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13
Foremost in the experience gained was the sense of close
co-operation which existed from the moment the first case was
suspected, and remained throughout subsequent events: between the
Ministry of Health; the North-East Metropolitan Regional Hospital
Board- the Virus Reference Laboratory, Colindale; the members of
the panel of smallpox opinion; local hospitals' medical and
administrative staffs; general medical practitioners and the
medical officer of health's department
The early stages
Over the telephone at 1015 a m Friday 28th June, 1957, the
medical officer of health (G H H ) was informed by the consultant
physician for infectious diseases (GD McK ) at St Ann's General
Hospital, Tottenham, of a case of suspected smallpox in that
hospital The patient, an unvaccinated male child, aged 6 (M B)
had been admitted to the poliomyelitis unit of the hospital on
23rd June, with a history of backache fever, abdominal pain and
vomiting, Examination on admission had revealed an ill child
with abdominal tenderness and guarding,, and a temperature of 102°FIt
was also observed that there were both general ichthyosis and
superimposed patches of eczema The practitdoner"s provisional
diagnosis of poliomyelitis was not borne out by this further
examination, which suggested an acute abdominal emergency, At
laparotomy the appendix (which was removed) was found to be normal
but the mesenteric glands were seen to be enlarged During the
following three days the patient remained febrile and ill and
there was some bleeding around the abdominal wound On admission
a few macules had been noted in the inter-scapular area and by
27th June it was evident that there was a rash, predominantly
papular in character and peripheral in distribution additional to
the chronic skin condition At the time, eczema herpeticum was
considered to be more likely than smallpox, but skin scrapings and
fluid from one or two vesicular lesions were sent to the Virus
Reference Laboratory, Colindale By the following morning there
was a striking change in the child's appearance, The rash was
vesicular and becoming confluent and a diagnosis of smallpox
could be confidently made on clinical grounds Following the
telephoned report of these facts to the medical officer of health
an immediate consultation was held at the hospital when it was
agreed to call in a second member of the panel of smallpox opinion
(Dr. AM Ramsay) and to report the situation by telephone to the
Principal Medical Officer of the Epidemiology Division of the
Ministry of Health (Dr W H Bradley) Before 12 noon both Dr