NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. IX. ]
spread of infection by sea.
309
effects or baggage, open, in the opinion of the sanitary authority, to
the suspicion of being contaminated, will be disinfected. The dura-
tion of these operations, including the disembarkation, and embarka-
tion, should not exceed 72 hours. If no case of plague is reported
during the operations, the pilgrims will be re-embarked immediately,
and the ship will proceed to the Hedjaz.
Suspected ships, that is to say, those which have had a case of
plague on board, at the time of departure or during the voyage, but
no fresh case for 12 days, will be treated as follows: the pilgrims
will be disembarked ; they will wash or take a bath in the sea ; their
soiled linen, and any portion of their personal effects or baggage,
open, in the opinion of the sanitary authority, to the suspicion of
being contaminated, will be disinfected, the bilge-water will be pumped
out ; and the parts of the ship inhabited by the sick will be disin-
fected.
The duration of these operations, including the disembarkation
and embarkation, should not exceed 72 hours. If no case of plague
is reported during the operations, the pilgrims will be immediately
re-embarked, and the ship will proceed to Jeddah, where a second
medical inspection will take place on board. If the result is favour-
able, and the ship's doctor declares on oath that there has been no
case during the passage, the pilgrims will be at once disembarked.
If, on the contrary, any cases of plague have occurred during
the voyage or on arrival, the ship will be sent back to Kamaran,
where she will undergo the treatment for infected ships.
Infected ships, that is to say, those having cases on board, or
having had them within 12 days, will undergo the following treat-
ment :—
The plague patients will be disembarked and segregated in the
hospital. The disinfection will be thoroughly carried out, The
other passengers will be disembarked and isolated, by groups, as
small as possible, so that if the plague breaks out in one group, the
whole party will not be affected.
The soiled linen, the personal effects, and the clothes of the crew
and passengers and the ship, will be disinfected.
The local sanitary authority will declare if the discharge of the
heavy baggage and cargo is necessary, and if the whole ship must be
disinfected, or a portion only.
The passengers will remain at Kamaran for 12 days ; when the
cases of plague occurred several clays before arrival, the period of
isolation may be diminished and it may vary according to the date of
occurrence of the last case ; and the orders of the sanitary authority.
310
Measures to prevent the
[ APP. IX.
The ship will then proceed to Jeddah. where a strict individual
medical examination will take place on board. If the result is satis-
factory, the pilgrims will be disembarked. If, on the other hand,
plague has appeared during the voyage, or on arrival, the ship will
be sent back to Kamaran, where she will again undergo the treatment
for infected ships.
Improvements to be made in the station of Kamaran.
A.—Complete evacuation of the Island of Kamaran by its inhabi-
tants.
B.—Measures to ensure safety, and to facilitate navigation in the
bay of the Island of Kamaran :—
1. Provision of buoys and beacons in sufficient numbers.
2. Construction of a principal mole or quay for the disembarkation,
of passengers and baggage.
3. A separate pier for the embarkation of the pilgrims of each-
encampment.
4. A steam-tug and sufficient barges for the disembarkation and
embarkation of the pilgrims. The disembarkation of pilgrims from
infected ships will be carried out with the appurtenances on board.
C.—The establishment of a sanitary station, which should con-
tain—
1. A system of railways, connecting the wharves with the head-
quarters of the administration, the places for disinfection, and the
p'aces where the different offices and encampments are situated.
2. Quarters for the administration and for the staff employed in
the sanitary and other offices.
3. Buildings for the disinfection and washing of wearing apparel
and other articles.
4. Buildings where the pilgrims can wash or take sea baths whilst
their clothes are being disinfected.
5. Separate and completely isolated hospitals for both sexes :—
(a) For the observation of suspected persons.
(b) For plague patients.
(c) For patients suffering from other contagious diseases.
(d) For ordinary patients.
6. The encampments should be completely separated from each
other, the distance between them being as great as possible ; the
pilgrims' quarters should be constructed on the most approved sani-
tary principles, and must not contain more than 25 persons each.
APP. IX.]
spread of infection by sea.
311
7. A well situated cemetery, distant from all habitations, free
from sub-surface water, and drained 20 inches below the level of the
graves.
D.—Sanitary appliances :—
1. Steam disinfectors in sufficient number, constructed with due
regard to safety, efficacy and rapidity.
2. Generators, disinfecting stoves and the necessary appliances for
chemical disinfection, as described in Chapter III of the annexure to
this Convention.
3. Condensing machines ; apparatus for the sterilization of water
by heat ; ice machines.
A system of pipes and reservoirs for the distribution of drinking-
water, which should be closed, and only capable of being used by
means of taps or pumps.
4. A bacteriological laboratory with the necessary staff.
5. An arrangement of portable vessels for the reception of fcecal
matter after disinfection. Sewage farms for the disposal of fcecal
matter on the part of the island most distant from the encampments,
arranged with due regard to their proper sanitary working.
6. An arrangement for the removal of dirty water from the en-
campments, which must prevent its stagnation and its use for drink-
ing purposes. The dirty water of the hospitals should be disinfected
with slaked lime, according to the instructions contained in Chapter
111 of the annexure to this Convention.
E.—The provision by the sanitary authority in each encampment
of a store for food and fuel.
The tariff of prices fixed by the appointed authority should be
hung up in several places in the encampment, in the languages com-
monly spoken by the pilgrims.
The doctor of the encampment will be responsible for the daily
control of the quality and quantity of the provisions.
Water should be provided free of charge.
Improvements to be made in the sanitary stations of Abu-Saïd,
Vasta, and Abu-Ali.
1. Erection of two plague hospitals, for men and women, at
Abu-Ali.
2. Erection at Vasta of a hospital for ordinary cases.
3. Construction at Abu-Saïd and Vasta of masonry barracks,
capable of containing 50 persons each.
4. Three disinfecting stoves to be placed at Abu-Saïd, Vasta and
Abu-Ali, with laundries and accessories.
5. Washing places to be provided at Abu-Saïd and Vasta.
312
Measures to prevent the
[APP. IX.
6. Condensers to be provided on each of the islands of Abu-Saïd,ïd
and Vasta, capable of distilling 15 tons of water perdiem.
7. The rules for cemeteries, fæcal matter, and dirty water, will be
the same as for Kamaran. A cemetery should be provided on one of
the islands.
The rules with regard to the supply of food and water at Kamaran
prescribed under heading E above will be applied to the encamp-
ments of Abu-Saïd,ïd, Vasta and Abu-Ali.
It is desirable that the arrangements at Abu-Saïd,ïd, Vasta and
Abu-Ali should be completed as soon as possible.
Reorganisation of the sanitary station of Jebel-Tor.
The Conference confirms the recommendations and views expressed
on previous occasions and leaves to the Sanitary Board the duty
of carrying out the improvements. The Conference also considers—
1.
That it is necessary to supply the pilgrims with good drinking-
water, either from a local source or by distillation.
2. That it is desirable that all food imported by pilgrims from
Jeddah and fromYembo, when there is plague in the Hedjaz, should
be disinfected as a suspected commodity, or completely destroyed, if
it appears to have deteriorated so as to have become dangerous.
3. That steps should be taken to prevent pilgrims bringing with
them leather bottles from Jebel-Tor. They should be replaced by
earthenware vessels or by metal cans.
4. That each section should be provided with a doctor.
5. That a Port Officer should be posted at El-Tor to superintend
embarkation and disembarkation, and to see that the rules are
observed by the captains and sarangs of the vessels.
6. That during the pilgrim season, only pilgrims should be de-
tained in observation at Jebel-Tor.
7. That the village of Kouroum should be evacuated.
8. That the encampment of Jebel-Tor should be connected by
telegraph with the sanitary station of Suez.
Rules for the Arabian Ports of the Red Sea during the
Pilgrim season.
Sanitary Rules to be applied to Pilgrim Ships coming from the
North.
(1) The outward -voyage.
If plague is not reported to exist at the port of departure or in its
neighbourhood, and if no case has occurred during the voyage, the
ship is immediately given free pratique.
APP. IX.]
spread of infection by sea.
313
If the plague is reported to exist at the port of departure, or in its
neighbourhood, or if a case has occurred during the voyage, the ship
will be subjected at Jebel-Tor to the rules prescribed for ships which
come from the south and stop at Kamaran.
(2) The Homeward voyage.
Art. 1.—Any ship coming from a port of the Hedjaz or from any
other port on the Arabian coast of the Red Sea, infected with plague
having on board pilgrims or any similar collection of persons bound
for Suez or for a Mediterranean port, must proceed to El-Tor, there
to undergo the prescribed observation as detailed below.
The disembarkation and disinfection of passengers, baggage and
susceptible goods will then be effected, as well as the disinfection of
personal effects, and of the ship.
Art. 2.—Ships bringing back pilgrims will only be allowed to
pass through the Canal in quarantine. Egyptian pilgrims after leav-
ing El-Tor must disembark at Ras Mallap, or some other place
appointed by the Sanitary Board, there to undergo three days' observa-
tion and a medical inspection, before being given free pratique.
In the event of a suspicious case occuring on board during the
voyage from El-Tor to Suez, the ship will be repulsed to El-Tor.
Art. 3.—Agents of navigation companies and captains of ships
are warned that, after the completion of the observation at the sani-
tary station of El-Tor and at Ras Mallap, only Egyptian pilgrims will
be permitted to leave the ship, in order to return to their homes.
Only pilgrims with a certificate of residence, issued by an Egyptian
authority, and in accordance with the prescribed form, will be recog-
nised as Egyptians or as residents of Egypt. Specimens of this form
will be deposited with the consular and sanitary authorities of Jeddah
and Yembo, where agents and ships' captains can inspect them.
Non-Egyptian pilgrims, such as Turks, Russians, Persians, Tuni-
sians, Algerians, Moors, etc., may not, after quitting El-Tor, be dis-
embarked in an Egyptian port. Navigation companies' agents and
captains are, therefore, warned that the transhipment of non-Egyp-
tian pilgrims, either at Tor, Suez, Port Said, or Alexandria, is for-
bidden.
Vessels having on board pilgrims belonging to the nationalities
mentioned in preceding paragraph will be treated according to
the rules for non-Egyptian pilgrims, and will not be permitted to
enter any Egyptian Mediterranean port.
Art. 4.—If it is not reported that plague exists in the Hedjaz, or
has existed during the pilgrimage, vessels will be subjected, at Jebel-
Tor, to the rules prescribed at Kamaran for healthy ships.
C 40
3H
Measures to prevent the
[ APP. IX.
The pilgrims will be disembarked ; they will wash or take a sea-
bath ; their soiled linen, the portion of their personal effects and
baggage, open, in the opinion of the sanitary authority, to (he suspi-
cion of contamination, will be disinfected ; the duration of these
operations, including the disembarkation and embarkation, should not
exceed 72 hours.
If plague is reported to exist in the Hedjaz or to have existed
during the pilgrimage, vessels will be subjected, at Jebel-Tor, to the
rules prescribed at Kamaran for infected ships.
The plague patients will be disembarked, and isolated in the hos-
pital. The disinfection will be thoroughly carried out.
The other passengers will be disembarked, and isolated by groups,
as small as possible, so that if the plague breaks out in one group the
whole party will not be affected.
• The soiled linen, personal effects, and clothes of the crew and
passengers, and the ship, will be disinfected.
The local sanitary authority will declare if the discharge of the
heavy baggage and cargo is necessary, and if the whole ship must be
disinfected, or a portion only.
All the pilgrims will be kept under observation for 12 full days,
counting from the davon which the operation of disinfection was com-
pleted. If a case of plague occurs in any of the groups, the period
of 12 days commences for that group from the day on which the
last case in the group is reported.
Art. 5.—Ships coming from an infected port of the Hedjaz or
from any other port on the Arabian Red Sea coast without having
embarked pilgrims or any similar collection of persons and without
having had any suspicious cases during the voyage, are placed in
the category of ordinary suspected ships. They will be subjected
to the preventive measures and treatment laid down for such ships.
If they- are bound for Egypt, they will be kept under observation,
at Moses' Wells, for ten days, counting from the date of departure, and
will, in addition, be subjected to all the measures laid down for
suspected ships (disinfection, etc.), and will only be given free pratique
after a favourable medical inspection.
It is to be understood that if these ships have had any suspicious
cases during the voyage, they will be placed under 12 days' observa-
tion at Moses 1 Wells.
Art. 6.—Caravans of Egytian pilgrims must, before entering
Egypt, undergo rigorous quarantine at El-Tor for 12 days ; they will
then be sent to Ras Mallap, and there kept under observation for 5
days, after which they will only be granted free pratique after a
favourable medical inspection, and disinfection of their effects.
APP. IX. ]
spread of infection by sea.
315
Caravans of foreign pilgrims will, before returning home by land,
be subjected to the same measures as Egyptian caravans, and must
be accompanied by sanitary guards to the limits of the desert.
Caravans coming from the Hedjaz by way oí Akabah or Moïla
will be subjected, on arrival at the Canal, to medical inspection and
disinfection of soiled linen and personal effects.
Art. 7.—(i). The trans-shipment of pilgrims is strictly forbidden
in Egyptian ports.
(2) Ships coming from the Hedjaz or from an Arabian Red Sea
port, with a clean bill-of-health, not having on board pilgrims or any
similar collection of persons and on which no suspicious cases have
occurred during the voyage, will be given free pratique at Suez, after
favourable medical inspection.
Art. 8.—Ships leaving the Hedjaz with a clean bill-of-health, and
having on board pilgrims bound for a port on the African coast of the
Red Sea, may call at Suakin, there to undergo three days' observa-
tion, all passengers being disembarked and detained in the quarantine
encampment.
Art. 9.—Caravans of pilgrims arriving by land will be subjected
to medical inspection and disinfection at Moses' Wells,
Sanitär v measures to be taken on the departure for the south of
pilgrims from the ports of the Hedjaz.
The ports of embarkation should be' provided with sufficient
sanitary appliances to enable pilgrims returning to their homes to
be subjected to measures similar to those which are enforced on the
departure of pilgrims from ports beyond the Straits of Bab-el-Mandeb.
The application of these measures will be optional, that is to say
that they need not be applied unless the consular authority of the
country to which the pilgrims belong, or the doctor of the ship on
board which they embark, considers it necessary.
B.—MEASURES TO BE TAKEN IN THE PERSIAN GULF.
/.—Sanitary rules for vessels entering the Persian Gulf.
Any ship with plague on board, or on board which one or more
cases have occurred within r 2 days, will be considered infected,
Any ship on board which there has been a case of plague at the
time of departure, or during the voyage, but on which no fresh case
has occurred for 12 days, will be considered suspected.
Any ship, even though coming from an infected port, which has
had no death, or case of plague on board, either before departure,
during the voyage, or on arrival, will be considered as healthy.
316
Measures to prevent the
[App. IX.
Infected ships will be subjected to the following rules:—
(1) The sick will be immediately disembarked and isolated.
(2) The other persons on board should also, if possible, be dis-
embarked and kept under observation, for a period varying
according to the sanitary condition of the ship, and the
date of the last case, but which must not exceed ten days.
(3) The soiled linen and personal effects of the crew and passen-
gers, which, in the opinion of the sanitary authority of the
port should be considered as infected, will be disinfected,
as also the ship, or the contaminated part of the ship.
A more thorough disinfection may be ordered by the local sanitary
authorities.
Suspected ships will be subjected to the following measures :—
(1) Medical inspection.
(2) The soiled linen and personal effects of the crew and passengers,
which, in the opinion of the local sanitary authority, may
be regarded as contaminated, should be disinfected.
(3) Disinfection of all parts of the ship which have.been inhabited
by patients or suspicious cases. A more thorough disinfec-
tion may be ordered by the local sanitary authority.
(4) Pumping out the bilge-water after disinfection, and the substi-
tution of good drinking-water for the water stored on board.
(5) The crew and passengers should be kept under observation for
a period of ten days, commencing from the date of the last
case on board.
Healthy ships will be given free pratique at once, irrespective of
the nature of the bill-of-health.
Such ships must, however, in all cases, have completed, or must
complete, ten full days from the date of departure from the last
infected port at which they have touched.
The only measures the authority of the port of arrival may apply
to healthy ships are those prescribed for suspected ships (medical
inspection, disinfection, pumping out the bilge-water, and the sub-
stitution of good drinking-water for the water stored on board).
It is to be understood that the appointed authority of the port of
arrival may always demand a declaration on oath from the doctor, or
failing him, from the captain, that there has been no case of plague
on the ship since her departure.
In deciding on the extent to which effect is to be given to the
measures prescribed above, the authorities of the port should take
into consideration the fact that there is a doctor or a disinfecting
apparatus (stove) on board the ships coming under the three headings
mentioned above.
APP. IX. ]
spread of infection by sea.
317
Special measures may be prescribed for ships in an insanitary
condition.
Goods arriving by sea should be treated in the same way as goods
transported by land, as regards disinfection, prohibition of import,
transit, and quarantine.
Any ship objecting to submit to the obligations imposed by the
authority of the port is free to put back to sea.
The disembarkation of goods may be authorised after the follow-
ing necessary precautions :—
(1) Isolation of the ship, crew, and passengers.
(2) Pumping out the bilge-water after disinfection.
(3) Substitution of good drinking-water for the water stored on
board.
The disembarkation of passengers wishing to land may also be
authorised, on condition that they submit to the measures prescribed
by the local authorities.
//.—Sanitary posts in the Persian Gulf.
There are two places in the Persian Gulf suitable for the estab-
lishment of sanitary posts—one in the Straits of Ormuz (the Island
of Ormuz, the Island of Kishm, or, failing these, a place to be settled
in their vicinity) ; the other at a place to be settled in the neigh-
bourhood of Bassorah.
The sanitary post in the Straits of Ormuz should be provided
with at least two doctors, sanitary officers and guards and appliances
for disinfection. A small hospital should also be constructed.
A big lazaretto and apparatus for disinfecting goods should be
constructed at the post near Bassorah with a medical staff of several
doctors.
Before entering the Persian Gulf, ships must touch at the sanitary
post in the Straits of Ormuz. They will there be subjected to the
sanitary measures prescribed by the rules. If there are any plague
cases on board, the sick will be disembarked.
Ships wishing to proceed atonceup the Shatt-el-Arab will be per-
mitted, if the period of observation is not completed, to continue their
voyage, through the Persian Gulf and the Shatt-el-Arab in quarantine.
A sanitary officer and two sanitary guards, taken on board at Ormuz,
will keep a watch on the ship as far as Bassorah, where a second
medical inspection will be made, and the necessary disinfection will
be carried out.
Ships wishing to disembark passengers or goods at Persian ports
will be permitted to do so at Bushire, when suitable sanitary arrange-
ments have been made ; until then, they must land their passengers
and goods at Ormuz or Bassorah.
318
Measures to prevent the
[ APP. IX.
It is to be understood that a healthy ship will be granted free
pratique at the ports of the Persian Gulf ten days after the date of
departure from the last infected ports at which she has touched, pro-
vided that she is shown to be healthy on arrival.
The sanitary posts at Ormuz and Bassorah will be under the con-
trol of the Constantinople Board of Health. The Ottoman and Per-
sian Governments will come to an agreement with regard to the post
at Ormuz.
Until the Ottoman and Persian Governments have arrived at this
agreement, a sanitary post will be established as a temporary measure
in one of the islands in the Straits of Ormuz, and the Board of
Health will post doctors and sanitary guards at this place. These
guards will accompany ships passing in quarantine up the Shatt-el-
Arab to the post established in the neighbourhood of Bassorah.
The Constantinople Board of Health will also organise without
delay sanitary posts at Khanikin and Kizil Dize, near Bayazid, on the
Perso-Turkish and Russo-Turkish frontiers.
CHAPTER II.
Measures to be taken in Europe.
SECTION 1.—Measures to be taken to keep the Governments which
are parties to the Convention acquainted with the existence of
an epidemic of Plague, and with the means taken to prevent its
spread and its importation into healthy countries.
Notification and subsequent communications.
The Government of an infected country must notify to the other
Governments the existence of all cases of plague. This measure is
essential.
It will only be of real use, if the Government of the infected
country is itself informed of cases of plague and suspicious cases
occurring in its territory. It cannot, therefore, be too strongly
impressed on the differnt Governments that doctors should be obliged
to report all cases of plague.
The notification should state the existence of cases of plague, the
places where they have occurred, the date of their appearance, the
number of cases reported, and the number of deaths.
The notification should be made to the diplomatic or consular
agents in the capital of the infected country. In the case of countries
not represented there, the notification should be made, by telegram,
direct to the foreign Governments.
This first notification should be followed by subsequent regular
communications, with a view to keep the Governments informed of the