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The above-mentioned districts differ widely from one another in
their topographical and other circumstances, but they are mostly in
agreement with West Ham in having recently suffered a high
diphtheria death-rate, presumably due to the general influences which
are conducive in all large congeries of people to the spread of
diphtheria. What these general influences are, and what special
variations of them are observable in West Ham, may be suggested in
a few words:—
1. SCHOOL INFLUENCE. The constantly-increasing body
of evidence associating Elementary Schools with the
dissemination of diphtheria is well known, and there
can be no doubt that our schools have to some extent
aided in rendering the disease pandemic in West Ham.
Looking over the attacks throughout the past, one
seems able to detect waves of diphtheria passing over
first one school, which for a time forms the chief
centre of attack in the Borough, and then moving on
to a second school whence, after a more or less determined
assault, followed, it might be, by a temporary
truce, a fresh campaign opens at a third. During the
present year some such sequence of attack was noticeable
at Odessa Road, Mathew's Park, and Custom House.
In no case could the disease be said to be epidemic in
the schools, but the}' were one after the other for a
limited time the heaviest sufferers. Tables VI. and
VII. show that, during the nine months under discussion,
71 per cent, of the persons attacked by, and
74 per cent, of the deaths due to diphtheria, were
between the ages of 3 to 15 years—a heavy percentage
when taken with .the fact that, unlike scarlatina,
diphtheria is no respecter of age. The reasons for this
result are clearly apparent when one views the necessarily
close gathering of the children in class rooms, the
limited floor area that can be allowed each scholar, the
possibilities of indirect contagion through the medium