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out a formalin fumigation of the whole of the accommodation in the ship,
public rooms, cabins and Officers and crews quarters. This would be carried
out over the Easter week-end under the supervision of the Inspectors of the
Port Health Authority.
Secondary cases of Smallpox arising among passengers.
42. A number of cases, some fatal, have occurred among passenger contacts including Mrs.
the wife of the first case, who was undoubtedly in the early prodromal stage even
on the evening of the 2nd April when she vra.s transferred to Clandon. None of the
secondary cases occurred within the area of the Port Health Authority and consequently
are not referred to in this report in detail. The cases confirmed as
smallpox reported to me by the Ministry of Health (20th April) were as follows :-
Place Onset of illness Died
Port of London 3.4.49 6.4.49
Paddington M.B 5.4.49
St.Pancras M.B 5.4.49
Isle of Axholme R.D.C 5.4.49 9.4.49
Paddington M.B. 6.4.49 14.4.49
Liverpoool C.B 6.4.49
Wembley B 7.4.49 9.4.4-9
Sutton & Cheam B 7.4.49
Torquay B 8.4.49
Aylesbury B 12.4.49
Richmond B. 12.4.49
43. There remains some uncertainty concerning the diagnosis in patients reported
from Southwark M.B. and Abertillery.
44. In numerous other persons who travelled on s.s. "Mooltan" and who subsequently
came under medical observation suspicion of smallpox was not confirmed.
45. It is interesting to note that none of the fatal cases, so I was informed,
had been previously vaccinated.
46. The disease was a severe form of variola major. Two patients died in the
prodromal phase. The disease was haemorrhagic in some - in others there was
marked modification resulting from vaccination.
47. It is clear from the history of each of the secondary cases and from the date
of onset of their illness that they contracted the disease on board the "Mooltan"
on various dates between 25rd March when the original patient first became infective
and the date of arrival of the ship. This indicates that isolation of the first
case on board the ship was not completely effective.
The following observations arise from the somewhat unusual circumstances
surrounding the incident on board the "Mooltan".
1. Mistaken Diagnosis.
48. There is little doubt that Mr. A's infection occurred as a result of his visit
to the town of Bombay and the period of incubation confirms this. He went ashore
at Bombay on the 10th March and if indigestion is to be regarded as a prodromal
symptom of the disease the incubation period was 13 or 14 days. The evidence goes
to show that the rash began to develop on the 25th and was well out on the 26th.
49. The distribution of the rash failing to involve the face and head in the first
instance and the absence of a prodromal rash were probably the reasons which misled
the Ship's Surgeon and caused him to make a diagnosis of chickenpox. But he clearly
was in doubt from the fact that he called in two Indian medical men, passengers on
board, to see the case. Their confirmation of his diagnosis (one of them said
that he had dealt with many thousands of cases of smallpox) was to say the least,
unfortunate and was probably a strong contributory cause to the decision of the
Surgeon to regard the case unquestionably as one of chickenpox and to take no
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