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This having been done it is next necessary to ascertain the address of the Medical
Officer of Health for each individual local authority.
For this purpose we have, in London, compiled our own index. This was achieved
by circulating every County Medical Officer in the United Kingdom and asking him
to be good enough to supply the official addresses of the Medical Officers of all Local
Authorities in his area. This met with a 100 per cent. response and forms an invaluable
reference.
This information is obtainable through other references, but such references
contain also a mass of information which is of no use for the purpose in hand and
obviously takes longer to find.
It is also our practice when sending out a notification to ask for an acknowledgment.
When these are received they are checked with the addresses in our index,
and any necessary alteration is made.
For addresses in London and the suburbs an up-to-date and authentic directory,
containing a street list, is used.
This part of the routine having been completed and the envelopes addressed,
the actual postcards, as filled in by the passengers and/or crew, are forwarded to their
respective districts together with a short but concise note respecting the case or
cases, e.g., "The person(s) mentioned on the enclosed card(s) arrived in London on
(date) per s.s. (Vessel), from which Vessel a case of (disease) was landed to hospital
at (place) on (date). The letter 'C' denotes a member of the crew."
The sending of the card already filled in by the passenger or crew saves the time
that would be involved if the particulars had to be copied out on to a notification
form as was the practice a few years ago. The parting with the card is of no account
as I have previously mentioned that the address thereon has been checked against
that appearing on the list supplied by the shipping company, which list is, of course,
retained for future reference.
The efficiency of this system can be judged by the following actual experience:—
A vessel with a personnel of 602 arrived off Gravesend and was boarded at 11 a.m.
The disembarkation of passengers was permitted at 1.30 p.m.
403 actual cards were filled in, representing the 602 passengers and crew.
These cards were forwarded to the Medical Officers of Health of 204 individual
sanitary areas in the United Kingdom and were posted from London by the evening
post the same day.
Subsequently 131 passengers notified change of address once and 8 passengers
notified change of address twice. Ten members of the crew notified change of address
once and 10 notified their return to the ship.
Although there were several queries in regard to addresses, every person on board
was ultimately traced.
Occasionally a medical officer of health has asked for an indication to appear on
the notification as to the vaccinal state of the contacts, but Dr. White's view is that,
in the first place this would frequently lead to delay in posting the cards and in the
second place the information would not relieve the local medical officer of health of
the responsibility of exercising surveillance.
The aim of Port Health Administration should be the maximum of efficiency
in the protection of the public health with the minimum of inconvenience to the
travelling public, port authorities, shipping companies and merchants, and it is
submitted that, in regard to the surveillance of contacts at least, the present system
approaches as nearly as possible to this ideal.