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SUSPECTED SMALLPOX.
The vessel left Sydney bound for London on October 24th, 1952, and made the following calls
during the voyage:—
Melbourne 28th October. Bombay 13th November.
Adelaide 30th October. Port Said 21st November.
Fremantle 3rd November. Marseilles 24th November.
Colombo 11th November. London 30th November.
On arrival in London the vessel had on board 506 passengers and a crew consisting of 249
Europeans and 267 Asiatics.
The Ship's Surgeon reported the following cases of chickenpox during the voyage:—
(1) A female passenger, aged 6, who embarked at Melbourne on the 28th October, developed
chickenpox, the date of onset being November 7th. Date of vaccination 13th November, 1949.
revaccinated 14th November, 1952, with positive result. She was isolated in the ship's isolation
hospital on November 8t.h. The attack was a mild one.
(2) Another female passenger, aged 9, who embarked at Adelaide on the 30th October, was found
to be suffering from chickenpox, the date of onset being November 5th. Date of vaccination 2nd
October, 1952. She was isolated in the ship's hospital on November 8th. The attack was a very mild
one.
(3) The third case—a Male Asiatic Steward, age 44, who had been a member of the crew since
May, 1951—developed chickenpox on November 22nd, was isolated in the ship's hospital on the 23rd
November with a mild attack. Date of last vaccination 22nd May, 1951.
(4) A fourth case, a female passenger, aged 27, who embarked at Fremantle on 3rd November,
had an attack beginning on the 25th November. She was isolated in the ship's hospital on the 26th
November, with an early moderate rash of chickenpox. Four large scars of childhood vaccinations.
Date of last vaccination 15th August, 1951.
All four cases were in fairly close contact since the Steward was the Bedroom Steward of the
three passengers.
The Ship's Surgeon was reasonably certain that the Steward was suffering from chickenpox, but
since the rash had a slightly wider distribution, there being a few pocks on the face, hands and feet, he
felt it wise to send off a specimen for laboratory investigation, by air from Marseilles; the first port
of call following the discovery of the case.
The specimen was posted from Marseilles on the 24th November and reached the Central Public
Health Laboratory, Colindale, on the 26th November and a report was issued on the 27th November
to the effect that the investigation of scab material was negative to smallpox.
On Saturday morning, the 29th November, the Laboratory reported that the colonies growing on
egg culture were atypical and that " smallpox could not be excluded."
Immediately upon receipt of this report, I decided that, whatever the clinical condition of the
Steward (and of the other three cases of undoubted chickenpox), the case of the Steward must in the
light of the Laboratory report be regarded as suspect smallpox and administrative action taken
accordingly. Consequently, a signal was sent to the ship by the Medical Superintendent of the shipping
company, to the effect that the case would be regarded on arrival as suspected smallpox; that the case
would be disembarked in the River for admittance to the Denton Isolation Hospital; that all persons
not in possession of a valid certificate of vaccination against smallpox should be offered vaccination;
and that all persons landing would be under surveillance for a period of fourteen days following
disembarkation.
The ship arrived at 0830 hours on Sunday, 30th November, and was boarded by myself, Dr.
Willoughby and Dr. Jones, and the Deputy Medical Superintendent of the shipping company, together
with five members of the staff of the Port Health Office.
It was found that the two small girls were clear of rash and had been released from isolation and
accordingly no further action was taken in regard to them.
The condition of the Steward on examination was as follows: A centralised rash occurring with
equal intensity on the back and chest, with a dozen spots on the face and neck; a few spots on the
upper arms; one in the hair, and two possible spots on the feet. Rash in the later stages; a few
vesicular but mostly pustular with scabbing well advanced. Patient afebrile and not complaining of
symptoms.
The female passenger on examination showed a typical early chickenpox rash, mostly in the upper
part of the trunk, on the back and upper chest. There were groups of spots on the edge of the back
and chest where she had exposed herself to the sunlight and was moderately sunburnt; a few spots
on the upper arms and on the face, and one on the soft palate. Rash in all stages, papular, vesicular
and pustular. Patient afebrile and not complaining.
The ship's Surgeon had vaccinated 250 passengers during the day before arrival.
The Asiatic Steward and the adult female passenger, together with their personal effects and
infected bedding, mattresses, etc., were promptly transferred to the Port Health launch and thence to
Denton Hospital, after which the ship was permitted to proceed to Tilbury Landing Stage for the
eventual disembarkation of passengers.
The Port Health Staff at once got to work on the distribution and collection of the yellow cards,
on which passengers are required to fill in the address of their immediate destination, and this was
completed by 1 p.m. The interrogation of each passenger was combined with the usual Immigration
proceedings with the result that all passengers were able to leave the ship in time to pass through
Customs and later to catch the train for London according to schedule.
The cards were separated into the areas of immediate destination and were despatched, at the
General Post Office, London, by 7.30 p.m. the same evening, together with a covering letter to the
Medical Officers of Health of 35 London Districts and 122 Provincial Districts.
A full list of passengers disembarking at Marseilles was posted to the Ministry of Health.
As regards the crew, arrangements were made whereby members of the crew proceeding at any
time on leave during the fourteen days following the arrival of the ship would be reported to the Port
Health Office and would be then reported to the Medical Officer of Health of the district to which they
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