DECLARATION OF HEALTH 651

HEAI/TH QUESTIONS

1. Has there been on board during the voyage * any case or

suspected case of Plague, Cholera, Yellow fever, Typhus

fever, or Smallpox? (Give particulars in the Schedule) ..................

2. Has plague occurred or been suspected amongst the rats or

mice on board during the voyage ?* ... ... .....................

«

3. Are you aware of sickness or deaths amongst the rats or mice

on board other than is attributable to poison or any other

method employed for killing them ... ... ........................

4. Has any person died on board during the voyage * otherwise

than as the result of accident ? (Give particulars in the

Schedule) ...* ... ... . ... ... ...................

5. Is there on board or has there been during the voyage * any

case of illness which you suspect to be of an infectious

nature? (Give particulars in the Schedule) ... .....................

NOTE.—In the absence of a surgeon> the Master should
regard the following symptoms as grounds for suspecting the
existence of infectious disease :—Fever accompanied by
prostration or persisting for several days, or attended with
glandular swellings ; or any acute skin rash or eruption,
with or without fever ; severe diarrhoea or diarrhoea with
symptoms of collapse; jaundice accompanied with fever.

6. Are you aware of any other condition on board which may

lead to infection or to tho spread of infectious disease?........................

' I hereby declare that the particulars and answers to the questions given in
this Declaration of Health (including the Schedule) are true and correct to the
best of my knowledge and belief.

Date.......................................... (Signed).....................................

(Master)

(Countersigned)............................

(SMp's Surgeon)

*If more than six weeks have elapsed since the date on which the voyage
began, it will suffice to give particulars for the last six weeks.

DUTIES OF MASTER-

ED AI,TH CONDITIONS ON BOABD.
ABTICLE 5.—The Master of a foreign-going ship approaching a district
from a foreign port must ascertain the state of health of all persons on board,
and in terms of Article 13 shall fill in and sign the Declaration of Health.
AJBTIC&E 6 (WIRELESS MESSAGES).—If the answer to any of the questions
1 to 6 is " Yes," free pratique will not be granted by His Majesty's Customs