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"Distribution
Whilst there are more to the upper than lower back, and more on chest than abdomen, there
are more on the thighs than shins and more on upper arm than lower. Whilst there are numerous
lesions on the palms of hands and soles of feet, there are also lesions in flexures.
"Nature of Lesions
The very clear history of cropping is not fully supported by the present state of the rash, the
"early" lesions having been slow to develop and the later lesions quicker developing. Thus
there is a rather uniform state of rash but still evidence of cropping.
The lesions are very irregular in size, but are all sound. Some are quite superficial but
others were "fleshy".
The most worrying factors were the severity of the rash in a child of 3 and the approximate
uniformity (size and shape) of the appearance of the lesions. Against this is the successful
vaccination and the clear history of cropping.
On balance it was decided to treat the case as one of chickenpox, but with the reservation
that smallpox had to be eliminated.
The family (mother plus 3) were admitted to Denton Hospital "Smallpox" block with all
reasonable precautions at 11.30 a.m. on 15th August.
A Smallpox Consultant was informed of the case and kindly examined the case in Denton
Hospital at 12.30 p.m. on 15th August.
He agreed with the opinion of the Deputy Port Medical Officer, the Senior Boarding Medical
Officer and the Ship's Surgeon.
Specimens were sent to the Central Public Health Laboratory at Colindale by messenger
(2.18 p.m. train), 3 slides of fluid and scrapings.
"At 7 p.m. Colindale reported that result was positive to Variola-Vaccinia group.
" (1) The Smallpox Consultant was informed. The case was then treated as Smallpox and was
transferred to Long Reach Hospital by L.C.C. Ambulance at 8.30 a.m. on 16th August.
" (2) The Ministry of Health were informed.
" (3) Mother and other 2 children were revaccinated.
Staff available at Denton Hospital were revaccinated.
" (4) Further Information
The child patient's movements before embarkation were as follows:—
26.7.62 Left Home — Punjab.
26.7.62 — 28.7.62. Train to Bombay. (48 hrs.)
28.7.62 — 30.7.62. In Bombay.
30.7.62 Embarked.
11.8.62 Rash.
Child was in cabin from Thursday 9th except for visit to Ship's Surgeon a.m. 10th and
visits to lavatory. (Otherwise confined to cabin.)
Other children coming and going and mother out of cabin after child asleep in evening.
Only one visitor, a woman unknown, for 1 minute not near the child.
All passengers were seen by the Deputy Port Medical Officer on 14th and only three
declared were ill.
All passengers reported as having valid International Certificate of Vaccination at time of
embarkation. "
Approximately 1,100 passengers, and 400 members of the crew, had of course disembarked
and proceeded to their destinations, some of which were out of this country in for instance Paris,
Ireland the the United States. It was, however, understood that all these passengers and crew
were in possession of valid Vaccination Certificates.
By the last post out of London on the 16th August, communications had been sent to the
Medical Officers of Health of the appropriate local authorities in this country in respect of every
passenger and member of the crew who had disembarked at Tilbury, informing him of the circumstances.
The Ministry of Health was at the same time informed of the names and destinations
of those persons who had left the country and proceeded abroad. The Medical Officer of Health
for Plymouth was informed of the circumstances as 60 passengers had disembarked at that Port.
The majority of these passengers and crew were traced and placed under surveillance for 16
clear days from the date of removal of the patient and his family to Denton Hospital. This
period was completed by the 1st September and no illness in any of those under surveillance has
been reported to the Ministry of Health.
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