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Further enquiry showed that J.P. Bo'sun, D.B. 2nd Engineer, E. McF.,
J.F., T.R., firemen, all of Newcastle ; J.E., fireman, of London ; J.S., Wallsend,
were left at Newcastle on January 29th because of an epidemic of " influenza "
which had occurred between the 24th and 28th. This was suspicious, in view of
the fact that W.B. had similarly been thought to have " influenza."
A vaccination and examination muster was held. Twenty-five of the crew
were vaccinated, one refused, one was ashore, one had been removed suffering from
smallpox, and one, W.McF., was found to have marks of quite recent smallpox on
his fore-arms and diagnostic " pips " on his palms and soles. This man had obviously
been a possible source of mischief. He could give no history of illness, but
had had a bottle of " medicine for his blood " three weeks to a month previously.
He had been well vaccinated in infancy and presented a mild type of illness now
at its close.
A further case, P.W., had on a former voyage been left in Newcastle, suffering
from " boils on the arms." These boils were described as quite large, with much
matter in them. Nevertheless there were possibilities of smallpox in this case also.
The sailors and firemen were removed to Denton with all the textile contents
of the forecastles, for bathing and disinfection, special attention in this being given
to W.McF.
A list of stevedores' men—35 in all—was communicated to the London County
Council, together with the circumstances of the ship. This list was also notified
to the Medical Officers of Health of the Metropolitan Districts concerned.
The Medical Officer of Health for Newcastle was wired and written to with
regard to the " influenza " in J.P., J.B., E.McF., J.F., and T.R. He was also
acquainted with regard to J.E. and P.W.
The Medical Officer of Health, for Wallsend, was also wired and written to
with regard to J.S. In each case full particulars were given.
The ship sailed for Newcastle on the 31st January.
The Ministry of Health was informed of all the circumstances and
procedure.
The Medical Officer of Health, Wallsend, wrote to say that J.S. " had a slight
follicular tonsillitis, and although he complained of pains in his back, there were
no signs of rash or any other symptoms of smallpox."
The Medical Officer of Health, Newcastle, wrote to say that E.McF. (who is
brother to W.McF.), T.R., and J.E., were isolated as smallpox cases in consequence
of the communication from this Authority, while J.B., he understood, was in hospital
at Gosforth, under suspicion. Further, that J.P., was well and W.McF.,
unable to throw any light on the source of his infection. There was, however,
already a case of smallpox in hospital from the same street as that in which E.McF.
lived, as far as was known an isolated case. Further, he had examined P.W.
(the " boils " case), and was more than suspicious that his boils had been smallpox
with a deep superadded infection by suppurative bacteria. The distribution of
the " boils " had been characteristic of smallpox and he had been a contemporary
in illness with W. McF., the mild case found on board.
The movements of the ship are comparable to those of a passenger train between
Newcastle and London. No list of addresses of the passengers from Newcastle
to London was obtainable.
In any epidemic of smallpox as of every other infectious disease in which rash
occurs, cases will be noted where rash does not develop, cases in which the history
and symptoms in general would lead one to suspect onset of the disease ; naturally
the complete diagnosis cannot be made in these cases.
It is possible that J.S., was such a case in this small epidemic. I think the
condition of smallpox without eruption occurs much more commonly than is
suspected, then constituting a malaise of three or four days' duration sometimes
quite severe in its manifestations.
It is gratifying to note that the official issue of Infectious Diseases for the week
ending 18th February only recorded the three cases of smallpox, which are
included among the above, at Newcastle. This may fairly be ascribed to the
prompt interaction between the Sanitary Authorities of Stepney, The Port of
London and Newcastle-on-Tyne.
B