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immunisation. There was also a rise in the number of notifications from four in 1954
to 16 in 1955, the largest single focus being a family outbreak in Shoreditch involving
one of the fatal cases. These events are a further reminder that the battle against diphtheria
is not yet won, and that the danger to children who have not been immunised
still remains. The present low incidence of this disease is the result of the immunisation
campaign begun in 1940. It will be seen from the diagram on page 21, that when
immunisation commenced in children aged 1 to 14 years there was an abrupt change
in the rate of decline in notifications at these ages.
The impossibility of guaranteeing freedom from imported infection in London
means that efforts to attain the maximum degree of immunisation in the population
must be maintained. The events of 1955 serve to drive home the facts that diphtheria
has not been abolished from the County, and that when it occurs in children unprotected
by immunisation it can be as severe as of old.
Dysentery
1955 was another year of heavy incidence of Sonne dysentery in London although
the number of notifications (3,019) was less than the record figure of 4,268 in the
previous year. Only a very small proportion of the cases could be regarded as possible
food-borne infections, the great majority having occurred as a result of personal contact.
In the report for 1954 reference was made to an inquiry which took place in cooperation
with the Borough Medical Officers in 1952 and 1953 and especially to the
finding that exposure to symptomless excreters appeared to result in a much lower
secondary attack rate in families than exposure to a clinical case with diarrhoea. This
would appear to suggest that if the infection breaks out in a nursery or school it might
be sufficient to exclude the clinical cases without embarking on a wide search for
carriers. Whether or not this is true will no doubt emerge from trials currently in
progress.
During the year there was a slight drop in the percentage of cases in the 5-14 years
age group. Nevertheless this disease continues to give far more trouble in the junior
departments of the schools than it did a few years ago.
Enteric fever
There was a rise in the number of notifications of enteric fevers from 49 in 1954 to
111 in 1955. A large part of the excess over the previous year was due to a single epidemic
of paratyphoid B in the boroughs of Hackney and Shoreditch. There was also a comparatively
small outbreak of typhoid fever among residents in West London.
Erysipelas
There were 361 notifications of erysipelas, compared with 368 in 1954, and one
death in each of these years. It has been recognised for some time that notification of
this disease is grossly defective and the figures therefore give little idea of the true
incidence of the disease.
Food
poisoning
Notifications of food poisoning rose from 1,060 in 1954 to 1,530 in 1955. The great
majority of the notifications were single sporadic cases or small family outbreaks.
Larger outbreaks were comparatively rare.
Influenza

It is not possible to estimate accurately how much influenza was occurring in the
population as the disease is not notifiable. Such indirect evidence as is available however
suggests that the influenza epidemic of 1955 was of very modest proportions.
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