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States of America), also that this general definition of "endemic areas" should
replace the various definitions, differing from country to country, which had
previously been employed.
The Airport Medical Officer (or the customs officer or immigration officer on
his behalf) should, as a matter of routine, ask to see the International Certificates
of all travellers (whether in transit or not) arriving directly by air from:—
(a) any place in Asia, Africa or the Americas (excluding Canada and the
U.S.A.).
or
(b) any smallpox-infected local area wherever it may be.
He should also continue the existing arrangements for issuing warning notices
("yellow cards") to all such travellers.
Travellers defined in (a) and (b) above who do not possess valid International
Certificates or who do not show sufficient evidence of protection by a previous
attack of smallpox should be offered vaccination and, unless they are in transit,
placed under surveillance in accordance with Regulation 31 of the 1952 Regulations.
If travellers defined in (b) above refuse vaccination, then unless they are in transit,
they should be isolated for fourteen days from the date of their departure from
the infected area, or for the length of their stay in this country, whichever is the less.
During the year 8 possible contacts have been placed under surveillance. All
cases remained free from infection during the ensuing critical fourteen days.
Leptospirosis (Weil's Disease)
In October, 1963, I was informed that a man was in hospital suffering from
Weil's disease.
He was employed as a sewerman and was assisting in rebuilding an old sewer
in another Borough. The Medical Officers of Health for the Borough in which he
was working and where the employer's offices were situated were notified.
In November, 1963, I received a message from a hospital in the Borough that
they had admitted a man from Hampshire suspected to be suffering from Weil's
disease. He was stated to be employed in kennels. The Medical Officer of Health
for Hampshire was notified. The patient was later transferred to another hospital.
Details of a case of this disease involving the death of the patient were given
in last year's Annual Report, and in view of the fact that there had been three cases
of this disease within twelve months it was arranged that letters should be sent to
all builders in the Borough warning them of the seriousness of the disease and of
the precautions which should be taken. It was also agreed that the cards issued
to the Council's sewermen should be amended and further information given to
them.
Several Builders in the Borough requested further information and permission
was asked for our letter to be used by other Medical Officers of Health.
Tuberculosis
Twelve years ago the principles of modern treatment for tuberculosis were in
their infancy and were applied to a minority of cases only. These methods of
treatment are now well tried and established, forming a major part of the work of
the Hammersmith Chest Clinic. Every patient with active tuberculosis now receives
the benefit of treatment which very rarely fails to control a disease which previously
carried an appalling mortality rate.
However, the number of cases on the register remains fairly constant indicating
that a reservoir of infection still remains. Various theories are advanced in support
of different views. One school of thought considers that adolescence is the danger
period as many children still do not receive B.C.G. vaccination. It is also
considered in some quarters that the main reservoir of infection is in the elderly