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2nd, and lay Sunday evening letters to 88 Medical Officers of Health were
dispatched in time for the last collection from the G.P.O. London; the remainder
of the notifications addressed to 276 Medical Officers of Health were dispatched
by midday on Monday, July 3rd.
19. The Asiatic members of the crew were not allowed to leave the precincts
of the ship till July 5the They were mustered and examined each day. None was
found with any fever or signs of rash.
20. Fifty changes of address were reported on July 4th. The Medical Officers
of Health concerned were promptly notified.
21. July 5th being the 16th day since the case was disembarked, no further
action was taken in regard to passengers' or crew movements.
CONCLUSIONS.
1. My impression is, after close consultation with the Ship's Surgeon, who is
an ex-Officer of the I.M.S. and who has seen a great deal of smallpox in his
time, that this was in all probability a case of chickenpox.
I am satisfied that the Ship's Surgeon took immediate precautionary measures
and that there was little chance of contact between the case and the passengers
before his immediate isolation after the rash had been seen on the morning of
the 19th.
I consider the Surgeon was right in making strong representations to the
Aden Port Health Authority, despite the objections of the Port Medical Officer
at Aden, to disembark this case of chickenpox in order to prevent its spread,
at least among the numerous children that were being carried on board. In this
connection it must be borne in mind that isolation in a very crowded ship can
never be regarded, even with the most stringent precautions, as absolute.
The health authorities at Aden did not notify the ship of their diagnosis
of modified smallpox until six days after the departure of the ship from Aden.
Consequently, the vaccinations immediately started on the 25th and continued on
receipt of further supplies of lymph from Malta, cannot be regarded as protecting
the crew or passengers from an attack of smallpox. It would be interesting and
it is, I consider, important to ascertain the reasons for the delay on the part
of the Port Health Authority at Aden in notifying their decision that the case
was one of modified smallpox. I suspect that the case immediately on landing
was vaccinated and, failing a positive reaction or a reaction of immunity, the
case was automatically reported as one of smallpox. On the other hand, some
turn of events in the progress of the disease may have led the Aden authorities
to report the case as one of modified smallpox.
One cannot, of course, dispute the absolute right of the Aden Authorities
to declare at any time a case which they are not satisfied to be a case of
chickenpox to be one of smallpox or modified smallpox, but if such a decision
is made, I feel that the reasons for making it should be declared if only to
inspire confidence in decisions of this nature.
There is one important point which no doubt was not overlooked by the Aden
authorities. If it is accepted that the disease was in fact smallpox and that
the rash began on the 18th, the infection took place not less than fourteen
days previously, which brings one to the 4th June. The ship called at Adelaide
on the 2nd June and at Fremantle on the 5th June. It seems highly improbable
that the man contracted smallpox in either of these ports which, so far as is
known, have been completely free from smallpox for a long time.
2. I examined the tubes of lymph supplied by Malta. Some came, I understand,
from the Civil Administration and some from the Navy, but it must be confessed
that the tubes were not satisfactorily filled. In many the calf lymph was
interspersed with bubbles which made it difficult for the lymph to be used on
more than one person. This is merely a slight reflection on methods of filling
individual tubes. On the other hand, the practice of supplying lymph to ships
exclusively in five-dose tubes is not very sound. A number of persons come to
the Ship's Surgery for vaccination and insist on immediate vaccination, e.g.
before landing at Bombay. If five-dose tubes only are supplied, this means the
rejection of lymph supplied for four other vaccinations since once the tube is
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