7
II.
RECOMMENDATIONS.
Although the facts and considerations summarized in the .foregoing .section
must, I think, lead to a modification of the opinions hitherto held regarding the
degree of danger of the spread of yellow fever to the East and to India as a
result of the opening of the Panama Canal, it cannot be too strongly urged that
they do not justify the conclusion that little or no action is at present necessary.
(1) In the first place it must be emphasised both that the knowledge obtain-
able for the purpose of forecasting the situation that will arise after the canal is
opened for traffic is unavoidably incomplete and imperfect, and that at any time
after the opening of the canal there.may occur unexpected events which would
alter the whole position. From the circumstances of the case the knowledge that
can be obtained at present is insufficient to enable us to do more than conjecture
what changes in the distribution of yellow fever in the endemic area, what
increased traffic to the East, and what measures to prevent ships from carrying
infection, will follow the opening of the canal. And although it has been shewm
in Section I that, in all probability, India will not be in danger until some of the
countries further East become infected, it seems to me essential that she should
be supplied with continuous information upon those subjects. It is, of course,
even more urgent that such information should be available to our Far Eastern
colonial ports, which, as I have shewn, are more directly exposed to the risk of
infection.
For these reasons my first recommendation is that permanent arrangements
should be made to obtain continuous first-hand information regarding the yellow-
fever situation in the endemic area, the actual shipping traffic in that area, the
actual shipping traffic from and through the area to the East, and the measures
that are taken to prevent ships from carrying infection. So far as I can learn,
the only satisfactory method of obtaining this information is to station
permanently in the endemic area a medical officer who will be constantly in
touch with the Consular and quarantine officers of the United States and
ether countries. I therefore strongly advocate the appointment of such an
officer. In practice he would be attached for duty to the British Consulate at
Panama, and his work would chiefly be that of an intelligence officer in the endemic
area. By acting in co-operation with the Consular and sanitary officers of the
United States, by visiting suspicious places, and by making a special study of
the local and trans-Pacific shipping, he would quickly become aware of any new
circumstances which threatened the safety of the East. He would, of course,
keep a continuous record of the shipping from the endemic area to the East, and
would ascertain the risk of infection to those ships. He might, as a rule, report
his transactions monthly, but he would also be empowered to cable at any time
to the quarantine officers in Eastern ports such information as would enable
them to take adequate precautions against any threatened danger.
Supplementary to that measure it is highly advisable, I think, to appoint a
second medical officer as an intelligence officer in an area of which Hong Kong
would be the centre. He would be stationed in Hong Kong and one of his first
duties would be to become thoroughly familiar with the shipping which enters
that port from the endemic area, and with the history of the voyages of such
ships ; but he would also place himself in frequent written communication with
the sanitary authorities of the Phillipines, and, if necessary, would visit Manila in
order to ascertain exactly what new or increased dangers may have arisen to the
those islands as a result of the opening of the Panama Canal, and what steps are
taken for their protection. In the same way he would endeavour ,to watch the
situation in its relation to Shanghai. In Hong Kong itself he would associate
himself with, and assist in, any measures that may be taken for the better
protection of the port and for the safety of ships which leave the port, for
Singapore,and India ; and, by his. reports to the central organisation presently to
be mentioned, India would be constantly informed ot any new circumstances of a
threatening character in regard to the spread of yellow fever, as well as of the
progress of any enquiries such as that relating to the presence or absence of.
stegomyia fasciata.
Following this-plan further, it would doubtless be of great advantage
though it is not perhaps essential, to appoint a third intelligence officer with