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was 1.94 per 1,000 of the population. The number of deaths from
this disease was 18, of which 6 were of males and 12 of females.
The death rate per 1,000 of the population was 0.07, and the
fatality rate was 3.58 per cent. The number of patients removed
to hospital was 496, which gives a removal rate of 98.61 per cent.
Age and seasonal incidence. Reference to Table I. will
show that, as is usually the case with this disease, three-fifths of
the attacks occurred during the third and fourth quarters of the
year. The incidence in the early part of the third quarter was
perhaps a little higher than is often found to be the case, but there
was nothing to suggest epidemic prevalence during any particular
week.
Table III. shows that the greatest number of cases occurred
in the Hudsons Ward. The case rate here was 3.85 per 1,000
of the population, and the wards with the next highest incidence
rates were West Ham (3.22), Ordnance (3.06), Custom House and
Sivertown (2.86), Canning Town and Grange (2.73), and Plaistow
(2.16). The lowest incidence (0.67) was found in Forest Gate
ward, but several other wards had low rates.
From the standpoint of age incidence it can be shown from
Table II. that 77.1 per cent. of the cases occurred under the age
of ten years, and that 77.8 per cent. of the deaths occurred under
this age. On the other hand, there was no marked variation in
the case mortality at different age periods. Under 3 years this
rate was 4.16 per cent.; from five to ten years it was 3.18 per cent.;
and over ten years 3.48 per cent. A notable feature of the figures
for this year was the great excess of females in cases over the age
of ten years. At these ages 80 females were attacked as against
35 males.
The statistics of diphtheria are set out fully in Tables VI.
and VII. The figures for incidence which are given in Table VI.
show considerable variation in the quinquennial periods. The
low rate in the first period is probably explained by the fact that
the practice of notification had not then been adopted by practitioners
as fully as it might have been. During the period 18911905
the case rate was high, with a peak towards the middle of
the period, and since the latter date there has been some reduction
in the case rates. In many areas diphtheria shows peak periods
which are separated by about eight or ten years, and the same
factor can be shown to be operative in the local rates. This factor
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