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standards of food hygiene accounted for the decline in the number of
cases. During the year 1929 a major outbreak of typhoid fever occurred
involving some 110 Borough cases. The outbreak occurred in Sydenham
and in portions of Beckenham and Penge. Altogether there were 129
cases with 17 deaths recorded. After exhaustive enquiries had been
made, circumstantial evidence pointed to a carrier in a food shop, who,
soon after the outbreak commenced was taken ill and died nearly a month
later. Post mortem findings pointed to the employee as having been
infected with the disease, and in all probability he had infected food
sold in the shop before he became too ill to continue.
From September 1901 and continuing for the greater part of 1902,
an epidemic of smallpox occurred when some 90 cases were recorded
in the Borough. This was part of a large outbreak in the County of London
which involved some 8,000 cases. Lewisham, in fact, was fortunate
in that the attack rate, 0.63 per thousand was much below the overall
for the County which was 1.67 per thousand, the highest being that of
Stepney with an attack rate of 4.58 per thousand. The first case occurred
in January. The person was attacked shortly after arrival from Paris,
where the disease was prevalent. In February a sailor was attacked
shortly after his arrival home. In May, a lady on her return home from
Egypt was notified in Highbury. In June a case was notified in Bethnal
Green. In the same month cases occurred in Wandsworth, two of which
were due to laundry infection. During the week ending August 24th
there were 16 cases. From this date the disease spread, chiefly in the
boroughs north of the Thames. The borough of Lewisham enjoyed
complete immunity until 19th September, when the first case occurred.
The 1901 outbreak of smallpox was the largest the borough has
suffered since its incorporation, but other outbreaks occurred through
the years. In 1905 there were 8 cases and 4 deaths were recorded; all
the cases were either members of the same family or very close contacts.
This outbreak was of the more severe haemorrhagic smallpox. The
source of infection proved impossible to trace as the first patient, who
was a commercial traveller, had visited many towns prior to his illness.
The next case of small pox in the borough occurred many years
later in 1923. This was an isolated case, the original source of infection
being a visitor from Spain who was thought to have infected five other
people living in London. Smallpox was prevalent in London from
1929 to 1934 and over these years Lewisham was fortunate in having
only 51 cases of a mild character. None of the cases in any of these years
could be traced back to an ascertainable source of origin. Since that
time the borough has been completely free from this disease except
for two cases which occurred among servicemen during the war.
Between 1901 and 1938 the average number of cases of diphtheria
occurring in the Borough each year was 330 with 21 deaths. This
incidence, however, dramatically changed in 1939 when only 137 cases
were recorded, and from then on the number rapidly fell until in 1950
none were recorded. Since 1950 only two cases have been notified, the
last in 1955. In July 1935 a scheme for the immunisation of children
against diphtheria was started. The Borough Council made arrangements
with medical practitioners to pay the doctor's fee for the protection
of children between the ages of one and twelve years. A modest