certificate. "Erevy it is confirmed that horses are on a public export shambles under a vetinary control "murdered and it is also by an officional veterinar's examing ascertained that animals are either "in alive or in daed mode healthy as well as the meat is good for people's food. "In the People's Republic of during the last two months time there was no Dourine. Besides "in her shires during a six months time there was no appearance of anaemia plague. "Horses were by anophal method mallinized on the 7th 1959 with a negative result." LOADING AND TRANSPORT OF REFUSE BY LIGHTERS Until amended in 1958 the Byelaws constituted by the Port Health Authority in 1948 for the prevention of nuisances arising from refuse in or upon any ship, boat or vessel, were rather difficult to enforce, particularly in one respect, namely that Byelaws 2(a) and (b) required that the coaming had to be sealed with close-fitting hatches and these to be covered with waterproof sheeting when the hold contained refuse and loading was not in progress. Representation to the Port Health Authority made by the Association of Master Lightermen and Barge Owners on behalf of the Refuse Contractors pleaded that the provision and securing of close-fitting hatches could not be properly met for various reasons and the demand was rather unreasonable in all the circumstances. As a result of discussion and successful tests that ensued, the Port Health Authority decided to relax in this demand and amended the Byelaws to the effect that close-fitting hatches would be no longer required, but the coamings must be sealed with stout water proofing sheeting in good repair, properly and securely attached to the coamings. This relaxation in the Byelaws considerably eased the burden of responsibility of the Contractors and was agreed to be a minimum standard acceptable to the Port Health Authority. Nevertheless, infringements have continued and during the year 1959 eight incidents have been reported officially. Legal actions were taken in respect of seven offences and a penalty imposed in every case by the Magistrate. All these infringements occurred, not when the lighters were actually transporting the refuse but after loading operations had ceased and the refuse was left in the lighter, unattended and without waterproof sheeting properly and securely attached to the coaming. 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 and City of London Health Committee 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 Council 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 Committee 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. During the year the Benfleet Urban District Council granted temporary consents, subject to the approval of the Port Health Authority, to twenty-three houseboats. No objection to these consents was raised by the Port and City of London Health Committee. 31 CLEAN ADR ACT, 1956 1959 was the first complete year that the Dark Smoke (Permitted Periods) (Vessels) Regulations, 1958 have been in operation and the overall result achieved has been most satisfactory. The conference which was held in May 1958 with representatives of various shipping interests to discuss the best ways and means of implementing the Regulations has proved during the year to have been of great value, as owners and agents of vessels have invariably been most co-operative in doing everything possible to prevent emission of smoke from their ships. The governments of foreign countries whose ships use the Port of London were asked,through the appropriate Consuls-General, to notify shipping departments and companies in their respeccountries of the provisions of the Clean Air Act and the Regulations. That these governments enthusiastically acceded to this request is suggested by the fact that only seven foreign ships were reported to have contravened the Regulations in the Port of London. In each case the shipowner and appropriate Consul-General were notified and in no instance has aforeign ship offended a second time. Three of these seven foreign vessels were owned by the U.S.S.R. Mr. Mackie, the Chief Port Health Inspector, had a most cordial interview with representatives of the Government of the U.S.S.R., culminating in satisfactoiy agreements to cover existing and future technical policies. No foreign ship has been observed to contravene the Regulations since October 1959. More than 2,000 cards pointing out that the emission of dark smoke from vessels is restricted by law have been delivered aboard ships personally by the Port Health Inspectors, thus providing opportunities for talks on smoke prevention with the personnel on board. It was decided that in the initial stages of the campaign official notices of contraventions should only be served on owners or masters of vessels in respect of emissions of black smoke in excess of the permitted period of three minutes. Black smoke is smoke of shades four or five as measured by the Ringelmann Chart, dark smoke being of shades two and three. Without doubt the campaign this year has been one of resolution and success. Naturally, the new duties have strained the limited staff of Inspectors and the burden has fallen more heavily on the River districts as was envisaged. In spite of applied warnings, reprimands, patience and persuasion, there have been defaulters and it has been necessary to serve 25Notices during the year for Black Smoke offences. 8 cases have been dealt with by Magistrates and penalties imposed. It is apparent from informal conversations with the Industry that the prosecutions, which were given widespread press publicity, have had a salutary effect. It is rather significant that of the 25 Notices served, only 6 were served in the latter half of the year, which strikes a note of optimism for the future. In regard to the remaining seventeen ships it was felt either that successful defences, as provided by the Act, could be advanced or the more ultimate good would result from personal interviews or correspondence with owners than by prosecution which is the last resort when it is decided that no other methods would be successful in preventing further offences. It is encouraging to note that Notices concerning smoke emissions in relation to the Clean Air Act have been affixed in many ships in appropriate positions. Large sums of money have been spent by Owners on improvements and furnace modifications and some have actually replaced obsolete boilers and engines with diesel machinery, especially in harbour craft. Oil fuel firing and diesel engines tend to monopolise future construction and ought to relieve much of the burden at present imposed on the Authority as far as smoke observation is concerned. It is, of course, far easier to deal with a ship which emits smoke in dock as she can be boarded immediately and the veracity of the Engineer's explanation of the offence checked. The experience of Mr. T.L. Mackie, the Chief Port Health Inspector, who is a qualified marine engineer, is invaluable in this connection. Furthermore the Port Health Authority's policy of 'Prevention rather than Cure' can be adopted in the Docks. It is customary for an Inspector who sees a ship emitting smoke, even as slight as Ringelmann one or two for an appreciable time to board the ship and discuss the position with the Engine Room staff. This policy prevents many offences, and provides an opportunity for giving helpful advice to Engine Room Officers. It was stated earlier in this report that statutory action has been taken only in regard to Black Smoke emissions. The success of the campaign in this connection has been so marked that it has been decided to implement during 1960 the remaining provisions of the Regulations in respect of Dark Smoke. It must be appreciated, however, that technical difficulties in obtaining evidence of contraventions in regard to Dark Smoke are greater than those in respect of Black Smoke, in that the permitted periods of emission are much longer. In some cases it is necessary for a ship under way to be kept under observation for as long as two hours in order to prove a contravention of the regulations. The speed of the launches available to the Port Health Inspectors is insufficient to keep most of the ships entering or leaving the Port of London in sight for so long a period. Furthermore, a fast ship could steam from Tower Bridge to the mouth of the River in little more than two hours. Fortunately, however, the decrease in emissions of Black 32 Smoke, appears to have brought about a corresponding improvement in Dark Smoke emanations, as the number of reports of emissions of Dark Smoke have been reduced to a negligible number during the latter months of 1959. Very little difficulty has been experienced in connection with shore establishments. Most of these are owned by the Port of London Authority who have been most co-operative in every way in eliminating smoke. Two flour mills, owned by firms other than the Port of London Authority, which initially gave rise to complaints, no longer do so, the owners having, at the suggestion of the Officers of the Port Health Authority, made such alterations as have corrected the offending firing systems. The position in regard to Harbour Craft has substantially improved during the year although these vessels, particularly some tugs and dredgers, still constitute a problem. It is felt that more co-operation could be forthcoming from certain sources. It is noteworthy that Port Health Authorities throughout the country are keenly aware of the urgency and difficulties of dealing with the smoke problem on ships,and at the Annual Conference of the Association of Public Health Inspectors in 1959, at which Mr. A.H. Marshall, Senior Port Health Inspector, delivered a paper on the 'Application of the Clean Air Act to Shipping', there was shown a real interest in this vital subject. In conclusion reference should be made to the assistance which has been received from the Port of London Authority Police, the Thames Division of the Metropolitan Police, and County Police of various riparian districts, in submitting to the Port Health Authority detailed reports of infringements of the Act which have been brought to their notice. RADIATION HAZARDS In my last Report it was mentioned that active consideration will have to be given to radiation hazards from nuclear powered ships visiting the Port of London in the future and when this time arrives it will be important for the Port Health Inspectors on the River and in the Docks to be equipped with the appropriate apparatus for taking measurements of radio-activity in the vicinity. As a first step arrangements were made for the Port Health Inspectors to attend a course of lectures at the Sir John Cass College on "Radio-activity and its hazards in biology and medicine" —a course which was conducted very successfully in the early months of 1959. In answer to a question in the House of Commons on 11th March, 1959, Mr. John Hay said that it was at present premature to assume that any nuclear-powered ship will come into the Port of London in 1960. Nevertheless, the problems that might arise from the entry of such vessels into the Port of London have already been discussed with the Port of London Authority and an outline scheme agreed. In the near future it is hoped to set up a system of regular sampling of air and water in a part of the Port, probably that part which would be allocated for the reception of nuclear powered vessels in the event of these visiting the Port of London. By this means it is hoped to build up a background of basic data as to "normal" content of ionizing radiations found in air and water samples. Then when a ship does visit that part of the Port, samples taken at the time can be compared with the basic data to see if there is any increase in the level of ionizing radiations. PUBLIC HEALTH ACT, 1936, PART X-CANAL BOATS One hundred and thirteen inspections of canal boats were made during the year. Twenty-five canal boats were found to have a total of forty-four defects, as follows: No. of defects Cabin in need of cleaning and/or painting 11 Defective condition of cabin top and/or sides 15 Defective condition of cabin hatch doors 2 Defective flooring 3 Defective bulkheads 3 Defective ventilation 4 Defective food storage 2 Excessive bilge water due to leak at stern 2 Defective drinking water can 1 Bug infestation 1 44 The Owners and/or Masters of the defective craft were in each case notified and requested to remedy the defects. 33 The following infringements of the Act were also found: Certificate of Registration not on board 17 Registration Marks on boat obliterated or illegible 3 20 The Owners and/or Masters were informed of the requirements of the Act in this respect. No new Registrations were effected during the year. DANGEROUS DRUGS During the year fourteen certificates authorising the purchase of scheduled Dangerous Drugs were issued under the Dangerous Drugs Regulations, 1953, Regulation 13 (2) of which is as follows:- (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. FERTILISERS AND FEEDING STUFFS ACT, 1926 FERTILISERS AND FEEDING STUFFS REGULATIONS, 1955 Eleven samples of Feeding Stuffs were submitted to the Agricultural Analyst. In each case the sample was found to be within the limits of variation permissible under the Regulations. STAFF Mr. P.J. Wilkins. It is with great regret that I have to record the death on the 29th June, 1959 of Mr. P.J. Wilkins who had been in the Port Health Service since 1928 and who at the time of his death was Senior Navigator of the launch "Howard Deighton". Mr. P.W. Coombe. On the 16th April, 1959 the General Council of the Association of Public Health Inspectors elected Mr. P.W. Coombe, Senior Port Health Inspector, a Fellow of the A&sociation. Fellowship of the Association is awarded to members who have given distinctive service to the Association or have given evidence of special knowledge and ability in the execution of the duties of a public health inspector. LAUNCHES The district of the Port of London Health Authority includes, as well as the dock systems, approximately seventy miles of the River Thames and Estuary from Teddington to the Nore Light, and to carry out shipping inspection in this area a complement of four launches is maintained. Two launches, the "Alfred Robertson" and the "Frederick Whittingham", are stationed at Woolwich, with moorings and office accommodation at the Port of London Authority Harbour Service Pier. These launches provide transport for the Port Health Inspector and Rodent Inspection staff stationed on the upper part of the River Thames from Teddington to Rainham Creek. The other two launches, the "Howard Deighton" and the "Alfred Roach", are stationed at Gravesend and are moored alongside the Hulk "Hygeia" which acts as the boarding Station for arriving ships and which also provides living accommodation for the Boarding Medical Officers while on duty. The "Howard Deighton", which is manned by three crews and is in the service twenty-four hours a day, seven days a week, provides transport for the Boarding Medical Officers. The "Alfred Roach" is used by the Port Health Inspector on the lower part of the River from Rainham Creek to the Nore Light at the mouth of the Thames Estuary. The Gravesend launches and the Hulk "Hygeia" are in radio telephone communication with each other and there is also a set on the same wave length in the Port of London Authority Thames Navigation Service Building at Gravesend. This year the Hulk "Hygeia", which was built in 1914 as an Admiralty lighter and was purchased by the Port of London Health Authority and converted into a boarding station in 1939, was taken out of water for a complete overhaul and is now likely to render useful service for many years to come. The "Howard Deighton" has been in service since 1934 and is now not really fast enough for boarding work. Plans are in preparation for replacing her with a rather larger and faster cutter of improved design including an ambulance room and living accommodation for the Boarding Medical Officer as well as the crew. 34 Ambulance Launch "Howard Deighton" Food hygiene on board ship — Cafeteria in crew's messroom of a freighter. LECTURES AND PAPERS Dr. J. Greenwood Wilson Numerous lectures and talks on the work of the Port Health Authority and allied subjects to various organisations, including: The Harvey Society, St. Bartholomew's Hospital Medical College. The Royal Institute of Public Health. London School of Hygiene and Tropical Medicine. Annual Meeting of the Association of Sea and Air Port Health Authorities —Paper on "Food Problems at Ports". Contribution to Symposium at the XV International Tuberculosis Conference at Istanbul. Mr. T.L. Mackie, M.B.E. The Royal Institute of Public Health —Paper on the "Clean Air Act and its application to shipping", Mr. H.A. Marshall Annual Conference of the Association of Public Health Inspectors —Paper on "Application of the Clean Air Act to Shipping". VISITORS AND STUDENTS Facilities were afforded during the year to students of the London School of Hygiene, the Royal Institute of Public Health, the National College of Food Technology, the Institute of Education, and the South East London Technical College, to see aspects of Port health workand to hear talks relating to their studies by members of the staff. Public health workers were also welcomed from a number of countries, including Australia, Burma, Denmark, Holland,Kuwait, Sweden, Turkey, U.S.A., and Yugoslavia. A party of members of the National Society for Clean Air were enabled to visit shipping in Tilbury Dock for the purpose of studying smoke control. In addition, assistance was given in training public health inspectors attached to the Admiralty. 36 APPENDIX 1 MEDICAL INSPECTION - From 1st January to 31st December, 1959 GRAVESEND Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total No. medically inspected 153 131 139 141 174 149 157 161 160 144 146 138 1,793 No. of passengers 528 547 760 464 1,404 4,426 3,312 3,354 2,595 822 503 272 18,987 No. of crew 882 875 504 455 1,019 345 305 527 1,151 500 601 1,048 8,212 No. of Foreign Arrivals 1,133 909 1,172 1,185 1,211 1,187 1,296 1,157 1,165 1,136 1,138 1,073 13,762 APPENDIX II INFECTIOUS DISEASES Disease 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 (a) Cases reported— Cholera (including suspected cases) - - - - - - - - - - Plague do. - - - - - - - - - - Yellow fever do. - - - - - - - - - - Typhus fever do. - - - - - - - - - Smallpox do. 4 6 - 1 1 1 - - - - Scarlet fever 7 3 - 2 - 2 2 2 1 4 Enteric fever 9 7 8 8 6 8 5 3 7 5 Measles 58 74 56 97 31 64 67 91 71 63 German Measles 17 67 13 6 7 5 3 7 25 2 Diphtheria - - 2 - - 1 - - 1 - Erysipelas 1 - - 1 - - 1 - - - Pulmonary tuberculosis 41 53 67 46 43 35 32 39 45 42 Other diseases (including Chickenpox) 114 130 128 184 347 368 212 1,328 659 313 TOTALS 251 340 274 345 435 484 322 1,470 809 429 (b) Admitted to Hospital— Cholera (including suspected cases) — — — — — — — — — — Plague do. - - - - - - - - - - Yellow fever do. - - - - - - - - - - Typhus fever do. - - - - - - - - - - Smallpox do. - - - - 2 — - - - - Scarlet fever - 1 - - - - - 2 - - Diphtheria - 1 - - - - - - 1 - Enteric fever 6 - 1 1 - 3 - 2 3 3 Measles 5 12 3 16 21 12 20 35 5 8 Mumps 1 13 4 2 1 10 5 3 7 - Dysentery - 1 1 - 6 6 - 1 4 7 Other diseases (including Chickenpox) 56 35 35 48 32 53 63 271 114 75 TOTALS 68 63 44 67 62 84 88 314 134 93 37 APPENDIX III RETURN OF RATS CAUGHT AND DESTROYED DURING THE YEAR 1959 Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total London Dock— Warehouses 53 26 14 39 116 124 43 54 154 131 157 67 978 Vessels - 12 - - - - - - - - - - 12 St. Katharine Dock— Warehouses — — — 1 — 1 — — — — — — 2 Vessels - - - - - - - - - - - - - Surrey Commercial Dock— Warehouses 4 10 — 17 8 46 9 5 — 1 3 2 105 Vessels - - - - 13 - - - - - - 5 18 Regent's Canal Dock— Warehouses — — — — - — — — — 1 — — 1 Vessels - - - - - - - - - - - - - East India Dock— Warehouses — 6 — 6 8 1 1 — — — — — 22 Vessels - - - - 2 - - - - 102 - - 104 West India Dock— Warehouses 26 7 10 8 12 17 24 28 32 9 8 27 208 Vessels 11 - 12 26 - 2 - 7 - - - - 58 Millwall Dock— Warehouses 14 9 15 26 13 6 11 10 — 8 12 8 132 Vessels - - - 43 - - 7 16 - - - - 66 Royal Victoria Dock— Warehouses 30 38 67 71 62 107 52 40 59 19 82 41 668 Vessels 9 15 - 15 3 2 10 4 1 21 82 36 198 Royal Albert Dock— Warehouses 9 5 14 11 5 52 16 10 26 30 13 4 195 Vessels 10 18 16 23 2 11 29 19 - 94 39 18 279 King George V. Dock— Warehouses 8 — — 16 16 6 5 — 5 3 18 10 87 Vessels 19 52 8 1 3 3 - 5 11 12 - - 114 Tilbury Dock— Warehouses 7 8 13 16 22 10 20 27 26 13 12 7 181 Vessels 17 33 155 61 3 133 107 47 197 77 31 38 899 River— Vessels 50 166 103 26 37 71 133 44 43 34 32 25 764 TOTALS 267 405 427 406 325 592 467 316 554 555 489 288 5,091 38 APPENDIX IV General Summary and Analysis of the Sanitary Inspections, etc., in the Port of London for the year ended 31st December, 1959 Foreign Going Inland Navigation Steam— Steam— Inspected 299 Inspected 10,944 Defective 4 Defective 154 To be cleaned 42 To be cleaned 429 Sail— Sail— Inspected 6 Defective Nil Inspected Nil To be cleaned 1 Defective Nil Lighters— To be cleaned Nil Inspected 1,221 Defective Nil To be cleaned 70 Coastwise Canal Boats Steam— Inspected 113 Defective 25 Inspected 1,612 To be cleaned Nil Defective 12 To be cleaned 24 Shore Premises Inspected 9,630 Sail— Defective 46 To be cleaned 226 Inspected 4 Defective Nil Sick Seamen referred to Hospital by Port Health Inspectors 46 To be cleaned 1 Inspections Dock and River No. Nationalities No. Total Inspections 1st January to 31st December 1959:— London and St. Kats. 849 American (U.S.A.) 198 Arab 2 Regent's Canal 592 Argentinian 23 Belgian 62 Foreign Going 10,944 Surrey Commercial 1,694 Brazilian 21 Coastwise 1,616 British 8,705 Inland Navigation Bulgarian 26 Inland Navigation i ,dzo East India 214 Chinese 1 Shore Premises 9,630 Costa Rican 6 Total 23,716 Danish 180 West India 1,139 Dutch 1,356 Eire 20 Finnish 256 Millwall 628 French 76 German 920 Royal Albert 1,434 Ghana 19 Greek 98 Guatamala 2 Royal Victoria 796 Honduras 3 Icelandic 5 Indian 33 Number of Vessels inspected in the Launches:— d King George V. 954 Iranian. 1 Israeli 18 Italian 71 "Alfred Roach" 687 River—Upper 687 Japanese 62 Kuwait 3 "Howard Deighton" Lebanese 10 River—Middle 724 Liberian 138 "Federick Whittingham" 1,411 Nicaragua 1 Nigerian 5 "Alfred Robertson" River—Lower . 1,289 Panamanian 52 Polish 34 Portuguese 16 River—Medway 1,253 Russian 143 Spanish 58 Swiss 13 Tilbury 1,833 Swedish and Norwegian 1,359 Turkish 24 Venezuelan 2 Yugo SIavian 64 In Docks, etc. 11,988 Total Vessels 14,086 Total Vessels 14,086 Shore Premises 9,630 Shore Premises 9,630 Shore Premises 9,630 TOTAL 23,716 TOTAL 23,716 TOTAL 23,716 39 APPENDIX V 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 68½ 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 Inspectors (Change of Designation) Act, 1956 Public Health Officers Regulations, 1959 S.I. No. 962 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. & O. 1925, No. 775; 1926, 1557; 1927, No. 577; 1940, No. 633; 1948, No. 1118 Public Health (Imported Milk) Regulations 1926. S.R. & O. No. 820. Public Health (Imported Food) Regulations, 1937 and 1948. S.R. & O. 1937, No. 329; S.I. 1948, No. 886. 40 FOOD (continued) 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 and 1957. S.I. 1955. No. 1906; 1957, No. 2157 Colouring Matter in Food Regulations, 1957. S.I. No. 1066 Antioxidant in Food Regulations, 1958. S.I. No. 1454. Fluorine in Food Regulations, 1959. S.I. No. 2106 Arsenic in Food Regulations, 1959. S.I. No. 831. 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 Poison Rules, 1958 SHELLFISH Public Health (Shellfish) Regulations, 1934, S.R. & 0. No. 1342. Order dated 23rd April 1936 made by the Port Health Authority under the Public 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 Dark Smoke (Permitted Periods) Regulations, 1958. S.I. No. 498 Dark Smoke (Permitted Periods) (Vessels) Regulations, 1958, S.I. No. 878 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. PUBLICATIONS OF THE PORT HEALTH AUTHORITY Corporation of London as the Port Health Authority of the Port of London: A Summary of Powers and Duties. Clean Food Handling. Social Services: Information as to National and Voluntary Organisations ready to assist the seafarer and his family. 41