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Blank Line who informed us that this man was not medically examined before engagement on
the "Blank" and that the last record of medical examination which they hold is dated
October, 1955 — this appears to have been a pre-shipment medical inspection. It is, thus,
quite clear that no Federation M.0. had examined this man after he had had his attack of
bronchitis with alleged coughing on the outward voyage which started at Newcastle on
4.8.56.
I am afraid that there are many seafarers who do not have medical examinations once they
have been taken over by a particular Company. We have no power to compel any Company
to have their seafarers medically examined but if they are sent to the Shipping Federation
they will, of course, receive medical examination or the more brief medical inspection. We
do try to impress Shipowners about the necessity for more frequent medical examinations
and many Lines co-operate very well in this respect; others, just d o not seem to care and
hope for the best".
"These case I have just reported well illustrates the enthusiasm for tuberculosis control that
animates the Shipping Federation Medical Service, and I should have mentioned that included in
the measures taken by them is a routine follow up of all case contacts. Whenever a Shipping
Federation Medical Officer diagnoses pulmonary tuberculosis in a seafarer, he at once tries to
ascertain the names and addresses of all who shared the patient's room on board ship, and this
may necessitate his communicating with the shipping company concerned.
"When those who have shared the room have been identified, the Shipping Federation Medical
Officers at their home ports interview them and suggest the advisability of a chest investigation
which can be carried out at a hospital or chest clinic free of charge. The name of the man who
is suffering from the disease is only disclosed to those who must know it in order to identify the
contacts.
"If a seaman has to be discharged abroad and the ship is to remain abroad for some months
every endeavour is made to secure chest investigation of his ship contacts at the first port of
call where there are adequate facilities.
"If the ship is on her homeward voyage and will be back in a few weeks, the necessary
arrangements for chest investigation of contacts at their home ports are made as soon as possible
after the ship's return.
"Similar follow up of contacts is made in cases where a seaman has been discharged abroad on
account of sickness which is subsequently discovered to be pulmonary tuberculosis.
"Another case concerned a native seaman on a ship which had been asked to accept him for
repatriation. Fortunately before the ship could sail the man was discovered by one of my port
health inspectors who, not liking the look of him arranged that he should see the Shipping Federation
Medical Officer at the dock concerned. It was ascertained that the native crew superintendent
had not been informed of the man's condition and that he had been put into crew accommodation
with seven others. On enquiry it was found that this man had been under a Chest Physician
in a General Hospital, who had given him treatment but had not seemed to understand the importance
of making sure that the man was quite free from infection before allowing him to travel in a
ship with other members of a crew. This man with others had been flown from India to make up a
crew for the ship concerned, and it was found, upon enquiry, that 3 or 4 others who had been
flown over with him had also got pulmonary tuberculosis. Steps were being taken by the Shipping
Federation to make sure that this sort of thing in the recruitment of crews should not be allowed
to happen again.
"My next case illustrates the vigilance of a ship's surgeon, who discovered tuberculosis in a
a passenger and through the shipping firm concerned arranged that the man should see a London
specialist when he disembarked. We were of course informed of the arrangements, and we notified
the medical officer of Health of the London borough where the patient had arranged to spend
the night pending his interview with the London specialist.
"In all these cases the quarters occupied are fumigated with formaldehyde and bedding taken
away for steam disinfection.
"My next case illustrates the co-operation between different health authorities, because it
began with a letter to me from the Medical Officer of Health of Edinburgh stating that a patient
who had died of pulmonary tuberculosis in the Royal Infirmary there had been a member of the
crew of a certain vessel which was due in London. I immediately instructed my port health
inspector , who would meet the ship when she docked, to arrange for all contacts to attend the
nearest Shipping Federation Medical Centre for x-ray. Fortunately they were all found negative
but arrangements were made for repeat fluoroscopy in three months' time.
"In another case the shipping line themselves sent us an extensive crew list to enable us to
trace contacts of a patient who had been a member of that crew. They had received a cable from
Canada that he had been admitted to hospital for shingles but the diagnosis then became one of
pulmonary tuberculosis. In this case there was not time to arrange for mass fluoroscopy ofall the
contacts at the Shipping Federation Medical Centre where the ship docked, so we wrote to the
medical officers of health of the areas whence the contacts had proceeded, they having been all
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