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18
"SURVEILLANCE OF CONTACTS."
(By J. A. Gillis, First Class Assistant, Port Health Office.)
The International Sanitary Convention, 1926, and the Port Sanitary Regulations,
1933, both provide that persons on board ship who have been exposed to the infection
of Plague, Cholera, Yellow Fever, Typhus Fever or Small-pox may, on arrival in a port,
be subjected to observation or surveillance.
"Observation" is defined as the isolation of persons whether on board ship or
at a sanitary station before they obtain pratique.
"Surveillance" means that persons are not isolated, that they receive free
pratique immediately, but the authorities of the several places whither they are bound
are informed of their coming, and they are subjected to a medical examination with
a view to ascertaining their state of health.
It is intended in this paper to deal only with "surveillance." I hope to show
that the restrictions placed on the disembarkation of the personnel of ships which
arrive in this country having on board or having had during the voyage a case or
cases of one of the major infectious diseases, are now reduced to a minimum.
In this connection it is interesting to compare present day procedure Avith the
measures adopted in the past, and I am greatly indebted to Dr. C. F. White, who has
given me the opportunity of reading, and his permission to use, the information he
has gathered on Maritime Quarantine in the past, and which he has recorded in his
paper "Maritime Quarantine—Past, Present and Future."
Dr. White in the introduction to his paper says "The word Quarantine means
literally 'a period of forty days,' and was originally applied to the time, arbitrarily
fixed at forty days, during which ships from ports suspected to be infected with
plague were detained before being permitted to have communication with the shore.
During the nineteenth century the principle of detention was applied against cholera
and yellow fever as well as plague, and the period of isolation was varied from time to
time in efforts to adjust the balance between the demands of international commerce
and the danger of importation of these diseases. The term quarantine, however,
continued to be applied to this system of protection of the public health and in common
parlance its meaning has now been further extended to include the period of relative
isolation to which any person who has been exposed to any infection may be subjected."
The two greatest pestilences in history were the Plague of Justinian in 542 a.d.
and the Black Death of 1347-9. During the latter which destroyed at least a third
of the population of Europe, maritime quarantine was introduced in Venice where,
in 1348, three Overseers were appointed and authorised to spend public money on
isolating infected ships, goods and persons on an island in the lagoon, a physician
being stationed with the sick.
The first properly constituted maritime quarantine station was established by the
Venetian Authorities on the island of Santa Maria di Nazareth in 1403, and here all
travellers from the Levant were isolated for forty days in an old almshouse known
as the House of St. Lazarus. Hence arose the terms quarantine and lazarette, which
are both still in use, though neither with exactly its original meaning.
The Venetian Regulations whereby all ships from infected ports, whether there
was any plague on board or not, should be detained for forty days without being
allowed communication with the shore, became the basis of all subsequent quarantine
procedure throughout the world.
Despite all efforts to control the spread of plague it persisted in Europe for some
300 years after the Black Death and the part played by the rat was unsuspected,
though the fact that a rat mortality preceded the human epidemic was often observed.
Bills of Health were probably introduced in about 1527 during a severe epidemic
of plague in Italy, but they were not generally adopted until 1665. A "clean" bill
of health was granted to a ship if there was no suspicion of plague in the port of
departure and there had been none for forty days; a "suspected " bill was issued if
the port was free from plague but traded with infected districts, and a "foul" bill
meant that plague actually existed in the port at the time the ship sailed.