E. Cobham Brewer 18101897. Dictionary of Phrase and Fable. 1898.
Bill of Health.
A clean bill of health. A document, duly signed by the proper authorities, to certify that when the ship set sail no infectious disorder existed in the place.
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A foul bill of health is a document to show that the place was suffering from some infection when the ship set sail. If a captain cannot show a clean bill, he is supposed to have a foul one.