In 1971 I was surgeon on the P&O liner Orcades. On Christmas morning early the phone rang, could I come and look at someone with weird rash. The patient was Goanese, and was one of a batch of 20 or so that had been flown in to Singapore some 5 days ago to relieve others due leave. His problem was spots and slight fever. They were on the young man’s arms and chest, raised from the surface of the skin, with a central dimple, and in medical jargon ‘umbilicated’. This was big jump from treating seasickness.
All the internal red lights went on at once. The differential diagnosis was both mundane and terrifying. Chickenpox was favourite, followed by insect bites, or a sort of skin infection commonly called impetigo, but and it was a very big but, the spots themselves matched the classical textbook description of Smallpox. Was there smallpox where he came from? It was still very early in the morning, about 7am, and at last the ship was fixed and just setting out on its way to a stop at a top tourist spot on the Great Barrier Reef, Hayman Island. This was a good 2 days sailing away. Now smallpox anywhere is a terror, on a passenger liner it is a disaster of Hollywood proportions. Smallpox is one of the most infectious diseases we know of, it also has a truly frightening mortality, varying from nearly 100% to at the best 20-30% depending on the strain of the virus and the susceptibility of the community it struck. In recent years we are accustomed to think of it as a weapon of terrorism since the disease itself was wiped out by the WHO’s vaccination programme, the last non laboratory case being in the early eighties. Even at the time of which I write it was rare, and confined to poor populations in hot countries.
He needed isolating. We were lucky in that respect, the ship’s hospital was situated over the propeller at C deck aft. There was a small self contained room there designed for just this purpose, known as the Brig, as it also doubled as a cell should the need for restraint arise in aggressive crew or passenger.
Then we radioed the Darwin Port Health, who said we could not go back, and suggested talking to the Authorities in Brisbane. Eventually the Captain spoke briefly and I was handed the radio to talk to the Australian Chief Medical Officer. He was a cross sounding man with no discernable sense of humour, not that the situation was funny. He insisted all on board should be inspected 24 hourly, but 12 hourly within 48 hours of landfall and yes all on board without a valid certificate must be vaccinated, no excuses tolerated. He did give the impression that he was as certain as he could be that our diagnosis was wrong and this was probably a storm in a tea cup and of course it was only chickenpox in an Asian man. We were to move out of Australian Territorial Waters and make our way to Brisbane for further instructions.
The CMO had insisted only the Ship’s Doctors could do the inspections but the nurses could help with the vaccinations. There were only 2 doctors, 2 nurses plus Ron the ex naval dispenser who counted as a nurse as far as I was concerned. Fortunately there already was an established inspection routine pre docking in Australian Ports. The Port Health ruled that any ship from Non Australian Ports must undergo a full smallpox inspection prior to being allowed to dock, so that we were used to doing such inspections. There was an established routine, and even an expectation of such from both the passengers and the crew, but doing it for four days, twice a day for the last 2 days was going to severely test everyone’s patience.
Medically we decided to combine the first inspection with the mass vaccination; we did the crew first to get our hand in as it were. We decided to vaccinate all of the Goanese crew whatever their smallpox certificate said. This was because to a man they were all notorious needle haters and it was well known that most of the certificates were forged. It was a cottage industry in Goa. Vaccinating was done by placing a drop of serum on the skin, and scratching two parallel lines at right angles and rubbing the stuff in to the scratches with a needle. It was not a painful procedure but the reaction of many would belie that fact, we brooked no excuses however elaborate
We eventually got to Brisbane and were also instructed to fly two yellow flags. Normally only one yellow flag was flown prior to being cleared by Port Health, two yellow flags signified we were a dangerous pariah. Our patient was trussed like a cooked chicken, unceremoniously grabbed and dumped on the trolley and whisked away, his breathing tube poking through the wrapping. He looked like an insect chrysalis. We never saw him again. Though we made several enquiries Brisbane Port Health Authority never confirmed it as smallpox, but they never said it wasn’t either. I remain convinced we saw the last case of smallpox on a passenger liner.