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preventive measures such as the vaccination of the passengers and crew; he had some
600 doses of lymph on board,
50. This disastrous mistake compels one to take the view that there should be a
review of present day policy in regard to the vaccination or the offer of vaccination
to passengers travelling to or via the Far East and more particularly to
those who have not previously been vaccinated or have been vaccinated in infancy
or many years ago. Passengers who have no experience of the East cannot be
expected to appreciate the grave risks they run in going ashore at certain ports
such as Bombay where virulent smallpox is endemic and one cannot, help feeling that
if such risks were brought home to them many would readily agree to be vaccinated
or alternatively would forego their shore visit.
51. It is suggested, therefore, that, at the very least» and this, of course,
applies to all passengers whether travelling by sea or air via the Far East, they
should be warned of the dangers and urged to be vaccinated before embarkation.
To this end a notice might be issued by the Companies concerned at the same time as
the passenger takes his ticket.
52. In addition, on approaching a port such as Bombay the warning might be repeated
to the passengers on board offering those who have not already been vaccinated,
vaccination before they go ashore. Incidentally, I understand that most of the
States in the Commonwealth of Australia have laws requiring vaccination in infancy
but that these are a dead letter, consequently a large majority of the population,
even up to 80^, is unvaccinated.
2. Instructions to Ships' Surgeons.
53. I feel that in general Ships' Surgeons fail to appreciate the significance
and the menace of smallpox, particularly to passengers and no less to countries not
adequately protected against the disease.
54. Smallpox is a most subtle disease always lying in wait to pounce upon the
unwary and it is of the greatest importance that ship surgeons should realise that
smallpox modified by previous vaccination is the most dangerous form of all from the
point of view of its spread, because the most difficult to diagnose.
55. Consequently when they are confronted with a rash which might appear to them to
indicate an attack of chickenpox but which presents features which lead to some doubt
in their minds, they should invariably and without hesitation, if they have the
slightest suspicion that it might not be chickenpox, take all precautionary measures
as if the case were in face one of smallpox. In other words unless they are confronted
with signs and symptoms and a history which enables them to diagnose chickenpox
beyond all reasonable doubt, they should treat the case as one of suspected
smallpox and act accordinglyo Indeed they should adopt the attitude that there is
no such thing in International traffic as suspected chickenpox! The measures they
should take should, of course, include strict isolation of the suspected case and
vaccination of all persons on board who do not present clear evidence of recent
successful vaccination.
3 o Measures taken on arrival.
56o Some criticism has been made of the fact that the Boarding Medical Officer in
association with Dr. Boul, the Ministry's Smallpox Consultant, permitted the
"Mooltan" to tie up to the Tilbury Landing Stage and persons on the Stage to go
on board the ship. The ship should, it is asserted, have been kept in the River in
isolation, amy from the shore. Such an action would have unnecessarily disturbed
the landing arrangements and although the ship was tied up to the Stage her
isolation was complete and no unauthorised person gained access to her. The six
authorised persons who were allowed on board were the P. & 0. Co's Marine
Superintendent whose attendance was essential to arrange the further movements of
the ship and five Baggage Clerks who were also essential for arrangements for the
landing and disposal of baggage. These six persons were vaccinated on the Tilbury
Stage before they were allowed on board ship.
57, It was, in any event, in accordance with the current policy in this country,
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