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Case 3.—Reported sick on 6th February, 1936. Landed to hospital at Boston
(Mass.) on 14th February, 1936, for observation. He was returned to the ship on
20th February, 1936, as negative. The entire ship's company was revaccinated at
Boston, and further fumigation carried out.
Action on Arrival in London.—The entire personnel was examined, including the
single passenger who had shared in the second and third revaccinations, special attention
being given to Case 3. All were well except for one native who, though ill, showed no
symptoms suggesting the onset of Small-pox.
ss. "City of London."—Previous information.—On 23rd April I received a letter
from the Ministry of Health, informing me that a case of Small-pox had been landed
from the ss. "City of London "at Suez on 20th April. I accordingly communicated
with the shipping company (Messrs. Ellermen Lines, Ltd.) and arranged for a sufficient
number of cards for notification of address by passengers and white crew to be put
on board the ship by the Pilot.
On 30th April I was informed by the shipping company that a second case of
Small-pox had developed on board. I therefore arranged to meet the ship on arrival
myself, in company with the Boarding Medical Officer on duty.
Movements of Ship.— The ss. "City of London "left Calcutta on 3rd April, 1936;
Madras, 7th April; Colombo, 10th April; Suez, 20th April; Port Said, 21st April;
and arrived in London on 2nd May.
History of Cases.
First Case.— On 12th April a Lascar, Nawab Ali, reported sick with a rash
and slight fever. The Ship's Surgeon was unable to give a satifactory account of the
rash. He described it as discrete and papular, mostly on the face. He isolated the
patient in a lifeboat on the poop, there being no hospital of any kind in this ship.
On arrival at Suez the case was diagnosed as Small-pox by the Port Medical Officer,
and was landed to hospital.
The Surgeon vaccinated all those on board who did not show evidence of recent
vaccination.
Second Case.— The second case was a deck boy, Shamshul Huq, aged 20, who
reported sick on 26th April with a rash and fever. He was diagnosed as Small-pox
and isolated in the lifeboat Which had been occupied by the previous case.
Action on Arrival in London.— The ship arrived off Gravesend at 8 a.m. on 2nd May,
and was boarded by Dr. Willoughby, Dr. Jones and myself, a Sanitary Inspector and
two clerks. The patient was not ill, climbed out of the lifeboat in which he had been
isolated and was examined on the poop deck.
The eruption was discrete, definitely centripetal, superficial, and for the most part
in the crusting stage. Some of the crusts had been scratched off and left typically
oval scars. I examined him very carefully, and was quite satisfied that he was suffering
from Chickenpox. Finally, the fact that he had been well vaccinated in infancy
and again successfully at some later date and that vaccination performed at Calcutta
on 1st April, 1936, before sailing, had been unsuccessful, supported this diagnosis.
Nevertheless, since it was not safe to assume that the case landed at Suez was
Chickenpox, though he sickened exactly fourteen days before the second case, who
was a close contact, it was decided to proceed as for Small-pox.
The patient was landed to the Port Isolation Hospital, and the 25 other lascars
who had occupied the same forecastle were taken ashore, bathed, and their clothing
disinfected. Meanwhile, their quarters were put under fumigation with S02. The
passengers (184) and the crew (European 30 and Asiatic 166) were medically
inspected. None showed any symptoms suggestive of the onset of Chickenpox or
Small-pox.