Australian maritime quarantine and the evolution of international agreements concerning quarantine.

  • Cumpston, J. H. L. (John Howard Lidgett), 1880-1954.
Date:
1913
    Suez Canal. The importance of this highway between Asia and Europe as a channel of infection is obvious, and much of the time at this and subsequent Conferences was devoted to the adoption of regulations for the sanitary control of this traffic. This Conference instituted on its present basis the present International Council which controls the maritime traffic in the Suez Canal from the sanitary aspect; and it also intro- duced another important innovation, viz., the classification of vessels according to their own sanitary condition on arrival, with complete abolition of any detention based solely on the condition of the ports from which the vessel had come. Thus was established the fundamental change in quarantine adminis- tration, which embodied the evolution from the old irrational system to the present method. Under the old system, a vessel was detained and kept isolated if it came from an infected port; under this new modification, the vessel was treated entirely on the result of the medical inspection—a vessel was " clean " if it had had no cases of cholera on board during its voyage; " suspected " if it had had cases during the voyage, but no case within the seven days preceding its arrival; and " infected " if there were cases on board on arrival, or within the seven days preceding its arrival. This classification is still, with slight modi- fications, maintained. Dresden, 1893.—This Conference continued the consideration of the epidemiology of cholera, paying special attention to the notification by each country of the first cases of cholera within its borders, and to the part played by cargo, merchandise, and inanimate objects generally (fomites) in the spread of cholera infection. This Conference dealt with the question of merchandise much more completely than previous Conferences. It laid down that certain articles, mails, for example, should not be submitted to any restriction nor disinfection; that certain other articles might be prohibited, and either refused entry altogether, or permitted entry only after disinfection. Further modifications in the classification of vessels according to their sanitary state on arrival were introduced by the recognition of the danger inherent in emigrant ships, or vessels exhibiting insanitary conditions. It was recognised that such vessels, though actually free from cholera, might be regarded with suspicion and subjected to restrictive measures. Another important principle was adopted at this time, viz., that observation of a person from a " suspected " ship might, under certain circumstances, be permitted at the person's residence instead of requiring the detention of the person at a quarantine station. Thus was instituted the existing system of " surveillance." Paris, 1894.—This Conference dealt only with the question of the sanitary regulation of the Mecca pilgrimage, and of the mari- time trade of the Persian Gulf. Venice, 1897.—The appearance in Bombay, in September, 1896, of a disease which had not shown itself for many years, viz., plague, caused much uneasiness amongst European authorities, and accordingly, this Conference was summoned with the object of arranging the measures to be taken to prevent the introduction and dissemination of plague, and the sanitary control necessary for this purpose in the Red Sea and in the Persian Gulf. The
    Convention which was the outcome of this Conference is prac- tically a consolidation of the previous Conferences at Venice (1892), Dresden (1893), Paris (1894). Paris, 1903.—The necessity of obtaining a practicable Convention had become increasingly urgent, and it was decided to convoke a new Conference, with the object of codifying the previous Conventions, and producing one uniform set of resolutions and articles of agreement. At the same time, the knowledge that had been gained since the Venice Convention of 1897, on the role played by rats in the dissemination of plague, and of mosquitos in the dissemination of yellow fever, rendered necessary a revision of the articles dealing with those diseases. At this Conference, the proposal for the establishment of a permanent International Bureau of Health, first suggested at the Conference of Vienna in 1874, was finally adopted, and this ofl&ce has been in full working order since 1909. The classification of ships (detailed above) into " clean," " suspected," and " infected," has been maintained until the present day. For " clean " ships, notwithstanding that they may have come from an infected port, the only measures permitted are the original medical inspection, evacuation of drinking water and bilge water, and any necessary measures of disinfection (in- cluding measures for the destruction of rats). It is not con- sidered permissible to detain either passengers or crew on such vessel. For " suspected " ships, in addition to the above, it is recommended that measures of surveillance be employed—that is, that passengers and crew be kept under observation for certain specified periods, while in the case of " infected " ships it is recommended that the passengers and crew be detained under observation. The gradual evolution of the scope of these Conferences under the influence of the various epidemics which appeared from time to time, is one of their most striking features. Dealing at first only with cholera, the outbreak of yellow fever in America brought that disease within the range of discussion, while the great epidemic of plague subsequent to 1895 brought this disease forward into a prominent place in the discus- sions at Venice (1896) and Paris (1903-12). As yellow fever was not considered a menace to the European countries, it has never been assigned more than a minor place in the discussions at these Conferences, but it is so serious and widespread a disease in America that it has been found necessary for the American nations to hold frequent con- ferences and draw up international treaties, imposing restrictions on traffic and commerce, solely with the object of preventing the spread of this disease. This phase of the subject is of vital importance in view of the bearing it has upon the differences between the policy laid down by the International Conventions and that adopted in Australia. The United States and other American nations have registered their adhesion to the Paris Convention, but have, nevertheless, found it necessary to impose restrictions beyond those specified in the Convention, with the object of preventing the spread of yellow fever. Not only so, but in view of the necessity of protecting their country against small-pox, the United States have found it necessary to impose restrictions with regard to this disease also—a disease which has not even been discnsspd at nnv of the European Conferences. It is necessary to emphasize this, as the
    criticisms which have been directed against the Australian system of quarantine have almost entirely been concerned with the measures intended to prevent the introduction of small-pox. The fundamental principle underlying the existing International Conferences is that these Conferences have been convened with the object of devising some system of mutual protection against those diseases which most seriously threaten the countries concerned, and have always been convened at a time when an invasion by the disease has been actually very imminent. In adopting the same principle with regard to yellow fever and small- pox, the American nations were only following the same course, and their departure from the principles laid down in the International Con- ventions has, therefore, been regarded as perfectly legitimate, even though these same nations had registered their adhesion to these Conventions. That the same principle has actuated the present Australian system can be fully demonstrated. SANITARY CONFERENCES IN AUSTRALIA. After Australia had been free from any extensive epidemic of small- pox for a period of thirteen years a serious outbreak occurred in Sydney in 1881. Following this there were scattered cases, and in 1884 the disease became extensively prevalent, affecting New South Wales, Vic- toria and South Australia. Prior to this there had been several definite outbreaks in Australia—Melbourne, 1857 and 1868; Sydney, 1877—and the danger of small-pox to the community was very definitely before the minds of those in authority. In addition to this, as each of the Aus- tralian States had its own law and practice, and these differed materially as between the States, considerable confusion and irritating obstruction to commerce, especially by sea, was found to result. As a direct result of these two factors the New South Wales Govern- ment invited the Governments of the other States to send representatives to confer and report as to the best means of establishing a uniform and effective system of quarantine for Australia. The two words here used— "uniform" and "effective"—constitute the keynote of the objects of this and all subsequent Australian Sanitary Conferences. The striving after uniformity has had its direct outcome in the present Common- wealth system of quarantine—a system uniform for all Australia and under one central direction. The determination to secure efficiency led naturally to the discussion of those diseases which were most seriously to be feared in Australia. The Australian Conferences, therefore, were moved by exactly the same impulses and toward exactly the same ends as all other Conferences; but just as the European Conferences discussed the disease which most threatened European countries—cholera, and later, plague; and just as American Conferences devoted themselves almost entirely to the disease peculiarly dangerous to America—^yellow fever, and later, plague—so Australian Conferences, inspired by identical apprehensions, have devoted themselves primarily to small- pox, and later, to plague. Australia has never known cholera or yellow fever except on vessels arriving off the coast; but it has known very serious epidemics of small- pox, and has learned how great a loss of human life and how serious a hindrance to traffic and commerce, and how great a burden of cost to the community, is produced by this disease.
    First Conference, Sydney, 1881.—The greater part of the delibera- tions of this Conference were directed towards the production of a uniform Federal system of quarantine, and many of the resolu- tions deal with the details of this system. At that time, and indeed until 1908, there was no system introduced under any Commonwealth Act, and accordingly the system proposed by their delegates was based upon the assumption that all the States would act in unison and co-operate in detail. Provision was made for the introduction into each of the State Parliaments of a uniform Quarantine Bill, so that although there was no com- bined action in any other political sphere, uniform administration in quarantine would be insured by the passage of these several Acts to be known in each State as the Federal Quarantine Act, It was agreed by the Conference that Part VI. of the Public Health Statute 1865 of Victoria, should be the basis of this Federal Quarantine Act, and, although the Act has in its evolution changed considerably, yet this original basis can still be traced in the form of the existing Commonwealth Quaran- tine Act. Provision was made for the establishment of Federal quarantine stations at Albany and at Thursday Island, the ports first reached by vessels making Australia from the west- ward and northward respectively, these stations to be under the joint control of all the States. The procedure to be adopted on the arrival of vessels was also laid down. In the case of clean ships, from whatever port they may have come, no obstruction to the landing of passengers was per- mitted. Certain measures of disinfection were allowed at the discretion of the Health Officer. In the case of vessels infected with cholera it was prescribed that " all hands except such as are actually necessary to cleanse the ship expeditiously and thoroughly, shall be landed at the quarantine ground at the terminal port, where they shall be detained for a period of not less than ten days." In the. case of vessels infected with yellow fever it was pre- scribed that "if no cases of yellow fever have occurred on board during the voyage, being more than ten days from the date of leaving the infected port, the passengers may be admit- ted to pratique, but that if any case have occurred on board, the passengers and crew shall be detained for ten clear days on shore at the quarantine ground, and their effects, as long as may be necessary to disinfect them to the satisfaction of the Health Officer." Plague was not referred to. Considerable attention was paid to small-pox, and the following rules were agreed upon: — Every passenger ship bound for Australia was to carry enough lymph to vaccinate all on board. If small- pox broke out the surgeon was to vaccinate all on board. " Persons able to satisfy the Health Officer that they have been successfully re-vaccinated at a date being not more- than six months previous to their arrival in an infected ship may, at the discretion of the Health Officer, be released after such time as is necessary to cleanse and disinfect their clothing on shore."
    It may be seen from tliese provisions that except for the attention paid to small-pox the scope of the measures agreed upon as practicable did not differ from those agreed upon at the contemporary European Conferences. That the Australian Sanitarians were fully alive to the position taken up by their European colleagues is indicated by the following initial resolution: — " That by quarantine this Conference understands such measures taken in regard to vessels coming to the various Australian ports as will effectually protect the Australian Colonies from the invasion of contagious or infectious disease consistent with the least possible interference with the liberty of individuals and with the least possible restriction to commerce." This Conference was not productive of any immediate result, nor were any of its resolutions pub into practice by the Governments con- cerned. That it was, however, of great value in preparing the minds of those most concerned for the ultimate unification, and in establishing an understanding between the Health officials of the various States, is clearly shown by subsequent events. Second Australian Conference, 1S96.—This Conference was held primarily, if no'E entirely, for the purpose of arriving at some uniformity of practice in regard to quarantine administration. Confusion and annoyance had been produced in the case of certain vessels infected with small-pox by reason of the varying procedure adopted in the different States. The discussions dealt with Ihis question of uniformity of procedure in detail, but entirely with reference to small-pox, and the resolutions carried did not differ in any essentials from those carried at the First Conference. In order that the reality of the fear of small-pox in Australia might be appreciated it is only necessary to mention that in the interval between the first and second Conferences two disastrous epidemics of small-pox had occurred, namely, in Launceston (Tasmania), 1887; and Perth (Western Australia), 1893, and the necessity for placing this decision in the most important position amongst the subjects discussed at Australian Sanitary Conferences is indicated by the closing words of the President (Dr. D. A. Gresswell) at the conclusion of this Conference : — " The resolutions, if carried out, would secure a much greater degree of protection to the Colonies than they had previously enjoyed. Convinced though.all might be that small-pox must one day become endemic in Australia, the duty which had been confided to them of keeping it out as long as possible, and by such means as were fair and reasonable, would at all times receive their most careful and anxious consideration." Third Conference, 1900.—This was known as the Intercolonial Plague Conference, and the only subject discussed was plague. The world-wide spread of plague, and the appearance of the disease in two of the Australian States, had rendered a conference imperative. The Venice Convention of 1897 was taken as the basis of discussion. Certain important alterations were made, and the resolutions finally agreed upon differed from the Venice Convention primarily in two directions.