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Suspected Plague
(3) On the 19th September a ship arrived in the Thames and the master reported that one man
was ill. He was seen by the Boarding Medical Officer and removed to Joyce Green Hospital as a
case of pyrexia of unknown origin ? Malaria. Subsequently it was found that another man was ill
on board at the time of arrival. He too was admitted to Joyce Green Hospital. Diagnosis in the
second case caused grave concern, as the man had signs which suggested a differential diagnosis
of typhoid fever or plague. The hospital was unable to give a firmer diagnosis for either man and,
after protracted discussion between Medical Staff of the Authority and the Consultant in Infectious
Diseases at the hospital it was agreed that plague could not be ruled out. Despite the absence of
firm diagnosis in either case the appropriate preventive measures had to be taken. In so far as
the ? malaria case was concerned, there was no particular cause for concern, but in the case of
suspected plague, stringent investigations were undertaken with regard to the possible rat population
of the ship and a strict watch was kept on her whilst she was in Tilbury Dock. One rat
was trapped and sent for examination. Extra care had to be taken with dock labour working on
the ship. A further complication arose when the Hospital began to suspect that both cases were
suffering from paratyphoid fever, although laboratory investigation at that stage was unable to
disclose whether this was so or not. Eventually, on the 28th September a firm diagnosis was
made that both men were, in fact, suffering from Lymphogranuloma inguinale.
Typhoid Fever
(4) A vessel arrived on 6th October from Liverpool. Prior to her arrival, notification had been
received that a case of suspected typhoid fever had been taken off the ship on arrival in Liverpool,
and, on routine investigation of the crew there, one excretor of the typhoid organism, two
excretors of Salmonellae other than typhoid and one excretor of Shigella dysentery organisms
were found. The typhoid excretor was removed to hospital in Liverpool, but the others were left
on board. On arrival in London the ship was boarded and the three men were placed under treatment.
The ship was kept under strict surveillance and food hygiene practices were subjected to
close scrutiny. The vessel sailed for Rotterdam on the 12th October before the completion of the
course of treatment and the necessary information was passed to the Medical Officer of Health
of Rotterdam before the ship sailed.
Paratyphoid Fever
(5) This ship arrived in the Thames on the 15th October, was boarded by the Senior Boarding
Medical Officer and was cleared to berth. On follow-up inspection by the Port Health Inspector
it was reported that a crew member had been admitted to hospital in India before joining the ship.
The diagnosis, according to the man, was paratyphoid fever, and he was discharged cured. This
situation appeared potentially dangerous so a stool specimen was taken. This was found to contain
typhoid organisms. The ship was kept under close surveillance after the case was discovered
and the activities of the man were restricted. Immediately the diagnosis was made, he
was admitted to Joyce Green Hospital and full preventive measures taken to protect the rest
of the crew.
These incidents demonstrate the need for constant vigilance on the part of Medical and
Inspectorial staff. The days of serious infectious disease on ships are still with us, unfortunately,
and difficult epidemiological problems arise when an immediate clinical diagnosis cannot
be made.
SECTION X
OBSERVATIONS ON THE OCCURRENCE OF MALARIA ON SHIPS
One case of Malaria (a seaman) was reported on a ship during the year under review. This
compares with one case in 1969.
A notice giving advice on the Chief Precautions and Treatment of Malaria is issued by the
Ministry of Transport and should be on board every British ship.
SECTION XI
MEASURES TAKEN AGAINST SHIPS INFECTED OR SUSPECTED OF PLAGUE
No ships infected with plague arrived during the year although one suspected case occurred
see separate report:
The Fourth Schedule to the Public Health (Ships) Regulations, 1966, reads as follows:-
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