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5
SICKNESS.
IV.—SICKNESS: NOTIFICATION.
In Table III , Appendix, the numbers of cases of the infectious diseases recorded in each
of the years 1909-18 are set out. The annual averages for the two quinquennia and the
Index Numbers for 1914-18 are given in Table 5. The figures in both Tables are corrected
for duplicate reports, but not for "errors of diagnosis," &c. Table IV., Appendix, gives the
numbers of "errors" for (what are designated) the more important infectious diseases.
Of the diseases included in Table 5, diphtheria (and membranous croup—a clinical

* A verages 1909-13 = 100.
variation of diphtheria) is the only one with a higher annual average during the "war
period" (1914-18). The low prevalence of all the other diseases, and (to a less degree) even
of diphtheria during the three years 191G-18), forms a remarkable variation from the
experience of previous great wars. In this respect the Borough did not enjoy a special
immunity. I he returns for the Metropolis, extra-Metropolitan England and Wales, and for
the Ports have been collated—they have not been included in the Report for economy's sake
—and they tell the same tale. Smallpox and enteric fever were respectively epidemic on
great scales during the Franco-German War of 1870-72 and the South African War of 18991901.
The severest epidemic of smallpox of which reliable statistics are on record occurred
in this country during 1871-72, and there was a considerable prevalence of enteric at home
following the return of troops from South Africa. The relative immunity from these diseases
enjoyed by the country during the last war was attributable to the high standard of the
preventive medical services in the Army and the vigilance of the Port Sanitary Services. As
regards enteric fever the experience in the Services during the last war was a noteworthy
one. The conditions of trench warfare were such as to favour the development of an
epidemic of devastating proportions. The failure of the disease to overcome preventive
measures can be attributed only to the almost universal protection of the troops by inoculation
a statement which can be made without in any way minimising the value or efficiency
of the methods of conservancy or water purification. The success which attended antityphoid
inoculation should be an unanswerable argument to the anti-vaccination propagandist.
The success in the past nineteen years of the propagandum against vaccination is
clearly shown in cols. 5 and 9 of Table 6. If the proportion of unprotected children continues
to increase there can be only one result. At no very distant date the proportion of the
unprotected to the total population will become so large that the disease (smallpox) will not
be kept in check by the vigilance of health officers, and the experience of 1871-72 will be
repeated.
Errors of Diagnosis.—Table IV., Appendix, shows the distribution according to Wards of
the three diseases—diphtheria including membranous croup), scarlet fever and enteric fever
during the years 1914-18, together with the numbers of instances of variation of first diagnosis
("errors"). The data in that Table are summarised in Table 7. The percentages of
"errors" to all notifications follow this.