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No further cases were notified until 4th March, when Dr. Shadick Higgins was called to see a
woman (P. U.), aged 42, living at 12, Ceuntess-road, who was found to have smallpox, the rash having
appeared 3 days before. l)r. Higgins discovered that a woman next door (E. B.) and her two children
(F. B., aged 6 months and F. K., aged 9) had been and were still suffering from the disease. The mother
(E. B.) only had the scars remaining, the rash having first appeared 3 weeks previously, whilst as regards
the children the rash had been out 7 days and 2 days respectively. E. B.'s husband was employed as
a disinfecting officer by the Borough Council, and on 20th January he had disinfected 6, Dewsburyterrace.
The man remained in good health and had no sign of rash, but as no other source coidd be
discovered it was assumed that he must have been the means of infecting his wife, who in turn infected
her own childrer, P. U. living next door, and another child, D.H. (aged 6), 54, Leverton-street, Kentish
Town, who had visited the house. Two of these children attended Burghlev-road and Raveley-street,
L.C.C. schools respectively, and the pupils and staff at both schools were offered vaccination: large
numbers a\ailed themselves of the facilities and this, no doubt, helped to check the spread of the disease.
Two other pupils from Burghley-road School, living at 25, Tremlett-grove, Islington, developed smallpox
on the 6th and 29th March, respectively, but in both cases the children had ceased attending school
before the onset of illness. A medical practitioner in attendance on these cases also contracted the
disease.
The disquieting feature of this outbreak was the large proportion of cases not recognised as smallpox
until some time after the rash appeared. In 12 out of 18 cases which occurred, varying periods of between
2 and 21 days had elapsed before the diagnosis was mad"1 and the patient removed to hospital. The
Council decided, therefore, to circularise all the medical practitioners1 in London in April, 1919, drawing
attention to the fact that the services of the Council's smallpox expert were at their disposal in suspected
cases.
Measles,
scarlet fever
dihtheria,
whooping-
cough.
Typhus
fever.
At the time of writing this Report cases of smallpox are occurring in different parts of the country,
mainly imported from abroad. During the war epidemics of smallpox and other diseases have been
reported in foreign countries but fortunately the spread of infection has, so far, been kept within close
bounds. The resumption of intercourse with all parts of the world as soon as hostilities ceased has
undoubtedly greatly increased the dangers of spread of epidemic illness.
During 52 weeks of 1918, 45,115 cases of measles, 6,807 of scarlet fever and 8,173 of diphtheria
were notified, the deaths (365 days) being 1,649, 120 and 669 respectively. Whooping-cough was very
prevalent and caused 1,687 deaths. The case incidence and mortality rates from the principal notifiable
infectious diseases in the Metropolitan boroughs are shown in Table I. appended to this Report (p. 20).
One case of typhus fever occurred in London (Borough of Bermondsey) in September, 1918The
patient was removed to the S.E. Hospital where the diagnosis was confirmed. The source of
infection was not traced.
An outbreak of typhus fever among gipsies in Surrey, Sussex and Kent, was reported in May.
A gipsy woman Mas admitted very ill on 3rd May to the Hambledon Union Infirmary. Surrey. She was
seen bv Dr. T. Henry Jones, County Medical Officer of Surrey, who diagnosed typhus fever. Eight
days later an old man who had been in the infirmary for 14 years fell ill with typhus. It was later
ascertained that three gipsies had been admitted to the Infirmary during April and had died, the cause
of death being certified as broncho-pneumonia. The old man referred to helped to put them in their
coffins. On 13th May another gipsv woman admitted to West Hampnett (W. Sussex) Hospital was
found to have the disease. Dr. Manby of the Local Government Board instituted inquiries and traced
a long series of cases of illness, among the gipsies in that part of the country, described principallv as
" pneumonia," dating back to the early part of February and even as far back as Christmas among the
gipsies at Eastbourne.
Typhoid
fever.
Particulars of two families, contacts of previous cases, whose later movements could not be
traced by Dr. Manbv were, on receiving the information from the Local Government Board, communicated
to the Borough Medical officers, with the result that both families were discovered in gipsy haunts in
S.W. London. Fortunately no developments arose in London as a result of this outbreak.
During 1918, 357 cases of typhoid fever were notified as compared with 449 in 1917, 4-61 in 1916,
607 in 1915, and 789 in 1914. It is clear that even after allowing for the absence of men of military age
on war service, there have been appreciably lower case rates in 1916, 1917 and 1918 than in 1915, and the
rate for that year represents a distinct fall as compared with the years immediately preceding. Thus
excluding all men at ages 15-45 the numbers of notified cases in the rest of the London population for
the years 1912 to 1918 are as follows—470, 530, 504, 453, 333, 366, 271.
In all 20 cases, including three military cases, were desciibed as paiatyphoid fever. In June two
groups of cases were notified as paratyphoid fever. The fiist included a matron and seven nurses in
an infirmary; a nurse sickened on June 9th, and the remainder for the most part within a few days
of that date; the last of the group was notified on July 13th. The patients exhibited an irregular
temperature for a week or more, tendency to diarrhoea, abdominal discomfort, and in two instances
profuse sweating; there was no cutaneous eruption. The diagnosis on the strength of a not very
marked agglutination reaction was held to be paratyphoid B.
At about the same time five cases in Wandsworth and two in Battersea also suspected to be
paratyphoid B were notified; all had taken meals at a particular dining table. None of the
illnesses in these groups were of a severe character.
In the light of the fact that the summer influenza prevalence was just commencing in London
at the time, the question of course aiises as to whether these two groups of cases might have been
examples of the gastro-intestinal vaiiety of that disease.