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defective sanitary conditions in the schools themselves, and, in my opinion, the ave???
child when attending one of the schools of the Board is placed under more favoura???
sanitary surroundings than those pertaining to the average private house; apart fr???
the one necessary condition of the aggregation of large numbers of children.
With regard to the physical conditions of the district which may have had a
influence on the spread of diphtheria, it may be mentioned that the Stratford and
Forest Gate Wards are from seventeen to twenty-two feet above ordnance datum, while
the Plaistow and Canning Town Wards may be said to range in various parts between
six and sixteen feet above ordnance datum. The soil is generally gravelly throughout,
but there is a considerable amount of peaty alluvium resting upon a sub-soil of clay in
some parts of the two latter wards, which is retentive of water, and gives rise to a
universal dampness of soil even after small rainfalls. The dwellings vary greatly in
character, the majority having been hastily erected in bye-gone times of cheap materials
and with bad workmanship, necessitating an incessant watchfulness on the part of the
Inspectors of Nuisances. A network of open ditches—the Dagenham system of sewers—
intersects a large area of the Borough ; these ditches being filled at high tide with wats ???
from the river Lea, and at the same time taking the effluents from the sewage works ???
the two large and neighbouring districts of Walthamstow and Leyton, are at times in a???
foul condition.
With regard to the possible sources of infection, I submit that the milk and food
supplies may be entirely excluded. Sanitary defects were discovered in about fifty per
cent. of the houses in which the disease occurred, but they were chiefly minor defects
not in any way connected with drainage or the removal of excremental and other
offensive matters, and were, in the large majority of cases, not such defects as could be
associated with the conveyance of diphtheritic germs. Although I have mentioned the
numerous offensive ditches running through parts of the Borough and regretted their
periodical condition, it is apparent that the diphtheria of the Borough does not follow
the course of these streams, and I can see no cause for the increase of that disease in
West Ham, but the association of children together both in the school and in the street.
Enteric Fever.—This disease showed a distinct increase on the preceding
year—nearly one hundred more cases being notified. The cases appear to have been
evenly distributed throughout the Borough and throughout the year, never showing in
epidemic form. Nor could I satisfy myself that there was a common cause for any
large number of attacks.