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recorded in London. It will be seen from the following table that the principal
cause of the higher rate was an increase in the mortality from Diarrœha and
Measles:—
Cause of Death.
1911
to
1914.
1915
to
1918.
1919
to
1922.
1923
to
1926.
1924.
1925.
1926.
1927.
1928.
Measles 3.40 3.84 1.64 2.02 3.37 0.87 2.88 0.63 3.93
Whooping-cough 3.63 4.45 2.50 2.60 2.30 4.58 1.29 3.08 2.45
Influenza 0.27 1.10 0.81 0.38 0.62 0.38 0.34 0.46 0.23
Tuberculosis 3.40 3.20 1.52 1.26 1.20 1.48 1.14 1.05 0.95
Bronchitis 6.41 6.72 4.42 2.91 3.62 3.02 2.59 2.12 2.56
Pneumonia 12.28 14.96 12.60 11.51 14.13 12.27 10.59 11.37 13.03
Diarrhœa 24.28 16.10 12.16 9.36 7.89 9.72 10.78 6.97 9.52
Premature birth 18.16 17.42 17.00 14.74 15.89 14.31 14.11 13.94 14.22
Congenital defects 14.69 14.66 11.26 8.39 7.96 8.70 8.12 7.17 7.60
All causes 108 103 79 65 69 68 64 59 67
Infectious Diseases.
The attack rates and death rates of the principal infectious diseases in
London and the constituent metropolitan boroughs are shown in the table on
page 30.
Smallpox.
During 1928, London was invaded by smallpox of the mild or Western type
which has been prevalent in the Midlands and the North of England for some years.
A table is appended shewing the total number of cases and the boroughs in which they
occurred. The infection was brought to the South of England by a man who had
tramped from Lincolnshire to the East Preston Casual Ward, Sussex, where he arrived
in a collapsed condition in December, 1927. His illness was not recognised as smallpox
until secondary cases occurred a fortnight later and were then suspected to be
smallpox. The Council's smallpox consultant was asked to see the cases at East
Preston Casual Ward, and he confirmed the diagnosis. By this time large numbers
of vagrants who had been infected in the casual ward had already left the institution
and were scattering the disease over the countryside. During January, cases were
reported in the casual wards at Edmonton, Barnet, Isleworth, Ware and Guildford.
In several instances the services of the Council's consultant were utilised to confirm
the diagnosis.
In the first two cases which occurred in London in 1928 the source of infection
could not be traced. In the next case, however, which occurred in Southwark,
the patient had just been discharged from the Southwark Hospital, which is situate
in Camberwell, and on enquiry it was discovered that he had been infected in the
hospital by a vagrant who was admitted from the Salvation Army Shelter, Blackfriars,
on 1st January. This man was at first thought to be suffering from influenza and
afterwards chickenpox. The real nature of his illness was realised when secondary
cases occurred and he was removed to the smallpox hospital. Eight direct contacts
developed the disease, and one of these, a cleaner employed at the hospital, gave rise
to four other cases in her family.
The Holborn and Finsbury Hospital, Islington, was invaded by the disease
in February, but prompt and vigorous measures reduced the outbreak to five cases.
One man who was infected in the Holborn and Finsbury Hospital developed the
disease in the Metropolitan Asylums Board Hostel, Holborn, but there was no spread
from this particular source.
A more serious outbreak occurred in an institution in Wandsworth in March,
when cases were discovered in the Springfield Mental Hospital, belonging to the
Middlesex County Council. It is probable that the infection was introduced by a
visitor from Middlesex where a number of cases had been occurring, with the result
that 12 cases occurred in the Mental Hospital, including one female nurse. Owing