View report page

the other, even though less "deadly", infectious diseases, which if they do not simulate the
quarantinable diseases themselves may at least at one stage or another resemble the prodromes
of those diseases, particularly smallpox. Hence I think it perfectly justifiable even for purposes
of quarantine control to suggest a comprehensive list of infectious diseases (including tuberculosis)
which should be reported on the Declaration of Health. Thanks to many years of tradition of
co-operation with pilots, customs officers and shipping companies, we in the Port of London
seldom experience any difficulty in seeing that the Declarations of Health are very completely
filled up in the way that we like. This fact coupled with the fact that the N.H.S. have kindly
allowed us to keep the use of our Port Isolation Hospital down river enables us to run a kind of
occupational hospital service for the benefit of the individual seafarer — as distinct from his
importance as a menace to the community through carrying communicable disease. A further help
in this direction is that every ship when it docks or ties up at a mooring station in the Port of
London is boarded by a port health inspector who will automatically pursue epidemiological
enquiries either on his own initiative or as a result of a telephone call either from the whole
time duty medical officer at Gravesend Boarding Station or from head office.
"Our Port of London Health Inspectors are particularly well equipped for such enquiries
because all of them have held officer rank for years at sea before training in public health.
"In all these devious ways we try, and usually succeed, in discovering most cases of tuberculosis
coming into the Port of London. The first step then is to hospitalise the case either in
our own or in some other hospital such as the Thurrock (Essex) or the Greenwich Seamen's Hospital.
If we cannot do that we notify the medical officer of health of the area of the patient's
destination on disembarkation from the ship. The next step is to secure x-ray of all likely contacts
amongst his shipmates, e.g. those sharing his cabin and/or watch, messmates and so forth.
Those who are positive are also hospitalised. These first and second steps apply whether the
seafarer is British or Foreign, but if he is British, by means of the co-operation we have built up
with the Shipping Federation Medical Services we try to trace the case history. This we do, by
sending to the Chief medical officer of the Shipping Federation the full case particulars as
ascertained by us, together with the patient's Discharge Book Number. By this means it is
possible to ascertain the particulars of the patient's record of attendance at Shipping Federation
Medical Centres at major ports throughout the United Kingdom, where his medical examination as
far as practicable should have included fluoroscopy — almost invariably for all new entrants and
those medically examined for general service or company contracts. Nevertheless it cannot be
said that in the British Merchant Navy the organisation has yet reached the stage when the
seafarer has a routine fluoroscopy or x-ray at fixed intervals. Personnel of the 'loyal Navy do
receive x-ray annually as do those of the Merchant navy in most Scandinavian Countries. Some
Scandinavian shipping companies even arrange for Mantoux testing and B.C.G. of all new recruits.
One well known British passenger line arranges a routine x-ray of all Asian crews annually.
This is important because of the known higher racial incidence in Asians and partly because
Asian crews prefer communal sleeping quarters at a relatively high temperature and relatively
low rate of air movement.
"The need for special measures for the control of tuberculosis in seafarers is no longer in
dispute, for although their quarters have been considerably improved since I wrote my paper
"Slum Clearance at Sea" (1936) there still remains the fact that from the nature of their occupation,
they live round the clock together in a closed community for relatively long periods at a time.
"At this point in my dissertation, I think it would be helpful to illustrate by quotation from a
few recent case histories. I begin with one that involved Glasgow. This was an AB on a tanker
who reported sick at sea. He was seen by a doctor at Baytown in Texas, where he was x-rayed
and sent to hospital. A diagnosis of pulmonary tuberculosis was cabled to the London headquarters
of the shipping company, which immediately notified me, having previously arranged for
the Shipping Federation doctor at Tilbury to undertake fluoroscopy of all contacts when the ship
docked there. I then communicated with the head of the Shipping Federation Medical Service, who
replied
Investigations have shown that this man had a full general medical examination at Glasgow
on 10.4.56., this included chest fluoroscopy which was normal. I would add that I have
every confidence in the fluoroscopy carried out by our two doctors at Glasgow as with the
slightest abnormality seen on screening they always refer the case to Chest Clinic or
Hospital for full investigation".
"The next case concerned a 2nd steward on a ship bound from South America who had a sudden
severe haemoptysis while the ship was at sea. Radio aid was requested by the ship and on the
advice of an American ship carrying a doctor, morphia was given and ice to suck. In spite of this
the bleeding persisted and the patient died suddenly the following morning. The body was landed
at Recife where a post-mortem examination was performed. \ radiogram from the agents stated
death was due to pulmonary tuberculosis. The reply from the Shipping Federation Medical Service
was that
"very extensive enquiries have been made at a large number of Shipping Federation offices
about any medical examination of this man but since he started employment with the Blank
Line he seems to have re-engaged with this Line on various vessels from 1951 and we cannot
trace any full medical examination since 12.2.51. We have taken the matter up with the
24