NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
37°M easures to prevent the spread of infection by sea. [CHAP. XI.
when it is officially reported that no death or fresh case of plague has
taken place for ten days after the recovery or death of the last case,
provided that the necessary measures of disinfection have been
carried out.
The Secretary of State forwarded instructions to the Government
of India with regard to the method of notification in a despatch,
dated the 8th of July. It was then arranged to send telegraphic
information to the States who are parties to the Convention of the
extension of plague to any fresh local area, or of its extinction in any
area where it had existed. It was also arranged to send information
of any important change or extension of remedial and preventive
measures.
Inspection of
vessels sailing
from infected
ports.
The regulations next deal with the measures to be taken on
the departure of vessels from infected ports. It is laid down that
every person sailing on the vessel must be examined on shore,
immediately before embarkation, by a medical officer appointed by
the Government, and that the Consular authority interested in the
ship may be present at the inspection. All infected and suspected
articles must be subjected to careful disinfection on shore and in
the presence of the Government medical officer in accordance with
the rules for disinfection prescribed in Chapter III of the regulations,
and no persons showing symptoms of plague may be permitted to
embark.
Pilgrim traffic.
The rules regarding the pilgrim traffic form the next portion
of the regulations. It has been stated above that they are derived
with some modifications from Paris Sanitary Convention of 1894.
The subject is a complicated one, and it is unnecessary for the
purposes of this report to examine the details of the rules.
The Red Sea
and the Suez
Canal,
Persian Gulf.
The important subject of the control of the general traffic in the
Red Sea and the Suez Canal is next dealt with. The regulations
are based on the threefold classification of ships into healthy, suspect-
ed, and infected, adopted in the Venice Convention of 1892, with the
modifications rendered necessary owing to the period of incubation
in the case of plague having been fixed at ten days. The rules are
described in detail in Chapter XIV, in which is also given an account
of the arrangements for the Persian Gulf prescribed in the first
chapter of the Convention regulations.
Measures to be
adopted in
Europe.
The second chapter of the regulations deals with the measures to
be adopted by the European Governments which have assented to the
terms of the Convention. The provisions relating to notification have
been mentioned above. In Chapter II allusion has also been made to
CHAP. XI.] Measures to prevent the spread of infection by sea. 371
the regulations regarding the importation of merchandise, and this
important subject will be further discussed in Chapter XIV. The
measures to be taken on land frontiers have been noticed in the
discussion on land quarantine contained in Chapter X.
Measures to be
adopted at
ports of arrival.
Threefold
classification of
vessels.
The portion of the second chapter of the regulations which relates
to traffic by sea and the measures to be adopted at ports of arrival
is of great interest, not only because of its direct bearing on the con-
ditions of intercourse between India and Europe, but also because it
contains the conclusions of the Conference on the subject of the quar-
antine of vessels. The threefold division of vessels, referred to above,
is maintained in this chapter. Healthy vessels are those on board of
which there has been no case of plague ; suspected vessels are those on
which, though cases of plague have occurred, no fresh case has occurred
within twelve days ; and infected vessels are those on which plague has
been present within twelve days of the date of arrival, The period of
twelve days is calculated, as in the case of the seven days' period in
the Convention of 1892, by adding two days to the period of incu-
bation.
Infected vessels.
The regulations for infected vessels require the sick to be landed
and isolated, and the remainder of those on board to be subjected, at
the discretion of the local authority, either to " observation " or to
" surveillance " for a period which is not to exceed ten days from the
occurrence of the last case of plague. The term " observation " means
detention under observation either on board a ship or in a place of
segregation on shore. Persons subjected to " surveillance " are not
to be isolated, but are to be allowed to proceed at once to their desti-
nation where they are to remain under medical supervision. In the
case of an infected ship the dirty linen and other effects of the passen-
gers and crew which the local sanitary authorities may consider likely
to be contaminated, must be disinfected. So also must the parts of the
ship where the sick have resided, and the local authorities may require
a more extensive disinfection to be carried out. Lastly, the bilge-
water must be thrown out after disinfection and fresh drinking-
water supplied.
Suspected
vessels.
In the case of suspected vessels, a medical inspection and the
same process of disinfection, discharge of bilge-water and supply of
fresh drinking-water is prescribed. It is further recommended that
the crew and passengers should be subjected to " surveillance " for
a period of ten days from the date of arrival of the vessel.
Healthy vessels.
Pratique is to be given at once to healthy vessels, but it is also
provided that, at the option of the local authority, the precaution-
ary measures enforced in the case of suspected ships, except the disin-
fection of the vessel may be required ; and it is also recommended
372 Measures to prevent the spread of infection by sea. [ CHAP. XI .
that the passengers and crew should be subject to " surveillance"
for a period sufficient to complete a term of ten days from the date
of departure of the vessel from the infected port. In the case of
both suspected and healthy vessels it is recommended that the crew
should only be allowed to land on duty.
Other chapters.
The third chapter of the regulations contains a set of instructions
regarding the best way to carry out the various processes of dis-
infection. The fourth chapter consists of a set of precautionary
rules recommended for ships sailing from infected ports at the time
of departure, during the voyage and on arrival. The fifth and
last chapter deals with matters connected with administration and
finance.
Regulations for Inspection of inward-bound Vessels
based on the Venice Convention.
INSTRUCTIONS OF THE GOVERNMENT OF INDIA.
Revision of the
Local
Government
Quarantine
Rules.
Period of
observation.
Infected
vessels.
In the circular issued by the Government of India on the 1st of
June, forwarding a copy of the Venice Convention, the Maritime
Local Governments were directed to revise the quarantine rules against
arrivals from infected ports in accordance with the regulations of
the Venice Convention. It was stated that the period of observation
should be reduced from fifteen to ten days, and that the Convention
regulations should be followed in the case of vessels on which there
is a case of plague at the time of arrival, or on which it is believed
that a case has occurred during the voyage. Special stress was
laid upon the undesirability of detaining the sick and healthy on board
ship together. It was stated that the " sick should be landed and
treated in an isolation hospital, and the healthy should be landed
and detained under observation in suitable segregation shelter
for a period of ten days from the occurrence of the last case. The
disinfection and other precautionary measures prescribed by the
Conference should also be complied with. "
Healthy vessels.
The following directions were given with regard to the treat-
ment of vessels on which no case of plague has occurred during the
voyage:—
"The maximum period of detention of a vessel on which the
Health Officer is satisfied that no case of plague has occurred should
be ten days from the date of departure from the infected port. If
the Health Officer is not satisfied that there has really been no case
on board or if ten days have not elapsed since the date of departure
from the infected port, the vessel may be detained, at his discretion,
CHAP. XI. ] Measures to prevent the spread of infection by sea. 373
up to this period. In any case in which a vessel is given free pratique
less than ten days after her departure from the infected port
the Health Officer should be empowered, on the analogy of the
rules for the observation of persons travelling by railway which have
been framed by several of the Local Governments, to detain under
observation in a suitable place of segregation, up to a maximum of
ten days from the date of the departure of the vessel, any person
landed from the ship whom he may consider to be in any way likely
to carry infection. Any articles of clothing or other effects belonging
to the persons detained or to other persons which, by reason of their
dirty condition or otherwise, may be considered likely to be con-
taminated, should be disinfected. Discretion may be given to the
Health Officer to apply the other provisions regarding disinfection,
etc., prescribed by the Convention in the case of suspected ships.
The Local Government may also make such arrangements as are
possible for the surveillance of persons who are not detained, on
arrival at their destination. Free pratique granted at Colombo or
other intermediate port should be recognised."
BOMBAY.
Draft rules for
the Port of
Bombay.
With a letter of the 22nd July the Government of Bombay for-
warded a set of draft rules for the inspection of vessels arriving at the
port of Bombay from infected ports. These rules appeared to the
Government of India to be generally suitable and in accordance with
the Venice Convention. They pointed out two defects—
(1) The Health Officer was given discretion, in the case of a
healthy ship which has not completed ten days from the
date of departure from an infected port, to (a) refuse
pratique until the end of the ten days' period, and (b)
until all persons on board had been subject to medical
supervision up to ten days from the date of departure.
It was understood that alternative (a) contemplated the de-
tention of all persons on board ship. The Government
of India considered that this alternative was open to
objection, and that the passengers should be disembark-
ed and kept under "observation" or " surveillance " on
shore.
(2) The rules left it to the discretion of the Health Officer to
allow the healthy passenger? and crew of an infected vessel
to land for the purpose of being kept under observation.
The Government of India considered that it should be obli-
gatory to land the healthy and keep them under observation
on shore, and that an exception should be made to this rule
374 Measures to prevent the spread of infection by sea. [CHAP. XI.
only in the case of those members of the crew whom it is
necessary to detain on board for the care of the vessel,
It was further pointed out that the rules should be framed so as
to apply to all infected and suspected vessels whatever their port of
origin, and that the form might follow more closely the regulations
of the Venice Convention.
Aden and other
ports in the
Bombay Presi-
dency.
The Government of India also suggested that the rules for Aden,
Karachi, and the other ports in the Bombay Coast at which it was
considered necessary to maintain an inspection of the inward sea
traffic should be modified on the lines of the draft Bombay rules.
It was recognized that in the case of Aden the imposition of quaran-
tine is complicated by the importance of keeping the port clean in
the eyes of the world. The Government of India considered, how-
ever, that if proper arrangements were made and proper precautions
taken, the enforcement of the regulations prescribed by the Venice
Convention would not injure the reputation of the port.
Draft rules for
Aden.
Threefold
classification of
vessels.
With a letter dated the 4th October the Government of Bombay
forwarded a set of draft rules, framed in accordance with the
principles of the Venice Convention, for the treatment at Aden of
vessels arriving there from ports declared to be infected with plague.
The rules were based on the threefold classification of ships into
"healthy," " suspected," and "infected," and prescribed a different
treatment in the case of vessels whose destination is Aden and vessels
merely using Aden as a port of call. The following is a summary of
the rules.
Period after
which free
pratique may be
given.
No vessel may be given pratique until ten days from the date of
its departure from an infected port. A vessel which carries no
qualified medical officer may not be granted free pratique until
ten days from the date of its arrival at Aden. Until the ten days'
period has expired the vessel must remain at the quarantine
anchorage and may have no communication with the shore.
Vessels whose
destination is
Aden.
If Aden is the destination of the vessel, an officer goes alongside
on its arrival and ascertains whether ten days have expired since
its departure from an infected port. If ten days have expired, and if
the vessel carries a qualified medical officer, the inspecting officer
goes on board and after the necessary investigation classifies the ship.
The rules of the Venice Convention for " healthy," " suspected " or
''infected" ships are then applied according to the condition of the
vessel. If it is ascertained that ten days have not expired since the
departure of the vessel from an infected port, or if it carries no qualified
medical officer, it is detained at the quarantine anchorage until,
in the former case, ten days have expired since its de-parture from an
CHAP. XI] Measures to prevent the spread of infection by sea. 375
infected port, or, in the latter case, ten days have expired since its
arrival at Aden, The vessel is then classified and treated according to
its condition. If, however, it is ascertained at any time after its
arrival that the vessel is infected, the measures for infected ships
are at once enforced.
Vessels using
Aden as a port
of call.
If the vessel merely uses Aden as a port of call, an officer goes
alongside, as before, and ascertains whether ten days have expired
since its departure from an infected port. If ten days have expired and
if the vessel is found to be healthy it must be given pratique. Other-
wise it must remain at the quarantine anchorage during its stay in port.
No persons may, in such case, be landed except at the quarantine
camps, and no communication may be held with the shore, or with
other vessels, except for the purpose of landing the mails in quarantine
and the embarkation and disembarkation of passengers in quarantine.
If ten days have not expired since the departure of the vessel from an
infected port, or if it carries no qualified medical officer, it must like-
wise remain in quarantine. The rules, require the inspection to be
ordinarily made during the day time, and the Government of Bombay
have approved of the suggestion of the Resident that when inward-
bound vessels arrive in the night, and do not care to stay for exami-
nation by day, the usual form of report should be sent on board to be
filled in by the Commander or Medical Officer.
The rules contain the following miscellaneous provisions :—
Other provisions
of the rules.
Transhipment may be made in quarantine of passengers, or other
persons, or mails, or cargo, from a vessel in quarantine to another
vessel, provided that thereafter the other vessel remains in quaran-
tine. Mails or cargo brought by a vessel from an infected port may
be landed under necessary precautions. The Port Officer must facili-
tate the conveyance to vessels in quarantine of provisions, etc.,
under necessary precautions. Vessels which have communicated with
vessels from an infected port are subject to the same rules as arrivals
from an infected port, All vessels which have undergone the pres-
cribed medical inspection and quarantine should have the fact clearly
stated on their bills of health.
The Government of India approved the draft Aden rules on the
25th of October.
Modification of
the Aden rules
with regard to
the grant of free
pratique.
In January 1898 the Government of India issued instructions that
the provision of the Aden Quarantine Rules refusing free pratique to
vessels with less than a ten days' healthy passage from an infected
port should be cancelled, and that such vessels should immediately
376 Measures to prevent the spread of infection by sea. [ CHAP. XI.
be granted free partique subject only to the enforcement of the pre-
cautions authorized in Chapter II, Section VIII, of the Convention,
in the case of healthy vessels arriving at European ports. The change
was made at the instance of the British Foreign Office who consider-
ed that the refusal to grant immediate free pratique to healthy ves-
sels was opposed to the Venice Convention, even though the vessel
had within ten days been in an infected port. In issuing the instruc-
tions the Government of India stated that vessels merely using Aden
as a port of call should as before be given the option of remaining in
quarantine instead of seeking free pratique since experience had shown
that the delay inseparable from medical examination, etc., renders the
former course more convenient for them.
BENGAL.
Draft rules for
Calcutta.
Healthy
passengers not
to be detained on
board ship.
The Government of Bengal forwarded a set of draft quarantine rules
for the port of Calcutta with a letter dated the 17th July. The Gov-
ernment of India considered that these rules were well adapted to
meet the requirements of the Venice Convention, but pointed out that
the form was incorrect inasmuch as it made the rules of permanent
application, and that the definition in the draft rules of the term
" observation" was not in accordance with the Venice Convention
since it contemplated the detention of the persons to be observed on
board the vessel in which they arrived. It was stated that healthy
passengers should never be detained on board ship, and that in the cases
of infected vessels no one should be left on board except the persons
whose presence was necessary for the care of the vessel.
Publication of
revised rules for
Calcutta.
The Government of Bengal made the necessary corrections and
then issued a notification (dated the 26th August) under the Epidemic
Diseases Act prescribing the new rules, and, with the previous sanction
of the Governor General in Council, a second notification under
the Quarantine Act, cancelling the rules at the time in force. •
Threefold classi-
fication of ships.
The rules in the first place make the threefold classification of
ships of the Venice Convention, and define the terms " observation "
and " surveillance " as in the Convention. They then provide for the
hoisting of signals, the position at the anchorage to be taken up by in-
fected and other vessels, the prohibition of communication with the
shore and with other vessels until permission is granted, and inspec-
tion by the Health Officer of the Port.
Treatment of
vessels of each
class.
Rules are next laid down for the treatment of infected, suspected,
and healthy vessels, which follow the rules prescribed by the
Venice Convention. These rules summarize in a very clear and con-
CHAP. XI.] Measures to prevent the spread of infection by sea. 377
cise manner the way to treat infected vessels and vessels from an in-
fected port. They are reproduced at length in the following ex-
tract :—
Infected ships.
"Rules relating to infected skips—
(1) If an infected ship has, under Rule IV, been stopped at Dia-
mond Harbour, she will await the orders of the Health
Officer there. If under Rule V, she has been brought up
to Mateabrooj, the Health Officer will direct the Com-
mander to take her to the sanitary station at Diamond
Harbour, or elsewhere as may be appointed by Govern-
ment, and to await orders there.
(2) On arrival at the sanitary station, the sick will be imme-
diately disembarked and isolated under the order of the
Health Officer.
(3) The other persons on board shall also be disembarked and,
when necessary, kept under observation at the sanitary
station for a period varying, in the discretion of the
Health Officer, according to the sanitary condition of the
ship and the date of the last case. Such period must not
exceed ten days from the date of the last case, whether
that occurred on board ship or during the period of obser-
vation on shore. It is also in the discretion of the Health
Officer to allow such persons to proceed to their destina-
tion on their giving a written undertaking, in the form
annexed as Appendix I, to submit themselves to surveil-
lance by the Medical Officer (if any) appointed for the
purpose, at their destination, for a period of ten days from
the date of the arrival of the ship. The undertaking shall
be executed in duplicate, and one copy shall be sent by
the Health Officer to the Medical Officer concerned.
No one arriving on the vessel shall be left on board except
those persons whose presence is necessary for the care of
the vessel.
(4) The soiled linen and personal effects of the crew and passen-
gers, which, in the opinion of the Health Officer, may be
considered as infected, shall be disinfected, in accordance
with the rules contained in Appendix II.
(5) The bilge-water will be pumped out after disinfection, and
good drinking-water will be substituted for the water
stored on board.
(6) All parts of the ship, which have been inhabited by plague-
patients, will be disinfected; and the other parts of the
48
378 Measures to prevent the spread of infection by sea. [CHAP. XI.
ship may also be disinfected at the discretion of the
Health Officer.
(7) When these rules have been fully complied with, the Health
Officer shall, by an order in writing under his hand, to be
delivered to the Commander, permit the yellow flag to be
hauled down.
Suspected
ships.
" Rules relating to suspected ships—
(1) If a suspected ship has, under Rule IV, been stopped at
Diamond Harbour, she will await the orders of the Health
Officer there. If, under Rule V, she has been brought up
to Mateabrooj, the Health Officer will go on board of her
there.
(2) The passengers and crew will be medically inspected by the
Health Officer.
(3) The soiled linen and personal effects of the passengers and
crew which, in the opinion of the Health Officer, may be
considered as infected, will be disinfected in accordance
with the rules contained in Appendix II.
(4) The bilge-water will be pumped out after disinfection, and
good drinking-water will be substituted for the water
stored on board.
(5) All parts of the ship, which have been inhabited by plague-
patients, will be disinfected; and the other parts of the
ship may also be disinfected at the discretion of the
Health Officer.
(6) Passengers who are suspected by the Health Officer to be
infected with plague may be detained under observation
in an isolation hospital appointed for the purpose, for ten
days from arrival of the ship, or if plague occurs among
them while under observation, from the date of the last
case.
(7) The crew will not be allowed to land, except on duty, for
ten days from the arrival of the ship.
(8) Passengers who are passed on medical inspection as healthy
will be allowed to proceed to their destination on their
giving a written undertaking, in the form annexed, to
submit themselves to surveillance by the Medical Officer
(if any) appointed for the purpose, at their destination,
for a period of ten days from the date of the arrival of the
ship. The undertaking shall be executed in duplicate,
and one copy shall be sent by the Health Officer to the
Medical Officer concerned.