Duties imposed upon port sanitary authorities

1913.

PUBLIC H E A L T H .

D U T I E S I M P O S E D UPON P O R T SANITARY AUTHORITIES. BiT J. W R I G H T MASON, M.B., C.M., D.P.H., M.R.C.S.E., Medical Officer of Health of the City and County and Port of Kingston-upon-Hull.

BY

the adoption of improved systems of administration based on enlightened principles of sanitary science, great changes in our national system have been brought about. Quarantine is now in oblivion, and the abandonment-of its restrictions has probably been one of the most powerful of t h e many stimulants which the cause of sanitation has ever received: Port Sanitary Authorities now have resort t o less stringent measures. Ships arriving from infected or suspected ports are now only detained at the boarding stations for the purpose of inspection and then only for a limited period. In the event of a case of cholera, yellow fever, or plague being found on board ship the vessel is ordered by the medical officer of health to the appointed mooring station. These stations are approved by H.M. Customs and the Local Government Board. Cases of other infectious disease occurring on board ship whilst in port must, under the provisions of the Infectious Disease (Notification) Act, 1889, be notified to the medical officer of health. T h e development of our mercantile marine service has brought us in closer touch with all nations of the world, and our risks and responsibilities have consequently increased. Hence the altered duties imposed upon us. As, in the case of urban districts, disease follows the course of canal traffic, and the tramp transmits infection by his migratory travels, so, with a Port Sanitary Authority, the many and varied routes of our ocean traffic are also sources of infection. Port Sanitary Authorities are constituted under Section 287 of the Public H e a l t h Act, 1875, and the Public Health (Ships) Act, 1885. Under these Acts the Local Government Board are authorised to constitute Port Sanitary Authorities, and to assign to them powers and obligations under the Public Health Act. There are over 6o Port Sanitary Authorities in the United Kingdom, and they act, as their name implies, as Sanitary Authorities for the various ports, and have exclusive jurisdiction in respect of the waters of such ports and ships thereon. Their duties are prescribed by orders of the Local Government Board, the chief of these being the treatment of sailors and other persons

195

suffering from infectious diseases on board ships, and the detection and prevention of nuisances, etc., on ships. A summary of the main duties which Port Sanitary Authorities are called upon to perform would not convey any idea of the amount of work necessary, and the time involved, in carrying out such duties. I will therefore describe as briefly as possible the many matters which come under the notice of a Port Sanitary Authority and require attention by them. The medical inspection and examination of the passengers and crew of all vessels arriving fro/n " i n f e c t e d " or "suspected" ports is of national importance, as only by this means can the importation of infectious and other diseases be prevented. Enquiries are made as to the illness, removal to hospital, or death from any infectious disease of any member of the crew; and as to the prevalence and mortality amongst rats, especially having regard to the measures taken to prevent the spread of plague. Bills of health are also carefully examined, and useful information is often gleaned therefrom. It would be a great advantage if bills of health were made out in one universal language--say English, or probably even better still, Esperanto - - f o r there are times when a medical officer of health requires linguistic knowledge to" obtain the information he desires. Much has been recently brought about by the confidential communications issued periodically by the Local Government Board setting forth particulars as to the existence of infectious disease at various foreign ports. These lists have proved to be invaluable to medical officers of health. The Privy Council formerly had powers to deal with certain forms of infectious disease. These powers no longer exist. A Port Sanitary Authority can direct the cleansing and disinfection of any ship or any part of it, or of any articles likely to retain infection, so as to prevent or check infectious disease; they may direct the destruction of any bedding, clothing or other articles which have been exposed to any infection from any dangerous infectious disease ; they may remove to hospital any person who is suffering from any infectious disease, and is on board any ship or vessel; should the patient object to removal, an order can be obtained on the certificate of the medical officer of health from any justice for compulsory removal; they m a y make ambulance and other arrangements for the conveyance of patients to, or their discharge from, the hospital.

196

•P U B L I C

The possession by a Port Sanitary Authority of a thoroughly equipped disinfecting station is a valuable asset. In Hull, where the local health committee own a disinfecting station, arrangements have been made for its use by the Port Sanitary Authority for a fixed annual sum. A ship's crew is removed to undergo bathing and disinfection, and their vessel (including the crew's quarters) is also disinfected during their absence therefrom. In the case of the discovery of an emigrant suffering from scarlatina, diphtheria or measles, the whole family is detained and removed to hospital as a precautionary measure. The clothing and effects of all deceased seamen should be thoroughly disinfected prior to their being handed over to the Board of Trade,

HEALTH.

APRIL,

Under these regulations, the medical officer of health, if he has reason to believe that any ship is " i n f e c t e d " or " suspected to be inf e c t e d " with cholera, yellow fever or plague, visits and examines such ship, and gives a certificate stating whether the ship is or is not infected with the disease. Every person on board is examined, and in the case of any person suffering from cholera, yellow fever or plague, or from any illness which the medical officer of health suspects may prove to be cholera, yellow fever or plague, the patient, if his condition admits, is removed to hospital, and instructions are given to the master as to the obligations devolving upon him. No person is permitted to land unless h e gives his name and place of destination, and'his address

EG~-So~
and a certificate furnished by the medical officer of health, certifying that such disinfection has been carried out. If, on the arrival of a vessel, the master reports having on board the dead body of a passenger or of a member of the crew, an inquest and post-mortem is invariably held. These precautions are sufficient to deal with the ordinary infectious diseases--smallpox, scarlatina, measles, etc., where it is not necessary to detain a vessel, but with cholera, yellow fever and plague other powers are required, and regulations dated the 9th November, 1896, and revised regulations dated the 9th September, 19o 7 , have been made by the Local Government Board with regard thereto.

at such place. The particulars are transmitted to the local authority of the district in which the place of destination of such person is situate. If a ship is not ascertained to be infected, but has passengers on board who are in a filthy or otherwise unwholesome condition, such • passengers are not allowed to land unless they give their names, addresses and places of destination. Our ports are subjected to great dangers by the large alien traffic landed thereat. Alien passengers are inspected immediately on their arrival. According to the annual report for 1911 of H.M. Inspector under the Aliens' Act, the number of aliens arriving in Hull was 47,136, 39,73 o of whom were transmigrants. The subjoined information shows the ports of departure

1913.

PUBLIC HEALTH.

from the United Kingdom of those transmigrants who made Hull their port of arrival :-Liverpool . . . . . . . . . 32,381 London and Southampton ... 4,646 Glasgow . . . . . . . . . 1,852 Bristol ......... 58o Dover ......... 264 Other ports . . . . . . . . . 7 39,73° The remainder--7,4o6--stayed in this country. The total number of transmigrants arriving in the United Kingdom during 1911 was 89,2o2, a decrease of 51,I51 compared with 191o. H.M. Inspector is of opinion that " t h e marked decrease was due to the somewhat depressed industrial Conditions prevailing in the United States." Regulations as to the precautions to be taken

197

concentrated with a view to the suppression or limitation of their numbers. Any unusual mortality amongst rats should be notified to the medical officer of health in order that enquiries may be made into the circumstances, and for a bacteriological examination to be made with a view to the diagnosis of the disease. Whilst ships are in dock discs are attached to the moorings or the ropes are tarred, so as to prevent rats gaining access to the docks and warehouses. The great need for precautions with regard to rats is often emphasised by the experience of Port Sanitary Officials. For instance, in 19o8 twenty-nine dead rats were discovered in a warehouse on one of the docks at Itull. The bacteriological examination, which was confirmed by the Local Government Board, showed

]~)AMAGED POTATOES,

with regard to the importation of rags have from time to time been made. A v.ery necessary precaution is the pumping out of all bilge water and water ballast before an "infected " or " s u s p e c t e d " vessel enters the dock. Perhaps there is no question of greater importance than that of the water supply, and provision is made in the cholera, yellow fever and plague regulations for the emptying and cleansing of a vessel's water tanks. Samples of water for bacteriological examination and analysis should be taken regularly, and the result of such analysi s and examination has often revealed the probable cause of disease. Seeing that it has been demonstrated beyond doubt that rats are the common media for the propagation of plague, efforts should be

them to have died from pestis. The men engaged on the unloading of vessels from India were medically inspected and kept under observation, and their names and addresses obtained. Fortunately there was no spread of the disease. Specimens of rats are regularly trapped and collected by our Port Sanitary Inspectors from various ships and warehouses, and are killed, disinfected and carefully packed in tin boxes and forwarded to our city laboratory. The sanitary condition and ventilation of crews' spaces, particularly noting their communication with paint lockers, ships' stores, etc., should receive the closest attention. In I9o7, the Public Health (Regulations as to Food) Act became law. Under this Act the Local Government Board made regulations as

198

PUBLIC HEALTH.

to the importation, preparation, storage and distribution of articles of food. Two principal sets of regulations have been made under this Act, viz. : - - T h e Unsound Food Regulations dated the i2th September, 19o8 , and the Foreign Meat Regulations of the same date. The effect of these is to throw upon Port Sanitary Authorities where food is imported the duty of examining all food which comes into the port, although it may be intended to be immediately put on rail and sent inland. This duty was hitherto only self-imposed. Trained inspectors have been appointed. Although no hours of inspection are defined in the regulations, our inspectors at Hull carry out these duties in daylight, and have found this arrangement very helpful to them. Were these inspections carried out at all hours, the

APRIL,

Government Board for examination and analysis by them. Various Port Sanitary Authorities are of the opinion that the extraordinary expenditure incurred by them in the removal to hospital of persons on board ships, and the inspection and examination of our foreign food supplies, is not a local but a national service. No contribution is made, as is often supposed, by shipowners, and thus the expenses of the Port Sanitary Authority fall on the locality. We assume that at Hull quite 98 per c e n t . of the imported food, etc., is despatched to inland towns and cities. In many cases whole cargoes are landed, and not one package remains at the port. The total quantity of foodstuffs condemned and seized at Hull during 1912 was 54 tons 17 cwt. 3 qrs.

POTATOES D A M A G E D BY CARELESS LOADING.

The Port Authorities consequently ask that possibility arises that articles of food might, some grant should be made to them from under varying light, escape detection, and, if the Imperial Funds. Representations have Sent inland, consequently become the subject already been made to the Chancellor of the of much criticismelsewhere. In support of m y Exchequer and it is not too much to hope that contention that the hours of food inspection in the near future some arrangement may be should be defined, I may say that in Hull no come to whereby relief will be given to Port complaints have been received from other Sanitary Authorities in respect of this expendiauthorities with regard to food supplies preture. Seeing, therefore, that the health of a viously examined at Hull having been found nation takes precedent in all things, and that unsound on arrival in their district. Commerce and industry are subservient to it, The danger of the spread of disease from it behoves us to be ever-ready as in a state of oysters and shell-fishis recognised, but present siege ; there must be no laxity, for it is during legislation does not give us powers to control such times as in the absence of epidemics the supply of foreign oysters from whatever that we are apt to be too self-confident of source. Bacteriologicalexaminations of batches our immunity from invasion by disease. are made periodically, and the result often goes I Such self-confidence would, in the case of an to confirm the suspicion. I epidemic making a sudden appearance, only Samples of food are from time to time lead to distrust in the Authority concerned. obtained and submitted to the Local

P U B L I C I-,2EAZTH.

1913. TABLE

SHEWING

Port.

PRINCIPAL

Import,

FOOD IMPORTS 3908.

LONDON-Grain . . . . . .

19o9.

199 AT OUR

CHIEF

191o.

PORTS. 1911.

L

L

£

16,9II,OOl 12,358,334 IO,482,r28 6,737,912 6,611,257 5,235,432 3,43o,oo 4 2,684,233 2,o91,163

I9,2oi,724 13,2oo,463 Ii,334,694 7,499,732 5,802,543 5,341,246 3,432,751 2,262,099 2,ii5,t82

17,22o,763 i6,35o,946 II,I2O,493 8,632,689 8,o18,3o8 5,684,311 3,57%1oo 1,866,i97 2,i82,464

16,949,321 i5,846,oi 3 "12,633,979 9,250,437 8,936,786 6,Io5,o66 3,763,5o3 1,941,232 2,399,822

15,268,485 I5,458,262 4,I26,319 3.513,145 3,059,699 1,712,572 1,264,581

I6,22I,O77 I4,to8,76o 4,o37,626 4,o15,o24 2,473,366 1,8o6,374 1,257,I42

16,IOI,IO7 I4,294,25I 4,135,791 4,554,492 1,619,187 1,738,335 I,i41,834

14,453,833 15,oo3,813 3, i96,95o 5,262,933 1,524,876 1,537,94I 1,277,i69

II,r44,227 3,o51,634 1,315,496

. . . . .

8,730,537 3,428,559 1,162,753 1,I56,o32 864,278 631,842 592,256 469,463 473,5Ol 330,551

993,151 660,547 682,I9I 632,733 532,289 379,904

9,895,771 3,303,743 1,514,o67 1,389,998 I,o89,o76 611,921 690,707 967,45I 537,839 341,174

io,143,969 3,175,943 1,554,279 1,517,o49 1,25t,o22 518,578 639,145 702,593 521,949 319,616

Meat . . . . . . Butter . . . . . . Cocoa and Coffee Grain . . . . . . Vegetables . . . . Fruit . . . . . .

3,383,23t 2,426,I84 1,338,533 423,611 732,729 616,822

3,o14,47o 2,357,89o 1,219,i74 738,719 664,328 566,759

2,526,o42 2,o81,6o 9 I,Oi7,I34 600,772 491,69o 529,611

2,52i,i29 i,oo8,752 1,I98,273 5o3,15I 551,9oo 642,069

2,897,977 2,558,Ol 4 1,36o,844 1,1oi,526

3,1o8,8o3 2,472,057 1,518,838 1,o48,596

2,526,542 2,554,559 1,49o,731 1,o21,55o

2,902,857 2,525,586 1,976,o94 1,184,o79

4,251,741 I,I96,24o 650,855 441,564

4,747,062 I,I96,223 659,964 328,899

4,248,663 1,o5o,639 644,524 191,984

4,258,8o5 1,195,936 768,432 lO9,55o

5,283,o44 1,646,266 I,I56,318 671,253

5,285,303 1,592,3o6 1,126,721 643,418

5,32o,488 1,455,2II 1,I62,79o 708,931

5,413,o78 1,5o2,38o 1,291,614 534,394

2,963,I67 852,453 795,035 9o2,541 46o, 867 365,791

3,641,33o 995,986 977,257 879,I48 473,299 440,664

3,795,285 I,I7O, I25 882,991 907,378 305,21 o 261,595

3,799,888 1,o57,33I 781,66o 957,839 23 i, 893 322,966

4,359,351 1,1o8,881 889,748 788,315 579,502 285,904 256,059 207,296

5,19o,964 1,15%993 914,175 734,I95 470,996 268,OOl 199,o31 97,841

5,117,857 1,36o, I47 981,394 722,472 366,047 269,636 I09,I91 60, 799

4,906,489 1,365,626 1,oo6,M8 937,292 574,I44 31o,24 ° 158,219 186,666

2,462,346 1,412,595 519,967 383,453 152,379

2,26o,814 1,5o6,31o 551,342 363,645 2oo,o82

2,225,259 1,352,991 643,o~o 363,385 221,958

2,413,o87 1,293,851 704,203 455,598 223,425

. . . . . . . . . . . . . . . .

3,118,868 374,713 444,836 21o,3o2

3,I4o,572 379,225 315,96c~ 231,562

3,124,154 465,297 311,878 324,022

3,374,441 589,892 326,436 294,053

Grain . . . . . . Meat . . . . . . Vegetables . . . . Fruit . . . . . .

2,451,6o8 238,896 139,926 44,353

2,589,I56 239,441 135,862 57,787

2,883,505 254,IO8 93,169 49,744

2,684,473 281,133 134,457 60,346

Meat . . Tea . . Sugar . . Butter . . Fruit . . Cheese . . Animals Eggs . . LIVERPOOL--Grain . . Meat . . Fruit . . Sugar . . Animals Lard . . Cheese HULL-Grain . . Butter . . Meat . . Eggs . . Sugar . . Fruit . . Fish . . 5~argarine Lard . . Vegetables

. . . . . .

. . . . . . . . .

. . . . . . . .

. . . . . . . . .

. . . . . . . . . . . .

. . . . . . .

. . . .

. . . . . . .

. . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . . .

1,274,I47

SOUTHAMPTON--

..

LEITH-Grain Butter Sugar Eggs

. . . . . . . . . . . . . . . . . . . . . .

GLASGOW--

Grain . . . . . . Meat . . . . . . Fruit . . . . . . Animals . . . . HAkq,WICH--

Meat . . Butter . . Eggs . . Ivlargarine

. . .

. . . . . . . . .

. . . .

MANCHESTER--

Grain . . . . . Sugar . . . . . Lard . . . . . Fruit . . . . . Animals . . Meat . . . . . BRISTOL

. . . . . . .

--

Grain Sugar Cheese Fruit Meat Lard Cocoa Butter

. . . . . . .

.

. . . . . . .

.

. . . . . . .

. . . . . . .

.

.

.

. . . . . .

. . . . . .

.

.

.

~TEWCASTI~E--

Butter . . . . . . Grain . . . . . . Meat . . . . . . Eggs . . . . . . Sugar . . . . . . GRtMSBY--

Butter . . Meat . . Eggs . . Margarine CARDIYF--

PUBLIC H E A L T H .

200 TABLE

COMPARING

FOOD

CHIEF

PORTS,

SHEWING

AND

I9o4,

LonDoN--

IMPORTS

£

Total Imports .. 174,475,676 Food Imports :. 67,620,504

THE

OF

TOTAL

IMPORTS

INCREASE

I9o7 .

[

181,o61,265 77,631,236

THE

RATE

I9O6.

19o5.

£

WITH

APRIL,

t9o8.

Z

AND

19IO.

£

I9I I.

£

i95,329,o43 205.639,879

I99,4o7,3II 2o9,672,562 72,702,835 74,864,461

DECREASE.

19o9 .

£

AT THE

74,3t8,7o7

8r,753,8i 3

228,26o,188 86,736,73 °

229,988,484 88,823,802

I6O,4o5,i83 14o,635,ooo 52,,74o,846 47.093,893

148,596,75 ° 47,389,221

17o,27o,246 46,6o9,863

I59,914,782 45,446,339

39,629,597

42,282, o26

LIVI~RPODL--

Total Imports Food Imports Hut.L-Total Imports Food imports

.. ..

137,523,276 49,332,556

~39,295,487 I46,7or,65 o 5L313,269 52,415,178

.. .,

3t,858,73o 16,775,o8o

32,545,886 35,557,397 17,139,857 17,429,3o5

39,603.363 I9,236,215

35,338,69o i8,192,495

2o,544,o6o 21,298,o48

41,o82,231 21,341,277

Total I m p o r t s . , Food Imports .,

21,468,225 4,975,415

23,290,796 5,o24,It9

26,536,274 5,634,oo9

30,402,229 0,496,657

25,647,640 6,719,i34

28.943,444 7,971,958

29,944,9°5 7,8oi,734

32.502,945 7,625,568

I5,586,75o 7,98o,715

I5,342,346 7,437,876

16,518,244 2o,161,486 7,252,985 8,406,600

2o,oi1,756 8,624,665

21,449,767 9,618,46r

21,286,io 5 8,133,961

20.764,972 7,395,798

.-A/IANCHESTER-SOUTHAMPTON--

Total Imports .. Food Imports .. HARWICH--

Total Imports .. Food I m p o r t s . ,

~8,494,579 i8,i97,675 9,335,304 8,490,654

I9,OI4,4II 8,824,483

18,958,169 19,444,348 9,616,262 9,843,289

19,824,2oo 9,822,538

2I,I52,857 9,856,777

22,437,602 IO,I92,379

I4,946,oo6 6,617,71t

14,294,42i 7,275,1oo

15,396,381 7,6oo,258

15,2o4,846 i4,25o,32i 7,9o8,289 7,io5,912

i4,267,67o 7,636,454

i4,533,33o 7,099,963

15,63t,I49 7,258,822

.. ..

11,87o,8o9 7,687,092

I2,O9O,974 I2,897,273 7,980,432 8,367,26o

I3,5II,759 8,61o,993

13,644,676 8,418,226

14,392,176 14,991,615 9,432,74 ° 9,16o,267

.. ..

~3,255,~86 12,754,o72 7,694,993 7,924,342

I3,628.o73 9,5Ol,265

13,875,588 8,207,456

12,883,89o 8,556,205

i3,658,737 8,993,I22

13.559,655 15,o54,221 8,335,903 9,373.759

lO,i55,2o9 3,197,668

lO,687,421 3,I65,396

II,I22,293 11,112,568 3,868,395 4,329,7It

to,913,713 4,608,242

11,489,149 4,489,87I

12,615,959 4,587,246

Io,761,27o 745,398

lO,432,2o3 7Ol,889

I1,331,o97 Io,2o2,o53 649,262 527,818

GLASGOW~

Total I m p o r t s . , Food Imports ,, BRISTOL--

Total Imports Food Imports LmTH-Total Imports Food Import,

I5,55%5o6 9,715,6c9

GRIMSBY--

Total Import~ .. Food Imports ..

13,544,I25 5,t4r,554

]~OLKESTONE--

Total Imports Food Imports .. NEWCASTLE-Total Imports .. Food Imports .. ..

CARDIFF--Total Imports.,

Food imports ..

TABLE

9,785,I59 lO,OO8,946 lO,O68,224 13,o22,682 711,782 8r9,564 77o,218 962,088

lO,O55,619 6,146,133

9,I54,268 5,I83,216

9,893,t24 5,235,078

lO,361,3o5 6,869,940

9,423,983 5,573,463

9,048,035 5,502,492

9.442,944 5.424,098

9,784,592 5,746,806

4.884,295 2,298,346

5,173,437 2,541,67I

5,406,031 2,303,355

5,521,749 2,502,879

5,807,777 2,854,177

5,853,477 3,o74,I49

6,375,to6 3,326,144

6,oi6,772 3,211,689

SHEWING

DIFFERENCES

IN

COUNTRY

THE

THE

PRINCIPAL

AMOUNTS

IN THE

OF

SIX YEARS

PRODUCING FOOD

COUNTRIES

IMPORTS

AND THE

PRODUCED

FOR

THIS

19Ol , 19o7, 19o8, 19o 9 , 191o AND 1911.

(With acknowledgments to DR. DEARDEN, Port Medical Officer of ttealth, Manchester.)

Country.

19Ol.

19o7.

61.422,o52 zi,38I,lO8 lO,493,772 lO,321,914 8,908,059 13,o59,917 13,378,656 t3,3o7,9o3 I~,443,514 I2,627,oo9 2,732,063 4,636,519 4,254,114 I.O87,828

47.573,092

£

United States oLA.merica .. South and CentrM America .. A11stralia and New Zealand .. Russia . . . . .... India •. Denmark . . . . •. - Canada . . . . •. Germany . . . . •. Netherlands .. •. France .. •. Roumania .. .. Spain .... •. Belgium . . . . .... .... Sweden . . . . . ,

Totals

.. 179,o54,498

[

24,652,958 16,2o8,o65 15.237,744

15,797,659 17,797,437 21,594,763 13,62o.538 t2,o28,948 9,479,65I 4,o28,99I 5,o6I ,713 3,71o,837 1,638,795 2o8,431,191

19o8.

£

45,778,612 34,816,8o5 13,58<2,758 13,3o1,o66 9,548,245 I8,962.483 20 3o6,782 I2,574,651 I2,758,31o 9,361,652 2,466,997 4,613 , o 6 5 3,63@559 1,966,987 2o3,681,972

19o9 .

£

4o,171,224 33,880,283 I8,466,I3O 21,412,39o x5,45o,329 18,279,56o 19,254,54 ° 12,493,525 11,434,793 lO,822,4o6 2,614 ,078 4,823,767 1,65o,oi I 2,o68,5o2 212,821,538

I9To.

£

32,699,978 34,060,384 24,o6~,388 24.821,297 16,852,917 .~8,87I,I31 I9,I92,I83 lO,818,954 12,341,979 9.968,536 2,846, 684 4,867,966 1,818,988 2,3o7,549

215,529,934

1911.

£

34,413,I76 28,1Ol,989 23,666,148 23.59o,I6O I9,859,235 19,853,423 14,192,916 12,672,715 12.364,436 8,896,694 6,064, I93 5,57o,148 2,632,723 2,550,704 214,428,66o

1913

PUBLIC

HEALTH.

9,0t

F

.

C;A~

E.

~ .'r

R

A

N

C

"¢:

t~

"1

h h

PLAN OF T H E

HULl. DISINFECTING ~TATION.

202

•

PUBLIC H E A L T H .

DISCUSSION. THE PRESIDENT said that this paper was an exceedingly interesting one, and they would have listened readily if Dr. Mason had amplified his points still more. At the same time, Dr. Mason had touched upon a great many, most of them really vital points; his references to the defunct quarantine regulations and the substitution of medical inspection for them. H e wondered if sanitary authorities ever stopped to consider how it was that the country remained so long free from smallpox at a time when they unhappily saw a growing disregard of vaccination. T h e y were told that while vaccination was declining smallpox was disappearing; but those who said so failed to realise that it was to the efforts of the sanitary authorities at the ports of entrance that the disease was arrested. It probably came to this country as frequently as ever it did, but thanks to the methods adopted by the sanitary authorities it remained at the ports and did not find its way, as it formerly did, into the inland districts of the country. On arrival at the ports patients suffering from smallpox were removed to hospital, whilst contacts were cleansed, disinfected and vaccinated, and the consequence was t h a t the country had enjoyed a very long immunity from that disease. In regard to the other formidable forms of disease alluded to, he felt very strongly that the international agreements arrived at in the Conventions held in Paris and Vienna should be rigidly adhered to. As a matter of fact it was known that they were not always, and that some of their foreign friends were apt to be scared too easily into devising preventive measures of a vexatious and useless kind. Probably they suspected that something existed that did not exist. These were matters of great public moment, and if the nations agreed amongst themselves upon a certain line of policy--to conceal nothing, but let everything be k n o w n - - i t was the duty of them all to abide by these regulations. This led to the extremely important question of how to deal with rats. H e thought that in all parts of the country, in the inland districts as well as in the ports, the sanitary authorities were beginning to realise the important part which the rat could play in the spread of disease. Unhappily they could not rely on discs and tarred ropes to prevent rats from coming ashore from ships. I t was known that rats could climb over discs 15 inches or more in radius, by first jumping up to the top of the disc and then jumping down on the other side, so that that line of defence was unreliable. T h e real defence was the destruction of the vermin, and an appreciation of the fact that commerce and sanitation must go hand in hand. If the shipping community only realised that, he was sure they would give every possible help in destroying these vermin. Dr. Mason had suggested the use of a uniform language for bills

APRIL,

of health, such as Esperanto. H e was afraid they would not live to see that, but what could be done was their translation into what was after all almost a universal language, viz.,'French. T h e translation of bills of health into French was a very great facility, and the practice was becoming largely adopted. H e did not know whether it was done in other English ports, but in Liverpool many shippers required their certificates in French, and they had much pleasure in giving them in that or any other language the people thought necessary. H e complimented D r . Mason on his methods of dealing at Hull with rejected emigrants and those who needed or desired disaffection, and it was to be wished that these methods were adopted in all our other ports. DR. HERBERT WILLIAMS (medical officer of health for the Port of London), also wished to t h a n k Dr. Mason for his admirable paper. H e quite agreed with the President that it erred on the side of shortness, although he appreciated Dr. Mason's position when dealing with such a wide subject. T h e difficulty was that when once a man began :upon it it was difficult to know where to end, and so probably it occurred to Dr. Mason to only give an outline and allow others to fill in the gaps. H e agreed with the President that bills Of health were as a rule put into French, but looking at the matter practically he did not think they were of much value. T h e information had to be obtained from the consuls; and British consuls in foreign parts, he was afraid, did not take that interest in their work which they ought to do. T h e y were more concerned in signing and filling up forms, a n d looking at the value of the stamps to be imposed upon them. W h a t was more important was the necessity for more information as to disinfection and disease in foreign ports. In this respect our own Government fell behind the United States of America, which sent out from Washington every week an admirable little pamphlet giving an absolutely authentic record of the infectious diseases which had occurred in different ports up to certain dates. Its use was invaluable, and if our Consular service were better organised we could get similar infor. marion through our Government departments. W i t h regard to grants from Imperial funds to the Port Sanitary Authorities, it was quite true that the work done by these authorities was for the benefit of the country at large, and that the bulk of the cargoes and of the persons which were landed in London were immediately distributed to different parts of the country, and might spread infectious diseases. In London they were debarred from raising this question, as there was a clause in the Public Health Act of I89I which provided that all the cost should be paid by the Corporation of the City of London out of its private funds, and not a penny was paid by the

1913.

PUBZIC

ratepayers either in the city or county of London. T h e President had touched on an important point with reference to the International Conferences. The difficulty which this country had to fight against in entering these Conferences was this : Foreign countries, which had not so important a maritime commerce as we had, were anxious to impose restrictions on this country, while we entered into the Conference with the desire of making the restrictions no more than was absolutely necessary to protect public health. Foreign countries were liable to judge of the state of public health by the amount of sanitary inspection done in the ports of this country. T o illustrate his point he might say that if a foreign country knew that at any port in this country the sanitary authorities were not carrying out strict inspection, it would at once impose all sorts of restrictions on our commerce. And it could be imagined what that meant to the trade of ports like London, Liverpool and Hull! In these days of keen competition in the shipping industry, on a vessel's arrival in port there was a rush t o g e t the cargo out, a new cargo loaded and the vessel sent to sea at once in order to earn money. I f a ship went from England to a foreign port and the authorities there liked to say that in such a port from which it had come the sanitary authorities were not doing much in the way of medical inspection, or the destruction of rats, they could insist on t h a t vessel being moved out into the stream, and on the holds and cargo being fumigated irrespective of any damage that might be done thereby. Further, they could insist on all the cargo being discharged into lighters, a process which would involve a whole week instead of three days, had the ship been in dock or at the quay side. All this involved additional expense and the loss of four days. T h a t led him to emphasise the point that the port regulations which might be framed in this country must be carried out strictly to the letter, not only for the protection of our public health, but for the protection of English commerce abroad. Under the Board of T r a d e regulations the Port Sanitary Authorities had ample power to deal with cholera, plague and yellow fever. Ships on which these diseases were suspected could be held up, and everybody on board examined. T h e y could insist on the names of passengers with their addresses being given and a heavy penaltycould be imposed on those refusing or giving false addresses ; and if the authorities were not satisfied the passengers could be detained on board. But it seemed to him that some additional powers were required to enable the sanitary authorities to deal with smallpox. For instance, a vessel might arrive from Spain after a voyage of six or seven days. Now, almost every port in Spain was infected with smallpox, but all that the sanitary authorities here could do was to ascertain

HEA LTH.

203

that no one on board had smallpox on arrival. Passengers might disembark and go to different parts of the country, there develop the disease and become at once the means of spreading it. H e knew of a case where a man landed in London from a ship from Spain apparently quite well and went up to the vicinity of LiverpooI where, the day after, the disease developed and other persons were infected by the patient. Other passengers went to Gloucestershire and Kent and developed smallpox, thus each one became a potential factor in spreading the disease. T h e rat question was also very i~nportant. As members were aware the Local Government Board, two years ago, issued an order which gave power to Port Sanitary Authorities in cases where there was a suspicion of plague existing either in rats or persons on board ship, to " t a k e m e a s u r e s " for the destruction of all rats on board ship and for preventing rats from entering buildings on shore. In other words, they were to make the buildings rat-proof. It was very easy to make such a regulation, but extremely difficult to carry it out. In the first place what was meant by " m e a s u r e s "? " M e a s u r e s " was a very general term indeed. I t might mean giving instructions to someone to do something, or entering into negociations with somebody to do it, or to take upon themselves the expense of destroying the rats. Some Port Sanitary Authorities were taking more active steps than formerly in destroying rats and having them bacteriologically examined. All this meant a very h e a v y expense to these authorities, for they could not get the examinations done for nothing. Moreover, it was dangerous work, and had to be accomplished by competent skilled bacteriologists in properly eqaipped laboratories, where the "investigations could be conducted without the danger there would be in a private house. He anticipated that the expenditure in that respect in the P o r t of London would be between ~r4oo a n d ~5oo this present year, in order to say definitely ,~,hether there was, or was not, a cage of plague among the rats found in the port. T h e r e was a difficulty in preventing the rats getting on shore. T h e y were most intelligent and cunning animals, and if they wanted to get on shore they would do so in spite of precautions. There was only one thing to do and that was that the ships should be fumigated with some lethal gas, so as to destroy all noxious life on board. It was possible that when new regulations came to be framed to comply with the conditions agreed to at the International Conference held in Paris last year, they would contain additional powers enabling Port ~ Sanitary Authorities to deal with the fumigation of ships. In his opinion ships should be fumigated every six months, and if t h a t were done they would remain practically free from rats during the interval between the fumigations. But this duty

2Od:

PUBLIC

would involve great expense, for ships could not be properly fumigated by taking a few pots of sulphur down into the holds. An expensive plant was required for developing the sulphur dioxide and pumping it into every part of the ship. An extremely efficient apparatus had been recenlly put upon the market to draw the carbon monoxide and carbon dioxide from the funnels of steamers for fumigating purposes. These gases were first passed through scrapers to get rid of the soot, and were lethal [o the rats. But they did not kill the flea, and it was no use in having any gas which did not kill the fleas. T h a t only added to the risk, for once the rats were dead the fleas sought the nearest living creature in order to obtain nutriment. These were the chief points which had occurred to him in listening to the paper, which was of very much interest. In reply to an enquiry, Dr. H e r b e r t Williams said that t h e a p p a r a tus was the invention of Dr. Harker, a Doctor of Science of London University, who had been practising in Australia as a chemist. H e had devoted his attention to this a p p a r a t u s for some years, and it was in use in the United 'States of America at the present time. H e had had a talk with Dr. Harl
HEALTH.

APR:L,

like Hull, were well equipped for carrying out the duties devolving upon them, and it would be desirable if Riparian Authorities were equally prepared for emergencies which might arise. At Dover, regulations for fixing a boarding station for dealing with all cases of infectious disease occurring on board vessels have been prepared and submitted to the Local Government Board for approval. DR. TUBB-THoMAs (Wiltshire) pointed out that the smaller ports in the country felt the pinch of lack of funds in order to protnote efficiency of sanitary inspection of ships arriving there. In the large ports which had heavy port dues and other sources of revenue it might be possibIe for them to do without Imperial assistance; but in the smaller ports to which smaller ships resorted the danger from imported disease was very great, and some help from national funds should be given to them. It was quite possible, however, that more active and serious restriction on shipping would be resented by the shipowners. M a n y years ago he had something to do with a small port, but proper and efficient sanitary supervision was practically beyond their means. DR. HERBERT JON~S said that medical officers of health received at more or less irregular intervals information from Port Sanitary Authorities that certain individuals from infected shipswere coming to their district, and v e r y likely the port authorities thought that no use was made of that information. As a matter of fact, they did make use of it, and sought out the people as far as they could, and put them under observation. He believed the port authorities did all they could to get the correct addresses of the men and women ; but sometimes a person would say " Oh, I live in Bloomsbnry." T h a t was not sufficient. T h e y could hardly trace a man by simply being given the address " B l o o m s b u r y . " If it were possible the man should be asked where a letter should be addressed to him. T h a t would be great help to the medical officers of health in tracing the migrants; and allow of cases being followed up, and a record being kept of them, while it was an education for the people themselves. DR. WRIGHT MASON, in replying on the discussion, said that the object of his address was to lead to an interchange of thought and ideas. H e had been much satisfied with the discussion, especially with regard to disinfection, and the new ideas suggested by Dr. H a r k e r ' s experiments. It was highly necessary that the disinfection of ships should be carried out with the utmost efficiency. T h e President had alluded t o the spread of smallpox. T h e only power that port medical officers of health possessed as to smallpox was that the vessel should be disinfected, and that the men should be recommended to undergo re-vaccination. The names and addresses of the

1913.

PUBLIC

crew are taken and forwarded to the medical officers of health of the respective districts in which they reside. The men on being paid off went north, south, east and west, and he instanced one ship in which four distinct cases of smallpox developed in different parts of the country after the men had been disinfected and received their discharge. There was difficulty with regard to emigrants from tile Continent, who were a g r e a t source of anxiety. Take the case of Russian Jews who came to Hull from Libau. On disembarking at Hut1 they departed immediately for Liverpool. Some might develop smallpox at Libau, some at Hull, and others only after arriving at Liverpool. Some time ago he made inquiry as to tbe accuracy of the names and addresses of persons arriving at Hull. He always asked for postal addresses, and taking them all together he found that they were fairly correct. =-

A WATER-BORNE TYPHOID

EPIDEMIC FEVER.

OF

By DI~. DANTE Dt?. BLASt. Am~cdi d'fgieJte Sperimepztal¢, Vol. 22, Page iii, i9~2.

THE writer gives an interesting account of a serious outbreak of typhoid fever occurring in March, 1912 , in Albano, involving over 46o people, and due to a leak in the joints of the water-conduit supplying the district. The leaking point was in close proximity to a house occupied by one who had been ill with typhoid fever two or three weeks before the beginning of the outbreak, of which therefore he was presumably the source. The nature of the epidemic was recognised bacteriologically before the symptoms were sufficiently clear for a clinical diagnosis. Blast is enthusiastic regarding the value of direct culture of the organism from the blood as a valuable means of diagnosis. A study of his series of 29 cases examined by culture and by serum reaction simultaneously shows, however, that, of duplicate samples of blood, 17 gave a positive serum re. action (Widal's test) as against 11 which gave typhoid bacilli in culture. The culture tests afforded no clear indication that they gave positive results at an earlier stage of the disease than did the serum test. THa CHILD WELFARE CODE of the State of Ohio, U.S.A., includes the following enactments : - - " A l l children attending any of the public schools of the State of whatever grade shall be inspected as to their physical condition, including their lungs, at least once during each school year. Teachers having positively open pulmonary tuberculosis or other communicable disease cannot be re-employed at the expiration of their c o n t r a c t - - t h e y may be suspended pending recovery.

ERRATUM.--HulnaIz Tubercle Bacilli in the M i l k of a Vaccinated Cow, p. 176. Third line from bottom of first column should read " f o u r days old."

205

HEA L Ttt.

THE

PLAYGROUNDS OF PUBLIC ELEMENTARY SCHOOLS.

REPORT OF THE DEPARTMENTAL C("~.MMITTEE.

terms of reference to this T H Ewhich included amongst others

committee, Sir George Newman, chief medical officer to the Board of Education, were to determine whether or not the standard of playground accommodation, viz., 3o feet per head of accommodation, should be modified according to the size, design or situation of the school, the proximity of recreation grounds or open spaces, tile density of the population, the cost of land or otherwise ; and how far it is desirable to define more precisely the standard of playground accommodation, or to regulate the practice of the Board of Educatiou in dealing with cases in which the playground accommodation is considered to be insufficient. Having heard a number of witnesses, a few of whom were medical men, the committee have reported and made a number of recommendations. In the case of new schools they advise that the shape of the playground should be more carefully scrutinized, and that passages, forecourts, etc., should not be counted as forming part of the minimum space required. Except in very small schools, playgrounds should be separate for boys and girls, but playgrounds for girls and infants need not be separated provided the area is sufficient for the total number of children. If other provision is made for games, an undivided playground should provide 20 square feet for each older child and 16 square feet for each infant. If there are less than 20o children the provision should be 2,o0o square feet, plus io square feet for each older and 6 for each younger child. An undivided playground where there is no other provision for games should give, when the children number over 2o% 3 ° square feet and ~6 square feet per head of the older and younger children respectively. If the numbers do not reach 2oo, there must be 2,o0o square feet and 20 square feet for each older and 6 square feet for each younger child. When a site is expensive the Board of Education should be allowed to grant modifications, but each case is to be treated on its merits, and though measurements less than those for the undivided playground when no other provision for games is made may be allowed, nothing less than those stated for the undivided playground with other provision for games is to be permitted. In the case of the existing school it is recommended that every school should have space for each class to take its lessons in physicai exercise~ in the playground or an equivalent space. After 192o a playground allowing less than *o square