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The staffing of a small isolation hospital in which the amount and nature of
the work varies considerably, and the patients are of all types and races and frequently
unable to speak English, is difficult.
In the majority of English ports it is the practice to allow ships in which there
are cases of the minor infectious diseases to proceed to their berths with the cases
on board and then to remove the patients to the isolation hospitals in the adjacent
town. This is practicable in compact ports. But the Port of London Sanitary
Authority must maintain their own isolation hospital in close proximity to the boarding
station and must be prepared to receive there all the cases of infectious disease
arriving in ships, because once a ship passes Gravesend she may proceed to a berth
in any of the five dock groups with their 45 miles of quays or at any of the wharves
along the 25 miles of the Thames between Tilbury and London Bridge or at one of
the mooring buoys in the River. It is obvious that if infectious cases were left on
board until the ship berthed, to be removed to the nearest isolation hospital, there
would inevitably be serious delay and inconvenience both to patients and ships.
There is another essential reason for the Port Sanitary Authority having their own
hospital. The Boarding Medical Officers frequently have to make diagnoses under
very difficult conditions; the patient may be lying in an upper berth in a badly lighted
forecastle; only a vague history of his illness may be available and he may be unable
to describe his symptoms in English. Under such circumstances it is very desirable
that the Medical Officer should be able to remove the patient to a hospital where he
can be kept under observation.
Finally, the Port Sanitary Authority must provide accommodation for infectious
diseases such as Measles, Chicken-pox and Mumps, which are not usually nursed in
hospitals, because passenger patients cannot be allowed to travel home in public
conveyances and crew patients can neither be efficiently isolated nor nursed when
their ship is in dock.
(e) Ambulance transport.
The boarding launch "Howard Deighton" has an ambulance room on deck with
accommodation for four stretcher cases or eight walking cases. This room can be
warmed by an electric radiator and patients can be transferred from ships to hospital
in comfort and safety.
The up-river launch "James Howell" has a small cabin forward in which
a patient can be carried, but it is seldom used for this purpose. If a case of sickness
arises on a ship in the Tilbury or the Royal Docks, the "Howard Deighton" is
usually sent to remove it. If a case arises on a ship in the other docks nearer London
or at a wharf, the "James Howell" may pick it up and transfer it to the "Howard
Deighton" which is sent up to meet her, but more commonly arrangements are made
with the London County Council to take the case by road ambulance to the Port
Sanitary Hospital. This involves the patient in less risk of exposure to chill, is quicker
and usually cheaper.
(f) Supervision of contacts.
The method of dealing with contacts who are leaving a ship has been described
on page 22. Contacts remaining on board are kept under daily supervision by the
Deputy Medical Officer of Health, unless the Shipping Company have a Medical Officer
ashore who is able and willing to undertake the daily inspection and to notify
immediately any cases of illness.
Arrangements for the Bacteriological or Pathological Examination of Rats
for Plague.
The bacteriological examination of rats for Plague is carried out in the laboratories
of the Seamen's Hospital, Greenwich, where there is a Staff of skilled Bacteriologists