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11
The number of deaths from diphtheria registered in the Metropolis during the
year 1896 was 2,683, which gives, with the estimated population, a death-rate of 0.60
per thousand.
In the following table is shewn the distribution of the cases notified, and the
deaths amongst males and females in the 4 sub-districts of the parish:—

Of the cases notified 55.6 per cent. were removed to the Board's Hospitals.
It will be observed that more females than males suffered from the disease.
This preponderance is due to the marked greater frequency of attack amongst females
aged 10 years and upwards. The females about 10 years of age are frequently put
to look after the younger members of the family, and when sickness occurs in the
family the nursing mainly falls upon the female members thereof, who are thus more
exposed to infection than the males. This is, I believe, the chief reason of the
greater frequency of the incidence of the disease upon the female portion of the
population. Amongst males, 26.5 per cent. of the attacks proved fatal this year,
whereas amongst females, the mortality was 16.4 per cent.
As to the causation of the prevalence of diphtheria; surroundings prejudicial
to health such as insanitary dwellings, overcrowding, emanations from sewers,
defective drains, allowing of the pollution of the subsoil of dwellings, and dampness
are all conditions which favour the prevalence of the disease. Cases have come
under my notice where the origin of the disease has been ascribed to foul odours
from sewers; other cases where it has been thought that the drains have been the
cause; and others where the disease has been attributed to dampness of the walls
of the dwellings. On the other hand, numerous cases have occurred where the
sanitary conditions under which the patients were living have been perfectly
satisfactory.