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time to be suffering from scarlet fever. Dr. Reginald Dudfield, in an analysis of the cases
of scarlet fever occurring in Paddington, states tliat of 503 cases notified in the district,
in 328 instances but 1 case occurred in each house, 52 houses had 2 cases, 13 houses
had 3 cases, 1 house had 4, 4 houses had 5, and 1 house had 8 cases. In the houses which had
2 cases he found the interval between them was under 7 days in 18 instances, over 7 days and less
than 28 days in 1G instances, and over 2 months in 18 instances.
Scarlet fever and elementary schools.
The influence of schools upon scarlet fever prevalence is referred to in a few reports. This
subject, in relation to a Board school in Paddington, has been already mentioned. Dr. Parkes
stales that in Chelsea the fall in notified cases following the closing of the schools (board schools
on the 24th July) was well marked. Dr. Allan writes that in Westminster, after the usual fall
in numbers during the school holiday period, the succeeding rise was small, and did not continue.
Dr. Kenwood mentions that school attendance was ascribed as the origin of infection in
17 cases. Dr. Bond writes that in Holborn the greatest incidence of the disease occurred in the
four weeks prior to the closure of the schools for the summer holiday, when 48 cases were notified,
and that during the holiday scarlet fever much diminished, only 17 notifications being received
during the four weeks ending the 31st August. During the period of greatest incidence the
schools most affected were Tower-street and St. George, Bloomsbury. Dr. Davies mentions that
tl>ree schools were most affected, being attended by 1G, 18 and 28 of the children between 5 and
15 years of age who suffered from scarlet fever in Woolwich. The medical officers of health of
Fulham and Woolwich show in tabular form the number of cases of scarlet fever known to be
present among the attendants at each school in their districts.
In previous annual reports I have commented on the decline in scarlet fever prevalence
during the summer holiday period of the London Board Schools, and it will be seen from the
following table that the year 1901 presents no exceptional features in this respect. The summer
holiday of the London School Board schools began in 1901 on Thursday, the 25th July, i.e., the
latter part of the 30th week, and the schools re-opened on Mondav, the 2Gth August, i.e., at
the beginning of the 35th 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 followiug table are obtained. It
will be seen that the decrease during the period of holiday influence is most marked at ages
3—13, and the increase subsequent to the period of holiday influence is particularly marked at
the school age.

Return cases of scarlet fever.
" Return cases," i.e., cases occurring at a short interval after the return home from
hospital of a previous case, are mentioned in several reports. In Pulham there were 34 such
cases occuring within 10 days of the return of the previous case, in Stoke Newington 2 return
cases, in Bermondsey 21 return cases, or 3 per cent, of the cases removed, in Wandsworth 19, and
iu Woolwich 7.
Proportion of cases in hospitals.
It will be seen on reference to diagram (VII.) that there was in 1901 a slight increase
in the proportion of the notified cases of scarlet fever admitted to the hospitals of the Metropolitan
Asylums Board compared with the proportion in the preceding year. In the report
of the Statistical Committee of the Metropolitan Asylums Board for the year 1901 it is pointed
out that the proportion of scarlet fever admissions to notifications has risen from 42'82 per
cent, in 1890 to 78'89 in 1901, and that the low figures of 1893 and the falling off in the
admission rate of the year 1895 were due to inadequacy of hospital accommodation in those
years.
Owing to the allotment of the Gore Hospital for cases of smallpox, the medical officer of
Poplar states there was for some time difficulty in securing the removal of cases of scarlet fever,
and' the medical officer of health of Battersea mentions the same subject.