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1919 in this country as an aftermath of war, in spite of the dispersal of millions of troops from all parts
of the world, and their absorption into civilian life, is due in no small measure to the efficiency and
vigilance of the military and civil health services of the country. Innumerable opportunities were
presented both during the war and in the process of demobilisation for the introduction of infection from
abroad, and although smallpox and other diseases have been imported on various occasions, leading in
some instances to local outbreaks, general spread of infection has so far been averted. The responsibilities
of the health and sanitary services, however, in dealing with smallpox are becoming heavier in
proportion to the increasing number of unvaccinated persons. Investigations into cases of smallpox
which have recently occurred in the East End of London have revealed the fact that very large numbers
of persons are either unvaccinated or have not undergone revaccination, and even after exposure to infection
many have been unwilling to submit to vaccination as a measure of prevention. Smallpox has not
appeared in epidemic form in this country for the past 15 years or more, but the gradual accumulation
of large numbers of susceptible persons in the general population tends to increase each year the
danger of epidemic spread of the disease.
During 1919 there were 29,112 notifications of measles in London, as compared with 45,115 in Meaales.
1918. The order of the Local Government Board making cases of measles notifiable was issued in
1915, and in the years 191G and 1917 there were 47,470 .and 76,118 notifications respectively. The
Board's Order was rescinded by the Ministry of Health as from the end of 1919, and the notifications
for that year therefore relate to a period of 52t weeks—i.e., 29th December, 1918, to 31st December,
1919. The figures given for earlier years relate to 52 weeks. The deaths from measles during 52 weeks
in the years 1916-18 and 53 weeks in 1919, numbered 815, 1,998, 1,651 and 359 ; no measles case-rate
can, however, be calculated from the notifications since cases of German measles are not separately stated.
The mortality from measles in London in the year 1919 was only 0-08 per 1,000. This is far below
any rate hitherto recorded in London, even when the diminution in the birth-rate has been fully taken
into account. The Metropolitan Boroughs in which the decline was not relatively so great as for
London as a whole, were Chelsea, St. Marylebone, Finsbury, Shoreditch, Bermondsey, Deptford and
Greenwich. As noted in Part II. of this Report, measles became rather widely prevalent early in 1920.
There were 12,935 cases of scarlet fever in London during 1919, as compared with 6,807 in 1918.
ScaKet fever.
The deaths numbered 147 (365 days), giving a death-rate of 033, asagainst 030inthe preceding year. An
increase in the amount of scarlet fever occurred throughout the country in 1919, following upon the three
years of exceptionally low prevalence since the epidemic of 1914-15. In the first quarter of 1919 the number
of cases of scarlet fever notified was not much more than one-half the average for that quarter in the
preceding five years ; but in the third quarter the notifications were equal to the corresponding average,
and in the last quarter they were nearly 50 per cent, in excess. No sudden and widespread outbreak
occurred such as is associated with infected milk supply, and such localised prevalences as were noted
in the first half of the year, as for instance in Stepney, Deptford, Fulham, Lambeth and Wandsworth,
must be regarded as foreruners of the later general increase. The monthly incidence of scarlet fever
since 1908 is shown in a diagram on page 82 of this report.
The prevalence of scarlet fever was considerably above the average for London as a whole in the
following Metropolitan boroughs, arranged in order of excess:—Greenwich, Deptford, Southwark,
Stepney and Lewisham. On the other hand, the incidence in Hammersmith, Kensington and Hampstead
was very low.
The number of cases of diphtheria notified during the 53 weeks of 1919 was 9,459, as compared Diphtheria,
with 8,173 in 1918 (52 weeks). The deaths numbered 775 (365 days), being 106 more than in 1918. As
in the case of scarlet fever, the increase mainly occurred in the last quarter of the year, when the notifications
were nearly thirty per cent, above the average for that quarter for the preceding five years. The
prevalence of diphtheria in Bethnal Green was more than twice as great as the London average, which was
also considerably exceeded in the following boroughs:—Stepney, Hackney, Southwark and Greenwich.
Towards the close of the year cases began to occur with increased frequency in Wandsworth. In
Westminster and Hampstead the incidence of cases was very low. The monthly incidence of diphtheria
since 1908 is shown in a diagram on page 82 of this report.
Typhoid fever.
During 1919 (53 weeks) there were 342 cases of typhoid fever in London, as compared with 357
in 1918. The deaths numbered 63 (365 days), as against 82 in 1918. The cases notified among
males between the ages of 20 and 45 decreased by 2 (from 57 in 1918 to 55 in 1919), while among
females there was a decrease at these ages from 116 in 1918 to 97 in 1919. There was, therefore, for
both sexes, at ages 20-45, a decline of 21 cases notified in 1919, upon the figures for 1918 ; at all other
ages there was an increase of 6 cases. Similarly the deaths at ages between 20 and 45 years fell by 17
(from 50 to 33), but at all other ages by 2 only (from 32 to 30).
Multiple cases occurred in twenty-one houses. Fifteen houses had 2 cases, two had 3, and the
remaining four had 4, 5, 7 and 8 cases respectively.
The eight cases occurred in a house in North Woolwich. Between the 11th and 21st July seven
cases were notified. The first case led to the examination of other members of the family, one of whom
was stated to have been suffering since the 7th June from illness diagnosed as catarrh of the stomach.
Positive Widal reactions were obtained (1 in 100 in four instances, 1 in 20 in two others ; the baby gave
a negative reaction). No likely source of infection was traced. An additional case was notified in this
family on 12th August. On 13th September a case of typhoid was reported in a neighbouring house,
and on the 20th another case occurred in an adjoining house.
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