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9
quite evident that vaccination protects equally against the mild and the more
virulent forms of smallpox. A table shewing the vaccinal condition of the patients is
appended.
Among the administrative measures taken during the year may be mentioned
the order of the Ministry of Health by which it was directed that all casuals who
were admitted to casual wards should be examined by the medical officer with a
view to detecting any cases of smallpox. The order stated that, to facilitate examinations,
the casuals should be stripped to the waist. This strict medical supervision
made it unnecessary to close casual wards when a case occurred and soon resulted
in stamping out the disease amongst casuals.
Strict precautions were taken to obviate the introduction of the disease into
the Council's mental hospitals. The menace to these institutions was constantly
arising as a result of outbreaks which occurred from time to time in poor law
institutions where mental patients are kept under observation for certification under
the Lunacy Acts before being drafted to a mental hospital. It became necessary,
therefore, from time to time, to postpone the admission of patients to mental hospitals
from the affected Poor Law institutions.
Other preventive measures consisted of the notification of chickenpox in
Lambeth and Poplar and an intensive system of interchanging information concerning
smallpox in London and the counties and county boroughs in the south-east
of England and the Midlands. During the year the Council's public health department
issued 389 circular letters containing information of cases of smallpox, movements
of patients and contacts.
As in previous years the services of the Council's consulting staff were freely
placed at the disposal of medical officers of health both in London and in areas
contiguous to London. In London, 382 consultations were held and in 139 cases
a diagnosis of smallpox was made. Consultations outside the County totalled 114,
in 58 of which smallpox was diagnosed.
The following table shows the incidence of smallpox in England and Wales and
London. It will be seen that the striking immunity which London had enjoyed
up to the end of 1927 has ceased to operate. How long it will take to clear smallpox
out of London is a matter for conjecture and depends largely on the response to
appeals to the unprotected to be vaccinated.
Year.
England and Wales (including
London).
London.
Cases.
Deaths.
Cases.
Deaths.
1919 311 28 24 6
1920 280 30 18 4
1921 336 5 2 —
1922 973 27 65 20
1923 2,504 7 11 1
1924 3,797 8 4 —
1925 5,354 6 10 1
1926 10,141 11 5 1
1927 14,787 36 5 2
1928 12,420 53 285 1
The following table shows the corrected number of notifications of smallpox
in each metropolitan borough for the 52 weeks ended 29th December. (The figure
quoted in the Annual Report of the School Medical Officer, p. 140, was provisional.)
There was in addition a certain number of mild cases which passed unrecognised
and escaped notification. This leakage was inevitable in view of the benign type of
illness which generally prevailed and the liability in some instances of mistaking
the disease for chickenpox.