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10
would be caused if the hemorrhagic form of the disease invaded London whilst an
outbreak of the benign type was in progress.
Owing to the difficulties which have arisen from time to time, consequent upon
the differential diagnosis of smallpox, the Metropolitan Asylums Board revised
their arrangements for the removal of patients, and the following procedure was
adopted in December, 1927.
(i) When the Board receive an application from a medical practitioner
for the removal of a patient who is certified by the applicant to be suffering
from smallpox, the Board will forthwith send to remove the case, at the same
time notifying the medical officer of health of the borough of the application
by the quickest available means.
(ii) The Board's medical superintendent at South Wharf will, as soon as
practicable, inform the borough medical officer of health of his view of the case,
and, if he is unable to confirm the diagnosis but desires to retain the case at
South Wharf for observation purposes, the borough medical officer of health will
be given facilities for seeing the patient if he desires to do so.
(iii) When the Board receives an application from a medical practitioner
for the removal of a case which the applicant is not prepared to certify definitely,
but which he regards as doubtful, the applicant will be referred to the borough
medical officer of health and the case will not be removed until a definite certificate
is forthcoming, or the medical officer of health applies for the case to be
admitted for observation.
The Council has continued to place at the disposal of medical officers of health of
the metropolitan boroughs and certain of the Home Counties and extra metropolitan
authorities the services of its expert medical staff in connection with the diagnosis
of suspected cases of smallpox.
Finally, it must be emphasised once again, that the only bulwark against the
invasion of smallpox is vaccination, and until the population as a whole is more
adequately vaccinated, the risks of smallpox spreading in London will continue to
arise from time to time, and in addition to the suffering and loss of life, vast expenditure
of time, labour and money, which could be more usefully directed into other
more profitable channels for the benefit of the public health, will continue to be
expended in the Sisyphean labour of attempting to prevent a disease which would
be non-existent in a properly vaccinated community.
Measles was epidemic during the winter of 1927-28. The deaths in 1927
numbered 181, of which 130 occurred in the last quarter of the year, when the rapid
increase in the deaths gave warning of the approaching winter epidemic.

While the deaths in the present epidemic exceed those recorded in 1925-26,
they are below the number in the epidemic of 1923-24, when in the corresponding
28 weeks 1,309 deaths occurred.
The death-rates in the metropolitan boroughs are shown in the table on page 23.
There were 548 deaths from whooping-cough in London during 1927, the disease
being epidemic during the winter months. An increased incidence was anticipated
in view of the unusually low mortality in the preceding year when the deaths numbered
only 231. The distribution of the mortality in the various metropolitan
boroughs is shown in the table on page 23.
There were 13,178 cases of scarlet fever notified in 1927 (52 weeks), the corresponding
figure for 1926 being 12,293. The attack-rate was 2.9 per thousand,
Procedure
for removing
cases of
smallpox.
Measles.
Whoopingcough.
Scarlet
Fever.