View report page

In acknowledging the receipt of my letter the Chief Superintendent stated "As you are aware,
all our Officers are trained in First Aid, and we are always very anxious to give all the help we
can in such cases. Nevertheless the Chief Constable will be glad to read your letter which I
shall pass to him. Its contents will also be drawn to the attention of the Officers concerned."
It was subsequently ascertained from the Gravesend and North Kent Hospital that X-ray examinaction
showed that the patient's only injury was a broken collar bone.
"ON GUARD AGAINST PLAGUE"
A comment under this title appeared in the "Lancet" for 29th December, 1956, and since it
referred so aptly to the work of the Port Health Authorities throughout the world, copies were
circulated to the members of your staff and is reproduced as follows:—
"When the Fourth World Health Assembly adopted the International Sanitary Regulations
in 1951, it was a legal rather than a hygienic innovation. From that date all nations who
were members of the Assembly became bound by the regulations and such member nations
that wished to deviate from them in part or in whole had to submit their reservations to the
Assembly. It may be a sign of the times that so little fuss was made over this victory for
common sense over national prejudices. Since then the regulations have been modified in
detail and will, no doubt, be modified again to meet new dangers or to remove useless impediments
to commerce and travel. They are concerned with the 'quarantinable diseases' only —
plague, cholera, yellow fever, smallpox, typhus and relapsing fever. In general they do no
more than codify the many existing agreements, but in the process many absolute procedures
have been abandoned and the recommendations limited to what now appears sound and
efficacious.
"Even fifty years ago the medical officer of every port in the world knew that he was
sitting on an epidemiological volcano. His first news of plague in Surabaya or smallpox in
Bahia Blanca might be a ship in the roads with the yellow jack in her rigging or a dying man
in his isolation hospital. Today patient clerks in Geneva sort and distribute a weekly
return of infectious diseases from almost every country. The advances in the prevention and
treatment of the pestilent diseases are as great as those in any branch of medicine. Active
immunisation is effective not only against smallpox but against yellow fever and typhus
and (perhaps) against cholera and plague. Thanks to the newer insecticides the local extermination
of mosquitoes is now a reality and the louse a very rare animal indeed. The rat
survives, but new ships and more subtle poisons have drawn his teeth. That travel by air
might bring with it the risk of spreading disease was readily appreciated, and no traveller
can doubt that every care is now taken to avoid introducing undesirable aliens — with,
2, 4 or 6 legs.
"All these technical improvements have been accompanied by a remarkable and worldwide
decline in the quarantinable diseases which goes a long way to justify the optimism of
a recent review of the subject from the World Health Organisation. Nevertheless a carefree
faith in the certainty of continual and inevitable progress has led mankind into trouble before
now and it would be foolish to forget that these diseases remain danger so long as they
are endemic in any part of this contracting world. Cholera today l3 almost confined to India
China and the intervening countries. (It is hard to know whether India's place at the top of
the table is a merited disgrace or the penalty of conscientious diagnosis and notification).
Cholera is a 'simple' disease of which the cause and method of spread are well known; and
yet, in spite of much thought and toil, the stimulus which converts endemic to epidenic
infection is still a matter for surmise. In the future we may be able to confine the infection
more closely than in the past, but the threat remains. No one knows the origin of the outbreak
in Egypt in 1947 and very few are certain why it ended when it did. Much the same is
true of plague. The major epidemics have been more widely spaced than those of cholera,
but they lasted far longer. It is still a sporadic disease in many parts of the world and
endemic foci in wild animals are known in three continents. If we knew the chain of infection
from a marmot in Turkestan to a million rats in the slums of Bombay we would be better
placed to forecast our immunity from the pestilence. Vaccination against yellow fever gives
a lifelong immunity. This by itself should be enough, but vaccination is a costly business
and it is hard to justify the expense in a poor country where antibodies in the inhabitants'
blood are the only evidence of disease. In populous places it seems almost as effective to
eradicate Aedes aegypti (as has been done in parts of Brazil), but 'jungle yellow fever' in
monkeys and marmosets remains a threat of unknown potency. It is not entirely clear if the
'wild' disease can give rise to the urban epidemic form ; some slight evidence from Trinidad
suggests that it might. At any rate, during the last few years jungle yellow fever has been
advancing rapidly northward along the Central American isthmus; it may invade Mexico at
any time and the U.S.A. is not outside the zone of danger if the disease is transmitted to
Aedes aegypti in the coastal belt. Typhus and relapsing fever are diseases of war and at
the moment we enjoy peace of a sort; in any case the experience in Naples in 1943
suggests that louse-borne infection can be checked even in the middle of a war. Smallpox
is everywhere less common than it was, and. yet where doctors are few and money scarce it
is seldom absent. No doctor anywhere in the world can be quite certain that the next patient
may not show a pustular rash which will cause him some hard thinking. This seems the
disease most likely to be spread by air travel, but accurate diagnosis and sufficient vaccine
should ward off a major epidemic.
14