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Eradicating smallpox


Diagosing smallpox
Harold Lambert Physician
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Well, one thing that happened only a few years after I got to St George's was, there was still quite a lot of smallpox coming into the country because there was a lot of immigration, and it was almost inevitable that the odd person would come in incubating it and would then develop the disease when they arrived. And at that time long, long before the eradication of smallpox, which wasn't achieved until 1977 it was a big problem because the older generation of fever doctors, as I mentioned before and in the context of the hospitals, were retiring or dying and the Raj had come to an end so there weren't very many people, in fact there were very few who knew what smallpox looked like and how to diagnose it. So what the Ministry of Health, as it was then called, did was to send one or two people away to learn about it, and they sent me to Madras, now Chennai, on the Coromandel coast of India. And there was a very famous smallpox man there called Dr Rao and I saw in a few weeks I think it was 238 patients with smallpox and I took photographs of nearly all of them. So I accumulated that wodge of experience of what smallpox was like and so when I came back, I was put on the panel of consultants who were called out if there was a question about whether somebody had smallpox or not and, of course, the vast majority didn't. They had chickenpox or insect bites or this or that or the other or erythema multiforme or, you know, some peculiar thing, but there was always the question of whether they might have smallpox, and on two occasions, one in my own unit and one elsewhere, they did and this was a terribly... most of them were quite easy because they were quite clearly something else, but some of them were very difficult. The problem is that when it's classical smallpox fully developed you can do it from a picture in the book. It's a terribly easy diagnosis.

[Q] Yes.

But when it's developing or when it's very mild and modified or when it's very severe it can be a very difficult diagnosis, and the last outbreaks of smallpox in Britain and many others elsewhere had their origin in unrecognised haemorrhagic smallpox. That means when the person gets a haemorrhagic rash and dies before the characteristic smallpox rash appears, before it can be seen to be smallpox and nobody realises what it was and it's spread...

[Q] At that stage the patient would look like what, just... be a, a lot of...

Septicaemia with haemorrhages and stuff, people would... haemorrhages, right?

[Q] Yes, yes.

Yeah, yeah. Like what we would now say, a Lassa Fever or an Ebola or something.

[Q] Yes, yes, yes.

And that's something, I mean, unknown. People would be saying what on earth is going on.

[Q] Yes, yes, yes.

And so you were called out quite a bit and you went out with this little box which contained various bits of kit, slides and syringes and capillary tubes to take specimens to send to the public health laboratory and they were, they were quite taxing some of these occasions because you might be sent out... be called out by a medical officer of health, those are the people who actually rang you and said please come... to some casualty department where the, all the patients and all the nurses had been told not to leave until this chap arrived, so you'd be met with 26 eyes looking at you with hatred while you, while you could...

[Q] And that was because, being so infectious, that everybody had to actually, as it were, like you, they were, they were frozen.

To be recorded: your name, address, phone number so they could be followed daily for 16 days to see if they had a fever and, there were some, I must say, some quite funny episodes, but some quite taxing ones as well and, in actually fact, in actually fact, there were a couple of laboratory based things, as you remember, in Birmingham and in the School of Hygiene, but the first... sorry, the last imported case of smallpox was diagnosed by me at what was then the South Western Fever Hospital, which you remember.

[Q] Yes.

And it was an elderly Indian gentleman who wasn't at all ill and he had modified smallpox because he had been vaccinated many times, but he quite clearly did have major smallpox and, as you know, the point is he might have been mild, but the virus could be just as likely to kill you or somebody else as anybody else who weren't vaccinated. So that was, I wouldn't say it was a big part of my life because the callouts were pretty rare, thank goodness, but it was a rather interesting, taxing bit of medicine going on at that time and then, of course, it all disappeared.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: Public Health Laboratory, Community Health

Duration: 4 minutes, 59 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008