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15
diphtheria.
in 1911. The cases reported in extra-metropolitan districts during 1914 numbered 56, as compared
with 87 in 1913 and 107 in 1912. (See Table 6.) In addition, 7 cases were discovered
on inspection of ships in home ports, making a total of 65 for the whole of England and Wales.
No records are available of the number of certified cases of the disease which were subsequently
proved to have been wrongly diagnosed.
Vaccination.—Table 14, which has been constructed from'returns supplied by the Vaccination
Officer, shows the steady increase in the proportion of unvaccinated infants. In 1913 (the last
year for which complete returns are available) the percentage had risen to 24.8.
DIPHTHERIA*
During the past year 289 certificates of diphtheria were received, 7 less than in 1913.
The morbidity rate was equal to 2.03 per 1,000 persons, as compared with 2.05 in 1913 and
an average rate for the five years 1909-13 of 141. (See Table 4.) The local rate derived from
the figures published in the Quarterly Reports of the Registrar-General was 2'07. (See Table 5.)
As will be seen in the chart facing page 8, the prevalence of the disease was above the average
during practically the whole of the year, both in Paddington and in the Metropolis generally.
The numbers of cases recorded as belonging to- each Ward in each quarter of the year are
shown in Table 8, against the corresponding averages for the years 1909-13. The variations
in the morbidity rates in the different Wards are shown below.

Twenty-eight out of the 289 cases recorded last year occurred in local institutions, viz., the
Victoria Orphanage (17 cases), the Orphanage of Mercy (6 cases), and the Infirmary and
Workhouse (5 cases). The effect of the cases in the two orphanages is apparent in the morbidity
rate for the Maida Vale Ward (2.60), which is higher than the rate recorded in each of the
other Wards.
There were 16 cases in which the original diagnosis of diphtheria was not confirmed, the
percentage of "errors" being 5 5, as compared with 12.5 in 1913 and 6.0 in 1912.
The 289 notified cases occurred in 263 houses, 22 of which furnished two or more patients.
The following statement shows the house distribution of the notifications after the exclusion
of the cases referred to above as occurring in institutions.