View report page

17. The -whole of the crew remaining on board -were vaccinated as an added
precaution, even though not entirely necessary since the ships crews employed by
the P & 0 Company are regularly vaccinated.
18. The Medical Officers of Health were asked to keep passengers residing in
their area under daily surveillance for sixteen days following their disembarkation,
that is up to February 28 th
19. No secondary cases were reported among any of the passengers -who disembarked
from this ship owing, in all probability, to the fact that the child ms confined to
her cabin for the prodromal period proceeding the development of the rash and ms
immediately isolated on the appearance of the eruption. Any contact, therefore,
with other passengers -was remote and under conditions unlikely to convey the infectio
20. This case is of interest on several counts. The child suffered from a
highly modified form of smallpox, probably for the reason that she had still sufficie
immunity against the disease to prevent a full development of the infection, but not
sufficient to prevent infection altogether. At the same time she must have had a
sufficient level of immunity, on the assumption that the vaccine used at the time of
her revaccination only four months before she embarked -was of sufficient potency and
the vaccination properly performed, to prevent the revaccination producing a
postive results This is, therefore, one of those dangerous threshold cases "where a
revaccination appears to indicate immunity but -where, in fact, the immunity is not
sufficient altogether to prevent an attack of smallpox -when confronted with a
virulent viruso But it must not be forgotten, that records of the result of
revaccinations are notoriously unreliable.
21. On the diagnosis, it must be stated quite categorically that these modified
cases of smallpox are far from easy to distinguish from chickenpox. The MedicalOfficers
concerned appear to have had their opinions coloured by the fact that the
child -was satisfactorily vaccinated in infancy and revaccinated recently and,
consequently, to have overlooked the vital point that the child had had a previous
attack of chickenpox only so recently as May last year and that it -was therefore
highly improbable, to say the least, that she -was suffering from a second attack of
chickenpox.
22. Each incident of this kind brings with it a number of lessons to be learned
and generally affords an opportunity to improve methods of defence against the
introduction of disease into this country. Perhaps the most important lesson in
this instance is the need for a complete and as far as possible accurate passenger
list with the address of first destination on arrival. Without this essential
information it is impossible to keep control of potential contacts.
ANNEXE I.
Telephone: Port of London Health Authority,
Monarch 3030. 5, Church Passage,
Guildhall, London, E.C.2.
Dear Sir,
ReM.S. "Strathmore'1 - Suspected Smallpox.
The s.s. "Strathmorew arrived at Tilbury at 6®50 a.m., on the 12th instant
from Sydney via Bombay. A girl, aged 12 years, embarked at Bombay on the 26th
January and took ill on the 28th with malaise.
She reported sick to the Surgeon on the 30th with a rash just appearing.
She had slight pyrexia and malaise and she -was isolated in the ship's hospital as a
case of chickenpox® The child had two vaccination marks from vaccination in
infancy and held a certificate of recent unsuccessful vaccination.
On arrival at Tilbury the Port Boarding Medical Officer agreed with the
ship's surgeon's diagnosis of chickenpox and the child ms disembarked and admitted
to the Billericay Isolation Hospital. Further careful clinical examination of the
child and a history giving evidence of a previous attack of chickenpox and some
scars on the abdomen, tended to confirm this.
This history and the distribution of the rash, chiefly on the face and
lower limbs, with little or no rash on the abdomen, chest and back, have been
sufficient to raise some doubt as to whether the case is in fact chickenpox but is a
modified smallpox. The child is, of course, now convalescing with the scabs
becoming detachedo
The child, therefore, is being regarded as a case of suspected smallpox
pending the result of biological investigation. The undermentioned persons giving
(14)