Port

PORT, a place for the mooring, outfitting, loading, and unloading of vessels, sheltered from wind and waves. Ports are divided into maritime and river ports. Depending on their primary purpose and the volume of cargo and passengers passing through a given port during the navigation season, ports are classified into: 1) commercial ports in the broad sense of the word; among these, special ports are distinguished, serving exclusively or in overwhelming proportion cargo operations with specific goods (timber, coal, oil, fishing ports); 2) passenger ports, serving mail-passenger steamship lines; 3) military ports. Along the sea coast, in locations where cities and settlements are situated, a whole series of smaller ports are established to serve local needs. Epidemiological significance of ports. During a navigation season, thousands of vessels from all parts of the world may arrive at a port (depending on the size and purpose of the port); tens and hundreds of thousands of passengers and millions of tons of various goods pass through the port, among which many are food products or are dangerous from a sanitary standpoint (bones, rags, raw hides, etc.); a mass of large steamships with a large number of crew members may accumulate in a port simultaneously; tens of thousands of workers may be in a port to carry out loading operations and port work. Plague-infected rodents can enter a port from vessels, and ports can thus be places from which infections are carried into the interior of the country. The introduction of infections into ports is observed even now. Such are, for example, recent cases of the introduction of plague into Marseille (1930–1931), and recurring cases of the introduction of plague into Piraeus, Alexandria, Istanbul, etc. All these factors, which represent a great danger from a sanitary-epidemiological standpoint, compel the adoption of measures for the sanitation of ports and for the prevention of the spread of contagious diseases that may appear. General sanitary requirements for ports: the installation of proper water supply and sewage systems, lighting, the provision of residential buildings, facilities for passengers, etc. There must be special institutions for the sanitary protection of borders. In the pre-revolutionary period, the majority of ports in Russia were poorly equipped: a lack of mechanization, insufficient piers that did not meet the requirements of shipping, old and dilapidated wharves, cramped and unequipped facilities for passengers, a lack of refrigerators for storing perishable goods, insufficient equipment with sanitary installations and medical institutions; and a lack of housing, bathhouses, and canteens for port workers and stevedores. General morbidity and the incidence of contagious diseases were quite high. Due to the difficult conditions of labor and daily life, the main contingent of stevedores consisted of lumpen-proletarians. Drunkenness, syphilis, venereal diseases, and tuberculosis were almost a common phenomenon among port workers and stevedores. Water supply and sewage systems existed in only 2–3 ports; everywhere, there was a lack of organization in the removal of sewage and refuse, primitive latrines, an unsanitary state of residential and service premises, waterlogging of the port territory, etc. After the revolution, this heavy legacy was to a significant extent liquidated. Thanks to the special attention of the Party and the government and the persistent efforts of the water transport workers, the maritime ports of the Union have been brought into a state that satisfies modern requirements of transport and export, and they have been largely sanitized. Among the sanitary measures currently implemented in the ports of the USSR are the following: regarding water supply—in all large ports frequently visited by vessels (with the exception of small ones), a water supply system has been installed on the territory of the port and along the vessel mooring line; in remote areas and island sections, water supply is provided with the help of water-carrying barges, and special cisterns are being built for storing water in remote areas (the plan of the second five-year period provides for the supply of water pipes to all ports and their remote sections). Regarding sewage—large ports are provided with sewage systems; the removal of sewage from remote and island sections is carried out on special barges. Special bins have been installed for collecting refuse on the territory of the port and along the vessel mooring line. In a number of ports, new terminals have been built that meet sanitary requirements. In every port, bathhouses and shower rooms are being built; refrigerators are being installed, and storage facilities are being rebuilt. The morbidity rate of workers has significantly decreased. To implement measures for the sanitary protection of borders, ports are being additionally equipped with sanitary (medical-observation) stations (see Medical-observation stations and posts) and disinfection installations; new stations are currently being built in the Rostov, Novorossiysk, and Tuapse ports; health posts have been established in places where workers congregate, and a network of medical and preventive institutions has been organized (polyclinics, hospitals, tuberculosis and venereal dispensaries, day nurseries, etc.). To provide medical assistance to foreign sailors, the Russian Red Cross Society has organized free medical posts in a number of ports. The People's Commissariats of Health of the union republics have created, in general, the following medical organizations in ports: a) a port sanitary service consisting of a senior port sanitary physician, sanitary physicians, assistant sanitary physicians, and other necessary medical personnel, who carry out constant sanitary control over the condition of vessels, the port territory, and the state of health of ship crews and the port population; b) sanitary-food control in the port over canteens, places of sale of food products, and the supply of provisions to vessels, and places of cargo storage; c) sanitary and laboratory control over water supply in the port and on vessels; d) sanitary control over sewage and the removal of waste; e) surveillance of rodents, constant extermination, trapping, and examination of rats; f) organization of sanitary education, etc. On the basis of the decree of the Council of People's Commissars "On the Sanitary Organs of the Republic" dated June 6, 1931, in every maritime port, the following positions were established: 1 position of sanitary physician and 1 position of assistant sanitary physician. The number of sanitary physicians in large ports (Leningrad, Vladivostok, Arkhangelsk, Novorossiysk) is determined by the People's Commissariat of Health in agreement with the People's Commissariat of Water Transport for each port individually. Responsibility for the sanitary state of the port is placed on the port chief; the port chief is also charged with monitoring the execution of existing laws and orders regarding the sanitary state of the port; the port chief has the right to issue mandatory regulations for the port and the right to impose fines for violations of sanitary regulations. Upon the appearance in a port of contagious convention-regulated diseases, in accordance with the official "Rules for the Sanitary Protection of Borders," issued on the basis of the Decree of the Central Executive Committee and the Council of People's Commissars of the USSR dated August 23, 1931 (Collection of Laws of the USSR 1931, No. 55), and the resolutions of the International Sanitary Convention of 1926 (see Conventions), the following measures are taken: "The port chief and the captain of the vessel must immediately notify the port sanitary service of all cases of illness with contagious diseases or cases suspicious for contagious diseases that have occurred both on vessels docked in the port and on the territory of the port of the USSR." "Port authorities take measures to prevent the boarding of vessels by persons with signs of a contagious disease." "Persons traveling from areas infected with cholera are subjected to anti-cholera vaccinations." "In the case of cholera, control over the quality of drinking water and food products stocked by vessels is strengthened." "During an epidemic of parasitic typhus in a port or in the vicinity of a port, persons traveling from places affected by typhus are not allowed to board a vessel during mass departures without prior sanitary processing within the last 24 hours before boarding (washing in a bathhouse, disinsection of dirty linen, clothing, and used bedding)." "In the case of smallpox, mandatory vaccination is carried out." "During a plague epidemic in a port or the vicinity of a port, in addition to mandatory deratization, measures to prevent the penetration of rats onto the vessel are strengthened (attaching shields to ropes, removing gangways during non-working hours, etc.)." For vessels arriving from ports affected by convention-regulated diseases, measures are applied in accordance with the resolutions of the International Sanitary Convention and the Rules for the Sanitary Protection of Borders (mandatory sanitary control, medical examination, disinfection, etc.). In international sanitary conventions (see), special articles are usually devoted to the sanitary equipment of ports; a number of these measures are mandatory for implementation. Such is the International Sanitary Convention of 1926; in its development, the International Office of Public Hygiene now publishes special "Maritime Sanitary Yearbooks," where precise information about ports of the whole world is printed, with an indication of their sanitary equipment. (See also Medical-observation stations and posts and Conventions.) "During a stay in a port affected by convention-regulated diseases, the captain of a small coastal vessel is obligated, in the absence of a doctor on the vessel, not to allow the crew to go ashore without special necessity and without the permission of the port sanitary service." To characterize the sanitary organization in a port, one can focus on the following large port: the Novorossiysk Port—the port sanitary service consists of a senior port physician and 2 assistants (one for sanitary control over vessels, the other for the port territory), and 4 special sanitary physicians (for food sanitary control, for communal sanitation, for control over dormitories, and for disinfection and deratization).

In the port, a maritime sanitary station has been established with a bathhouse, laundry, laboratory, isolation ward, and observation ward. Attached to the station are 3 duty physicians for the sanitary inspection of foreign vessels, as well as intermediate and junior medical and technical personnel. The port has a steam disinfection chamber (mobile), a disinfection detachment, a vaccination detachment, etc. Among the therapeutic and preventive institutions in the port, there are 2 polyclinics with consultations in all specialties; 4 health posts, a venereal station for sailors; a hospital is under construction. - Leningrad Port. The port sanitary service consists of a senior port physician, 15 sanitary physicians for sanitary control over vessels, the port territory, and dormitories; intermediate personnel; a vaccination detachment; a disinfection detachment headed by a sanitary physician; a floating sanitary station (a stationary station is under construction). An emigrant base with all improved sanitary installations, a mechanical laundry; a transit point, an isolation ward with 10 beds, a sanitary-bacteriological laboratory with a plague department, an exhibition on deratization, tuberculosis and venereal dispensaries, hospitals with 220 beds, a port polyclinic, a central polyclinic, and a Clayton apparatus. In the port, there is also a steam disinfection chamber. Deratization is carried out using sulfur dioxide, Zyklon B, and chloropicrin. (See also Quarantine, Conventions, Waterways of communication, Medical observation stations and posts, Medical observation, Observation.)

A. Metaxa. PORTUGAL. Portugal occupies an area of 92,713 km², including the continent, the Azores, and Madeira. The population in 1926 was 6,195,000 people; the average population density is 66.8 people per 1 km². In addition, Portugal's colonies in Africa and Asia occupy an area of 2,424,059 km² with a population of 10,655,491 people. Portugal is a country with a high, by European standards, birth rate and an average death rate; the population growth is relatively high. The birth rate, death rate, and natural increase in recent years are as follows (per 1,000): Table 1. Years Birth rate Death rate Natural increase 34.9 32.3 34.1 32.3 20.8 20.0 20.0 19.1 11.1 12.3 14.1 13.2. Emigration from Portugal is quite significant: in 1928, 34,297 people emigrated from it, and in 1929, 40,361 people. The extremely backward character of the country with its impoverished peasantry, weakly developed industry, high percentage of illiterate people (in 1920, there were 40% illiterate), and the difficult socio-economic situation of the working people are the cause of the weak development of sanitary measures, high infant mortality, and the fictitious nature of most legislative measures in the field of public health and labor protection. Organization of public health. There is no separate ministry of health in Portugal. The Central Sanitary Administration, established by the law of December 24, 1901, with a director (Director Geral de Saude) at its head, is part of the Ministry of Labor. It is entrusted with the duties of general sanitary supervision in the country, the fight against infectious diseases, population statistics, supervision of industrial hygiene and labor hygiene, protection of motherhood and childhood, etc. Attached to the administration is the highest consultative scientific body—O Conselho Superior de Hygiene Publica, which includes the Minister of Labor, the director of the sanitary administration, professors of medical faculties, senior sanitary officials, and some physicians. The entire country is divided into 7 sanitary districts, headed by district medical officials (Delegado de Saude). They are subordinate to the civil governor. In each commune, there is also a sanitary official (Sub-Delegado de Saude), who is responsible for the development and implementation of sanitary measures in the commune, and for the registration of births, marriages, and deaths. He is subordinate to the administrative authority of the commune. Each parish, represented by its Council (Junta de Paroquia), must assist the sanitary official in the performance of his duties. In each district, there is also its own sanitary council under the district governor, with the participation of local authorities, physicians, and hospital directors. In Lisbon, there are the State Bacteriological Institute, the Central Institute of Hygiene, and the School of Tropical Medicine for the colonies. Sanitary protection of borders and ports is managed by a special section of the sanitary administration. The sanitary authorities of ports and borders are entrusted with the duties of registering vessels and their crews, passengers, goods, etc., and collecting information about infectious diseases within their sanitary district.

Infectious diseases. Statistical accounting is very weak. Thus, in 1929, out of 118,824 deaths, in 14,998 cases the cause was not indicated at all, 6,866 were attributed to "old age," 5,595 to "congenital weakness," etc. It should be noted that there is a significant number of smallpox cases, despite the fact that in Portugal there is mandatory vaccination (law of March 2, 1899, which is in practice poorly enforced). The spread of the main infectious diseases according to incomplete data, as mentioned, for the last 3 years is as follows (Table 2). Table 2. Diseases: Typhoid fever: cases ......... deaths ........... Typhus: cases ......... deaths .......... Smallpox: cases ......... deaths ........... Diphtheria: cases ......... deaths . .......... Scarlet fever: cases........, deaths ........... Cerebrospinal meningitis: cases ......... deaths ........... 1928 1929 1930 4,209 525 3,272 345 2,865 285 15 6 83 17 57 6 923 94 800 115 2,298 343 1,961 826 2,636 377 155 6 290 14 291 10 208 106. Social diseases. Tuberculosis, venereal diseases, and trachoma are widespread. In 1929, 10,575 deaths from respiratory tuberculosis, 794 from tuberculosis of the central nervous system, and 1,083 from other forms of tuberculosis were registered. There were 5 sanatoriums, two of which were seaside, and 7 dispensaries. There is a National Organization for the Fight against Tuberculosis (Assistencia Nacional dos Tuberculosos), which spent 6,024,172 escudos on the fight against it in 1928/29 (an escudo is equal to 2 rubles 10 kopecks in gold). The fight against syphilis is organized very poorly in a few dispensaries, mainly in Lisbon and Porto. In hospitals, 2,545 male syphilitics and 1,826 females were registered in 1929. In Lisbon, there is an Institute for the Study of Cancer, through which 1,522 patients passed in 1929. Trachoma is extremely widespread and is one of the main causes of blindness. Medical care. In the country, there were 339 hospitals, private and state, through which about 90,000 patients passed. Mental diseases. The number of mental patients is continuously growing (Table 3): Table 3. Years Patients present Admitted during the year 1,148 1,144 1,155 1,198 1,210 300 374 371 395 412. There are 3 medical faculties (Lisbon, Coimbra, and Porto), in which 1,082 students were enrolled in 1924/25, and 123 medical diplomas were issued. In addition, there is a pharmaceutical faculty in Lisbon, which issues from 10 to 20 diplomas per year. Protection of motherhood and childhood. Infant mortality in Portugal is very high and shows no tendency to decrease (Table 4). Table 4. Number of deaths per 1,000 births under 1 year of age. Years Number of deaths Years Number of deaths 152 144 164 144 132 146 144 151. In 1929, in Portugal, there were 10 obstetric clinics, 23 "Milk Drops" (Gouttes de lait), through which 2,195 children passed. In total, for children, there were 147 institutions in 1929 (boarding schools, shelters, etc.) and 10,747 children in them. The development of nurseries is proceeding very slowly (Table 5): Table 5. Years Number of nurseries Children passed 28 26 26 26 22 38 61,916 51,597 53,387 47,159 46,216 60,448. There are so-called "night shelters" (albergues nocturnos) for children, through which 1,150 children passed in 1929. Legislative protection of women and children is regulated by the decree of October 29, 1927, and the law on compulsory insurance. According to the first of these laws (§ 3), which in practice is also often violated, "children, women, pregnant and nursing mothers can work only in such enterprises that require moderate effort and do not interfere with their physical and spiritual development, as well as their morality." § 4: "Children from 12 to 14 years old are not admitted to work. Later they are admitted only after a medical examination and on the condition that they are literate." § 5: "Children from 12 to 14 years old cannot work more than 6 hours a day, and even then with intervals for rest; from 14 to 16 years old—not more than 7 hours. Sunday work is prohibited." In principle, women and children are not admitted to night work. § 9: In individual cases, there may be exceptions, but not more than 6 hours a day. Underground work is prohibited until the age of 16. In factories where women and children work, there must be a doctor. In his absence, his functions are performed by an occupational health inspector. For 2 months before childbirth, a woman must work "moderately" and stop working at the direction of a doctor. After childbirth, work is prohibited by law for 4 weeks. Every factory with at least 50 female workers must have a nursery at a distance of no more than 400 meters from the factory. In factories with a smaller number of female workers, there must be a room for feeding children where they could be left. A number of professions listed in the schedule are prohibited for women by the same law. Women in childbirth have the right to an allowance and free medical care, medicines, and hospital treatment for the entire period of disability and for at least 2 months. Since 1905, a section of school hygiene and physical education was created under the Ministry of Public Education, headed by an inspector; compulsory teaching of Swedish gymnastics was introduced in all schools. Every student has their own anthropometric form. Gymnastics teachers are trained in the school of physical culture. The hygiene inspection extends to both primary and secondary schools, both private and public. Social insurance. By the decree of May 10, 1919, compulsory insurance (Seguros sociais obrigatorios) against illness and accidents at work, against disability, and against old age was introduced. It applies to all "socially weak" persons earning no more than 30-50 escudos per month or 900 per year. Contributions are made by the insured in the amount of 2% to 2.5% of wages and by employers from 3% to 6%. Everyone is insured in mutual aid societies (Mutualista) of the employer's choice. The right to an allowance and assistance begins from the 6th month after the payment of the first contribution and on the condition of regular payment of all contributions. The wife of the insured and children under 16, as well as other disabled family members, also have the right to an allowance and medical care. The allowance is in the amount of 0.30 to 0.50 escudos per day, depending on the category of the insured (a total of 3 categories). Medical and dental care and medicines are free on the condition of treatment by a doctor of the mutual aid society. The patient can choose a doctor, but in that case, he pays the difference between the fee of that doctor and the society's tariff. In 1929, there were 543 mutual aid societies with 558,295 members. The societies had a capital of 183,680,896 escudos with an income of 43,261,129 escudos per year. Sickness benefits are issued for no longer than 1 year. The maximum benefit is issued during the first 30 days of illness, then it progressively decreases, reaching 1/4 of the initial amount. Labor protection. The decree of July 8, 1922, established an 8-hour workday in trade and industry. Working time is 10 hours during the day, with a 2-hour break for lunch. The workday can be extended to 10 hours in case of an agreement between the employer and the trade union, which in practice is the case. Working time should not exceed 48 hours per week, but again with the same reservation. The law of October 29, 1927, established an institute of occupational health inspection in industry (Inspecção de Higiene do Trabalho e das Industrias) with the participation of trade union representatives. "Occupational health inspectors" were introduced. These inspectors are tasked with examining and controlling working conditions in harmful, inconvenient, and dangerous professions, controlling the work of women and children, studying occupational diseases and their prevention, controlling vaccination, fighting tuberculosis and infectious diseases among workers, sanitary control of factories, and sanitary labor statistics. In each of the 7 sanitary districts, there is an inspector subordinate to the district sanitary administration. There is a Central Institute of Occupational Health.