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inadequate to stem a severe epidemic, should it attack the increasingly
unprotected population.
Diphtheria.—The epidemic prevalence of Diphtheria, which
was the occasion of a special report by me at the end of 1899,
maintained a strong hold upon the Borough during the greater part of
the year 1900. In all 1,300 cases were notified during the year,
while 161 deaths were recorded, giving respectively an attack rate of
4'91 per 1,000 living, and a death rate of '61 per 1,000. I have
previously pointed out that, until the life history of the Diphtheria
bacillus is accurately determined, it will be impossible to prevent
epidemics of this disease, or, indeed, to satisfactorily explain the
anomalies which at present occur in its attack upon or retreat from
different towns. At the end of the year I furnished the Council
with figures showing that several towns of widely differing characteristics
were suffering to a greater extent in this respect than West
Ham—notably Brighton, Leicester, Sheffield, and Leeds. Epidemics
have been shown to follow long-continued deficiency of rainfall such
as has pertained in West Ham for several years past : but there can
be little doubt that, so far as the great towns are concerned, the
improved facilities for inter-communication both in school and out of
school form the chief cause of the spread.
As regards the influence of personal infection at school, I have
this year been enabled to investigate and detect several cases in which
children have been in attendance at school in a probably infectious
condition. Through the kind assistance of the head teachers, I was
supplied with the dates of absence from school of all scholars living in
houses infected with Diphtheria. The number of children on the roll in
the 42 Board Schools was 46,233, and of non-Board Schools, 8,672. .
1,390'children (2'5 per cent.) were, in response to notice by me to the
head teacher, precluded, for a varying period, from attending school
on account of Diphtheria. On comparing the date of last attendance
with the date given by the friends as the date of the onset of first