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26
The London School Board's schools generally closed on the 26th July, i.e., at the end of the
30th week of the year, and generally re-opened on the 27th August, i.e., at the beginning of the 35th
week of the year. The effect, therefore, of the closing might be expected to be manifested in a
reduction of the number of cases notified in the 32nd week, and the effect of re-opening to be
manifested by an increase in the number of cases notified in the 36th week. Comparison of diagram IX.
relating to 1894, with similar diagrams published in my last report relating to 1892 and 1893, shows
that these changes are less marked in the year 1894. The year 1894 was characterized by irregularity
in the behaviour of the disease in successive weeks and by the absence of the increase usual in the
latter part of the year. There was decrease in the 30th and 31st weeks which was accentuated
during the period 32nd—36th week, no very obvious increase occurring until the 37th week. The
diagram undoubtedly shows diminished scarlet fever prevalence in the four weeks which might be
expected to be influenced by closure of the School Board's schools, but the decrease began two weeks
earlier and was continued one week later than would be explicable on this hypothesis alone. Whether this
difference between the behaviour of scarlet fever in 1892 and 1893 on the one hand, and 1894 on the
other, is due to irregularity in the behaviour of the disease in 1894, or to closure of some other schools
than those of the School Board and at some other times than those of the Board, I am unable to say,
for I have no information as to the date of closing of any other elementary schools than those of the
Board.

It will be seen that at each age there was decrease in the number of cases in the second period,
but that this decrease was most manifest in children at the school age. Again, while there was decrease
in the third period among infants under 3 years and among persons over 13 years of age, the number
of cases among children at the school age increased 33'5 per cent. These figures accord with a hypothesis
that the interruption of school operations was responsible for some part of the decrease in the
second period of cases among children at school age, and that the increase of cases among these children
in the third period was largely due to the re-opening of the schools. The experience of the years
1892-4 satisfies me that this hypothesis is correct.
The reports of a few medical officers of health make reference to the occurrence of cases of
scarlet fever in houses shortly after the return from hospital of an antecedent case. Thus the medical
officer of health of Fulham states that in twenty-four instances the disease recurred in the family
within seven days of the return to it of a patient. The medical officer of the Bow district of Poplar
mentions one case in which the return of a child after 14 weeks' absence in hospital was shortly
followed by the appearance of scarlatina in another child of the family. A similar experience was
noted after shorter absence both in Camberwell and in Kidbrooke.
The report relating to Shoreditch comments on the absence of the occurrence of such cases in
that district.
In the districts of St. George, Hanover-square, and Westminster, there were prosecutions for
neglect to notify cases of scarlet fever, and in Whitechapel and Bethnal-green for wilful exposure of
infectious persons.
Only two references are made in the annual reports to outbreaks of any magnitude. The
former of these occurred in Plumstead among the pupils of the Slade Board School " causing quite an
epidemic in the neighbourhood," the latter in the Shooter's-hill-road, Greenwich.
Inasmuch as the latter outbreak involved more than one district, I investigated its circumstances.
In my inquiry I was cordially assisted by the medical officers of health of Greenwich and
Kidbrooke, in whose districts the exceptional prevalence of disease was manifested, and who freely placed
at my disposal the information they themselves obtained.
The investigation clearly pointed to the milk distributed from a particular farm in Kidbrooke,
as the cause of this outbreak, and there was no reason for thinking that the milk had become infected
by human agency. Among the cows supplying the milk were certain animals having ulcerated teats.
Effort was made, by inquiry as to the circumstances of the distribution of the milk from these and
other cows, to learn whether there was reason for associating the milk of the former with the cases of
scarlatina occurring among the consumers of milk from the farm ; but the evidence was conflicting, and
it was impossible to arrive at any conclusion. Appended is a report on this subject which I presented
to the Public Health Committee. (See Appendix I.)
In the several sanitary districts the case rate ranged between 1.5 per 1,000 in St. Martin-inthe-Fields
and 8.2 per 1,000 in Rotherhithe, and the death rate between .0 in Holborn and .58 in
Limehouse.