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26
1926]
The total cases notified are 276 less than those of the previous year (2,194),
and 299 below the average (2,217) of the preceding ten years. The decreases
when contrasted with the decennial averages are to be found in the returns from
Diphtheria, Scarlet Fever and Erysipelas, which were respectively 153, 125 and
24 below the average, while the other diseases all showed a slight increase.
The 1,918 cases were equal to an attack.rate of 5.65 per 1,000 of the civil
population.

SMALLPOX.
One of two cases occurring in the Borough was allocated to Islington. The
primary case was that of a woman who had been admitted to the Royal Northern
Hospital on account of abdominal pain and the possibility of an operation, as the
symptoms pointed to possible infection of the gall bladder. She also suffered
from an old.standing chronic skin disease, psoriasis. These facts naturally
made diagnosis difficult, as also the particular type of smallpox which showed
itself, which was of the low, flat type preceding the ushering in of the confluent
type. The history of the probable source of infection is also interesting, as the
patient was in Paris on a visit from the 11th to the 24th September, and the
probable date of infection would appear to be there in Paris about the 22nd to
the 24th September. It is interesting to note that the origin of cases in the
same year at Willesden which infected persons in London was also considered to
be in Paris.
The case was a severe one, as I have stated, but it was at first hoped
that owing to the prompt action taken there might be no one infected. However,
a patient in the ward who occupied the next bed, and who like the others had
been carefully watched was isolated owing to a rise of temperature, which might
have been due to vaccination, which had taken well. On the 21st October a
rash appeared in this second patient, modified by vaccination, but considered
undoubtedly to be smallpox. This second case was also removed to hospital.