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vaccination. 5
V. VACCINATION.
The latest return available, viz., that for the year 1922, shows an insignificant improvement in the
vaccination condition of the Borough, the proportion of infants surviving to their first birthday and
remaining unvaccinated falling from 30.2 per cent, in 1921 to 29.9 in 1922. The proportion observed
in 1922 was, however, the highest on record except that for 1921. In 1921, 602 certificates of exemption
were taken out locally representing 22.5 per cent. of the children whose births were registered
during that year. For the whole country the proportion was 45 per cent. In 1922, 22.6 per cent. of
the children born in the Borough were exempted under the Act.
Having regard to the fact that smallpox has shown since 1919 an increasing tendency to epidemic
prevalence, the continued neglect of vaccination cannot be regarded as otherwise than perturbing. In
1919, 262 cases of the disease were notified in England and Wales, the total rising to 243 in 1920, to 311
in 1921, to 985 in 1922, and to 2,473 in 1923. In London the figures for the same five years have been
24, 18, 2, 62, and 11. Last year rather more than 90 per cent. of the notified cases occurred in five
counties, viz. Gloucestershire (945 cases), Derbyshire (463), Nottinghamshire (435, 94 in 1922), Yorkshire
West Riding (289, 232 in 1922), and Yorkshire, North Riding (109, 253 in 1922). Last year 14.1
per cent. of the notified cases occurred in rural sanitary areas, the numbers of cases notified exceeding
50 in each of 5 areas.
In the first quarter of last year 519 cases were notified, in the second 737, in the third 662, and in
the fourth 585. Expressed as percentages of the year's total, the cases in the first quarter formed 21
per cent. (18 in 1922), those in the second 28 (31 in 1922), those in the third 27 (21 in 1922), and those in
the fourth 24 (30 in 1922).
VI. SPECIAL DISEASES.
(See Tables 3, 4 and 5.)
SMALLPOX.
For the first time since 1902 a case of this disease occurred in the Borough in September last.
Cases have been notified at intervals between 1902 and 1922, but the diagnosis has in each instance
been found to have been erroneous. Last year's case was in the person of a man aged 47, who was
taken ill on August 31st, the rash appearing on September 2nd. He had been vaccinated in infancy
only. Although direct contact with another case of the disease was not demonstrated there was
every reason to believe that his case formed one of the series of cases which occurred in London during
September and October. Limited as was that outbreak, it was of sufficient interest to justify a brief
account being included here :—
A Mrs. X arrived in London from Spain on August 7th, remaining in town until the 11th, when she went
to the seaside for three days. She was back in London on the 13th, on which day she felt unwell, but not
seriously so. She was then staying at an hotel in the Strand, where she remained until the 19th—going
about as usual—when she left London for Willesden.
On August 29th a female, aged 30, living in Westminster, and employed at the hotel, was taken ill, the
illness being diagnosed as smallpox on September 8th. On August 31st the man residing in this Borough, but
employed in the Strand at an office opposite to the hotel, sickened, a similar diagnosis being made on September
7th. On September 2nd another member of the hotel staff, living in Camberwell, fell ill, the case being diagnosed
on the 7th.
On September 10th the Medical Officer of Health for Willesden, in consequence of information received,
visited the house in his district where Mrs. X was staying, and came to the conclusion that Mrs. X and her
husband (probably) and child had had attacks of the disease. Mrs. X's sister-in-law had sickened with the
disease on September 5th, her case terminating fatally on the 21st. All four patients were removed to the
M.A.B. Hospital.
At later dates cases of the disease occurred in Lewisham, Hackney and Ickford, which were traced direct
to the hotel, and other cases in Harrow, Battersea (fatal) and Richmond directly connected with the case
in this Borough, and a case in Carshalton, which, in all probability, had the same origin.
Concurrently with the above cases the disease was found in Finsbury (one case) and in Greenwich (four
cases, one family), the origins of which were not traced.
The foregoing paragraphs show that to the case of Mrs. X. 14 other cases were traced, in most
instances definitely so traced, including 4 cases in which the infection was acquired secondarily through
the case in this Borough. Two cases terminated fatally, one in an unvaccinated female and the other
in a male aged 53 who had been vaccinated in infancy only.
DIPHTHERIA.
(Including Membranous Croup.)
Last year 220 cases (including one of membranous croup) were notified, or 181 less than the total
(401) for 1922. For the five years 1913-17 the annual average was 260, and for years 1918-22, 365. In
1916 the notifications numbered 211, that being the only year since 1913 in which a total less than that
of last year was recorded. The maximum figure for the same period was that of 1920 (464 cases,