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The year 1927 showed the greatest relative incidence both in
scarlet fever and diphtheria, the succeeding years being less heavy.
If the extra incidence exhibited were due to the greater
relative infection amongst school children, one would have expected
the greatest percentage in the 5/14 group to appear in the year
1927; whereas actually there was an increase in the years 1928
and 1929.
In general the small effect of schools on infection is shown
by the absence of any marked alteration in the curve of incidence
of infection at each year of age at the time of entry to school.
Taking the incidence for each year from under one year of age
to nine years of age for the four years 1927 to 1930, the figures
for diphtheria are 8, 31, 74, 87, 102, 166, 143, 98, 78 and53,
and for scarlet fever 5, 47, 92, 152, 151, 203, 207, 144. 121.
and 79. Represented graphically, these show a slightly asymmetrical
curve, with a gradual rise up to a maximum at age six for
diphtheria and ages live and six for scarlet fever, with a gradual
fall beyond these ages. Were school infection a factor of great
importance, there would be a peak shown in the curves at the age
five, when children enter the schools. Also, the particular age
predilection was shown before the enforcement of attendance at
schools.
Another fact which shows the same point is the slight effect
school holidays have on the incidence of infections. Although, for
instance, the summer holiday has, as a rule, the lowest rate of
infection, the graph of incidence shows that this period lies at the
lowest point of a continuous curve, the decline having commenced
much earlier and being well marked before the holidays.
Schools apparently have played a very small part locally in the
dissemination of the infections, searlet fever and diphtheria. The
scarlet fever figures for the last 18 months show that 44.8 out of 852
eases were definitely not due to this cause ; either because the child
did not attend school, or the infection was contracted during