View report page

7
increase in the deaths from diseases of the respiratory system and of the heart.
An increase occurred in the deaths from nephritis, but, on the other hand, the
deaths from diarrhoeal diseases were considerably below the average.
Fatal street accidents continued to increase in number, the total being 669
in the 52 registration weeks of 1927 against 656 in 1926. Among children under
15 years of age, however, the deaths, numbering 149, were less by 14 than in 1926.
The death-rates from all causes and from certain specified causes in each
metropolitan borough and in London as a whole will be found in the table on
page 23.

Infectious diseases.
The attack rates and death-rates of the principal infectious diseases in London
and the constituent boroughs are shown in the table on page 23.
During 1927, five cases of smallpox occurred within the adminstrative County Smallpox,
of London, of which two proved fatal. Enquiry showed that, including one of the
fatal cases, two were definitely unvaccinated, one was vaccinated for the first time
after being infected but in time to modify the attack, another (aged fifty-four years)
was vaccinated in infancy, and the remaining case (aged forty years) which
terminated fatally was said to have been vaccinated but no scars were
discernible.
An outbreak in Hendon which occurred in March-May apparently originated
from some unrecognised source in London. About this time outbreaks of smallpox
occurred on board vessels coming through the Mediterranean from the East. In
one case a smallpox patient was transferred to the Port of London's Smallpox
Hospital at Denton from a ship (s.s. Nankin) which arrived at Gravesend from
India on the 7th March, 1927. In another instance a passenger on board the
P. & 0. liner, s.s. Rawalpindi, developed smallpox and was transferred to hospital
at Gibraltar, where she died on the 13th March, two days after being landed. Many
of the passengers on this vessel came to London, and the ship's surgeon developed
smallpox in Wimbledon, and was removed to hospital on the 31st March, 1927.
A case of smallpox also occurred at Gravesend at the end of March in the person
of a waterside labourer working on ships coming into the Port of London. These
facts are significant when considering the outbreak in Hendon and London which
comprised thirteen cases (including four in London), of which seven were fatal.
The outbreak is of special interest as it illustrates in a special degree two most
important factors associated with the spread of smallpox, i.e. (1) the danger of the
unrecognised mild case, diagnosed as chickenpox, which gives rise to secondary
fatal cases; and (2) infection by fomites and the need for such persons as laundry
workers being adequately protected by vaccination.