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(i) The vessel must be sufficiently heated to ensure that the patients are kept in an
equable temperature.
(ii) Since vessels in the docks are not allowed to use the water closets on board arrangements
must be made for the patients to be supplied with Elsan Chemical Closets, and
most important of all—
(iii) The doctor who attends the patients in the first instance must give his approval of the
patients being allowed to be isolated on board and must then pay a daily visit to the
ship until satisfied that his services are no longer required.
It was found that save for a vessel that was berthed in a dry dock condition (i) did not present
any difficulty.
The Port of London Authority very kindly undertook to supply the necessary Elsan Closets as
required by condition (ii).
Condition (iii) was in the hands of Medical Superintendents of the Shipping Companies concerned
and the various doctors of the Shipping Federation who are in attendance in the dock area.
This procedure was put into practice where possible and a classical example of the success
of such a procedure is amply illustrated in the following report from your Health Inspector on the
Tilbury Dock, Mr. D. E. Madeley, in connection with an outbreak of influenza on the s.s.
"Arcadia" which affected no fewer than 176 of a total crew of 725. This vessel had been on a
Cruise and on return to the United Kingdom all the passengers were disembarked at Southampton.
The vessel came round to London with only the crew on board and on arrival at Gravesend all
on board were well. It was not until the vessel had been in the Tilbury Dock for three days that
the epidemic commenced among the Asian crew (Goanese). At no time was any mention made of
the passengers having had influenza but in order to be quite certain of this I contacted the
Medical Division of the P & 0 Company who, on consulting the medical records informed me
that there were no 'flu' cases among the passengers of the "Arcadia" during the cruise.
Tilbury Dock,
15th October, 1957.
"The s.s. "Arcadia" arrived at Tilbury on Sunday, 6th October from Southampton, after
a season's cruising.
"An outbreak of influenza started on 8.10.57 when ten Goanese Catering ratings reported
sick and were taken to Denton Isolation Hospital. The following day there were 20 more
cases, on the third day 26 cases which now included 6 Engine room ratings.. On the fourth
day there were 34 cases including one from the Engine room.
"On the fifth day (12.10.57) the incidence amongst the Goanese catering staff showed a
sharp decline, but there were now cases amongst the Asian deck and Engine room staffs.
"At the start of the outbreak the patients were sent to shore hospitals. The ship was at
that time in dry dock. There was little heating and the sanitary arrangements — including
washing — presented formidable difficulties.
"However the ship's Assistant Surgeon was on board. The Nursing Sister, Hospital
Attendant and Dispenser were recalled from leave. One of the P. & 0. Medical
Superintendents arrived to co-ordinate the work on board and on 11.10.57, the ship now
being out of dry dock, the ship's hospital was opened to take the more seriously ill patients
and a section of the Tourist passenger accommodation on "F" Deck aft was appropriated
as an auxiliary hospital in which to isolate the less seriously ill.
"The ship's midships hospital (7 beds in 3 small wards) was reserved as an emergency or
to accommodate any Europeans who might need attention.
"Sanitation still presented difficulties and 12 chemical closets were placed in the
lavatory compartments of the after hospital and the "F" Deck section to cope with the
situation. In fact, with the willing co-operation of the ship's staff, this was much more
successful than I had hoped for.
"There has been a steady decline in the number of fresh cases since 11.10.57. There
were only three new cases amongst the firemen and none amongst the seamen or catering
staffs. It is now possible to hope that the worst is past. The ship is due to sail on Tuesday,
22.10.57, and one of the anxieties at the moment is how many of the men now sick will
be fit enough to rejoin before then.
"Another complication must also be faced. The European catering staff anij Officers
have up to the present had a large proportion of their number on leave. There have been a
few cases of influenza amongst those who have remained on board but those feeling sick
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