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I would instruct the master that if the answer to any of these questions is " yes " he must communicate
with the port sanitary authority by the quickest possible means ; and the customs officers that,
in similar circumstances, pratique must not be granted without the sanction of the port medical officer.
I would provide heavy penalties for failure to comply with these instructions.
It will be noted that the master is not required to make a diagnosis but simply to ascertain whether
each person on board is well or ill. In the case of ships carrying a doctor I would add a proviso that if
the doctor is absolutely certain that there is no suspicion whatever of infection in regard to the cases notified
under questions 3 and 4, the ship need not report for the port medical officer and pratique may be granted
without reference to him. A question might be added in regard to sickness or mortality amongst rats,
but I have yet to board the ship the master of which will give a reply in the affirmative to this inquiry.
The principle would then be that for boarding purposes the port sanitary authority would disregard
the ports of departure and call of a ship, but they would require medically to inspect her :—
(a) If any case of infectious disease had occurred during the voyage in order to ascertain that there
was no danger of the spread of infection on board or on shore.
(b) If any undiagnosed illness had occurred in order to ascertain whether it might have been of an
infectious nature.
(c) If any death from illness had occurred in order to ascertain if it had been from an infectious disease.
(d) If there was any case of illness on board at the time of arrival in order to ascertain whether it
might be of an infectious nature and to relieve the master of all responsibility in regard to
the diagnosis.
These would appeal to everybody as reasonable grounds for subjecting a ship to medical inspection
and personally I believe we should run far less risk of the introduction of infectious disease into this country
from abroad than we do at present.
Certain criticisms I foresee and wish to anticipate.
In the first place it may be said, " What then would be the use of the Ministry of Health record of
infectious diseases at ports, &c., at home and abroad " ? It would still be of the greatest value in guiding
the boarding medical officers in the diagnosis of doubtful sickness either during the voyage or on arrival
or in coming to a conclusion as to the cause of any deaths reported. If, in view of the prevalence of plague,
small-pox, typhus, cholera or yellow fever in any of the ports at which the vessel had called, his suspicions
were excited he would be justified in making a full inspection of the ship and taking any further precautionary
measures indicated. Again in regard to plague, the weekly record would indicate what ships should be
kept under special observation while in port for evidence of an epizootic amongst the rats on board. In this
country it is uncommon to find human cases of plague on board ships ; is is far more frequently the case
that rodent plague is discovered during the discharge of cargo.
Then there are administrative difficulties. In the larger ports where there is always a boarding medical
officer on duty night and day, the scheme would not be difficult; with the proviso suggested for ships
carrying a surgeon I do not think their work would be greatly increased and they would at least have the
satisfaction of knowing that when they went off to a ship there would always be either a case to diagnose
or some suspicious circumstance to investigate. In the smaller ports I can understand that the part-time
medical officer would be afraid that he would always be going off to ships to see cases of trivial sickness.
But in my view there should always be a sanitary inspector available during docking hours in every port
and the port medical officer could permit the sanitary inspector to decide whether it was necessary to
call him to the ship or whether the sanitary inspector himself could authorise the granting of pratique.
After all, at the present time in regard to ships which are not from infected ports you leave it to the master
or the customs officer to decide whether there is any suspicion of infection in regard to any case of illness
and a sanitary inspector under the control of the port medical officer could be trained to be a far better
diagnostician that the master of a ship or a customs officer is ever likely to be.
Foreign ships are another difficulty, perhaps, though it is remarkable how rarely one comes across a
foreign ship in which the master or the purser does not know sufficient English to be able to interpret the
simple form of " Declaration of Health " proposed. Moreover, if the system was uniform for all ports in
the British Isles, the instructions could be printed in the sailing directions for the various ports and the
master would then have a copy translated into the language of the country under the flag of which his
ship was sailing.
The scheme may be open to other criticisms, but I hope it will not be hastily condemned. In the
British Isles we never imposed the routine fumigation of ships from plague-infected ports but dealt with
them according to their condition as regards rats, and other countries are gradually coming into line, thanks
to the International Sanitary Convention. Similarly, I believe, that eventually we shall take the lead in
discontinuing the routine medical inspection of ships from infected ports and shall substitute a system of
dealing with ships strictly according to the health conditions existing on board.
In any case there is no immediate danger of the introduction of this scheme because the new port
sanitary regulations will shortly be issued which prescribe a much more elaborate form of " Declaration of
Health " and provide for the continuance of the present practice of inspecting all ships from infected ports
even if the answers to the questions in the declaration are all negative.
Finally, I would like to admit that such a scheme as I suggest does not eliminate all risk of the importation
of infectious disease, but I firmly believe that it is not only more rational than the present system
but would be a far better safeguard.