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9
it happened that several days elapsed before cases had developed sufficiently to
place the diagnosis beyond doubt. In consequence, many cases of smallpox, highly
infectious, remained unisolated and at large among the population; and until the
diagnosis had been cleared up preventive measures could not be even begun, much
less drastically carried out; the counter attack against smallpox was, therefore,
paralysed by the delay in arriving at a diagnosis. All executive measures had to
wait till that was settled; and in the meantime smallpox got a long start, and could
not be overtaken. That was what happened again and again, and this led in 19011903
to the loss of 1,600 lives and an incalculable expenditure of money. Happily
the mischief brought its own remedy. The late Dr. T. F. Ricketts after 10 years of
research formulated a method for recognising smallpox promptly and accurately;
a method which has this high scientific and educational value—that it was left
by its author, who died in 1918, in such a form as enabled all who will to acquire
and utilise it. The method in question was adopted by the Council in 1904 at the
close of the last heavy epidemic when Dr. Wanklyn, who has carried on the traditions
of Dr. Ricketts, was appointed in the Department, his services being placed at
the immediate disposal of all the medical profession in London for consultation
whenever a suspected case arose, and periodical warnings of the approach or presence
of smallpox were from time to time issued by the Council.
Since 1901 there have been a few restricted outbreaks of smallpox, notably
in 1911 (70 cases); 1918 (36 cases); 1919 (27 cases); 1920 (18 cases); and
in 1922 (65 cases); any of which might easily have developed into a repetition
of the events of 1901 but for improved organisation and more efficient
administration.
Measles caused 1,563 deaths in London during 1922, the death-rate being .34 Measles.
per 1,000 as compared with .05 in 1921. After a break in 1917 and 1918, in both
of which years measles was prevalent, the disease resumed its characteristic
rhythmic recurrence every other year.
There were 1,128 deaths from whooping-cough in London during 1922, the deathrate
being .25 per thousand. In the last seven or eight years whooping-cough has
been prevalent in alternate winters, and in the years 1918-1922 the mortality curve
is remarkably like that of measles.
Whoopingcough.
There were 17,226 cases of scarlet fever in London during 1922 (52 weeks), the Scarlet fever.
corresponding number in 1921 being 32,738. In the first half of the year the cases
notified were not far short of twice the average of the preceding five years; but
the prevalence thereafter declined, and in the last quarter had fallen to nearly half
the average. There were, however, more deaths in 1922 than in 1921, the figures
being 301 and 292. The increased case-mortality is referred to on p. 82 of Part II.
of this Report.
Diphtheria continued to be very prevalent during 1922, although the total Diphtheria.
cases notified, 15,304 (52 weeks) fell slightly short of the number in 1921 (16,319).
The incidence of diphtheria during the year was somewhat similar, in its relation
to the average, to that of scarlet fever; during the last quarter of the year the
prevalence fell off considerably, though it did not, as in the case of scarlet fever,
drop below the average of the preceding five years. The deaths numbered 1,145
as compared with 1,150 in 1921, the case-mortality for the 2 years being, therefore,
much about the same. During the first quarter of this year 3,434 cases have been
notified, as compared with the average for the past five years in this quarter of
3,288 ; but in recent weeks the cases have been below the average.
The case-rate and death-rate of the principal notifiable infectious diseases for
each Metropolitan Borough and for London as a whole will be found in the table
on p. 53.
There were 676 deaths among children under 2 years of age from diarrhoea and
enteritis in London during 1922, the mortality-rate being 7.13 per 1,000 births. This is
10161 B
Diarrhoea
and
Enteritis.