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19
TUBERCULOSIS ON SHIPS.
The recent statement by Mr. Justice McCardie on Tubercle infection will go
a long way towards that instruction of the public in matters of " infection " which
is the necessary precedent to any very large amelioration of the conditions under
which they live and die.
It will be more generally received, as being the judgment of one of the laity
whose words were well weighed and in accordance with the medically known facts.
The bacillus of consumption—the tubercle bacillus is difficult to kill because
of an envelope of fatty material which prevents to a certain extent the entry of
disinfectants into its body.
This protective coat on the other hand, prevents the drying out of the tubercle
bacillus so that it can persist outside the body for many months in the living and
infective state.
The difficulty of killing the tubercle bacillus inside and outside the body by
agencies natural or artificial is largely dominated by the protective coat. This
difficulty outside the body is intermediate between that for the germ of erysipelas
and that for the heavily-coated anthrax spore, being much greater than for the one
and much less than for the other.
The variable period of incubation of tubercle within the human body is prolonged
to such an extent that the original source and time of infection become often
only matters of speculation.
The immunity to attack of individuals placed under the same conditions varies
widely and in general increases with age. Immunity also varies for the individual
according to his state of resistance, a complicated state summed up in the term
"health," at the times of exposure to attack.
These variations in and prolonged incubation after infection have clouded the
eye of the public as to the infectious nature of the disease.
Attention is now justly directed to one of the sources of infection in tubercle,
i.e., infected premises.
The procedure of the Port of London Sanitary Authority for upwards of ten
years has been to notify cases of tuberculosis introduced into this country through
the Port to the Medical Officers of Health of the district in which the addresses of
destination of the cases are situated, and to disinfect the cabin or quarters occupied
and infected on ships.
The notifications have included cases of pneumokoniosis (silicosis, miners'
phthisis, knife grinders' disease), because in times past these cases have been recognised
to be frequently complicated by tuberculosis. Certain recent experiments
have shown that a state of silicosis renders animal tissues receptive of the tubercle
bacillus and is conducive to the growth of the bacillus in otherwise immune subjects;
thus such notification is justified in order that the tuberculous element in
a case of pneumokoniosis might be decided to be present or absent and precaution
taken accordingly; as the name miners' phthisis implies, this discrimination is
not easy on the signs and symptoms of the disease, but can be made by
miscroscopy.
The Public Health Tuberculosis Regulations, 1908 and 1911, are addressed
to Councils—County, City, Borough and Urban—to medical practitioners and to
all others whom it may concern, but not to Port Sanitary Authorities. The Regulations
are not adapted to Port Sanitary work.
The Port Sanitary Authorities (Infectious Diseases) Regulations, 1920, define
"infectious disease" as "any epidemic or acute infectious disease."
The Public Health (Tuberculosis) Regulations, 1908 and 1911, give pulmonary
tuberculosis as "an Endemic" and "infectious disease" in the preambles.
Thus tubercle is an endemic and chronic infectious disease and the position of
Port Sanitary Authorities in regard to this disease is not met by the 1920 Infectious
Diseases Regulations. Any work done by the Port Sanitary Authority in tuberculosis
is therefore without legal basis though the recent dictum from the Courts
suggests its importance to shipping companies and to Public Health. In general,
Shipping Companies are well advised by their Medical Officers in this matter of
tubercle infection and the work of disinfection proceeds smoothly without authorisation.