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Infectious diseases.
The attack-rates and death-rates of the principal infectious diseases in London
and the constituent boroughs are shown in the table on p. 63.
Smallpox.
Whilst smallpox has been increasing in prevalence in other parts of the country,
more especially in the Midlands and the North, London, during the year under review,
enjoyed comparative freedom from the disease, only four notified cases and one
unnotified case (presumed to have been one of smallpox) having occurred among
London residents as compared with upwards of 3,700 cases in the country as a whole.
Reference was made in the annual report for 1923 to London's record as regards
smallpox and a table illustrating the same was given (p. 14). The chief measures
upon which, in the absence of full protection by vaccination and re-vaccination,
reliance must be placed in the endeavour to prevent spread of the disease, may be
summed up in a few words, viz.: (1) prompt and correct diagnosis, and (2) efficient
administration. The Council places at the disposal of medical officers of health
and medical practitioners in London and certain areas in its near neighbourhood
the services of its expert medical staff for assistance in diagnosis, and co-operates
with the metropolitan borough councils as well as with the sanitary and port health
services all over the country in safeguarding the interests of the metropolis against
invasion by smallpox. Having regard to the special position of London and the
fact that sea borne traffic is plying daily to and fro between its docks and smallpox
infected countries, the need for constant vigilance is apparent, particularly as the
surest protection against smallpox is gradually being stripped of its influence by
the increasing unwillingness of the population to undergo vaccination and revaccination.
If the decline in vaccination continues it is possible that the time
is not far distant when a serious epidemic can no longer be prevented.
The continued prevalence of smallpox of a comparatively mild description
in the provinces during the pas., two or three years is a constant source of danger
to London and it is remarkable that, considering the duration of this prevalence,
off-shoots from one or other of the outbreaks in provincial towns have not affected
the metropolitan area. (See, however, cases 3 and 4 referred to later.) The fact
that the type of smallpox in the provinces is a mild one renders the possibility of
its introduction into London no less serious; in fact the danger of missed cases
is all the greater and the need for vigilance is accentuated. These milder forms
of smallpox have from time to time been referred to as " alastrim," " varioloid,"
"para-smallpox," etc., and there has been a tendency to regard such outbreaks
as of less importance than those of the more fatal type of smallpox such as occurs
in the East. The special danger of taking this view, in London, lies in the fact that
virulent smallpox is repeatedly introduced, and hence the danger of spread of smallpox
cannot be regarded as other than a very serious one. The Ministry of Health
issued a circular in 1922, entitled " Outbreaks of Smallpox of Mild Clinical Type,"
and made the following recommendations :
(1) That none of the customary and necessary procedures of smallpox
prevention (including vaccination) should be omitted.
(2) That close enquiry should be made to ascertain whether chickenpox
is prevalent at the same time as smallpox and to secure the differentiation
of these two diseases.
(3) Where cases are diagnosed or reported as cases of " varioloid " or
" alastrim," the terms should be treated for all purposes of preventive action
(including notification) as the equivalent of the term smallpox.
Having regard to the enormous cost to the community of an epidemic of smallpox
and to the dislocation of the social and business life of the people entailed, it is
highly important that watchfulness on the part of the London medical service as a
whole should not be relaxed. No risk should be taken by the private medical
practitioner in cases where the least doubt exists ; the services of the metropolitan