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Towards the end of April an outbreak began in Formosa and it has been estimated that
more than 100,000 cases occurred there in the course of two or three weeks. During the
first half of May another large outbreak developed in Manila, in the Phillipine Islands, and
subsequent outbreaks have been reported from Japan, India, Sarawak, North Borneo, Vietnam,
Cambodia and Indonesia. Outbreaks have also been reported among persons travelling by
sea and air from the affected regions.
"Most of the cases have been described as clinically mild with severe headache, generalised
pains and fever (101° — 103°F.) lasting two or three days and followed by about 4 days
disability. There have been a number of deaths, but the fatality rate has been low.
"The Port of London Health Authority and its staffs are ready, as usual, to meet this
threat with all the means in their power. Every endeavour will be made to secure the
admission to hospital of all sick persons coming into the Port of London when the ship is
boarded by the Port Health Authority's Boarding Medical Officers at Gravesend, to whatever
number may be needed.
"The Medical Officer of Health is in close contact with the Ministry of Health and with
the Medical Research Council. Laboratory specimens will be obtained from patients who
are admitted to hospital suffering from or suspected to be suffering from influenza and
these specimens will be sent to the World Influenza Centre, London, for investigation of
the virus strains. This is important to enable the experts to make effective vaccines
against the disease.
"Arrangements have been made for yellow warning cards to be issued to passengers and
members of crews on ships suspected to be incubating influenza so as to warn their own
doctors, wherever they may go, of the possibility of their infection.
"Hospital accommodation, cabins, etc., on board ships that have been occupied by
infected persons will be disinfected under the supervision of the Port Health Authority.
"All Boarding Medical Officers and Port Health Inspectors have been made acquainted
with the situation and will be on the alert to co-operate in all necessary measures of
protection."
At this time the threat of Asian influenza reaching the United Kingdom was "front page news"
and your Chairman was interviewed by I.T.V. in front of the Television Cameras.
In reporting this matter to your Worshipful Committee, I commented on the Chairman's statement
(quoted above) as follows
1. 'Yellow warning cards' are not normally issued at seaports. They are used regularly at
airports where passengers are in a hurry to get away or fly on to the next airport and may not
know the address they will have at their next destination. In the seaport there is ample time,
normally, to check addresses of destination of infectious disease contacts and then to warn the
Medical Officers of Health of the places where those addresses are. With 1-200 people down
with influenza in, say, a P & 0 Liner carrying 1,700 persons (passengers and crew) it would be
logical to assume all those who were not actually ill to be contacts. It will not be practicable
with such large numbers or justifiable with a non-quarantinable disease like influenza (quarantinable
diseases are the 'deadly' diseases, smallpox, yellow fever, cholera, plague, typhus and
relapsing fever) to check the vast number of destination addresses and then forward a great
number of letters to Medical Officers of Health all over the United Kingdom. Hence the adoption
of the same procedure in this 'flu' emergency as at airports where regularly they have great
numbers of people arriving every 24 hours.
The yellow warning card is issued at airports when the passengers arrive from an 'infected
area' whence they may be carrying an infectious disease and urges them to consult a doctor
immediately they feel at all ill, showing him the warning card. This will alert him to make a
diagnosis of smallpox, typhus, or now of influenza. The card conveys its message to the
passenger and (if necessary) the doctor, in English, French and German.
2. We get roughly 100,000 passengers per year into London by sea from abroad. The figures
for London Airport are ten times as many, about a million. The incubation period of influenza is
21-72 hours and the period of communicability is one week from the date of onset. Thus, whilst
the disease remains in the Far East, epidemics on board ship will normally have burnt themselves
out before arrival in the Port of London. We had one ship that had had nearly 100 cases
on board affecting the crew and passengers but the last case was more than a week before she
docked so we had no need to worry about any further spread of the disease from this ship into
this country. These conditions obviously apply differently to travel by air from the East (5 or
6 days) than to travel by sea (a little over three weeks). Obviously passengers can arrive by air
on a Monday feeling fit and on Tuesday morning come down to breakfast at their hotel with a
'cold' which is really 'Asian Influenza'. If and when the disease creeps to Europe we, in the
seaport, will be more like they are now at the airport.
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