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13
Smallpox
The year 1961 was marked by a larger number of references for suspected smallpox and
supervision of possible smallpox contacts than had occurred for many previous years. The
reasons for this were in part due to the changed situation caused by the far greater speed
of air travel as compared with surface travel which enables persons travelling through
parts of the world, particularly Asia, where smallpox is still relatively common and endemic,
to arrive in this country well within the incubation period. Before air travel became so
common any traveller from the Middle East incubating an infection would in all probability
have begun to show symptoms while still on board ship and in consequence illness would be
reported to the Port Health Authorities on arrival in this country. On the other hand, with
air travel, illness may not appear until some time after the person has arrived in this
country although apparently well on arrival. Visitors to this country who have developed
skin rashes have sought advice by attending at a doctor's surgery or at the Casualty
Department of a hospital and it will be understood that in these circumstances there may
be many administrative and medical complications when there is even the possibility of a
diagnosis of smallpox.
During the year, nine patients were referred by family practitioners to the Medical
Officer of Health or his Deputy as suffering from rashes of a type where it was desirable
to exclude smallpox as a possible cause. Seven of these were confirmed as cases of chickenpox,.
one was an allergic rash, and the remaining case was diagnosed as not smallpox
One of those reported as a suspect was a male Nigerian Doctor on holiday in Islington from
Northern Ireland. He presented himself at an Islington hospital because he was unwell and
had a rash. The Deputy Medical Officer of Health and, later, a Smallpox Consultant, were
called in and the patient was transferred to an isolation hospital. All appropriate precautions
were taken and the resultant diagnosis was chickenpox,
Another suspect, a man,' aged 35 years, arrived at the casualty department of a local hospital
with symptoms of cough, cold, headache, for three days and he had since developed a rash.
The Medical Officer of Health was informed and all admissions to the hospital were temporarily
suspended. The Deputy Medical Officer of Health visited the hospital on the same evening and
was of opinion that it was not a case of smallpox, The hospital was therefore re-opened. Twentysix
of the hospital medical and nursing staff were vaccinated by the Deputy as a precautionary
measure.
A Consultant" s report was also received on a case where the family practitioner reported a
rash of uncertain origin. The subsequent diagnosis was ''sensitivity reaction".
Information was received during early April that a ship had arrived in London with a history
that a member of the crew had been landed at Suez in late March suffering from modified smallpox.
All passengers and crew had been vaccinated since that date. Pour members of the crew and one
passenger resided in Islington; they were visited by staff of this Department and kept under
surveillance for the incubation period,
A young man who arrived in England in early September by ship (Ostend-Dover) was admitted to
Long Reach Hospital, Dartford, suspected to be suffering from smallpox. The diagnosis was not
confirmed and all laboratory tests proved negative.
A family practitioner reported that a patient of his, who resided in Islington, had been in
contact with this suspected case This young man was visited by this Department and revaccination
advised. He was kept under observation until notification was received from the Ministry
of Health that the original suspected case was not confirmed.
Smallpox was diagnosed in a Pakistani visitor, who arrived at London Airport on 25th
December, from Karachi. He was seen at University College Hospital, and removed to Long Reach
Hospital, Dartford, where he died. This man had been staying in another borough, but eight
contacts or possible contacts were resident in Islington and kept under observation for the
routine quarantine period; all were vaccinated.