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30
It is obvious from the above Table that Essex is one of
the counties where Diphtheria tends to be rather prevalent.
The average rate during the above ten years being much
greater that the average for England and Wales as a whole.
Local Prevalence of Diphtheria.
In dealing with smaller areas and populations great care
is needed if fallacious conclusions are to be avoided, for in
addition to the periodical and geographical variation above
mentioned, there are other factors instrumental in the spread
of this disease which must be considered, and which vary
materially in extent in different localities. The most
important of these are:—The percentage of young children in
a district, school attendance and accommodation, and social
conditions favouring close personal concact, such as overcrowding,
poverty and density of population. All these points
must be taken into consideration in connection with the
prevalence of Diphtheria (and other infectious diseases) as
well as the degree of thoroughness and efficiency which Local
Public Health Authorities attain in their efforts to control this
disease.
I have purposely omitted any reference to defective drains
and other insanitary conditions as these are not direct causes
of Diphtheria. The ill-health these conditions produce
diminishes the resisting power of the body and so predisposes
to attack when anyone is exposed to infection, but in the
absence of the Diphtheria germs, such conditions alone cannot
produce Diphtheria.
In the following Table (III.) I give the average attack-rates
and death-rates from Diphtheria per 1,000 of population for East
Ham, for all the adjoining Districts, and also for the whole of
the Urban Districts of Essex for the ten years 1898 to 1907.
For comparison the figures for England and Wales for the
same period are also given. The density of population both per
acre and per house, as these existed at the last Census (1901),
is also shown,