In 1971 I was a surgeon on the P&O ocean liner Orkney. Early Christmas morning the phone rang, could I go see someone with a weird rash? The patient was from Goa, and was one of a batch of 20 or more who had been flown to Singapore about 5 days ago to relieve others due to furlough. His problem was spots and a 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 a huge leap from treating seasickness.

All the internal red lights came on at once. The differential diagnosis was both mundane and terrifying. Chickenpox was the favourite, followed by insect bites, or a kind of skin infection commonly called impetigo, but it was a big but, the spots themselves matched the classic textbook description of smallpox. Was there smallpox where it came from? It was still very early in the morning, around 7 am, and the ship was finally repaired and headed for a stop at a top tourist spot on the Great Barrier Reef, Hayman Island. These were a good 2 days sailing. 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 terrifying mortality, ranging from almost 100% to at best 20-30%, depending on the strain of the virus and the susceptibility of the virus. the affected community. In recent years we are used to thinking of it as a weapon of terrorism since the disease itself was eradicated by the WHO vaccination program, the last non-laboratory case being in the early 1980s. Even at the time I write about it was rare and confined to poor populations in hot countries.

I needed insulation. We were lucky in that respect, the ship’s hospital was located above the propeller on the aft C deck. There was a small separate room designed just for this purpose, known as the Brig, as it also functioned as a cell should the need for restraint arise in the crew or aggressive passenger.

We then radioed Darwin Port Health who said we couldn’t go back and suggested speaking to the authorities in Brisbane. Finally, the Captain spoke briefly and handed me the radio to speak to the Australian Medical Director. He was an angry man with no discernible sense of humor, not that the situation was funny. He insisted that everyone on board must be inspected every 24 hours, but every 12 hours within 48 hours of landing and yes, everyone on board without a valid certificate must be vaccinated, excuses are not tolerated. He gave the impression that he was as sure as he could be that our diagnosis was wrong and that this was probably a storm in a cup of tea and of course it was just chickenpox in an Asian man. We were to leave Australian territorial waters and proceed to Brisbane for further instructions.

The CMO had insisted that 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 was already an inspection routine in place prior to docking in Australian ports. Port Health ruled that any ship from non-Australian ports must undergo a full smallpox inspection before being allowed to dock, so we were used to carrying out such inspections. There was a set routine, and even an expectation from both passengers and crew, but doing it for four days, twice a day for the last 2 days was going to test everyone’s patience.

Medically we decided to combine the first inspection with mass vaccination; We made the crew first to put our hand in it so to speak. We decided to vaccinate all Goa crew regardless of what their smallpox certificate said. This was because, to a man, they were all notorious needle haters and it was well known that most certificates were forged. It was a cottage industry in Goa. Vaccination was performed by placing a drop of serum on the skin, and scratching two parallel lines at right angles and rubbing the material into the scratches with a needle. It was not a painful procedure, but the reaction of many would believe it, we do not accept excuses however elaborate they were.

We finally reached Brisbane and were also instructed to fly two yellow flags. Normally only one yellow flag was flown before Port Health cleared it, two yellow flags meant we were a dangerous outcast. Our patient was tied up like a cooked chicken, unceremoniously grabbed and thrown into the cart and taken away, breathing tube poking through the wrapper. It looked like an insect chrysalis. We never saw him again. Although we made several inquiries, the Brisbane Port Health Authority never confirmed that it was smallpox, but they never said it wasn’t. I remain convinced that we saw the last case of smallpox on a passenger liner.