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5
stage, when, of course, there was nothing to attract attention, and subsequently to have developed the
disease while residing in London.
2. The Council's diagnosis arrangements for London and Home Counties.—A striking instance
of the value of this service is afforded by one of the foregoing cases which passed the Port in
the stage of incubation. This man proceeded to Hammersmith, and the borough medical officer
of health having his attention drawn to the patient when he fell ill, called Dr. Wanklyn, who at once
diagnosed the case to be one of smallpox. This consultation having been held while the patient was in
the early stages of the disease, enabled all necessary measures at once to be taken. A similar consultation
at an early stage of another case, which occurred at Hampstead in 1920, also resulted in all
necessary measures being taken. So also with a case which came to light in Holborn in 1921. So, too,
with a case in Wandsworth in 1921. In each of these cases, owing probably to the effect of warnings
issued by the Council at various times, the practitioners in attendance had smallpox in mind, and
promptly sought the advice of the local medical officer of health, who, being uncertain of the exact
diagnosis at that early stage, called Dr. Wanklyn. Thus the procedure initiated by the Council in the
year 1904, has again been of the greatest value in checking smallpox.
3. Executive measures taken in co-operation by the county and borough medical officers.—Locally
all necessary measures of vaccination, segregation and observation of contacts, disinfection and other
steps were initiated by the medical officers of the respective localities; Dr. Wanklyn afforded every
possible assistance and information that was in his power; the Council's health department circularised
a note of the occurrence to all concerned in and near London. The result was, that in each of the
above-mentioned cases in Hammersmith, Hampstead, Holborn, and Wandsworth, the consultative and
executive steps taken were so prompt and thorough that not a single secondary case occurred from any
one of the four. This is a great contrast to what formerly used to happen, when almost every case that
occurred was followed by a group of secondary cases, numbering anything from 3 or 4 to 15, 20 or more.
A similar satisfactory result has followed the loan of Dr. Wanklyn's services to the councils of the
adjoining home counties.
Such is briefly the manner in which smallpox is kept in check; but it is always to be borne in
mind that the outside pressure of smallpox in the world at large remains about the same, while the
liability to smallpox of the population of the County, owing to the decreasing use of vaccination, is
increasing : the difficulty of keeping smallpox out by this method therefore continually increases.
Only one case of typhus fever was notified during 1921, and another case was removed to hospital
on suspicion. In neither instance was the diagnosis upheld.
Typhus
fever.
No cases of plague and only one of cholera were notified during 1921, and in the latter case the
diagnosis was subsequently withdrawn. During the year passengers from four ships on which plague
had occurred came to London and were kept under observation as contacts. An arrangement has been
made whereby the Lister Institute acts in a consultative capacity, both clinically and pathologically, in
connection with suspected cases of plague or cholera.
Plague and
cholera.
During 1921, only 3 cases of anthrax occurred in London none of which proved fatal. In two cases
the source of infection was attributed to the nature of the patients' employment, whilst in the third case
a shaving brush was deemed to have been the cause. Dr. Howarth took all necessary measures in the City
as regards tracing the source of supply of the suspected brush, and it is satisfactory to record that the
restrictive measures employed in regard to the importation and supply of cheap shaving brushes from
Japan and elsewhere have minimised the risks of infection from that source.
Anthrax.
The death-rate from pulmonary tuberculosis in the civil population of London during 1921, was
1.07 per 1,000 living, the deaths numbering 4,813 as compared with 4,675 in 1920. Tuberculosis other
than pulmonary caused 964 deaths, as against 1,071 in 1920. The number of primary cases of tuberculosis
notified in London during 1921 (52 weeks) was 12,214 as against 13,163 in 1920. Of these 10,015 were
pulmonary and 2,199 were other forms of tuberculosis. These figures compare with those published in
previous reports, but further corrections (by rejection of cases notified as primary but eventually found
to have been previously notified) reduce the total of primary cases to 10,648; the corresponding figure
for 1920 was 11,663.
Tuberculosis.