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medical quarantine inspectors. There is only one Medical Officer retained in the whole of the
U.S.A. for this duty at the ports, viz., Dr. Vanderhook in New York. The quarantine inspectors
are recruited for the most part from orderlies of the medical service of the U.S. Navy. They
receive an intensive eight-weeks course of training for their duties.
There are nominated medical officers for each Port who can be called in if required by the
quarantine officers to help in the medical aspects, e.g., diagnosis of doubtful infectious disease.
The Medical Officers may be skin specialists, US PHS doctors, or other medical specialists.
(2) In addition to the downgrading of the professional staff employed on quarantine duty,
sweeping changes are in process of being introduced in the mode of inspection carried out. The
rationale on which the new system, as advocated by its supporters, is based, is on such considerations
as the following:-
International inspection procedures.
(a) These are often totally ineffective, e.g., smallpox is not seen or diagnosed at the time
of the inspection, but invariably declares itself after being imported into the country, and
even then it is often not discovered till a number of other persons have been infected.
(b) Persons who defend the newly proposed system consider the whole inspection procedure
as a barrier against a non-existent threat. The last case of imported smallpox in the U.S.A.
occurred in New York in 1947.
(c) The procedures are considered unduly involved.
(d) They form part of a pipeline, yet are completely unco-ordinated with the operations of
contiguous units of other governmental agencies acting before or after in the process.
(e) They are laws unto themselves, are dictatorial in their treatment of the passengers, and
inclined towards self-preservation.
(f) They are unable to accept modern technological change owing to fragmented organization.
(g) They are a significant factor in economic cost of travel.
"Primary Line Inspection"
As a consequence what is called "primary line inspection" is being introduced to ports in
the U.S.A. and also in Canada. The quarantine, customs, animal health and agriculture agencies
inspection services are being integrated. A passenger on arrival will be inspected at the primary
line inspection with regard to the requirements of all these four agencies. It is known from experience
that over 90% of passengers can be cleared quickly. Any passenger having some matter
requiring attention that will hinder the rapid flow through will be referred to a secondary line
inspector. He will be a quarantine officer if referred for health reasons, a customs officer if for a
customs matter, and so on.
It is considered that these arrangements will facilitate the operation of the services without
loss of efficiency. Some such arrangement is becoming imperative with the great continental
increase of traffic at airports and this will be aggravated by the introduction of jumbo-jets.
The Green Paper and the British Port Health Service
The second Green Paper on the future structure of the National Health Service lists port
health as one of the responsibilities which will be retained by Local Authorities. While this is
clear, the situation of the Medical Officer of Health is by no means as specifically outlined. The
ambiguous phrase "for a time" is used in relation to the allocation of limited responsibilities
now exercized by Medical Officers of Health as well as new duties in relation to preparation for
the new health service structure. But there is no clear indication of his responsibilities after the
elapse of time or whether in fact he will continue to have port health responsibility. It is stated
that the medical staff will be transferred to the service of the area health authorities. Though it
is accepted that local authorities will need medical officers for examination of persons arriving
at sea ports and airports, it is suggested that such staff might be seconded to the local authority
by the area health authority. Senior medical officers of the area health authority will also be
available to advise. Another form of association between the area health authority medical officers
and the local authority suggested is the appointment on an honorary basis of medical officers
who are in the employment of the area health authority. As it is also stated that most of the
present work of the medical officer of health will be included in the wider functions of the chief
administrative medical officer it would appear that the traditional medical officer of health will
be phased out in the future. The basic duties and responsibilities of the medical officer of health
stem from local authority legislation. It is most unlikely that all this legislation will be unscrambled,
so one can see these functions pass to public health and port health inspectors if
the principles of the second Green Paper are followed in the future legislation amending the
structure of the National Health Service.