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of infection. Complications or sequelae may follow even in the mildest
of cases: such as otorrhœa, mastoiditis, nephritis, or albuminuria,
rheumatism, rhinitis, and secondary glandular affections forming
abscesses. As any one or more of these complications may occur in
the same patient, prolonging his recovery, the uncertainty, variability,
and treacherousness of this complaint can be understood. Bacteriology
has not as yet been of any help in defining when a patient is free from
infection, therefore the difficulties of discharge of such cases from scarlet
fever hospitals into homes where there are other susceptible children
can be realised, especially as any eczematous condition of the mouth,
nostril, or ear is known to be highly infective. In some cases a patient
may be released who has escaped any of the above-named complications
in six weeks, whereas another may have to be isolated for prolonged
periods, for any one or more of these reasons and released even then
with some risk lest a " return " case be the result.

These two diseases are grouped together, as they are symptomatic
of each other and the terms are regarded as synonymous. This method
is also adopted by the Registrar-General, and therefore allows of
comparison. The total number of notifications received was 276,
relating to 270 cases. Of the number notified, 9 were errors of
diagnosis and hospital cases, reducing the number of cases to 261,
compared with 240, 195 and 182 for the previous three years.
Sixteen deaths were registered during the year. The rate of
mortality was 0.1 4 per 1,000
The death-rate for England and Wales was 0.13, for the 96 great
towns 0.14, for the 1.48 smaller towns 0.12, and for the County of
London 0.18 The disease was most prevalent in the latter part of
the year.
When the patient is treated at home, no other child from the same
house is allowed to attend school while the patient is infectious, nor
until two weeks after the premises are disinfected.
The examination of the throats of diphtheria contacts whenever
practicable, by bacteriological means, is a most important aid to