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It will be seen from the foregoing table that the scarlet fever death-rate was, in the period
1904-8, highest in Bethnal Green (0.23) and lowest in Kensington, Hampstead, Holborn and Lewisham
(0-06); in the year 1909, Bethnal Green (0.19) had the highest death-rate, and Hampstead, Hackney
and Battersea (0.04) the lowest, exclusive of the City of London, where no deaths occurred. The
scarlet fever death-rates obtaining in London in the four quarters of the year 1909 were as follows : first
quarter, 0.09; second quarter, 0.09; third quarter, 0.07; and fourth quarter, 0.07 per 1,000 persons
living.
Scarlet Fever—Age and sex distribution.
The following table shows the notified cases, deaths, case-rates, death-rates, and fatality of
scarlet fever at the several ages and for each sex in London during the year 1909. It will be seen that
at " all ages ' the case-rate, death-rate and fatality were higher among males than among females.
In the age-groups adopted for the purposes of this table the greatest incidence of attack was upon both
males and females of four years of age. The greatest incidence of death was upon males of three and
females of one year of age. The fatality, it will be observed, was highest among male children under
one year of age and among female children of one year of age. The fatahty shown foi males aged 45—
is obviously abnormal, and occasioned by the smallness of the figures.

, [_J Scarlet Fever and Elementary Schools.
In connection with the reduction in the number of notified cases during the summer
holiday of the schools it may be stated that the summer holiday of the London County Council
schools began in 1909 on Thursday, the 22nd July, i.e., the latter part of the 29th week, and the
schools re-opened on Monday, the 23rd August, i.e., at the beginning of the 34th week. If the
number of cases notified in the four weeks which would be most subject to holiday influence be
compared with the number of cases notified in the four preceding and four subsequent weeks, ;the
results shown in the following table are obtained:—
Period.
Notified cases—Age-periods.
Increase ( + ) or decrease ( —) per cent.
0-3
3-13
13
and upwards.
0-3
3-13
13
and upwards.
Four weeks preceding weeks of
holiday influence (27th to 30th)
Four weeks of holiday influence
(31st to 34th)
Four weeks following weeks of
holiday influence (35th to 38th)
187
148
174
1,100
812
1,238
215
169
222
-20.9
+ 17.6
-26.2
+52.5
-21.4
+ 31.4
The only outbreak of scarlet fever during the year which was attributed to milk occurred in
the month of June, the milk being derived from a dairy farm in Wiltshire. Prevalence of scarlet fever
resulted in several districts of London, and in greater degree in Surrey. The occurrence of this outbreak
was first brought to my knowledge by Dr. Allan, after investigations of cases of scarlet fever in Westminster,
and its circumstances in the various localities invaded were subsequently investigated by
Dr. W. H. Hamer, on behalf of the London County Council, and by Dr. T. Henry Jones, on behalf of
the Surrey County Council, and a detailed report by these officers is appended. (See appendix I.)
1 See footnote (2) page 6. 2 The cases are those notified during the year, but, as is the case in similar
tables published in previous reports, the deaths relate to a period of one year commencing somewhat later, in order
that they may correspond more closely to the cases upon which the case-mortality is calculated.