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is called in to give an opinion and specimens for laboratory investigation are taken in all cases,
including clinical smallpox, and sent to the Central Public Health Laboratory. Standard kits for
this purpose are held on the "HYGEIA", the launches and at the Hospital. A decision as to the
disposal of the patient is taken immediately as one normally cannot wait for results of laboratory
tests though reliable reports within a few hours have been given by electron microscope
examination in a recent outbreak of smallpox.
When one is in the happy position of being able to decide with certainty on clinical grounds
that smallpox can be excluded "free pratique" is given to the ship and the patient admitted to
hospital or allowed to proceed and be treated by his own doctor as indicated by his clinical state.
When smallpox cannot be excluded on clinical grounds, the Boarding Medical Officer decides
whether the patient should be admitted to the smallpox hospital at Long Reach Hospital, Dartford,
Kent. It is for the Boarding Medical Officer to decide whether to keep a suspect case on board
pending a Consultant opinion. A lot depends on the degree of doubt in a suspected case. This is
also the crux in regard to admission to Denton Hospital in exceptional circumstances. If this is
done any other patients there are removed beforehand and all occupants of the hospital protected
by recent successful vaccination or re vaccination. The strictest hospital quarantine comparable
to that of a smallpox hospital is maintained. The Boarding Medical Officer keeps in close touch
with the Medical Officer of Health until a firm diagnosis has been established. A case of clinical
smallpox is removed at once to Long Reach Hospital by ambulance. In these circumstances
facilities are used at Denton Hospital for terminal disinfection of the patient's clothing and that
of all who have been in contact with him since the onset of his illness and prior to his removal to
Long Reach Hospital. Special care is taken to trace, collect and disinfect any of the patient's
clothing or bed linen which has been sent to be laundered. Accommodation in the ship, quarters,
launch, Denton Hospital, etc., occupied by the patient are also disinfected.
Routine action is taken to check an outbreak of smallpox by the tracing, vaccination and
surveillance of known and probable contacts. If the ship with the case is a passenger liner bound
for Tilbury, this may involve up to 1,500 passengers and 650 members of crew.
Careful enquiries elucidate a full and accurate list of all persons, who from the time the
patient was taken ill are known or are likely to have been in contact with the case, such as other
passengers, members of the crew, persons who worked in close contact with him, anyone who
entered his cabin or quarters before they were disinfected and persons who handled his personal
belongings, clothing or bedding, and anyone who disembarks from the ship or who goes on board.
This will clearly include Health Department staffs such as public health inspectors engaged in
terminal disinfection as well as launch crew who were in contact with the patient. Any person
who has been in contact with the body of a patient should he die of smallpox should not be
forgotten. The names and addresses of all travellers who are proceeding beyond the Port Health
District are transmitted on appropriate forms to the Health Department, Guildhall. Each form
when completed gives addresses at which the person will stay the first night ashore anH
during the next fourteen days. Each traveller is also given a reply paid postcard on which he is
required to notify the Medical Officer of Health at Guildhall of any change of address within 14
days of disembarkation, in case he is unable to give all this information when he fills in the
form. All these persons are checked by the Medical Officer and must be offered vaccination or
revaccination immediately whether or not they hold valid International Vaccination Certificates,
and if probable contacts, irrespective of age or contra-indications. They are placed under surveillance
for 14 days from the date of last possible contact. This is usually the date of isolation
of the patient. The Medical Officers of Health of districts to which each traveller is proceeding
are notified accordingly.
The intimate contacts of known or probable contacts of any person placed under surveillance
should be vaccinated immediately in order to protect them before the onset of illness in the
person under surveillance.
Possible contacts such as persons who visited the ship or other place occupied by the
patient without actual contact with the patient, i.e. his sick berth or personal effects, are offered
vaccination irrespective of age if there is no specific contra-indication. These are not put under
surveillance but advised to call in their own doctor if they feel unwell within a specified period.
This is a short review of the main duties of a Boarding Medical Officer. In addition he undertakes
medical emergencies and "first-aid" calls if his time allows. These include cases of cardiovascular
disease such as coronary thrombosis and indeed any cause of acute collapse amongst
members of crews or passengers on ships in the River. Various accidents calling for immediate
first-aid for haemorrhage, respiratory failure or fractures are attended to. This "Good Samaritan"
service is given as an ex gratia service and helps to maintain the excellent good relations which
obtain between Port Health Authority's Officers and the other Port Services, as well as Masters
and crews of the Shipping Companies.
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