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diphtheria. 13
At the same time it must be recognised that children returned as "insusceptible" of
vaccination, although officially recognised as beyond the scope of the Vaccination Acts, cannot
be regarded as protected against smallpox, and in any estimate of the proportion of unprotected
children, they must be reckoned among the unvaccinated. During the five years 1905-09
14,282 children survived the first year of their lives, of whom 2,304 (or 16.1 per cent.) were
left unprotected against smallpox. During 1906-10 the deaths at ages between one and five
years numbered 790, so that there remain upwards of 1,500 children under five years of age who,
exposed to the risk of taking the disease in its worst form, constitute a menace to the whole
Borough. No estimate can be formed of the total number of unvaccinated persons residing in
the Borough, which takes a high position in the ranks of vaccinated communities, but the
children already referred to are sufficient to cause a fairly extensive outbreak of smallpox once
the disease gets a footing in the Borough.
The percentages of children successfully vaccinated in each of the three last years for
which complete returns are available (viz., 1907, 1908 and 1909) are 75.94, 75.72 and 70.78
respectively. Against the small increase observed in the last year must be set off the increase
in the proportion of "conscientious objectors," the percentages of children exempted by
certificates increasing from 3.13 in 1907 to 6.48 in 1908 and 8.32 in 1909. Doubtless the
occurrence of a few cases of smallpox will greatly alter the present state of unprotectedness,
but it requires no words to condemn the folly of running an absolutely unnecessary risk before
securing the protection which vaccination affords.
DIPHTHERIA.
The cases of this disease recorded last year numbered 116,* as compared with 175 in the
previous year, and 140 in 1908. The total for 1909 included 2 cases of membranous croup,
and that for 1908, 4 cases; but last year no case was reported under that designation. Last
year's total was lower than that of any year since 1901, except 1905 (90 cases). The
morbidity rate (0.76) was 25 per cent. below the mean rate (1.01). In Lancaster Gate,
West, Ward alone, were more cases reported last year than in 1909 (Table 0).
According to the Registrar-General's figures (Table 7) the morbidity in the Borough was
0.78 per 1,000, 0.25 less than the mean rate (1.03). In Hampstead alone was the rate for last
year (0.53) less than that for the Borough, while the mean rates for Marylebone (0.98) and
Hampstead (0.84) were below that for the Borough (1.03).
Table 12 gives a comparison of the numbers of cases reported in each quarter of the past
and the preceding five years. The cases reported in the first quarter (40) were two in excess
of the average (38), those in the remaining three less than the averages.
The 116 reported cases included 13 subsequently certified to have been erroneously
diagnosed (equal to 11.2 per cent.), the average for the quinquennium being 13.3. Of the
remaining 103 cases, in 11 the infection appeared to have been contracted outside the Borough,
including one case which occurred in hospital during the treatment of another disease.
One patient was reported to have a second attack during the year, the particulars
being:—
F. M., f. aet 8, 1st attack, 12 vii., '08; 2nd attack 25 x., TO.
The diagnosis was confirmed on both occasions.
*The certificates of diphtheria received actually numbered 121, but in 5 cases it was found subsequently
that the disease was scarlet fever, and the cases were transferred to that heading.