Medical Surveillance

MEDICAL SURVEILLANCE (French surveillance), a special term introduced into the practice of international measures to combat epidemics and formalized by the relevant articles of international sanitary conventions. Former measures for protecting borders from the introduction of epidemic diseases, especially plague and cholera, were reduced to so-called police or quarantine measures, which were extremely burdensome for passengers and severely disrupted trade interests (ban on the import of goods, closing of borders, multi-day quarantines, etc.). Only in 1893 at the Dresden International Sanitary Conference was this burdensome quarantine system abolished, and new, simplified and unburdensome methods of combating these epidemics and corresponding border protection measures were introduced. Instead of quarantines, the following were introduced: a) so-called observation for a period not exceeding the incubation period of the given disease, and only in cases strictly defined in the convention; b) medical surveillance. In subsequent international conventions (1903, 1912, and 1926), these measures were defined more precisely. The 1926 Convention (Paris) in its introductory part defines this term as follows: "the word 'surveillance' (medical surveillance) means that persons are not isolated; they immediately receive free 'practice', but the sanitary authorities of the localities to which they are heading are immediately notified of them, and they undergo a medical examination there, which determines their state of health." Both medical surveillance and observation may, according to the 1926 Convention, be applied only in special cases, when, for example, the sanitary authority of a port is dealing with a so-called infected ship, i.e., one where cases of contagious diseases provided for by the convention were discovered, and even then only during the period preceding the arrival of the ship in port and equal to the incubation period of the corresponding disease. The sanitary authority has the right in these cases to carry out a number of measures and apply either observation or medical surveillance to the passengers of the ship. At land borders, medical surveillance may be applied if passengers are traveling from localities where "an imported case of plague or 87

MEDICAL OBSERVATION STATIONS AND POINTS

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yellow fever has been discovered, or when cases of cholera form a focus, or typhus and smallpox exist in an epidemic form" (Art. 10 of the 1926 Convention). Under medical surveillance, passengers have the right of immediate further movement, but upon arrival at their destination, they are also obliged to report their address to the local sanitary supervision; and during the possible incubation period (for plague 6 days, for cholera 5 days) they are registered with the sanitary supervision. The international measures indicated above, according to the 1926 Convention, are applied only in relation to the following infections: plague, cholera, yellow fever, smallpox, and typhus.

D. Sysin. : Medical surveillance is also used within the country in relation to persons who have come into contact with those ill with certain contagious diseases. According to the definition of the Academic Medical Council under the People's Commissariat of Health of the RSFSR, "Medical surveillance is called that form of medical supervision over persons recognized as dangerous in terms of spreading a certain contagious disease, in which these persons are not isolated and are not subjected to any burdensome measures and are allowed to continue their normal occupations, but are obligated to report at specified times to the medical-sanitary supervision for examination, to fulfill all the doctor's prescriptions regarding the observance of necessary precautions, and to notify the appropriate sanitary authority of any change of residence." Such medical surveillance is applied, for example, in relation to persons who have been in contact with a patient with epidemic or recurrent typhus (after disinfection of the body and clothing, these persons remain under medical surveillance for two weeks), with a patient with natural smallpox (after smallpox vaccination, these persons remain under medical surveillance for two weeks), with a patient with glanders (medical surveillance for at least 10 days). The same terms of medical surveillance are established by the sanitary legislation of Ukraine.