View report page

9 1922
the Autumn of 1921, and. an extensive epidemic occurred in London
and Greater London. The epidemic continued during the early
part of 1922 and gradually subsided in the Summer.
In 1921, 630 cases were notified and 1 death occurred. In
the two years 935 cases were notified with 4 deaths—a case fatality
of .42 per cent. In other words 1 death occurred in every 234
cases. It will be seen from these figures that the type of disease
has become a very mild one.
Diphtheria.—Two hundred and twenty-three cases were
notified and 12 deaths occurred. The case fatality was 5.3 per cent.
The case fatality of Acton patients admitted to the Fever
Hospital was the same—5.3 per cent., and the fatality of all
Diphtheria cases admitted to our Hospital was 5.5 per cent.
This is a remarkably low mortality and several factors have
contributed to this result.
Foremost, probably, in the list of causes is the early and
sufficient use of Antitoxin. In pre-antitoxin days, Diphtheria
was one of the most terrible and formidable of diseases, with a
case fatality of 25 to 30 per cent. The curative use of Antitoxin
has robbed the disease of much of its terror.
The preventive use of Antitoxin has not been extensively
used in this country. In America the Schick test has been used
extensively, and toxin—antitoxin immunisation carried out,
especially amongst school children. It is doubtful if the test is
practicable as a universal method of immunisation; but its use
opens up a vast field in the prevention of Diphtheria.
It would not be fair to claim that the reduction in the case
fatality is entirely due to the administration of Antitoxin. The
improved technique in the bacteriological examination of Diphtheria,
the increased facilities for such examination, and the appreciation
by doctors of the existence of mild cases, have led to the notification
of a greater number of cases.
The notified cases thus tend to increase, whilst the number
of deaths from the disease may diminish.
On Table 5 is given the Ward distribution of the disease.
In contrast with Scarlet Fever, which was almost evenly distributed
throughout the district, there was a marked preponderance
of cases from the South West Ward.
Cerebro-Spinal Meningitis.—One case was notified and the
patient died. The case was notified from the West Middlesex
Hospital, but the patient was removed there from a common
lodging house. The man was working at the British Empire