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Interests in infection and medicine and transferable drug resistance

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Diagnosing smallpox
Harold Lambert Physician
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When you were called out to see a possible patient with smallpox you came out with this box, which had a form to send to the public health lab and this canister, which I can't open, yes I can, and the canister contained 31 ounces, it would be called, glass jar, some slides in a slide holder, some capillary tubes - can't get it out; let's get it all out - a little bulb to stick on the end of the capillary tubes and a needle and another sort of tube, I've forgotten about which was which. And you took the appropriate specimen scraping the base- oh, and a hagedorn needle. That's a needle like an ordinary needle with a flat, flanged edge so you didn't have to pierce but you could scrape things with. It's called- Is it here somewhere? I can't see. I haven't got my glasses on. That's probably that. And you took specimens, appropriately, from mostly the patients' skin lesions, both fluid if you could get it into the capillary tube and scrapes to slide on- to scrape onto slides and dry and then you called up some Hell's Angels and these motorcyclists would take this to Colindale. It wasn't- and they'd electron microscope it but it wasn't 24 hour cover as it is now and they'd grow the smallpox virus or, in most cases, the chickenpox virus and it wasn't much help at that moment because you had to make the decision about whether to- it was like pressing a bomb thing and the whole public health system of the country, voom, or not. So it was actually pretty onerous. The only thing was that you knew perfectly well what most things were and they weren't smallpox. But when you thought it was, you actually, you made a phone call and everything went up in the smoke. All the people, surroundings, all the families had to be kept in where they were, be followed up for 16 days. The patient had to go to then a smallpox hospital which was open specially on the edge of a fever hospital and, as you can imagine, endless admin and public relations and tracing and where the patient had come from, where they'd been to. The patient- of the two patients I saw in England with smallpox, one was the Indian man and the other was a child who had come into my own unit. It was the receiving room for fevers and my registrar at the time rang me up and said- I think we've got smallpox here and I said- what do you mean, another generalised vaccinia which is one of the things that looks like smallpox. He said- no, no, I, I think, I think it is. And he was right. Gosh. And this child who was three had been twice in the previous week in crowded doctors' surgeries in Tooting, being diagnosed as chickenpox and nobody got smallpox. Extraordinary. It's this capriciousness of infectious disease. And, nobody actually got it, although it was technically an outbreak because the child was obviously very distressed. It was an Indian child and mother and, the mother although it had finished feeding had put the child to her breast to comfort it and the child had, although she was fully vaccinated, she was very highly protected, but he, he'd, he'd bitten her breast slightly and she got one smallpox lesion. It's called variola innoculatae, an inoculated variolar lesion and for that reason it was technically and in the World Health records it's an outbreak because somebody else got it but it wasn't really an outbreak and none of those doctors' surgeries- But you can imagine the work of going to that surgery, finding who'd been there and what happened and tracing them for 16 days. It was a hugely onerous thing actually. And who did all that work? That was- Medical officers of health. Right. It was before the decline of public health and the ascent of community medicine, whatever that was and, and then, in actuality there's quite a serious point there. The medical officer of health used to be a person of immense power and authority and knowledge, they'd all done fevers, and then it all became community medicine, about committees and, and arranging things and one thing and another and, they didn't have the experience or the training for that. But they were, they were put in a very difficult position because if somebody came in querying Lassa fever they were meant to be the people and for many, many years before they kind of rebounded into public health medicine more in the old fashioned sense and there were consultants in communicable disease control I used to get endless phone calls from MOHs who, who, poor chaps, didn't know what to do because it- there was nothing- they weren't being silly or ignorant. They just, it wasn't their trade and yet they were being put in this position of seeing the most acutely daunting pubic health emergencies. Do you think we're back now in a safer position in the UK? I think we are, partly in a way bioterrorism but even before that. The idea of communicable disease control people whose- actually their sharp business is what you do when you get queried Legionnaire's disease and very- but it was still, it was still- I don't remember when infectious disease became respectable. When I was made a professor, which was in, I think, I think it was 1972, the medical school made me a professor of microbial diseases and the reason for that, would you believe it, was because professor of infectious diseases sounded so incredibly old hat. Isn't that amazing? And now, of course, all the best people want to do infectious diseases, except general practice of course.

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: canister, slides, capillary tubes, needle, electron microscope, patient, family, inoculative lesion, microbial diseases, medical officer of health

Duration: 6 minutes, 1 second

Date story recorded: October 2004

Date story went live: 24 January 2008