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more exposed than that of the "Hygeia," close contact with the Customs would be
more difficult to maintain and the Port Health Authority's Staff would be about
a mile from Gravesend and so out of touch with valuable sources of information in
regard to the movements of ships.
When the boarding launch is undergoing overhaul the Medical Officers board
from the Customs launch, but the new launch "Alfred Robertson," which will
normally be used by the Sanitary Inspector for the inspection of vessels in the
middle river district, will be suitable for use as a boarding launch, when necessary,
and when she comes into commission there should no longer be any necessity to
depend upon H.M. Customs for assistance in this respect, except occasionally when
a ship requiring medical inspection arrives unexpectedly and the boarding launch
is away from her station conveying the Sanitary Inspector to vessels lying in the
lower river district.
Vessels proceeding up the River Medway are dealt with by a part-time Medical
Officer from Sheerness whose duty it is to visit, as soon as possible, every vessel in
which sickness is reported by H.M. Customs, and to board, within twelve hours of
arrival, every other vessel from "foreign" remaining in the jurisdiction of the Port
of London Health Authority.
The list of scheduled ports on page 4 of the Declaration of Health covers, broadly
speaking, the whole of Asia, Africa, South and Central America and the Eastern
Mediterranean. To attempt to supply to Pilots and Customs Officers a weekly list of
infected ports based on the Record of Infectious Diseases in Ports, &c., at Home and
Abroad, issued weekly by the Ministry of Health, would lead to chaos and to much
more delay and inconvenience to shipping than the system of inspecting, as a routine,
ships from any part of the world in which dangerous infectious diseases are endemic or.
from time to time, epidemic. I still hope that some day the routine boarding of ships
from infected ports will be discontinued, and that we shall be able to substitute the
boarding, not only of ships on which infectious or doubtful sickness or deaths have
occurred during the voyage, but also of all those which have on board at the time of
arrival any cases of sickness of any sort whatever, however trivial such cases may
appear to be. It might be possible to extend some concessions to ships carrying
surgeons who fully comprehend the requirements of Port Health Authorities and
who could be relied upon to notify any case of sickness which might conceivably be
of an infectious nature. But I am of the opinion that the Master of a ship should not
be required to carry the responsibility of diagnosis in any case of illness once his ship
is within a Port Health district.
When the Port Medical Officer sees a case of sickness his first thought is "May this
be a case of infectious disease?" and only when he is confident that it is non-infectious
is he prepared to allow the patient to proceed. Neither the Master nor the Surgeon
approach the question of diagnosis from this angle, and therefore they will, from time
to time, miss infectious cases which the Port Medical Officer would at least remove to
hospital for observation.
Many cases of Typhoid Fever, some of Small-pox and a few of Plague have been
landed in this country as Influenza, a diagnosis which should always be regarded with
suspicion by every Port Medical Officer.
Notifications to the Authority of inward Vessels requiring special attention.
By arrangement with the General Post Office, wireless messages sent in accordance
with the instructions on the Declaration of Health are received by the North Foreland
Radio Station and telephoned direct to the Medical Officer on duty on the "Hygeia.''
Ships have not, up to the present time, been required to send the standard Quarantine
Message prescribed in the Second Schedule to the Regulations. There is always a
Medical Officer on duty, a launch available and a hospital ready for the reception of
cases, so that all that is absolutely necessary in the Port of London is advance
notification of the name of the ship and the time she is expected to arrive on the
boarding station. A number of ships voluntarily send the full Quarantine Message in
code, which is deciphered by the Medical Officer from Volume II. (Radio) of the