Table Of ContentGood Health Abroad:
A Traveller's Handbook
W. H. JOPLING
FRCP (LOND), FRCP (EDIN), DTM & H (ENG)
BRISTOL
JOHN WRIGHT & SONS LTD.
1975
COPYRIGHT NOTICE
© JOHN WRIGHT & SONS LTD., 1975
All Rights Reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of John Wright & Sons Ltd.
By the same author:
Good Health in the Tropics (2nd ed., 1966);
The Treatment of Tropical Diseases (2nd ed., 1968);
Differential Diagnosis for Practitioners in the Tropics (2nd ed., 1968);
Handbook of Leprosy (1971)
ISBN 0 7236 0397 9
Printed in Great Britain by John Wright & Sons Ltd.,
at the Stonebridge Press, Bristol
Preface
The proposal that I should write this handbook came from
Mr. H. A. Humphrey, the Publisher of John Wright & Sons,
when the question of producing a third edition of my booklet
Good Health in the Tropics came up for discussion, and he
suggested that the subject matter should be expanded to
include advice to travellers the world over. The result is the
present handbook, and in writing it my objective has been to
inform travellers of possible risks to health, comfort and peace
of mind which may be encountered abroad, and to describe
what can be done to counter them.
I have followed the scheme adopted in Good Health in the
Tropics by describing the steps to be taken before departure,
during the journey, and after arrival, and in so doing I have
supplemented personal experience with useful information de
rived from articles and correspondence in the British Medical
Journal and the Lancet over the past decade, and also from
the various pamphlets supplied to travellers by the Department
of Health and Social Security.
I have had to make a special study of the circadian rhythm
in order to give a concise account of how it can be disturbed by
air travel, and in this I have found Dr. Strughold's book
Your Body Clock very helpful. The subject of shipwreck has
interested me ever since the days when I was a ship's surgeon,
and the book on this subject which has been of particular value
to me is Safety and Survival at Sea by Lee and Lee. In pre
paring the section on clothing I had many discussions with
my brother-in-law, Dr. E. T. Renbourn, author of Material
and Clothing in Health and Disease, and I am grateful to him
for his helpful advice.
The items in the Appendices have been included in order
to give travellers ready access to the addresses of Embassies in
London and of Vaccination Centres in Britain, and as most of
the world uses the metric system of weights and measures I
hope that the conversion tables will prove of help to those
British readers who, like me, find it difficult to think in terms
of kilograms, metres and degrees Centigrade.
Finally, I would like to express my gratitude to Sir Robert
Drew, an eminent and widely travelled physician, for writing
a Foreword to this handbook.
London, June 1974. W. H. J.
Foreword
by Sir Robert Drew
KCB, CBE, MB, FRCP, Hon FRCS, DTM&H
Deputy Director, British Postgraduate Medical Federation
For the traveller a journey abroad is an adventure but it also
implies real or imaginary dangers. It is therefore not surprising
that measures to protect the health of the individual cannot be
taken for granted in the same way as they are at home.
The problems of modern travel have become so diverse
that it is difficult to obtain all the necessary information con
cerning them. This was brought home to me in 1962 when I
helped the Royal Geographical Society to organize a scientific
meeting on 'Exploration Medicine'. This conference was fol
lowed by some notable publications in this field.
With this experience in mind I willingly agreed to write a
Foreword to this new guide to travel and health. Dr. William
Jopling is a physician with a wide experience of tropical medi
cine, and his 25 years on the staff of the Hospital for Tropical
Diseases, London, have provided him with exceptional oppor
tunities to discover exactly what the adventurer, business man,
holiday maker or indeed emigrant needs to know in order to
preserve good health while overseas. He has written a useful
handbook which is simple, comprehensive and fits easily into
the pocket or handbag. Naturally its main emphasis is on the
prevention of disease but it also contains much general advice
on carefree travel and safe living abroad. I predict that this
work will prove invaluable to explorers and travellers alike.
Section i
Preparation for Departure
A. MEDICAL AND DENTAL OVERHAUL
In order to reduce the chances of the tourist or traveller having
to face medical or dental expenses abroad, it is advisable that
a medical and dental overhaul should be carried out prior to
departure so that any hidden abnormality may be brought to
light and any neglected disability corrected.
B. ACTIVE IMMUNIZATION
The term 'inoculation' is now described internationally as
Vaccination', so this nomenclature will be adopted in this
book.
Preventive vaccinations are an important safeguard, and
should be begun well in advance of the intended date of
departure so that they can be carried out without haste and
in the best order. The tourist or traveller should write to the
representative, in his own country, of the country to which
he is going, asking for the precise requirements as to preven
tive vaccination, and he should state by what means and by
which route he intends to travel. For example, a list of
representatives in England is supplied by the Passport Office
in London. The reader will find this list, together with
addresses, on pp. 87-92.
Vaccination against smallpox, typhoid and tetanus are basic
safeguards irrespective of where one proposes to travel, and
1
2 GOOD HEALTH ABROAD
can be carried out by a medical practitioner or at a vaccination
clinic. As regards travellers from Great Britain a list of official
vaccination centres is given on pp. 93-97. These centres are
primarily intended for yellow fever vaccination, but many of
them will undertake certain other vaccinations in addition, such
as those against smallpox, cholera, tetanus and typhoid.
Parents should make sure that children travelling abroad have
been protected against diphtheria and poliomyelitis. These
various immunization procedures will now be described.
I. VACCINATIONS WHICH ARE COMPULSORY FOR SOME REGIONS
OF THE WORLD
Vaccination against Smallpox
This is compulsory for persons travelling to or from the tropics
and sub-tropics, and for persons travelling to or from coun
tries in the temperate zone in which smallpox is occurring and
which are temporarily listed as danger areas by the WHO
{see Fig. 1). The vaccine contains living vaccinia (cowpox)
virus which gives a cross-immunity to smallpox virus. The
vaccination must be recorded on an international certificate
which becomes valid 8 days after successful primary vaccination
and extends for a period of 3 years; it is valid from the day of
revaccination if this is done within the 3-year period.
A primary vaccination must be inspected by the doctor
7 days later and the result recorded on the certificate, but re-
vaccination need not be inspected provided that there has
been successful vaccination at some time in the past. Vaccina
tion may be carried out by any doctor whether employed at a
vaccination clinic or not. Some of the centres listed on p. 93
will vaccinate against smallpox, by appointment, and will
supply a certificate of vaccination which is internationally
acceptable once the doctor has signed it, but if carried out by
a medical practitioner the traveller must obtain an international
form from the travel agent arranging his transport and must
take it with him when attending for vaccination. Alternatively,
PREPARATION FOR DEPARTURE 3
Areas where cholera, smallpox and malaria occur
^r\ A™5 ^m cholera is endemci
Fig. 1: World map to show areas where smallpox, cholera and
malaria occur. (Reproduced from the map illustrating Profes
sor Brian Maegraith's article, 'Health risks of travel', in the
British Clinical Journal, December 1973.)
4 GOOD HEALTH ABROAD
a traveller from Britain can obtain a form from the Local
Authority or from one of the Health Departments listed below:
England Department of Health and Social Security,
Alexander Fleming House,
Elephant and Castle, London SEi 6BY.
Wales Welsh Office,
Cathays Park, Cardiff CFi 3NQ.
Scotland Scottish Home and Health Department,
St. Andrew's House, Edinburgh EHi 3DE.
Northern Ministry of Health and Social Services,
Ireland Dundonald House,
Upper Newtownards Road, Belfast BT4 3SF.
After the doctor has signed it, the certificate must be taken to
the Local Authority of the area in which the doctor practises
and there it is stamped (franked).
When reporting for vaccination the traveller should inform
the doctor of any disease from which he may be suffering, for
there are a number of conditions which carry increased risk
and are considered contra-indications to smallpox vaccination
except in exceptional circumstances. These conditions are:
recent exposure to other infections, constitutional upsets,
failure to thrive (infants), septic conditions, a history of or the
presence of eczema, pregnancy, hypogammaglobulinaemia,
leukaemia, lymphoma and other reticulo-endothelial malig
nancies, corticosteroid and other immunosuppressive therapy.
Of the exceptional circumstances mentioned above, recent
exposure to smallpox infection is the most important, and, in
the event of a person with one of the above-mentioned dis
abilities coming into contact with smallpox, the risk from
vaccination is less than the risk from contracting smallpox and
therefore vaccination should be carried out if at the same
time an intramuscular injection of human antivaccinial
immunoglobulin can be given into a suitable site; this will
help to reduce any adverse reaction from the vaccination.
PREPARATION FOR DEPARTURE 5
The vaccination site is covered with a strip dressing which
should be kept dry, and on the fourth day the dressing should
be removed so that the vaccination can be inspected; if a
blister is developing, a fresh dressing must be applied to
protect it from inadvertent scratching during the night; if
fingers are contaminated with discharge from the blister there
is danger of spreading virus to other parts of the body. Should
the skin appear inflamed where the Elastoplast has been in
contact, Sellotape can be used to keep the fresh dressing in
position (it does not irritate a sensitive skin) or Micropore
surgical tape can be used. The vaccination site is again in
spected on the eighth day and the skin around the pustule is
gently cleaned with a piece of cotton-wool dipped in surgical
spirit. When the spirit has dried a fresh dressing is applied and
is left in position for a few more days, by which time a scab
will have formed. On the first inspection day (the fourth day),
if there is nothing to see, or if there is a small papule signifying
an immune reaction, no further dressings are needed.
A primary reaction ('take') may be associated with swelling
and discomfort in the region of the vaccination, and if this is
severe and the local lymph-glands are painful, the arm should
be kept in a sling so as to ensure complete rest to the limb. In
the case of a vaccination on the thigh, the patient should rest
in bed for a few days.
In Britain an infant is usually vaccinated during the second
year of life, but if a healthy infant younger than this has to
travel to a country where smallpox occurs vaccination should
be carried out irrespective of age. If the infant's mother has
been successfully vaccinated within 3 years of the infant's
birth, the infant is likely to be immune from smallpox infection
during the first few months of life (i.e. during the time anti
bodies derived from the maternal circulation remain in the
infant's blood); but these antibodies will disappear after a few
months—certainly after 6 months—and smallpox would then
be a very real danger to the infant's health. The difficulty is
that it is not possible to be sure, in any given case, how long the
