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25
the disease. I do not hold extreme views as to the necessity
for compulsory general infantile vaccination, but it must be
apparent that the present unprotected state of the population
as a whole is a somewhat dangerous one.
DIPHTHERIA.
139 cases were notified, 104 patients received hospital
treatment, 90 being treated in the Hendon Isolation Hospital,
the remainder were nursed at home.
The deaths from this disease numbered 9, of whom 1
died at home, 6 died at the Hendon Isolation Hospital and
2 in other hospitals.
A rather severe outbreak of Diphtheria began in
December, 40 cases being notified during that month.
The District was never quite free from Diphtheria during
the year, which was a year of high prevalence in London.
The cases, however, were scattered and not numerous
until December when an epidemic began, which continued
into 1922. The epidemic was fully dealt with in a special
report to the Council dated 16.1.22. Cases occurred in all
parts of the District, but it was only in Cricklewood and
West Hendon that the epidemic assumed serious proportions.
These are the parts of the district which are nearest to and
in most frequent communication with the Cricklewood and
Kilburn portions of Hampstead and Willesden, and a marked
increase in prevalence in the latter districts preceded the
epidemic in the Hendon Urban District. It appears quite
certain that the Hendon epidemic was an extension from the
neighbouring districts.
A very marked feature of the epidemic was the exceptional
severity of the cases. The change in type of the
disease took place with dramatic suddenness Up till 25th
November, scarcely any cases admitted to hospital had caused
any anxiety and only one patient (who was admitted in
practically a dying condition) had died The first of the very
severe cases was admitted on the 25th November and died on
the 2nd December and thereafter case after case of the
utmost severity was admitted. On some of these cases the
antitoxin treatment. which is usually so successful, seemed
to have very little effect or only brought about a temporary
improvement. On enquiry, I found that other Hospital
Superintendents were having a similar experience. 8 of
these severe cases died but a number of patients who appeared